JOINT REPLACEMENT PRE-OPERATIVE TEACHING

1. JOINT REPLACEMENTPRE-OPERATIVE TEACHING FOR THE WHITE PLAINS HOSPITAL CENTER ORTHOPEDIC INSTITUTE PATIENTS

2. WELCOME We have prepared the following to provide you with information to make your stay in our Orthopedic Institute more comfortable and to let you know beforehand, what you can expect during your stay. Our goal is that all patients should have a very goodexperience while they are here.

3. Within 5 days of your surgery a blood testing procedure called a “Type and Cross” will need to be completed at White Plains Hospital. This is done in the Admissions Testing Department next to Admitting. No appointment is necessary. Just go to the Admitting Department and tell the receptionist what you are there to have done.

4. Also, your doctor should have had you stop taking blood thinners, anti-inflammatory, and aspirin products generally 7 days prior to surgery. Be sure to discuss this with your doctor.

5. Preparingtoleaveforthehospital • Discuss with your medical doctor which, if any, of your regular medications you should take before leaving for the hospital on the day of your surgery. Once taken, leave all medications at home. You will be given medications from the hospital while you are an in-patient here. Do not bring your own. • Remember to bring your medical history packet and your Medication Reconciliation pamphlet with you when you come to WPHC. Be sure you’ve put your name on it.

6. Pre-operative procedures • Pre-operatively, you will be given a surgical scrub. Use it as directed the night before and the morning of the surgery. This will help control bacteria prior to the surgery. This scrub will be given to you when you come for your pre-operative teaching class prior to surgery. (The instruction sheet for use can be found at the end of this presentation.)

7. To prevent infection, DO NOT shave or use depilatories on the surgical area. The surgical team will use clippers to remove hair just prior to surgery. • Remember you cannot drink or eat after midnight before surgery.

8. Understanding your admitting procedure: • When you arrive at White Plains Hospital on the day of your surgery, GO DIRECTLY to the third-floor Ambulatory Surgery Department. The admissions process has been streamlined so you can by-pass the Admitting Department.

9. Once in this department, your nurse will escort you to the pre-operative holding area where you will change into a gown in preparation for your surgery. • Your nurse will provide and reinforce pre-operative teaching and you will be given the opportunity to have any questions answered. • As an added measure to prevent infection, the nurse will use a pre-treated wipe to cleanse the surgical area once again.

10. At this time, you should give your valuables to a family member/ accompanying friend for safekeeping.

11. From the holding area, you will be wheeled on a stretcher to the operating area. • Once you are wheeled to the operating room area, your family/significant others who have accompanied you for the surgery can wait in the 3rd floor family waiting area. The doctor will come out to them once the surgery is completed to let them know your status. Generally, the surgery can be expected to last 1 to 2 hours.

12. Prior to your surgery, you will meet with the anesthesiologist, your surgeon, and the nurses involved in your surgery. • You will have an IV started for the administration of fluids and necessary intravenous medications. • The anesthesiologist will give you an antibiotic before the surgery. • The surgical team will take you to the operating room and they will go through a process of site verificationto ensure that the correct procedure and site are identified.

13. Generally you will be given spinal anesthesia to anesthetize your body from the waist down. • In addition to spinal anesthesia, patients having knee surgery may have a peripheral nerve block. If this applies to you, expect to have less leg control for about 24 hours. You’ll need to wear a knee immobilizer when you get out of bed.

14. An anesthetic procedure called On-Q might be used in the period after your surgery to deliver local anesthesia to the nerves of the knee. This procedure helps with pain control in the area of the incision. Your anesthesiologist will discuss this if it is an option for you.

15. After the spinal anesthesia, you will be sedated for the surgery so you will not be awake for the surgical procedure. • The incisions that will be made are minimally invasive and are generally around three inches in length.

16. Once the procedure is completed, the surgeon will close the incision and you may have a drain placed into the surgical area. The drain will collect bloody drainage from the area. If it is felt that there is a large amount of bloody drainage, the drainage will be filtered and transfused back to you (auto-transfusion) to keep your blood volume up.

