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Total Joint Replacement

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Presentation on theme: "Total Joint Replacement"— Presentation transcript:

1 Total Joint Replacement
Pre-operative Class Preparing for your surgery

2 Class Objectives The purpose of this presentation is to: Help you to feel more comfortable about your upcoming hospitalization Let you know what you can do to help in your own recovery

3 Preparing for your surgery

4 Before your surgery You will meet with your physician approximately 2 weeks before your surgery: You must have your labs, EKG and clearance from your PCP 2 weeks before surgery You will receive phone calls from the hospital giving you details of when to come to the hospital. ©2015

5 Reduce Risks, Complications
Stay active – Exercises for before your surgery are in your book and will be explained further by PT Healthy diet - Before your surgery, avoid foods that increase inflammation in your body. Those foods include sugar and white flour; saturated fats from red and organ meat; trans fats from commercially baked cookies, cakes and pastries; and alcohol. Aim for fresh foods, including fresh fruits, vegetables and nuts Manage diabetes – see your PCP if needed Reduce, eliminate tobacco. Smoking increases your risk of developing wound infection so we encourage you to try to stop before your surgery Quit-Now can offer free advice Reduce, eliminate alcohol. Hazardous alcohol use (3 or more drinks per day) can increase your risk of postoperative infections, cardiopulmonary complications and bleeding risk ©2015

6 Prevent Surgical Site Infection
Dental work – must be completed 4 weeks prior to surgery and 12 weeks after your surgery Shaving – do not shave your legs or use any hair removal products near the surgical site 5 days prior to surgery Hand washing – Good hand hygiene is essential. Encourage your family and friends to utilize an antibacterial cleanser and to always wash their hand to prevent spread of infection. You will be given skin preparation instructions by your surgeons office please follow them ©2015

7 What to bring into hospital with you
If you have Advance Directives please bring them with you Personal care items Robe Slippers – your leg/foot will be swollen following surgery so make sure they are not tight Loose shorts, T-shirt/top You don’t have to bring a pillow – if you want to bring your own pillow please make sure it is not in a white pillow case, easy to loose in hospital If you use a CPAP machine at home bring it with you, we have distilled water in the hospital for you to use. Please remove nail polish before you come into hospital Please bring in your prescription medications in their bottles ©2015

8 Surgery and Postoperative Recovery

9 Arriving at the hospital for surgery
If you are having your surgery at Livingston hospital enter the hospital through the main doors Stay right, turn right twice to main cafeteria elevators. Exit straight ahead to surgery waiting room If you are having your surgery at Brighton enter through the main doors Go up the elevators in front of you Turn right to open sitting area and check in desk ©2015

10 Day of Surgery Meet anesthesiologist to discuss options for anesthesia
e.g. epidural, nerve block. Please let him know if you have problems with motion sickness or nausea with surgery You will have some medication prescribed before your surgery to help control your pain Please inform your nurse if you get motion sickness or get nauseated from anesthesia Only 2 members of your family are allowed in to pre op with you. All family members can wait in the surgical waiting room during your surgery. Surgery will take between 1-2 hours and the patient will remain in the recovery room for 1-2 hours so from the beginning of the surgery to arriving on the unit may be up to 4 hours ©2015

11 Recovery Room You will wake up after your surgery in the recovery room. Your nurse will ask how your pain is on the pain scale of 0-10, 0 no pain, 10 worst pain imagined When you wake up you will have a dressing over your incision, a drain, SCD’s (sequential compression devices) on your legs, oxygen in your nose and IV fluids connected to an IV in your arm For these reasons please do not try and get up by yourself, you will need nursing or PT assistance. ©2015

12 Sequential Compression Devices (SCD’s)
Sequential Compression Device (SCD) is a method of DVT prevention that improves blood flow in the legs. SCD’s are shaped like “sleeves” that wrap around the legs and inflate with air one at a time. This imitates walking and helps prevent blood clots. You should wear your SCD’s any time you are in bed or sitting in a chair. ©2015

13 Pain Management Your caregiver will do everything they can to get you comfortable enough to participate in your recovery. Caregivers will often ask you to rate your pain level on a scale of 0-10 Our goal is to Always keep your pain level at a 4 or less Your pain will be managed with different medications including epidurals, local nerve blocks, IV medications and oral medications

