Transcript Joint Replacement Powerpoint

Your Guide to Joint Replacement Surgery
Your journey to wellness
begins here.
Welcome.
Thank you for choosing
Rome Memorial Hospital and
Rome Orthopedics & Sports Medicine
for your joint replacement surgery
Updated June 28, 2016
How this class
can help you.
 This class is designed to give you some basic, important
information about joint replacement surgery
 We will cover what to expect before, during, and after your surgery
 You will be given a booklet in the physician’s office
 The booklet contains detailed information about your specific
surgery (hip or knee), your care and recovery
 Please bring your booklet to all preadmission visits
and hospital stay
Our goals for you.
 To answer any questions you have about your
upcoming surgery
 To inform you of what to expect so you are
comfortable with your surgery and your stay
at Rome Memorial Hospital
 To be discharged within 2-4 days
What are your goals?
 Golf?
 Walking?
 Playing with your children
and/or grandchildren?
 Gardening?
 Vacationing with your family?
We will work with you to help
you achieve the goals you set
for yourself.
Why joint replacement
surgery?
“I work closely with my patients to
understand their goals as we develop the
best plan of care to relieve their pain and
restore their activity to the highest level of
function possible. For my surgical
patients, managing post-surgical pain is a
priority so patients can begin the
rehabilitation process promptly and
recover more quickly.”
Dr. Mihail (Mike)
Radulescu, M.D., FRCSC
Orthopedic Surgeon
Normal joints.
 Allow for movement
between bones
 Each bony surface of
the joint is lined with
cartilage
 Cartilage provides
smooth friction-free
movement, nutrition to
the joint, and provides
shock absorption
Hip joint.
 Ball (femur) and socket
(acetabulum) joint
 Moves in three directions
 Socket not lined completely
with cartilage
Knee joint.
 Hinge joint is largest joint
in the body
 The thigh bone (femur) and the
shin bone (tibia) meet to form
the knee joint
 The knee cap (patella) covers
and protects the knee joint
 Cartilage covers the end of the
knee bones and “cushion” the
knee for smooth, easy
movement
What is arthritis?
Osteoarthritis
Rheumatoid Arthritis
 Slow developing joint
pain
 Stiffness, bony
enlargement
 One or both sides
affected
 Usual onset is middle
age
 Symptoms come and go
 Affects all ages
 Chronic systemic inflammatory
disease
Rheumatoid arthritis usually affects
joints symmetrically (on both sides
equally), may initially begin in a
couple of joints only, and frequently
attacks the wrists, hands, elbows,
shoulders, knees and ankles
How do we treat arthritis?
Non-surgical care
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Medication
Injections
Activity modification
Physical therapy
Minor surgery
 Arthroscopy
Surgical Care
 Joint replacement
surgery
Healthy Knee
Arthritic Knee
People just like you
are having joint replacement
surgery.
 There are over 1.1 million procedures done each year
in the United States
 Knee and hip joint replacement surgeries are two of
the most common surgeries performed in the United
States
 With the rise in the number of baby boomers reaching
retirement and increasing demands on athletes, the
number of joint replacement surgeries is expected to
increase each year
Prepare yourself for surgery.
 Stop aspirin, aspirin containing medications,
Coumadin (Warfarin) and anti-inflammatory (NSAIDS) 5
days before surgery
 Stop factor Xa inhibitors, ie: Xarelto (Rivaroxaban), Eliquis
(Apixaban) 24 to 48 hours before surgery
 Stop Plavix (Clopidogrel) 7 days before surgery
 Stop smoking as soon as possible
 Stop drinking alcohol as soon as possible
 Eat a healthy diet
 Become familiar with the exercises in your joint
replacement surgery guide
What to bring to the hospital.
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Your joint replacement guide
Eye glasses, dentures, hearing aid
Supportive rubber soled shoes or sneakers
Loose fitting clothes (no jeans)
Health Care Proxy
Insurance Card
Written list of home medications
Leave all valuables at home
Your Care Team.
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Surgeon
Physician Assistants/Nurse Practitioner
Anesthesia Care Provider
Nurses
- Registered Nurses
- Licensed Practical Nurses (for short-term rehabilitation)
 Physical Medicine and Rehabilitation Professionals
- Physical Therapists
- Occupational Therapists
 Case Manager
 Pharmacist
Who else plays a vital role?
YOU and
YOUR COACH
play a key role in
your recovery.
What is the role of the
coach?
A coach can be:
Your spouse, friend, family member, neighbor
Anyone that can be a support to you as you recover from your surgery
Your coach will help you with:
Activities of daily living (as needed)
Transportation to follow-up appointments
Preparing your home
Any necessary errands
How to prepare your home:
both inside and outside.
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Good lighting
No trip hazards
Clear pathways (plan for leaf, snow removal)
Handrails
Frequently used items within reach
A comfortable place to sleep and rest
Please refer to your booklet for more information
Preventing complications:
Pre-surgery testing.
To evaluate your overall health and prevent complications from unknown or
uncontrolled medical problems, we will order pre-surgical testing including:
 Blood work for diabetes, iron levels for anemia, kidney and liver
function, clotting function
 EKG
 Chest x-ray
 Urinalysis
 Physical Therapy Functional Evaluation
Preventing complications:
What we do to prevent infection.