17. Post-operative/Recovery Room • After the surgery, you will arrive in the Recovery Room (Post Anesthesia Care Unit). • The Recovery Room nurses will monitor your vital signs and provide care and comfort measures until your anesthesia wears off. Let the nurse know if you are experiencing nausea or pain. • You can expect to be transferred to your room after you have regained sensation and movement in your legs.

18. Pain Control after your surgery and during your hospital stay: • Starting in the immediate postoperative period and continuing throughout the day, the nursing staff will use a Pain Assessment Tool to evaluate your level of pain or discomfort. This will generally be a scale of 0-10.

20. Once a level of pain or discomfort has been determined, the nurses providing your care will refer to the doctor’s orders for pain medications. They will administer the appropriate pain control medication to you. • It is our goal to help you achieve a tolerable and functional pain level. • It is your responsibility to inform the nurse if the pain control is not effective.

21. You may also have an ice pack machine or ice bag applied to your operative joint to assist in controlling swelling and pain of the joint and surrounding area. Frequent use of an ice pack is helpful for pain control throughout your stay.Speak-upso staffcan provide this as needed.

22. For your safety, the hospital has implemented a bar code scanning system for medication administration. On admission you will be given a bar-coded bracelet. Whenever you are given medication, the nurse will scan both your bracelet and the medication. If you have questions, we encourage you to speak up and ask the nurse.

23. You will receive an anti-coagulant to reduce the chance of blood clots forming in your legs. • If it has been ordered by your doctor, you will be instructed in how to self-administer the anti-coagulant upon discharge.

24. Post-Operative Care-continued • In the post-operative period you will have light-weight leg wraps called SCDs (sequential compression devices) placed on your legs. You are also encouraged to do the ankle pumping exercises throughout your stay and after. These will assist in diminishing your chances of having a problem with blood clots in your legs in the postoperative period.

25. Incentive Spirometry • After the surgery, you will need to actively work on breathing deeply. • As a tool to help you with this deep breathing, you will be given an incentive spirometer. This is a tube with a mouth piece attached to a casing with a small ball inside.

26. As you inhale through the mouthpiece, you should try to have the ball lift up in the tube and keep it up for as long as possible. • When you use the incentive spirometer, you should take long, slow breaths. Be sure to concentrate on breathing in deeply and directing air to the base of your lungs.

27. You should be able to feel the bottom of your rib cage expand outwardly in all directions if you are doing this correctly. • It is important to do not only deep breathing, but to also cough up any phlegm that may be in your airways. You can help avoid having respiratory problems after the surgery if you follow these guidelines.

28. Your Arrival on 4I-the Orthopedic Unit Your room set-up on 4I will include: • Phone availability (at a small charge) • TV availability (at a small charge-and run by an outside company) • There will be a trapeze placed over the bed for you to use in positioning yourself

29. A special orthopedic chair will be at your bedside for sitting. • A raised commode will be in the room to keep you at the proper height to protect your newly replaced joint. • As part of providing very good care during your stay on 4I, the staff will do hourly rounding to ensure that your needs are met.

30. You will be provided with our “Joints are made for Walking” race track to record your progress. • Your Joints are Made for Walking… START FINISH

31. Visiting hours are from 8:00am to 9:00pm. If friends and family are ill, please request that they not visit. We encourage family members to be involved in patient care in collaboration with the hospital staff caring for the patient.

32. An Orthopedic Unit Room,the Dining Area and the Gym

33. Good HygienePreventing infections is important! • After your surgery, the 4I staff will provide you with a liquid hand-sanitizer to enable you to clean your hands when you are in the bed. Once you are able, you can clean your hands at the sink. • There is hand sanitizing foam at the doorway of each room. Caregivers should use this prior to rendering care. Speak up if your caregivers forget.

34. Good Hygiene Continued.. • Ask visitors from the outside not to sit on your bed. • Ask visitors not to use your hospital bathroom. There are public restrooms for visitors use. • If the dressing is not intact, ask the nurse to reinforce it.

35. Activity • You can expect to be assisted out of bed by the physical therapist on post-op day one, generally by noontime. If for some reason you are not out of bed and sitting in your chair by noon, you must let your nurse know. Your nurse will check with the rehabilitation department to determine when the therapist will make the first PT visit.

