Presentation on theme: "Pre-Op Knee Information"— Presentation transcript:
1Pre-Op Knee Information Welcome!Welcome to Duke Raleigh Hospital! We look forward to caring for you and your family during your stay.
2Duke Raleigh Hospital has recently become the first hospital in the region to achieve certification in Total Joint procedures. This prestigious designation signifies Duke Healthcare’s commitment in providing excellent care.
3Goals Inform the patient about what to expect… Before Surgery During SurgeryAfter SurgeryThis outline will explain what to expect before, during, and after knee replacement surgery.
4Goals Reduce anxiety Answer questions Help you become better-prepared We also hope to reduce your anxiety, answer questions, and help you become better prepared after this presentation.
5When you arrive on the Orthopaedic Unit, you will notice a baseball poster in your room. As each goal is achieved, your healthcare team will sign off each goal to track your progress. We will also ask you what you would like us to focus on for each day so that we can individualize your care. This will be written in the “Patient’s Priority” section on the poster.
6Sections Nursing Case Management Physical Therapy Occupational Therapy This presentation will be divided into four sections: Nursing, Case Management, Physical Therapy, and Occupational Therapy.
7Information From The Nurse About Care And Your Concerns First, let’s discuss Nursing Care.
8We Care About You!!!In an effort to personalize your care while in the hospital, please let us know of any needs ahead of timePlease complete the enclosed “Care Card” and forward it to the Patient Navigator at the end of classIn an effort to personalize your care while in the hospital, please let us know of any needs ahead of time. Please complete a pink “Care Card” and forward it to the Patient Navigator. You may also contact the Patient Navigator at if you do not have a Care Card and one will be filled out for you.
9What To Bring List of medications and allergies Glasses, hearing aids, denturesToiletry itemsToothbrushToothpasteFlat, supportive, non-slip walking shoes (with a backing)Incontinence products (you may prefer a specific product not provided by hospital)On the day of surgery, please bring anything you need to operate on a regular day (i.e. glasses, hearing aids, dentures). If you forget toiletry items, then we can supply these for you. Most importantly, bring supportive walking shoes with a backing and rubber sole.
10What To Bring Night clothes/pajamas, loose clothing Books, magazines, hobby itemsOn the day of surgery and the day after surgery, you will be wearing a hospital gown. On post-op days 2 and 3, we will help you dress in your normal clothing. Ideally, shorts or baggy pants should be worn so that the knee dressing can be easily changed.
11While in surgery…CHG wipes will be used to cleanse and disinfect the surgical site before surgery beginsCHG reduces bacterial growth on the bodyCHG will help reduce the chance of infection following surgeryPrior to beginning surgery, Chlorohexadene Gluconate (CHG) wipes will be used to cleanse and disinfect the knee area to reduce the chance of infection.
12Orientation To Room Call bell TV Controls/Volume Thermostat When you arrive to the Orthopaedic Unit, your Nurse will orient you to the Call Bell TV Controls, and the Thermostat.
13Equipment After Surgery We would like to review what equipment you may have following knee surgery.
14Oxygen Used a short time Let us know if you have sleep apnea or use oxygen or CPAP at homeYou may have oxygen in place when you wake from surgery. Typically, it will be nasal cannula oxygen with the two prongs fitting inside the nostrils. If you use a CPAP or BiPAP at home for sleep apnea, please bring your machine into the hospital.
15IV or Intravenous Therapy May have one or two linesFluids-body water, blood, antibiotics, pain medicationWill leave it in until dischargeYou will have one or two IV lines in your hand and/or your arm to give you any fluids or medications. It will be left in until you are discharged.
16Dressings and Drains Large dressing initially Drains and dressings removed 1st or second day after surgeryDressing will bechangedYour initial dressing in surgery will extend from the mid-thigh towards the ankle. After the initial dressing is removed, a smaller dressing will be placed over the incision. Your surgeon may also place a drainage catheter in the wound to help reduce fluid on the wound and, likewise, reduce swelling.
17Foley Catheter To Drain Urine Stays in no longer than 2 daysHelps to keep track of fluid balanceGood initially when not moving wellPut in after you are asleepDoes not hurt to come outYou will have a drainage catheter placed in your bladder to help drain urine during and after surgery. It will be inserted while you are asleep. Typically, this will be removed on the morning of Post-Op Day 2. It will not only help drain urine, but it will also let us know how well your kidneys are working.
18PCA - Patient Controlled Analgesia “Pain Button”Administer to selfClose monitoringNO ONE IS TO PUSH THE BUTTON EXCEPT THE PATIENT!!!***Please ask your surgeon if this is an option for youYour surgeon may order a PCA machine as one of many pain options for you. You may push the button to administer a dose of pain medicine. It is programmed so that you will only get a certain dose in a specified amount of time. Please let visitors know NOT to push the button for you as this is very powerful pain medication.
