Pre-Op Total Joint Class
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Transcript Pre-Op Total Joint Class
Pre-Op Knee Information
Welcome!
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Goals
Inform the patient about what to expect…
Before Surgery
During Surgery
After Surgery
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Goals
Reduce anxiety
Answer questions
Help you become better-prepared
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Sections
Nursing
Case Management
Physical Therapy
Occupational Therapy
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Information From The Nurse
About Care And Your Concerns
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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
forward it to the Patient Navigator at the end of
class
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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 (you may prefer a specific
product not provided by hospital)
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What To Bring
Night clothes/pajamas, loose clothing
Books, magazines, hobby items
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While in surgery…
CHG 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
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Orientation To Room
Call bell
TV Controls/Volume
Thermostat
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Equipment After Surgery
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Oxygen
Used a short time
Let us know if you have sleep apnea or use
oxygen or CPAP at home
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IV or Intravenous Therapy
May have one or two lines
Fluids-body water, blood, antibiotics, pain
medication
Will leave it in until discharge
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Dressings and Drains
Large dressing initially
Drains and dressings removed 1st or second
day after surgery
Dressing will be
changed
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Foley Catheter To Drain Urine
Stays in no longer than 2 days
Helps to keep track of fluid balance
Good initially when not moving well
Put in after you are asleep
Does not hurt to come out
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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 for you
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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
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Knee Immobilizer
May wear when out of bed if you have a nerve block/catheter (dependent
on your Therapist)
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)
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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**
For total knee patients
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)
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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
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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
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Rating Pain
0 to 10 pain scale
Pain patterns
Mechanical Pain
Surgical Pain
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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)
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Preventing Pneumonia
Incentive Spirometer
Breathe in 10-12 times an hour
while awake
Helps to expand air sacs in lungs
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Preventing Blood Clots
Medication (“Blood Thinners”)
“Calf/Foot Pumps”
Walking and Exercising
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Coumadin and 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
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Compression Devices
Foot or calf pumps
Help to push the blood back into circulation
Wear them when you are in bed or in the
chair
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Walking and Exercising
Helps to prevent blood
clots from forming
Exercise in and out of bed
Ankle circles, foot pumps,
tightening leg muscles
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Diet
Initial diet is typically clear liquid unless
otherwise designated by your physician
Diet will advance as tolerated
Constipation
High fiber
Increase activity
Fluids
Nausea
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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.
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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
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Sleep
Dial L.O.U.D. (5683) on phone if sleep disturbed
Anonymous call
TIGR TV Channels
Relaxation/Meditation channels
Comfort Cart
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Case Management
Joan Paramore RN
Case Manager
(919) 954-3878
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Discharge Plan
Goal: To get you home safely!!!
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Discharge Plan
Everyone is assigned a Case Manager who
will usually meet with you the day after
surgery
Average Length of Stay: 2-4 nights
That means you should be ready for discharge
around the 2nd, 3rd, or 4th day after surgery
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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.
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Discharge Plan Options:
Home Health
You will choose agency (list provided)
RN (if on Coumadin)
Physical Therapy (2-3 times/wk)
Occupational Therapy (if ordered by Doctor)
***Your Case Manager will set up a Home Health Agency (of your
choice) for you
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Discharge Plan Options:
Home Health
Equipment ordered…
Rolling Walker
Bedside Commode
CPM (if ordered by Doctor)
***Your Case Manager will order your equipment for you from an
agency of your choice
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Discharge Plan Options:
Short-Term Rehab
If not safe to return home, Short-Term Rehab may be
an option.
Based on…
1. Your insurance
2. How well you progress with Therapy
while in the hospital
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Discharge Plan Options:
Short-Term Rehab
Two types of Rehab Facilities…
1. SNF: 1 to 3 hours of therapy/day
Average Length of Stay: 1-2
weeks-as needed
2. Acute: 3 to 5 hours of therapy/day
Average Length of Stay: 5 days
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Discharge Plan Options:
Outpatient Therapy
Usually set up after Home Health is
completed
Rarely set up at time of discharge from
hospital
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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)
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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
Use the Main Pharmacy on weekends or after 4:30PM (but
make payment arrangements with Plaza Pharmacy
Mon-Fri 9:00AM to 4:30PM
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Physical Therapy
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Treatment Sessions
Seven days/week
One or two sessions per day with the Therapist
Your therapeutic activity will also involve walking
with Nursing staff
Typical treatment session
Post-op Days 1, 2, and 3
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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
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Homeward Bound Gym
Stair training
Car transfer exercises
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Medical Equipment
Walker
Proper use
Bedside Commode
Proper use
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Occupational Therapy
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Treatment
Demonstration of equipment
***Knee patients rarely need this equipment at discharge. The Therapist will
determine your specific needs.
Reacher
Sock aid
Bathing sponge
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Helpful Tips
How to properly carry items in pockets and/or
basket while driving a walker
Safety in the shower (have someone close by)
While at home prior to surgery, move low- and
high-lying items to waist level
(i.e. in kitchen/bathroom cupboards, refrigerator)
Make arrangements to have appropriate-sized car
available for your discharge
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Before Surgery…
Assess your home environment and let the Therapist know the
following once you are in the hospital…
Tub/Shower (location, height, grab bars)
Number of steps (outside of home and upstairs)
Height of bed
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Assessment
The following slides contain questions based
on the Powerpoint.
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Question 1
One risk of a blood thinner medication is:
___________?____________
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Answer
Increased bleeding
(Can also be increased bruising)
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Question 2
You should call your Doctor immediately if
you notice any sign of a blood clot.
Name a symptom of a blood clot in your leg:
_____________________
Name a symptom of a blood clot in your lung:
______________________
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Answer
Leg: Pain in the back of the leg (usually in the
calf, but can radiate throughout the leg)
Lung: Difficulty breathing (may also have a
rapid heart rate)
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Question 3
True or False
When standing up or sitting down, you should
keep your operated leg slightly in front of
your non-operated leg.
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Answer
True
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Question 4
True or False
When lying in bed, you should keep your
operated knee in a straight position as much
as possible. You should never place a pillow
or rolled-up towel under the knee.
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Answer
True
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Question 5
Some pain is normal and expected after surgery, but the
best way to keep your pain at a manageable level is to:
1.
2.
3.
4.
Take pain medication when it reaches a “5” on a “0 to 10 pain scale”
Take pain medication only when the pain is unbearable
Use medication as well as other methods to control pain. For example:
ice, positioning, etc.
Try distracting yourself from the pain by watching television for an
hour or two
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Answer
3. Use medication as well as other methods to control pain.
For example: ice, positioning, etc.
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Question 6
The best and safest way to raise the height of a
chair in your home is to:
1.
2.
3.
4.
Stack pillows on the chair
Stack folded blankets on the chair
Place a small book under each leg of the chair
Place two large telephone books on the chair
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Answer
2. Stack folded blankets on the chair
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Question 7
One side effect of pain medication is
constipation. List 3 ways to prevent it:
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Answer
1. Increase fiber
2. Increase fluids
3. Increase activity
You may also take a stool softener or laxative
if needed.
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Thank You!!!
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