36. On subsequent days, the nurse/nursing tech will assist you out of bed in the morning and have you ready for your morning therapy session. The 4I staff will bring you to the gym at the time designated for your therapy. • We expect that you will be out of bed walking with therapy or the nursing staff at least 4 times a day to aid in your recovery.

37. Rehabilitation • The first day after your surgery, you will be seen by the Physical Therapist. The therapist will evaluate how you are functioning and will get you out of bed. Depending on how you are moving, you will be assisted to the chair at your bedside or you may walk a short distance before returning to your chair.

38. You will remain seated out of bed for part of the morning-a minimum of an hour is the goal. • In the afternoon, the therapist will return and have you do exercises and walk again.

39. Post-operative days 2 + 3: • On the second and third post-operative days, the physical therapist will see you in the 4I Gym area in the morning where you will do exercises and walking. This session will include stair climbing on the 3rd day, if not sooner. • In the afternoon, the therapist will see you for another session of walking and/or exercises.

40. In addition to walking and exercises, your therapy sessions will include instruction and practice in: • getting in and out of bed • getting up and down to/from a chair • getting in and out of a shower • using special equipment for dressing and reaching while maintaining hip precautions

41. Further post-operative days: • It is anticipated that you will be discharged on the 3rd postoperative day. If you need to stay longer for medical reasons, then on the fourth post-operative day, the therapy frequency will become once daily, and will remain as such, unless your medical status dictates otherwise. • These sessions will include exercises and/or ambulation as indicated by your need.

42. Precautions to observe if you are having a Total Hip Replacement (to minimize the risk of dislocating your hip) • DO NOT bend the operative hip more than 90 °. • DO NOT rotate the operative leg inward. As you lie in bed, the toes should remain pointing up toward the ceiling or rotated outward slightly. They should not rotate inward toward each other. • Keep the legs apart. DO NOT cross your legs.

43. Further hip precautions to observe after Hip Replacement surgery are: 1. You must avoid twisting your body around either while in the bed, in your chair, or while standing. Position items close to you in bed or in the chair so you can avoid reaching or twisting to get them. 2. You will need to avoid leaning forward when seated in a chair.

44. 3. To turn while walking with the walker, turn incrementally. Place the walker a little to the side and move your feet in small steps in the direction of the walker. Keep repeating this until you are turned around. Avoid pivoting around on your operative hip.

45. 4. Sit in a firm, upright chair with a pillow or extra cushion to raise the height of the seat. A chair with armrests is suggested. DO NOT sit on a soft or low chair. 5.Use a raised toilet seat or place a raised commode directly over the toilet. DO NOT sit on a standard height toilet.

46. 6.Youmust avoid bending at the operative hip and using your hands to pick items up off the floor. • Use a reacher to pick up light items, or ask for assistance.

47. 7. You must use adaptive equipment to dress your lower body. • Use a sock aid to put on your socks. • Use a dressing stick or reacher to put on your underpants and slacks. • Use elastic shoelaces for your shoes or use slip-on loafer style shoes with a back to them. • Use a long handled shoe horn to put on your shoes.

48. 8.You must useadaptive equipment to wash your lower body. • Use a long handled sponge or back scrubber to wash below your knees.

49. 9.You may not shower until the staples are out and your doctor has given permission. • Hold on to a safety bar in order to enter the bath tub for showering. Step over side of tub by bending your knee up behind you to clear the tub side. (Donot bend at the hip). Straighten knee once it has cleared the tub side. You will only be able to shower. • You must not sit down in the tub. A bath seat for ease of showering may be recommended by your therapist.

50. 10.You will not enter a car as you did before your surgery. As a passenger: • Sit in the front passenger seat. • Have the car seat positioned as far back and as high as possible. You may place 1-2 pillows on the seat if needed. • Open the passenger car door as wide as possible. • Using walker/crutches walk up to car door, then, turn facing away from the car and back up to car seat. Place one hand on dashboard or car door and the other on the seat back. Sit slowly. With legs separated, pivot onto the seat.