1. Pre-Op Shoulder Surgery Information
Welcome!
Welcome to Duke Raleigh Hospital! We look forward to caring for you and your family during your stay!

2. Goals Inform the patient about what to expect…
Before, during, after surgery
Reduce anxiety
Answer questions
Help you become better-prepared
This outline will explain what to expect before, during, and after shoulder surgery.

3. Information From The Nurse
First, let’s discuss Nursing Care.

4. We Care About You!!!
In an effort to personalize your care while in the hospital, please let us know of any needs ahead of time
If you have any specific requests, please contact the Patient Navigator at
In 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.

5. What To Bring List of medications and allergies
Glasses, hearing aids, dentures
Flat, supportive, non-slip walking shoes
Incontinence products -you may prefer a specific product not provided by hospital (If staying overnight)
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.

6. What To Bring Comfortable and loose clothing to wear after surgery
Oversized T-shirt or button-down shirt
Wear 2-piece outfits (i.e. top and bottom)
Ideally, an oversized T-shirt or button-down shirt are the most comfortable shirts to wear following shoulder surgery.

7. On the Day of Surgery…
CHG (Chlorohexadene Gluconate) wipes will be used to cleanse and disinfect the surgical site before surgery begins
CHG reduces bacterial growth on the body
CHG will help reduce the chance of infection following surgery
Prior to beginning surgery, Chlorohexadene Gluconate (CHG) wipes will be used to cleanse and disinfect the shoulder area to reduce the chance of infection.

8. Equipment After Surgery
We would like to review what equipment you may have following shoulder surgery.

9. Oxygen Used a short time
Let us know if you have sleep apnea and if you use oxygen or CPAP/BiPAP at home (if so, bring mask and machine with you to hospital)
You 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.

10. IV or Intravenous Therapy
May have one or two lines
Fluids (blood, antibiotics, pain medication)
Will leave it in until not needed.
You 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.

11. Dressings and Drains You may have a drain in place.
Leave the dressing on until the Doctor says to take it off.
Your surgeon may insert a drainage catheter in the wound to help reduce fluid on the wound and, likewise, reduce swelling. Please leave your dressing in place until the Doctor says to take it off.

12. Foley Catheter To Drain Urine
Rotator Cuff patients typically do not have catheter placed
Total Shoulder patients usually do have catheter placed
Helps to keep track of fluid balance
Put in after you are asleep
You may or may not have a catheter placed to drain urine. If so, it will be placed while you are asleep. It will not only drain urine, but it will also help us monitor how well your kidneys are working during and after surgery.

13. Interscalene Nerve Block/Catheter ***Some surgeons prefer not to use this***
Numbs the shoulder region
Patients will also receive IV sedation to go to sleep
Stays in from one to two days
Some patients may be sent
home with catheter in
place
Your surgeon may place an “Interscalene Nerve Block” in the shoulder region prior to starting surgery. This block will numb the shoulder area and help reduce pain.

14. Shoulder Sling/Immobilizer
Purpose: to immobilize arm after surgery
Length of time: dependent on Physician
Keep shoulder still! Do not remove sling unless instructed by your Physician or
In most cases, your shoulder will be immobilized in a sling immediately following surgery. Your surgeon will let you know how long it should be immobilized as well as when you can begin moving it.

15. Fall Precautions
After surgery, it is common to be off balance and unsteady
For your safety, you may not get up on your own and must call for assistance

16. Cryotherapy - “Polar Care” Device
Your Physician may choose to use cryotherapy (cold therapy)
Sends a cold signal to the brain to help with pain management
Helps with pain and
swelling
You take this home
with you
“Ambulatory” or “Day-Surgery/Outpatient” patients may or may not have Polar Care ordered
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 shoulder. 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.

17. Rating Pain 0 to 10 pain scale Pain patterns Mechanical Pain
Surgical Pain
You 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.

18. Know the Zone!
Our staff will make every effort to help control your pain
We will automatically give you pain medication around the clock
We ask that you partner with us and ask for additional pain medicine if needed
Alternative pain options may be used such as cold therapy and distraction
Our 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.