14 When you arrive on the orthopedic unit
You will be able to eat/drink juice, jello, crackers, water, ginger ale when you get to the unit Again your nurse will ask your pain level 0-10 We will show you how to use an incentive spirometer and encourage you to use in 10/hour You will have your cold machine delivered to your hospital room to use on your knee You may be seen by physical therapy today. If not nursing staff will help you sit on the side of the bed. Your nursing staff will have to check on you frequently tonight so please be prepared Discharge planning will meet with you to start planning your discharge home ©2015

15 First day after surgery
You will have blood drawn. Your orthopedic surgeon/PA will round on you. Your incision may be closed with surgical glue, sutures or staples depending on surgeon preference, you will have a dressing over your incision that will remain in place until day 7 after your surgery. Your nurse will continue to assess your pain level and work on a plan with you to ensure it is controlled using scheduled Tylenol and opioid medication A side effect of the pain medication is constipation so you will also be started on a bowel management program Physical Therapy will continue to work with you today and nursing staff will help you to the bathroom and with your hygiene needs Our discharge planners may meet with you again today to discuss your discharge and any equipment needs you may have ©2015

16 Anticoagulation Therapy
Your surgeon will prescribe an anticoagulant to help prevent blood clots There are many different medications we use for this, the anticoagulant will begin to be administered on post op day one and will continue as prescribed by your surgeon You will receive information and instructions on how to take this medication from your nurse before you are discharged home ©2015

17 Second Day After Surgery
You will again be seen by your orthopedic surgeon/PA, they will give you instructions for your discharge today You will be able to shower today with help from the nursing staff Physical therapy staff will work with you on exercises to regain strength and mobility needs to help you when you are discharged home Please make sure you arrange to have someone available to drive you home today Discharge instructions will be given to you by your nurse and prescriptions given to you which can be filled in our pharmacy, just ask your nurse to do this ©2015

18 Possible complications following surgery
Blood clots – follow your surgeons instructions carefully to minimize this potential risk. Make sure you take your anticoagulation medication as instructed by nursing staff and continue doing your ankle exercises Infection – follow instructions given at discharge to prevent infection. Your dressing should remain in place until day 7 after your surgery. Do not use any creams or lotions on your incision Constipation – Your pain medication can make you constipated. Make sure you take laxatives following your discharge and eat a diet high in fiber and drink lots of water Pain - Make sure you take your pain medication as instructed. Swelling - Elevate your leg higher than your heart. Your leg will swell and this can add to your discomfort CONTACT YOUR SURGEON OR HOME CARE PROVIDER IF YOU ARE CONCERNED ABOUT ANY OF THESE ©2015

19 Discharge We want you to go home after your surgery
Patients recover better in their own home environment Home physical therapy will be provided for two weeks to provide additional assistance with physical therapy and your mobility. This will continue until your postoperative appointment with your surgeon. Your orthopedic surgeon can continue to manage your care with your PCP ©2015

20 Total Joint Hotline Total Joint Hotline – 517 545 5303
If you have any questions about anything you have heard today, or have any concerns about your surgery please do not hesitate to contact us on the Total Joint Hotline – You can leave a message and we will return your call as soon as possible If you have urgent questions please call your orthopedic surgeons office ©2015

21 Physical Therapy ©2015

22 What are some of your activity goals?
Physical Therapy PT will see you Day of surgery – most likely Post op day 1 - morning and afternoon Post op day 2/3 - as needed What are some of your activity goals? Thinking of the things you want to do can help motivate you to do the rehab ©2015

23 Pre-op Exercises See “Pre-op exercise”
- Start with 5 reps, increase to 15 as able We’ve targeted functional exercises We also target your thigh muscle – quad sets Do these exercises on a bed, no need to get on the floor! ©2015

24 Pre-op Exercises Word of Caution: Don’t hold your breath
Don’t aggravate anything Don’t strain - If an exercise hurts too much or you are straining too hard, move on to the next one. ©2015

