Pre-Op Total Joint Class

1. Pre-Op Total Joint Class Welcome!

3. Goals Inform the patient & family what to expect… • Before, during & after surgery • Reduce anxiety • Answer questions • Help you become better-prepared

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 Please complete the enclosed “Care Card” and turn it in at the end of class

5. What To Bring • List of medications and allergies • Glasses, hearing aids, dentures • Toiletry items • Toothbrush • Toothpaste • Flat, supportive, non-slip walking shoes (with a backing) • Incontinence products (if you use and prefer a specific product that may not available at the hospital)

6. What To Bring • Night clothes/pajamas, loose clothing • Books, magazines, hobby items

7. Day of Surgery - Park in parking deck P-2 (To the left of the hospital)

8. Infection Prevention • ChlorhexidineGluconate (CHG) wipes will be used to cleanse and disinfect the surgical site before surgery begins • Constant handwashing/use of anti-bacterial lotion • IV antibiotics (before, during, after surgery)

9. IV or Intravenous Therapy • May have one or two lines • Fluids-body water, blood, antibiotics, pain medication • Will leave it in until discharge

10. Your Surgery Surgery is about 1-2 hours long Recovery is about 1 ½ hours Staff will page family/visitors once patient is out of recovery and give the room number. This is where you will meet your family/visitors after surgery.

11. Welcome to your room!

12. After Surgery - Oxygen • Only used a short time • Let us know if you have sleep apnea or use oxygen or CPAP at home • If so, bring CPAP manual with settings as prescribed by MD

13. Dressings and Drains • Large dressing initially • Drains and dressings removed 1st or second day after surgery • Dressing changed daily after that • Cell Saver

14. Foley Catheter To Drain Urine • Stays in about 1 day • Helps to keep track of fluid balance • Good initially when not moving well • Put in after you are asleep

15. Our goal is to keep you comfortable and functional. It is unlikely that your pain will be 0. 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 relaxation Our staff will make every effort to best manage your pain. Pain Management

16. PCA - Patient Controlled Analgesia • “Pain Button” • Administer to self • Close monitoring • NO ONE IS TO PUSH THE BUTTON EXCEPT THE PATIENT!!! ***Please ask your surgeon if this is an option he will use for you

17. Femoral Nerve Block/Catheter***Some surgeons prefer not to use this*** • Numbs the front part of the leg from the groin to the knee • Stays in about two days • May cause you to have a “noodle leg” • Need to wear a knee immobilizer while standing or walking

18. Knee Immobilizer • May also wear at night to remind you to keep the leg straight • Used for safety reasons Note: You may or may not walk with the knee immobilizer on while exercising with a Therapist. However, you should ALWAYS continue to wear it with Nursing until you are able to do a full straight leg raise (with no bend at the knee)

19. 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** • Sends a cold signal to the brain to help with pain management • Helps with pain and swelling • You take this home with you (if it is ordered by your surgeon)

20. While You Are Here

21. Medications • 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 hospital

22. Preventing Pneumonia • Incentive Spirometer • Breathe in 10-12 times an hour while awake • Helps to expand air sacs in lungs

23. Preventing Blood Clots • Medication (“Blood Thinners”) • “Calf/Foot Pumps” • Walking and Exercising

24. Coumadin, Xarelto, Lovenox***Please check with your surgeon as to which blood thinner will be prescribed*** • Will help to prevent blood clots from forming • Will need to learn how to take these medications safely • Will need to watch a video

25. Compression Devices • Foot or calf pumps • Help to push the blood back into circulation • Wear them when you are in bed

26. Walking and Exercising • Helps to prevent blood clots from forming • Exercise in and out of bed • Ankle circles, foot pumps, tightening leg muscles

27. Bedside Shift Report • Takes place @7:00AM and @7:00PM at shift change • Promotes patient safety • Opportunity for patients and/or Caregiver(s) to ask questions and address patient needs

28. Diet • Initial diet is typically clear liquid • Diet will be advanced as you can tolerate • First tray is “house tray”, then you will order • Constipation because of pain meds • High fiber • Increase activity • Fluids • Nausea

29. 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.

30. 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 after speaking to the healthcare team • You notice a change in your loved one’s condition • You still have serious concerns about your loved one’s condition

31. Sleep / Relaxation • Dial L.O.U.D. (5683) on phone if sleep disturbed • Anonymous call • TV Channels • Relaxation/Meditation channels • Free WiFi

32. Case Management &Discharge Planning Goal: To get you home safely!!!

33. Discharge Plan • Everyone is assigned a Case Manager who will usually meet with you the day after surgery • Average Length of Stay: 2-3 nights • That means you should be ready for discharge around the 2ndor 3rd day after surgery

34. Discharge Sometimes the discharge 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.

35. Discharge Plan Options:Home Health & Equipment • You will choose agency (list provided) • RN (if on Coumadin) • Physical Therapy (2-3 times/wk) • Occupational Therapy (if ordered by Doctor) • Equipment ordered… • Rolling Walker • Bedside Commode • CPM (if ordered by Doctor) ***Your Case Manager will set up a Home Health Agency (of your choice) for you

36. Discharge Plan Options:Short-Term Rehab Two types of Rehab Facilities… • SNF: 1 to 3 hours of therapy/day Average Length of Stay: 1-2 weeks-as needed 2. Acute: 3 or more hours of therapy/day Average Length of Stay: 5 - 7 days

37. Discharge Plan Transportation (depends on what is medically necessary) • Car • Wheelchair Van • Not covered by insurance • Cost: $55-$120 • Ambulance • Covered by insurance if “medically necessary” ***Your Case Manager will set up your Wheelchair Van or Ambulance for you (if needed)

38. If 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) 954-3921 Pick up from the Main Pharmacy on weekends or after 4:30PM (but make payment arrangements with Plaza Pharmacy during M-F business hours)

39. Physical Therapy

40. Treatment Sessions • Seven days/week • Will typically begin the day after surgery • One or two times per day with the PT • Goals will be simply to get you up walking, start you on an exercise program, and teach you any appropriate precautions

41. Treatment Sessions (cont) • Sessions will typically be brief, lasting approximately 30 minutes • Sessions are tailored for each patient and therefore will vary from patient to patient • A few of you may do well enough to walk with family, but only if approved by your therapist! • Last visit will usually be morning of discharge

42. CPM Machine***Some surgeons prefer not to use this*** • Continuous Passive Motion machine • May be used for total knee patients (if ordered) • Passively bends knee while in bed

44. Precautions 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 knee • Do not sleep or rest with a pillow or anything under your knee • Operated leg out in front while sitting or standing

45. General Precautions Hip Replacement • Do not bend hip past 90 degrees • Do not cross middle of your body with operated leg • Do not lie on stomach for at least 6-8 weeks after surgery • Do not stay in one position for more than an hour or two

46. Homeward Bound Gym

47. Preparing for Therapy Now • General strengthening for arms and legs • Don’t do anything that would make your symptoms worse or irritate any other problem you may have • Chair push-ups can be useful for strengthening arms and preparing to use a walker or crutches • Walking or riding a stationary bike can improve your endurance

48. Occupational Therapy

49. Treatment • Sessions will usually begin Post-Op Day #1 (the day after surgery) • You may not have a session every day • Instruction will include: lower body dressing, bed transfers, bedside commode transfers, tub bench/shower transfers, personal hygiene, and use of ADL equipment if needed

50. Treatment (cont) • Demonstration of equipment ***Knee patients rarely need this equipment at discharge while most hip patients do need this equipment at discharge. The Therapist will determine your specific needs. • Reacher • Sock aid • Bathing sponge