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Pre-Op Shoulder Surgery Information

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Presentation on theme: "Pre-Op Shoulder Surgery Information"— Presentation transcript:

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!

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