Presentation on theme: "Surgery Teaching Packet"— Presentation transcript:
1 Surgery Teaching Packet Lina Flores RN, BSNDr. Robert G. JohnsonCall nurse for any questions (210)Ext. 1171Surgery Teaching Packet
2 Prior to Surgery: PREPARING FOR SPINAL SURGERY Hello , Today we are going to discuss your pre-op teaching.Location:Southwest Texas Methodist Hospital7700 Floyd Curl Drive(see map in next slide)CLEARANCE FOR SURGERY:Your Surgery Packet contains a script for:blood work, chest x-ray, urine analysis and EKG.You will be given a scriptYour primary care physician will need to do the testing and send a pre-operativeclearance prior to surgery. And/or any other specialty: CardiologistIt is the patient’s responsibility to make an appointment with a primary doctorMEDICATION BEFORE SURGERY:You will need to be off all “blood thinning” medicines 5 days prior to surgeryPlavix, Coumadin, ibuprofen, Aspirin, Vitamin E., Ginkoba, dietary supplementsIf you are diabetic and take Metformin you will need to stop that 24hrs before surgerySmoking significantly delays the healing of the fusion, and also increases your risk ofwound infection. We will be happy to discuss this with you.
6 BLOOD DONATION: You may opt to donate your own blood to have on hand during your surgery. If this is something you wish to do, we will arrange it for you. Please make sure your verify with your doctor that you are are not anemic donate 2-3 weeks prior to surgery.
8 Cont. Prior to Surgery: DAY BEFORE SURGERY: Brace You will be fitted for a brace, depending on your insurance, the brace will be obtained from usor the hospital. You may contact our office medical assistant for more information. SHOWER BEFORE SURGERY:We ask that you shower the night before and the morning of your surgery with an antibacterialsoap. No heavy scrubbing is necessary.DO NOT EAT OR DRINK ANYTHING FOR 8 HOURS PRIOR TO SURGERYIf your surgery is in the am/morning stop eating solid food after midnight the night beforeHave a list all of the medications you are currently taking.Do not bring you medicines to the hospital. . .they will be sent home.Report to the Admitting on the 1st floor approximately 3 hours before surgery.Approximately one hour prior to your surgery, you will be taken by stretcher to the SurgeryHolding Area.Usually 2 family members can accompany you.Dr. Johnson and the anesthesiologist will review the procedure, discuss anesthesia and answerany questions.Once you are taken to the surgical area, your family will be directed to a family waiting roomnear the area. They will be notified when the surgery is complete.
9 Spinal Surgery:SPINAL SURGERY The goal of spinal surgery is to relieve the pressure on your spinal cord or the nerves. The spinal cord consist of nerves that travel through the vertebrae openings. Between your vertebrae are intervertebral discs. These are like shock absorbers or cushions. They let you bend and twist your spine.
12 SPINAL SURGERY cont. Dr. Johnson will decide if Surgery may be needed to relieve the pressure on the nerves byremoving bone, arthritis, scoliosis and/ordamaged disc. There are different diseaseProcesses that require surgery and eachindividual case is different, you can refer to ourteachingwebsite:Most surgeries involve removing the damageddisc, and using some of your bone marrow toact as “cement” & is combined with donorbone, to fuse your vertebrae together.Donor bone (allograft) Over time will hardenjust like cement and will hold the vertebrae inplace.Bone that is removed during a laminectomyfrom your spine is also used/crushed andadded to the bone graft (this is also called localbone).Dr. Johnson goes a step further & obtains adultstem cells through bone marrow aspiration. Thismethod concentrates adult stem cells from thepatient’s bone marrow. It is done during thesurgery and creates little discomfort. Theextracted adult stem cells are then implantedback into the patient at the fusion site. Thebone is usually packed along the back sides ofthe vertebrae that need to be fused.
17 The bone graft may take a up to 12 months to become SPINAL SURGERY cont.The bone graft maytake a up to 12months to becomesolid, extra support isneeded during thattime.
18 SPINAL SURGERY cont.Dr. Johnson will use a system of titanium screws, plates and/or rods to support your spine until your fusion is solid. Sometimes cages (“spacers”) are placed in between the vertebrae to add extra support Once the bone graft is solid Dr. Johnson usually recommends that the metal not be
21 SPINAL SURGERY cont. Example of Thoracic Fusion
22 SPINAL SURGERY cont. Example of Cervical Fusion
23 SPINAL SURGERY cont.One vertical incision will be made in the middle line of your back or anterior forneck. Because these muscles will be weak, Dr. Johnson does not want you to doany severe bending, stooping or twisting. He will use x-rays to see how well thefusion is healing.This surgery is performed to stabilize your spine. It is up to your body to heal itself.The surgery can not make your back new.” It can take up to 18 months for thenerves to heal, and they may not heal completely.There is no way of knowing how well your nerves will heal, we just have to wait andsee. You should however, have a significant decrease in the pain and numbnessthat you had before surgery as the nerves begin to heal.Anything that decreases the blood supply to your nerves and the graft site candelay and/or prevent healing. This may necessitate further surgery. Smoking,diabetes, heart and lung disease, and obesity can decrease the blood supply to thefusion.As the bone graft begins to fuse, Dr. Johnson will let you increase your activityslowly.He usually recommends a course of physical therapy to begin after your first x-ray.