19. Compression Devices (While in the hospital)
Helps prevent blood clots
Worn on the calf of each leg
Help to push the blood back into circulation
Wear them when you are in bed or in the chair
You will be wearing compression devices on your calf muscles after surgery to help reduce the chance of blood clot formation. These devices will inflate with air and squeeze the calf muscles to push blood back towards the heart. These will be worn while in bed or in the chair but will be removed when walking.

20. Walking and Exercising
Helps to prevent blood
clots from forming
Exercise in and out of bed
Ankle circles, foot pumps,
tightening leg and buttocks
muscles
If staying overnight in the hospital, then our staff will walk and exercise with you to help reduce the chance of blood clot formation.

21. Diet
Initial diet is typically clear liquid unless otherwise designated by your physician
Diet will advance as tolerated
Constipation due to pain medications
High fiber
Increase activity
Fluids
Nausea-will have medication available
Your 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.

22. Call for Help
Never get out of bed or chair unless you call for assistance
Call as soon as possible.
Try to ask for help when a staff
member 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.

23. Discharge
Discharge from the hospital will occur 1 to 3 hours after surgery ends
Discharge from the hospital will occur 1 to 3 hours after surgery ends.

24. Discharge Plan Transportation (depends on what is medically necessary)
Most patients will go home in a car with family or friends.
Most patients have a family member or friend drive them home from the hospital. The Case Manager can also arrange for transportation if you have no one to transport you.

25. Prescriptions Your Surgeon will typically write prescriptions for…
Pain medications
Anti-inflammatories
Antibiotics (if needed)
Nausea (if needed)
Before you leave the hospital, your Surgeon will give you prescriptions for pain medication. He may also give you prescriptions for anti-inflammatories, antibiotics, and nausea, if needed.

26. Follow-Up
Follow-up appointments are usually within 5-10 days after discharge from the hospital During your Pre-Op visit to your Surgeon’s office, your Post-Op follow-up date and time will be scheduled
You will return to your Physician’s office for a follow-up visit. This visit is usually 5 to 10 days after you leave the hospital. Typically, your follow-up visit will be scheduled before your surgery takes place.

27. Precautions
In most cases, your shoulder will be immobilized in a sling following surgery
You will not be permitted to move your arm until your Physician/Therapist say so
This includes no lifting, pushing, pulling, sports, etc.
You should keep your shoulder immobilized in a sling. You will not be permitted to move your arm until your Physician/Therapist say so. This includes no lifting, pushing, pulling, sports, etc.. Follow your physician guidelines strictly to avoid complications and re-injury.

28. Therapy Progression
Passive Range of Motion (PROM)
Active Assisted Range of Motion (AAROM)
Active Range of Motion (AROM)
Resistive Exercises
***In order to prevent injury, Passive Range of Motion should be maintained until your Physician and Therapist advance your therapy
Your Surgeon will also let you know when to progress your shoulder movement as outlined in the above diagram.

29. Activity
Your Surgeon and/or Therapist may instruct you to squeeze a ball or towel to decrease hand or arm swelling
Your Surgeon and/or Therapist may ask you to perform certain activities after surgery. These may include squeezing a ball or towel to decrease hand or arm swelling.

30. Prior to Surgery…
You may want to practice performing basic activities (bathing, dressing, eating, etc.) before your surgery using only the non-operated arm…especially if your operated arm is your dominant arm
In order to prepare for shoulder surgery, you may want to practice performing basic activities (bathing, dressing, eating, etc.) using only the non-operated arm…especially if your operated arm is your dominant arm.

31. Positioning
Use pillows or rolled towels to position/support arm while lying in bed or sitting in chair It’s not uncommon for patients to sleep in a recliner because it can be a comfortable position
It is challenging for some shoulder patients to maintain a comfortable position while in a chair or in bed. Pillows or rolled towels may be used to help promote comfort by supporting the arm.

