Pre-Op Shoulder Surgery Information

1. Pre-Op Shoulder Surgery Information Welcome!

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

3. Information From The Nurse

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 866-552-9357

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)

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)

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

8. Equipment After 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)

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

11. Dressings and Drains You may have a drain in place. Leave the dressing on 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

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

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

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

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

18. 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) Know the Zone!

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

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

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

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.

23. Discharge • 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.

25. Prescriptions • Your Surgeon will typically write prescriptions for… • Pain medications • Anti-inflammatories • Antibiotics (if needed) • 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

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.

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

29. Activity • Your Surgeon and/or Therapist may instruct you to squeeze 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

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

32. Positioning Seated (reclined) Supine (on back) Side-Lying (on non-operated side)

33. Infection Prevention • To prevent infection, do not get incision wet until your Physician says it is alright

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

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

36. If You Are Staying Overnight… You will be oriented to your room • Call bell • TV Controls/Volume • 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

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!!!

39. If You Are Staying Overnight… Preventing Fever and Pneumonia Incentive Spirometer • Breathe in 10-12 times an hour while awake • Helps to expand air sacs in lungs

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

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

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) 954-3921

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

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)

46. If You Are Staying Overnight… Occupational Therapy

47. If You Are Staying Overnight… • Your Occupational Therapist will evaluate your adaptive equipment needs • Reacher • Sock aid • Bathing sponge

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

49. Thank You!!!