19Femoral Nerve Block/Catheter ***Some surgeons prefer not to use this*** Numbs the front part of the leg from the groin to the kneeStays in about two daysMay cause you to have a “noodle leg”Need to wear a kneeimmobilizer while standingor walkingYour surgeon may or may not place a femoral nerve block prior to surgery. If so, the catheter will be fed down to the femoral nerve on the side where surgery will be performed. The nerve will be bathed in numbing medicine and will help with reducing pain in the front part of the leg. It usually stays in place for about two days. Whenever this is infusing, you will need to wear a knee immobilizer when out of the bed or the chair.
20Knee ImmobilizerMay wear when out of bed if you have a nerve block/catheter (dependent on your Therapist)May also wear at night to remind you to keep the leg straightUsed for safety reasonsNote: You may or may not walk with the knee immobilizer on while exercising with a Therapist. However, you shouldALWAYS continue to wear it with Nursing untilyou are able to do a full straight leg raise (with nobend at the knee)There are times when your Therapist may have you remove the knee immobilizer while walking. Your surgeon may also have you wear it at night in bed to remind you to keep your leg straight.
21Cryotherapy - “Polar Care” Device Cryotherapy - “Polar Care” Device **Some surgeons prefer to use ice instead of the Polar Care Device** **Some surgeons may choose not to use the Polar Care Device or ice**For total knee patientsSends a cold signal to the brain to help with pain managementHelps with pain andswellingYou take this homewith you (if it is ordered by your surgeon)Your surgeon may also order a Polar Care device for you after surgery. This device will pump ice cold water to a pad wrapped around the knee. It will help reduce pain and swelling. If it is not ordered, ice packs will be supplied as needed. Never place ice or the Polar Care directly on the skin. Always keep a barrier (bandage, pillowcase, towel) between the ice and skin.
22CPM Machine ***Some surgeons prefer not to use this*** Continuous Passive Motion machineMay be used for total knee patients (if ordered)Passively bends knee while in bedYour surgeon may order a CPM machine as part of your post-op care. This machine lies in bed with you, and your leg will be placed in it. This machine will gently and slowly flex and extend your leg for you.
23Medications Different color and number Always ask nurse what meds are for“Combination medications” that you may take at home may be given as separate pills while in the hospitalMedications come in different colors and numbers depending on the brand. If you take a “two-in-one” combination drug at home, you may receive the two separate medications that make up that pill while in the hospital. Please do not bring home medications into the hospital.
24Rating Pain 0 to 10 pain scale Pain patterns Mechanical Pain Surgical PainYou will be asked what your pain level is many times throughout your stay. “0” means “No Pain” and “10” means “Horrible Pain”. Our goal is to get your pain at a 3 or 4 out of 10 or less. At this level, you will be awake and alert enough to participate in therapy and learn what we will be teaching you.
25Know the Zone!Our staff will make every effort to help control your painWe will automatically give you pain medication around the clockWe ask that you partner with us and ask for additional pain medicine if neededAlternative pain options may be used such as cold therapy and distractionOur goal is to keep you in the 3-4 Pain Zone (or less)You will receive pain medication around the clock without asking for it. However, if you experience “breakthrough pain”, please ask for that additional pain medication. This is typically written on your white board in your room along with the times it can be taken.
26Preventing Pneumonia Incentive Spirometer Breathe in times an hourwhile awakeHelps to expand air sacs in lungsSurgical patients are at a higher risk of pneumonia following surgery. You will be given an incentive spirometer and encouraged to perform breathing exercises throughout your stay. Your Nurse will explain these exercises to you.
27Preventing Blood Clots Medication (“Blood Thinners”)“Calf/Foot Pumps”Walking and ExercisingSurgical patients are also at a higher risk of having a blood clot following surgery. There are three ways that we prevent blood clots from forming: medication, “calf/foot pumps”, and walking/exercising.
28Coumadin and Lovenox ***Please check with your surgeon as to which blood thinner will be prescribed***Will help to prevent bloodclots from formingWill need to learn how totake these medications safelyWill need to watch a videoMedication is one way to help reduce blood clot formation. You will take a blood thinner while in the hospital as well as for a short time after discharge from the hospital. Two common blood thinners are Coumadin (a pill) and Lovenox (an injection).
29Compression Devices Foot or calf pumps Help to push the blood back into circulationWear them when you are in bed or in the chairThe second way to help reduce blood clot formation is to use compression devices on the foot and/or calf muscle. These devices will inflate with air and squeeze the foot and calf to push blood back towards the heart. These will be worn while in bed or in the chair but will be removed when walking.