25 Post–op Walking Walkers - Use front-wheeled walker
- Check for proper fit - Avoid 4-wheeled walkers (ok to use later) Walker will be ordered by physician’s office We recommend buying a cane before surgery Weight-bearing as tolerated ©2015

26 Loan Closets Loan closets in our area are : Brighton senior center Hartland Senior center Howell Methodist Church VFW American Legion ©2015

27 Stairs Does a walker fit on your entry steps? This is a very good option! You will lead with the stronger leg going up and the weaker leg going down ©2015

28 1 rail and 1 cane works well!
If your walker does not fit on each step we strongly recommend you have a railing installed We will practice stairs in the hospital Most people can manage stairs inside the home – assuming you have a railing ©2015

29 OUTPATIENT PT Outpatient PT will usually start 2 weeks after your surgery – determined by your surgeon You can go to a St Joe’s facility (now named Probility) or a place of your choice – St Joe’s list available on table ©2015

30 Online Resources http://www.stjoeslivingston.org/helpful-resources
©2015

31 Home Care

32 Home Care Home Care begins the day following discharge
Continues for 2 weeks until follow-up appointment with surgeon Nurse will do comprehensive evaluation PT evaluation same day or next day, will continue 3 times a week Focus for hip rehabilitation is strengthening Focus for knee rehabilitation is range of motion ©2015

33 Home Care Goals Maximize home safety & mobility
Help you manage pain, swelling, and constipation We are the “eyes and ears” for the surgeon ©2015

34 Typical Home Care Visit
Check vital signs Monitor incision Problem solve issues Assess pain Progress exercises Gait and transfer training ©2015

35 Tips for Preparing Your Home
Unobstructed pathways are important Check every room for tripping hazards Remove throw rugs Check stair handrails Night lights are helpful ©2015

36 Tips for Bathroom Safety
TOILET ●access without stairs necessary ●equipment    •commode    •grab bars    •riser ©2015

37 Shower •non-skid rubber bathmat •non-skid rug •NO SUCTION GRAB BARS •shower chair options if needed Shower seat Tub transfer bench •remove shower doors ©2015

38 Additional Equipment Reacher – very helpful, may want to get one ahead of time Hip Kit - may be useful Leg lifter ©2015

39 Where you will spend your day
Elevate leg when possible Managing stairs to living areas You may decide to sleep in recliner for a few days after surgery Chair with firm back and arm rests ©2015

40 Tips to Make Life Easier
Arrange for help for 5 to 7 days Prepare meals ahead of time High protein, Fiber, Vitamin C Cordless/cell phone Arrange kitchen/bedroom items for easy reach Pet suggestions Contact Home Care with any issues, we are here to help! ©2015

41 Post-Operative Guide IF YOUR LEG IS SWOLLEN: IF YOU ARE HAVING PAIN:
Elevate your leg: Lie down 4x/day for minutes and position your leg above your heart. Ice your leg: Apply an ice pack or cold machine throughout the day (20 minutes on, 20 minutes off). Make sure you have something between your skin and the ice, unless using the prescribed ice machine. If swelling does not improve call your surgeons office. IF YOUR LEG IS SWOLLEN: IF YOU ARE HAVING PAIN: Take pain medications as directed by your surgeon. Elevate and ice your leg as instructed above. Please refer to your Total Joint Patient Guide pages 22 and 26. If pain does not improve call your surgeons office. IF YOU ARE HAVING CONSTIPATION: Take an over-the-counter stool softener and laxative each day you are taking pain medication. Eat a high fiber diet and drink plenty of water. Walk as tolerated. Please refer to your Total Joint Patient Guide page 22. If no bowel movement by the 3rd day after surgery call your surgeons office. ©2015

42 Manage Constipation Cocktail: 2oz Prune Juice 2oz Clear Soda
2oz Milk of Magnesia follow with 8oz warm water ©2015

43 Pre-Op Shopping List Tylenol Cane Rubber Bathmat
Mild soap such as Dial ©2015

44 We are looking forward to helping you through each stage of your surgery and rehabilitation.
©2015

45 Enjoy your new joint! Your preparation and hard work will pay off You’ll be very glad you had the surgery We wish you well! ©2015


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