Transcript Pre-Operative PPT for Total Joint Replacement Program

WELCOME
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Introduction
Pre-admission
Your role in a successful outcome
Hospital course
Physical Therapy
Physician Assistants
Discharge Planning
Discharge concerns
Holistic Care
PRE-ADMISSION TESTING
• Surgeon has fully explained your surgery
• Complete any medical follow-up as directed by your
surgeon
• Blood work: A “Type and Cross” needs to be drawn
within 5-7 days of your surgery at White Plains
Hospital
• STOP taking blood thinners, anti-inflammatory, and
aspirin products generally 7 days prior to surgery
• Discuss with your medical doctor which, if any, regular
medications you should take the morning of surgery.
• DO NOT shave or use depilatories on the operative leg
for one week prior to surgery
YOUR ROLE IN HAVING A
SUCCESSFUL OUTCOME
• Smoking cessation
• Exercise
• Good oral hygiene
• Good hand hygiene
• Good nutrition
• Home accessibility and resources.
HOME SAFETY TIPS
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Have a clear path from your bedroom to your
bathroom.
If you have a commode, raised toilet seat, or tub
bench at home, check that the equipment is in
good condition.
If you have crutches or a walker at home, check
that the equipment is in good condition.
PREPARE HOME FOR YOUR RETURN
PRE-SURGICAL WASH
• HIBICLENS (antiseptic antimicrobial solution)
• Shower the night before and morning of surgery as directed
• Avoid contact with the eyes, inside ears, or other mucus
membranes
• DO NOT perform the pre-surgical wash if
• Allergic to Hibiclens (Chlorhexidine) or any soap
preparation
• If you have a history of any skin condition (eczema,
psoriasis, contact dermatitis)
WHAT TO BRING TO THE HOSPITAL
• Complete your Medical History and the Medical
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Reconciliation forms
Under shorts/underpants, and if desired, loose fitted
clothes, robe, or pajamas
Eyeglasses, hearing aides, dentures if used
Loose fitting clothes and shoes for discharge
Brace or orthotics
Personal toiletries
Leave all valuables home
DAY OF YOUR SURGERY
• Do not eat or drink as directed
• Arrive 2 hours prior to the time of your surgery. You’ll
check in at the Admitting Department for registration
• You will be escorted to Ambulatory Surgery, where you
will be introduced to your pre-op team
• Your surgeon and surgical team and go through a
process of site verification
INCENTIVE SPIROMETER
ANESTHESIA
• Westchester Anesthesiology (914) 428-5454
• Various forms of anesthesia:
Spinal anesthesia
General anesthesia
Regional/Localized blocks to your joint
Peripheral nerve block (knee surgery only)
OPERATION
• Your actual surgery will take 1.5 -2 hours
• The surgical team needs additional time for:
• Application of monitors
• Anesthesia
• Proper positioning
Your surgeon will speak to your family after the surgery is
completed.
POST-OPERATIVE COURSE
• You will go to the PACU/Recovery room immediately
after the surgery.
• Your incision will be closed with either staples or glue.
• You will be transferred to your room after you have
regained sensation in your legs.
• A drain may be placed to the surgical area. The
drainage will be filtered and transfused back to you.
This drain is removed on the first day after surgery.
WELCOME TO 4I – ORTHOPEDIC
UNIT
• Phone/TV available at a small charge.
• A trapeze will be placed over your bed.
• Raised commode
• Orthopedic chair
• Visiting hours are 10:00am- 9:00pm. (We ask that
family/friends that are ill to not visit).
• Visitors should not sit on your bed or use your
bathroom.
INFECTION PREVENTION
• Hand sanitizers available for patients
• All employees must “wash-in and wash-out” during
each patient encounter
• Your sheets will be changed daily and as needed
• Keep your hands away from your surgical incision
• Proper nutrition and glucose control (for Diabetic
patients)
PAIN CONTROL
The nursing staff utilize a Pain Assessment Tool to
evaluate your level of pain or discomfort.
Together a “pain goal” will be discussed. Adjustments of
medications/treatments will be made in order to get
you to the goal.
• Antibiotics administered for 24hrs
• Anti-coagulants administered as per your surgeons
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recommendations (up to 6 weeks).
SCD (Sequential Compression Device)
Knee Immobilizer (Total Knee Replacement)
Pain management and anti-nausea management
Bowel regimen
Incentive Spirometer
FALL PREVENTION
• Patient Safety is a priority!
• Fall prevention tools:
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Bed alarms
Chair alarms
Fall risk assessed every 12 hours
“call before you fall.”
• Review contract
PHYSICAL THERAPY
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Role of the Therapist
- Physical Therapy plays a critical role in
every stage of the process
- The goals of physical therapy is to
prevent tightness/stiffness, improve patient
education, and strengthen muscles around the
joint through controlled exercises
- Educate/ Improve functional mobility
PRE-SURGERY EXERCISE
 Starting exercises prior to surgery help prepare the
patient for surgery and ease the postoperative
process
 Only do exercises that you are able to do without
increasing your pain
THERAPY
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Therapy may start as early as the day of your
surgery
Therapy will continue twice daily for the 3 days
and then once daily till your discharge
Group exercise class are offered Monday-Friday
Physical Therapy session last about 15-30 minutes
Continuous Passive Range of Motion
(CPM)
 A CPM machine may be used after surgery based
on your physician’s recommendation
POST OPERATIVE DAY #1
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Out of bed transfer to chair
Tolerate sitting upright for 1-2 hours
Exercising will help stimulate blood circulation
and keep your muscle strong
Begin walking with physical therapist using
assistive device
Studies have shown that people who exercise heal
faster and better than individuals that do not
exercise
POST-OPERATIVE DAY 2 & 3
 Pain Management
 Physical Therapy
 Increase exercise and range of motion
 Stair training
Post Operative Day #3
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Progress stair training
Progress walking distance
Enhance exercise program
Activities of daily living training
Practice car transfers
Practice tub transfers
HOME SAFETY TIPS
If you have any further questions about therapy, call the
White Plains Hospital
Physical Medicine Department at:
(914) 681-2440
Outpatient Physical Therapy before or after your surgery,
consider one of our expertly staffed White Plains
Hospital Physical and Occupational Therapy Centers
222 Westchester Avenue
White Plains, NY
(914) 681-1116
Role of the Physician Assistants
• A Physician Assistant is a healthcare professional who
works as part of your team with your surgeon to
address your post surgical needs
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Pain management
Dressing changes
Other medical related issues
Discharge Planning
CARE MANAGERS and your
DISCHARGE PLAN
• A nurse Care Manager will visit with you to establish
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the most appropriate discharge plan.
An individualized discharge care plan will be
established by the multidisciplinary team.
Your discharge plan is based on your needs and
covered benefits.
Your hospital stay should be 2-3 days
Our discharge time is 11 :00 A.M.
DISCHARGE PLAN
• The discharge plan is formulated based on the
following factors:
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Your post-operative medical status
Your mobility
Your home environment and support systems
You insurance and financial considerations
The discharge plan is heavily dependent on what
arrangements your insurance company agrees to cover.
POST DISCHARGE CONCERNS
• Fever
• Redness, swelling to surgical site
• Drainage from your incision
• Calf pain
• Trouble breathing
• Constipation
• Pain management
• Avoid driving until cleared by your surgeon (generally
6-8 weeks)
Our goal is to provide exceptional care everyday!
We are continually trying to improve our
program and would very much appreciate your
input on how we can make it better. Please
speak to us regarding your concerns or
suggestions before you leave.