30Walking and Exercising Helps to prevent bloodclots from formingExercise in and out of bedAnkle circles, foot pumps,tightening leg musclesThe third way to help reduce blood clot formation is through walking and exercising. Not only will our staff walk with you, but they will also teach you exercises to perform while lying in bed or sitting in the chair.
31DietInitial diet is typically clear liquid unless otherwise designated by your physicianDiet will advance as toleratedConstipationHigh fiberIncrease activityFluidsNauseaYour first meal after surgery will be clear liquid. If you tolerate this, your diet will be advanced to your regular diet. Pain medication may cause constipation, so we encourage you to eat foods high in fiber, increase your activity, and increase your fluid intake. We also have medications if you experience nausea.
32Call for HelpNever get out of bed or chair unless you call for assistanceCall as soon as possible.Try to ask for help when a staffmember is already in the room.Never get up without calling for help. You may experience changes in blood pressure, lightheadedness, dizziness, and nausea which may cause you to fall and injure your new implant.
33Condition H (Help) Dial 3111 and give room number Gives family and friends a way to call a Medical Emergency team to the bedsideCall if…You notice a change in your loved one’s conditionYou still have serious concerns about your loved one’s condition after speaking to the healthcare teamIf a family member or friend notices a change in your condition, they may dial extension “3111” and a Medical Emergency team will be sent immediately to the patient’s bedside.
34Sleep Dial L.O.U.D. (5683) on phone if sleep disturbed Anonymous callTIGR TV ChannelsRelaxation/Meditation channelsComfort CartWe make every effort to reduce noise in the hospital. If your sleep is being disturbed, you may dial “LOUD” (5683) on your phone, and someone will address the noise issue. We also have relaxation/meditation channels on our television. A Volunteer will also bring a Comfort Cart to your room .
35Case Management Joan Paramore RN Case Manager (919) 954-3878 Joan Paramore is the Nurse Case Manager for the Orthopaedic Unit.
36Goal: To get you home safely!!! Discharge PlanGoal: To get you home safely!!!Our goal is to get you home safely.
37Discharge PlanEveryone is assigned a Case Manager who will usually meet with you the day after surgeryAverage Length of Stay: 2-4 nightsThat means you should be ready for discharge around the 2nd, 3rd, or 4th day after surgeryThe Case Manager will meet with you the day after surgery and each day after to track your progress. The average length of stay is 3 nights.
38DischargePlease remember that once the Physician has written orders to discharge you home, there are still many things that have to be completed before you will be leaving the hospital. We want to make sure you have everything you need-prescriptions, home health or rehab arrangements, and information about your home care. Sometimes this process can take up to 4 or 5 hours. We know you’ll be eager to leave the hospital, and we want to be sure everything’s in place to ensure a smooth and safe transition.
39Discharge Plan Options: Home Health You will choose agency (list provided)RN (if on Coumadin)Physical Therapy (2-3 times/wk)Occupational Therapy (if ordered by Doctor)***Your Case Manager will set up a Home Health Agency (of your choice) for youIf you are “safe” to return home, then the Case Manager will arrange for Home Health to visit you at home. Typically, this involves a Registered Nurse and Physical Therapist. If needed, an Occupational Therapist may be ordered.
40Discharge Plan Options: Home Health Equipment ordered…Rolling WalkerBedside CommodeCPM (if ordered by Doctor)***Your Case Manager will order your equipment for you from an agency of your choiceThe Case Manager will also order any equipment you will need for home (if you go directly home from the hospital). A rolling walker and bedside commode are ordered and delivered to your hospital room prior to discharge. If you have a walker at home, please bring it into the hospital for our Therapist to perform a safety and height check. If you need a CPM machine, the Case Manager will arrange for it to be delivered to your home. If you go directly to a Rehab facility from the hospital, then the Rehab facility will order any equipment for you.
41Discharge Plan Options: Short-Term Rehab If not safe to return home, Short-Term Rehab may be an option.Based on…1. Your insurance2. How well you progress with Therapywhile in the hospitalIf you are not “safe” to return home, then your healthcare team may recommend that you go to Rehab for a short-term stay before returning home. Your Case Manager will help arrange a Rehab stay for you, if needed.
42Discharge Plan Options: Short-Term Rehab Two types of Rehab Facilities…SNF: 1 to 3 hours of therapy/dayAverage Length of Stay: weeks-as needed2. Acute: 3 to 5 hours of therapy/dayAverage Length of Stay: 5 daysThere are two types of Rehab facilities. Most patients that need Rehab go to “SNF’s” (Skilled Nursing Facilities). Acute Rehabs are usually hospital-based facilities. Your Case Manager will meet with you and discuss Rehab facility options.
43Discharge Plan Options: Outpatient Therapy Usually set up after Home Health is completedRarely set up at time of discharge from hospitalOutpatient Rehab may also be an option for you immediately after discharge from the hospital, Rehab facility, or when Home Health is completed.