32. Positioning Seated Supine Side-Lying (reclined) (on back)
(on non-operated side)
Shoulder patients may rest or sleep in a seated, supine, or side-lying position. Shoulder patients should avoid lying on their operated side.

33. Infection Prevention
To prevent infection, do not get incision wet until your Physician says it is alright
Your Surgeon will let you know when you can get the incision wet.

34. Helpful Tips
Pick up loose rugs and move furniture to the edges of the room, make sure pets are out of the way
While at home prior to surgery, move low- and high-lying items to waist level
(i.e. in kitchen/bathroom cupboards, refrigerator)
Arrange to be transported home in a car that is easy to get in/out of
Your Therapist will also teach you helpful tips related to using the walker, shower safety, and home preparation.

35. If You Are Staying Overnight…
Please bring toiletry items
Toothbrush
Toothpaste
Incontinence products-you may prefer a specific brand not provided by the hospital
Books, magazines, hobby items
If you will be staying overnight in the hospital, please bring the appropriate items. These include: glasses, hearing aid(s), dentures, and toiletry items.

36. If You Are Staying Overnight…
You will be oriented to your room
Call bell
TV Controls/Volume
Thermostat
If you are staying overnight at the hospital, then your Nurse will orient you to the Call Bell, TV Controls, and Thermostat.

37. If You Are Staying Overnight…
Medications you receive in the hospital may come in different colors and/or shapes than the same medication you take at home
Always ask nurse what meds are for
Medications 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.

38. If You Are Staying Overnight…
Your Surgeon may choose to use a PCA machine
PCA - Patient Controlled Analgesia
“Pain Button”
Administer to self
Close monitoring
NO ONE IS TO PUSH THE BUTTON EXCEPT THE PATIENT!!!
Your 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.

39. If You Are Staying Overnight…
Preventing Fever and Pneumonia
Incentive Spirometer
Breathe in times an hour
while awake
Helps to expand air sacs in lungs
Surgical patients are at a higher risk of pneumonia following surgery. If you are staying overnight in the hospital, you will be given an incentive spirometer and encouraged to perform breathing exercises throughout your stay. Your Nurse will explain these exercises to you.

40. If You Are Staying Overnight…
Condition H (Help)
Dial 3111 and give room number
Gives family and friends a way to call a Medical Emergency team to the bedside
Call if…
You notice a change in your loved one’s condition
You still have serious concerns about your loved one’s condition after speaking to the healthcare team
If 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.

41. If You Are Staying Overnight…
Dial L.O.U.D. (5683) on phone if sleep disturbed
Anonymous call
TIGR TV Channels
Relaxation/Meditation channels
Comfort Cart
We 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 .

42. If You Are Staying Overnight…
Before 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)
If 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.

43. Discharge
Please 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.

44. If You Are Staying Overnight…
Physical Therapy
The next portion of the presentation will cover Physical Therapy.

45. If You Are Staying Overnight…
Physical Therapy Treatment Sessions
Available seven days/week
One or two sessions per day with the Therapist
A Physical Therapy/Occupational Therapy evaluation will be performed (if you are staying overnight in the hospital)
Depending 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.

46. If You Are Staying Overnight…
Occupational Therapy
If staying overnight in the hospital, then an 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..

47. If You Are Staying Overnight…
Your Occupational Therapist will evaluate your adaptive equipment needs
Reacher
Sock aid
Bathing sponge
If 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. If you go directly to Rehab from the hospital, you will receive this equipment from the Rehab facility, if needed.

48. Pre-Surgical Checklist
Please discuss the following with your Surgeon before surgery takes place…
Date and time of follow-up appointment(s)
Date and Time of Therapy appointments
When you can shower
When you can drive
Exercises to perform at home
Activities allowed/not allowed following surgery
Please discuss the “Pre-Surgical Checklist” with your Surgeon before your surgery date to clarify any questions. This will help ensure that you are well-prepared after your surgery takes place.

49. Thank You!!!
We look forward to caring for you and your family! Thanks for choosing Duke Raleigh Hospital for your surgery!