25 AFTER- SURGERY:You will be in the recovery room for approximately I - 2 hours.After surgery it is not unusual have mild throat irritation (Cervical Surgery dueintubation, and the larynx/esophagus being retracted. You may request throatlozenges or spray to help decrease discomfort.Your incision will be tender, but most of your pain will be felt in your low back,buttocks, legs and feet (if Cervical then no pain or a few spasms between theshoulder blades. The pain may be in a different place than it was before surgery,please reportPatients are given medication through a PCA machine (Patient ControlledAnalgesia.) With PCA, the medication is sent through an IV line at the push of abutton, which the patient controls. To provide a steady level of pain relief, only youshould push the button. For your safety, the pumps have special features to limit theamount of medication you receive. Once you are taking liquids (bowel sounds), youwill begin taking pain pills and taken off the PCA.
26 AFTER- SURGERY:Dr. Johnson will instruct the Nurses and Physical Therapists to begin assisting you towalk very soon after surgery. This process begins slowly and they will increase theamount you walk as you gain strength. This reduces some risks of surgery, such asblood clots and pneumonia. BE SURE TO CALL FOR ASSISTANCE WHEN GETTING OUTOF BED.You may shower 2-3 days after surgery. The nurses will assist you. Your incision will becovered with waterproof dressings.You will begin to wear back brace. The brace helps to support your back muscles,especially when walking or for exercises. You do not need to wear it to sleep or justto go to the bathroom.You will be discharged from the hospital approximately 1-3 days for cervical surgeryand 4-6 days after lumbar surgery, depending on the procedure.Some patients are transferred to an in-patient rehabilitation facility depending ontheir needs.
27 RECOVERY AT HOME:PAIN MANAGEMENT: Dr. Johnson or your pain management Doctor will prescribe medication for you to take once you leave the hospital. You can set your alarm to take your pain medication as needed for the first couple of weeks. In order for you to heal, you have to walk, sleep and eat well. You may refer to our refill medication policy for more information Our hope is that you will eventually be weaned off all pain medications, but everybody does this at their own speed. We will refer you to a Pain Management Specialist who handles these issues
28 RECOVERY AT HOME: WOUND CARE: Before your surgery day, you should purchase: 4x4 gauze pads ; paper tape,waterproof adhesive tape.Once you are home, you will need to change the dressing every day at least once,preferably after you shower, or more often if the incision is draining. It is best to keep thearea as dry as possible. The light gauze dressing allows air to get to the incision whichhelps with healing.Please cover the incision when showering for the first week. Then, After I week, you mayshower without any covering, letting the soapy water run over the incision. Pat it dry, andcover with the gauze. Call the office to report any redness, swelling, bleeding or pus fromyour wound, or for a fever.NUTRITION:Be sure to eat a well balanced diet. Protein promotes wound healing. Pain medicationand decreased activity can cause constipation. Drink 8-10 glasses of water a day, eatfresh fruits and vegetables, and add prunes, raisins and bran cereals to your diet if you dobecome constipated. A stool softener taken 1-2 times a day is helpful. You can use over-the-counter laxatives, such as Senekot, or Milk of Magnesia. Dulcolax suppositories orFleets enemas are also available without a prescription. Call our office if the problemcontinues.
29 RECOVERY AT HOME: ACTIVITY AND EXERCISE: Avoid riding in a car for the first two weeks until you come to the office to have yourstaples removed.Start taking short, frequent walks in the beginning. Shorter, more frequent walks throughoutthe day are more beneficial than one long walk each day.You may gradually increase the distance as tolerated.Your back brace/walker will help give support to your muscles when you walk.If your pain increases, you may be walking too much or too far, so try backing off for a dayor two and then resume slowly.No lifting greater than 5 lbs. No pushing, pulling or overhead work. No baths, swimming orhot tubs until you discuss this with Dr. Johnson or his nursePlease call the office after you get home from the hospital to schedule your two-weekappointment to have your staples removed. Your will need 2 appointments 1 for staplesand another for your post-op appt. If you’re in rehab they can take out your staples there.Feel free to call the office during office hours for any questions you may have.Thank you very much if you have questions we will answer them after this presentationThis concludes our pre-op teaching.