Transcript Pre-Op Total Joint Class

Pre-Op Spine Information
Welcome!
Goals
Inform the patient about what to expect…
 Before Surgery
 During Surgery
 After Surgery
Goals
 Reduce anxiety
 Answer questions
 Help you become better-prepared
Sections
Nursing
Case Management
Physical Therapy
Occupational Therapy
Information From The Nurse
About Care And Your Concerns
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
What To Bring
 List of medications and allergies
 Glasses, hearing aids, dentures
 Toiletry items
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Toothbrush
Toothpaste
 Flat, supportive, non-slip walking shoes (with a
backing)
 Incontinence products (you may prefer a specific
brand not provided by hospital)
What To Bring
 Night clothes/pajamas, loose clothing
 Books, magazines, hobby items
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
Equipment After Surgery
Oxygen
 Used a short time
 Let us know if you have sleep apnea or use
oxygen or CPAP at home
IV or Intravenous Therapy
 May have one or two lines
 Fluids-body water, blood, antibiotics, pain
medication
 Will leave it in until discharge
Dressings and Drains
 Drains and dressings removed 1st or second
day after surgery
 Dressing changed daily
after that
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
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
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
Rating Pain
 0 to 10 pain scale
 Pain patterns
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Mechanical Pain
Surgical Pain
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)
Preventing Pneumonia
 Incentive Spirometer or Acapella
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Perform breathing exercises
while awake
Helps to expand air sacs in lungs
Preventing Blood Clots
 Medication (“Blood Thinners”)
 “Calf/Foot Pumps”
 Walking and Exercising
Coumadin and Lovenox
***Your surgeon may or may not place you on a blood thinner after
spinal surgery
 Will help to prevent blood
clots from forming
 Will need to learn how to
take these medications safely
 Will need to watch a video
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
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
Diet
 Initial diet is typically clear liquid unless
otherwise designated by your physician
 Diet will advance as tolerated
 Constipation
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High fiber
Increase activity
Fluids
 Nausea
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.
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…
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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
Sleep
 Dial L.O.U.D. (5683) on phone if sleep disturbed
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Anonymous call
 TIGR TV Channels
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Relaxation/Meditation channels
 Comfort Cart
Case Management
Joan Paramore RN
Case Manager
(919) 954-3878
Discharge Plan
Goal: To get you home safely!!!
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
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That means you should be ready for discharge
around the 2nd, 3rd, or 4th day after surgery
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)
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RN (if on Coumadin)
Physical Therapy (2-3 times/wk)
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Occupational Therapy (if ordered by Doctor)
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***Your Case Manager will set up a Home Health Agency (of your
choice) for you
Discharge Plan Options:
Home Health
Equipment ordered…
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Rolling Walker (if needed)
Bedside Commode (if needed)
***Your Case Manager will order your equipment for you from an
agency of your choice
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
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
Discharge Plan Options:
Outpatient Therapy
 Usually set up after Home Health is
completed
 Rarely set up at time of discharge from
hospital
Discharge Plan
Transportation (depends on what is medically necessary)
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Car
Wheelchair Van
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Not covered by insurance
Cost: $55-$120
Ambulance
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Covered by insurance if “medically necessary”
***Your Case Manager will set up your Wheelchair Van or Ambulance for you
(if needed)
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
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Use the Main Pharmacy on weekends or after 4:30PM
(but make payment arrangements with Plaza Pharmacy
Mon-Fri 9:00AM to 4:30PM
Physical Therapy
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
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Post-op Days 1, 2, and 3
Specific Exercises
Your Therapy will involve a lot of walking with
our staff
General Precautions
No “BLT’s” !!!
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No Bending
No Lifting
No Twisting
Your Therapist will also teach you how to
“logroll”
Homeward Bound Gym
 Stair training
 Car transfer exercises
Medical Equipment
 Walker
 Bedside Commode
Occupational Therapy
Treatment
 Post-op Day 2 visit
 Demonstration of equipment
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Reacher
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Sock aid
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Bathing sponge
Helpful Tips
 How to properly carry items in pockets and basket
while driving a walker
 Safety in the shower (have someone close by)
 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 day of discharge
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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Thank You!!!