44Discharge Plan Transportation (depends on what is medically necessary) CarWheelchair VanNot covered by insuranceCost: $55-$120AmbulanceCovered by insurance if “medically necessary”***Your Case Manager will set up your Wheelchair Van or Ambulance for you (if needed)Most patients have a family member or friend drive them home or to Rehab from the hospital. The Case Manager can also arrange for transportation if you have no one to transport you.
45If You Are Going Home…You may fill your prescriptions at our Plaza Pharmacy(Located on the First Floor of the hospital)Hours of Operation:Mon-Fri (9:00AM-4:30PM)(919)Use the Main Pharmacy on weekends or after 4:30PM (but make payment arrangements with Plaza PharmacyMon-Fri 9:00AM to 4:30PMIf you are going directly home from the hospital, you may fill your prescriptions either the day before discharge or the morning of discharge at our hospital pharmacy.
46Physical TherapyThe next portion of the presentation will cover Physical Therapy.
47Treatment Sessions Seven days/week One or two sessions per day with the TherapistYour therapeutic activity will also involve walking with Nursing staffTypical treatment sessionPost-op Days 1, 2, and 3Depending on your individual needs, Therapy will work with you either once or twice a day. Your therapeutic regimen will not only involve walking/exercising with Therapists, but it will also involve working with Nurses and Nurse Assistants as they help you up to the chair, bathroom, and hallway.
48Precautions Knee Replacement Do not stay in one position for longer than an hour without standing up, walking a short distance, and straightening and bending your kneeDo not sleep or rest with a pillow or anything under your kneeOperated leg out in front while sitting or standingAs part of your therapeutic regimen, your Therapist will teach you about knee precautions, or what NOT to do with your new knee.
49Homeward Bound Gym Stair training Car transfer exercises If needed, you may be brought to the Gym to perform stair training and transfer exercises.
50Medical Equipment Walker Bedside Commode Proper use Your Therapist will also teach you how to properly use a walker and how to properly and safely sit and stand.
51Occupational TherapyAn Occupational Therapist may work with you prior to discharge if needed. Occupational Therapy deals with Activities of Daily Living (ADL’s)-bathing, dressing, eating, etc..
52Treatment Demonstration of equipment Reacher Sock aid Bathing sponge ***Knee patients rarely need this equipment at discharge. The Therapist will determine your specific needs.ReacherSock aidBathing spongeIf your Occupational Therapist feels that you need any adaptive equipment prior to discharge, then she will give you the necessary equipment and teach you how to properly use it. Knee patients rarely require any of these equipment at discharge. If you go directly to Rehab from the hospital, you will receive this equipment from the Rehab facility, if needed.
53Helpful TipsHow to properly carry items in pockets and/or basket while driving a walkerSafety in the shower (have someone close by)While at home prior to surgery, move low- and high-lying items to waist level(i.e. in kitchen/bathroom cupboards, refrigerator)Make arrangements to have appropriate-sized car available for your dischargeYour Therapist will also teach you helpful tips related to using the walker, shower safety, and home preparation.
54Before Surgery…Assess your home environment and let the Therapist know the following once you are in the hospital…Tub/Shower (location, height, grab bars)Number of steps (outside of home and upstairs)Height of bedYour Therapists will ask many questions about your home environment including your bathroom, stairs, and bed. Please be prepared to answer questions regarding these areas so that your Therapy can be customized to your individual needs.
55The following slides contain questions based on the Powerpoint. AssessmentThe following slides contain questions based on the Powerpoint.
56Question 1One risk of a blood thinner medication is: ___________?____________
57AnswerIncreased bleeding (Can also be increased bruising)
58Question 2You should call your Doctor immediately if you notice any sign of a blood clot. Name a symptom of a blood clot in your leg: _____________________ Name a symptom of a blood clot in your lung: ______________________
59AnswerLeg: Pain in the back of the leg (usually in the calf, but can radiate throughout the leg) Lung: Difficulty breathing (may also have a rapid heart rate)
60Question 3True or False When standing up or sitting down, you should keep your operated leg slightly in front of your non-operated leg.
64Question 5Some pain is normal and expected after surgery, but the best way to keep your pain at a manageable level is to:Take pain medication when it reaches a “5” on a “0 to 10 pain scale”Take pain medication only when the pain is unbearableUse medication as well as other methods to control pain. For example: ice, positioning, etc.Try distracting yourself from the pain by watching television for an hour or two
65Answer3. Use medication as well as other methods to control pain. For example: ice, positioning, etc.
66Question 6The best and safest way to raise the height of a chair in your home is to:Stack pillows on the chairStack folded blankets on the chairPlace a small book under each leg of the chairPlace two large telephone books on the chair