At Rome Memorial Hospital, we take great pride in our track
record for keeping our patients safe from infection.
 We wash our hands frequently
 We clean our equipment and workstations frequently
 Each patient has a dedicated walker, equipment is not shared
between patients
 Rome Memorial Hospital is top rated in the region for protecting
patients from surgical site infections
Preventing complications:
What can you do to prevent
infection?
 Do not shave the surgical site prior to surgery
 Wash with chlorhexidine soap as directed in your
pre-admission visit
 Complete nasal ointment application as directed
in pre-admission visit
 Wash your hands often including before meals
and after using the bathroom
 Ask family members to wash their hands often
 See your dentist on a regular basis
What to expect
the day before your surgery.
The business day before your surgery date,
you will receive a call from the hospital
about your expected arrival time.
(Please arrive on time.)
What to expect
the day of your surgery.
DAY 0:
 You
will be “NPO after MN” – this means no food or drink after
midnight (including chewing gum)
 Morning medications will be taken with just a sip of water, enough to
get the medication down
 Limit belongings and leave all valuables at home. Your family will be
responsible for carrying your personal items
 You are expected to arrive on time. Go directly to the Ambulatory
Care Unit, 2 East
What to expect
before the operating room.
 Nurses will review your medical/surgical history
 Medications will be reviewed
 An IV will be inserted
 You will receive multiple pre-op medications including those for pain, nausea and antibiotics
 You may have a urinary catheter inserted (most patients do not)
 You will be transferred to a holding room prior to entering the operating room
Your surgeon will talk to you and mark the surgical site
Your Anesthesiologist will talk to you
Anesthesia.
You may receive spinal anesthesia
Spinal anesthesia blocks the nerves to a specific area
 You will be in a comfortable twilight state while in the OR; you may
be able to hear what is happening around you
 You will not feel any pain during your surgery
 Research has shown that this type of anesthesia results in less
complications and shorter hospital stays
You may receive general anesthesia
Please ask your surgeon any questions you have regarding anesthesia
For your family.
Family Surgical Waiting Room and Visiting Hours
 Your family will be directed to the Information Desk in the
main lobby and receive a pager
 Your surgeon will speak with your family after surgery in the
Surgical Consultation Room next to the Information Desk.
 Visiting hours are from 8 a.m. – 8 p.m.
 We encourage family members to visit and stay as long as
possible if it will aid your recovery
What to expect
after you leave the operating room.
 Arrive in Post Anesthesia Care Unit (PACU), you will
be there approximately 1-2 hours
 When you are ready, you will go to your room; you will
be greeted by your nurses
 You will have a private room as soon as one becomes
available
What to expect
after arriving in your room.
 Frequent vital signs and assessments
 Clear liquid diet, advanced to regular food as you can
tolerate
 Physical Therapy (PT) evaluation if able
 You should take deep breaths and cough; use your
incentive spirometer
Pain control is important
Please talk to you nurse about pain
Incentive
Spirometer
Managing your pain.
 We use oral medications for pain control
 Medications may be adjusted based on your specific needs
 Asking for pain medication one hour before Physical Therapy is an
option
 If you have spasm, uncontrolled pain and/or you can’t sleep, ask your
nurse, there are more therapies/orders for medications that can be
used
 We also use an ice cyrotherapy device on your surgical site to help
with pain management and swelling
 Mobility and other therapies can help (music, imagery, etc.)
Pain scale 0-10.
Pain control can help speed your recovery. If your pain is well controlled
(at or below 3 on the pain scale), you will be better able to participate in
physical therapy and deep breathing exercises and sleep.
0= No Pain
10= Worst
Pain Possible
Your White Board:
Communicating with your caregivers.
 On the wall across from your bed
 A way to keep you involved in your
care; use the white board to make
notes and post questions
 Names of your Care Team
 Family members may use it to leave
notes for your providers
 Pain Control Goals
Preventing complications
after surgery:
Blood clots and pneumonia.
Sequential stockings and compression devices
Compression stockings and devices help prevent post-op blood clots
 Wear them when you are in bed or in the chair
 Various anti-coagulation medications
Incentive Spirometry and deep-breathing
 Use your spirometer 10 times every hour while awake to prevent pneumonia after
surgery
 Pre-op antibiotics (post-op if indicated)
Preventing complications
after surgery:
Constipation.
 Pain medications can cause constipation
 We will start you on a post-operative bowel regime with
various stool softeners
 Good hydration is important, you will have clear liquids
first then advance to solid foods as tolerated
 Return to activity – get moving
Preventing complications
after surgery:
If you have diabetes
 We may monitor your blood glucose while you are in
the hospital more frequently than you do at home
 We may give you insulin while you are here
 If you currently take insulin at home, we may give you
a different insulin while you are in the hospital
For some knee surgery
patients.
CPM (continuous passive motion) machine
 For knee replacement surgery patients only
 May be used by some physicians
 Helps range of motion with passive motion of
the knee
Your post-surgery team.
 The nurse practitioners
(NPs) and hospitalists that
see you post-operatively
are an extension of your
surgeon
 They work together closely
to take care of you
What to expect
the first day after surgery.
DAY 1:
 Your Case Manager will visit to discuss your discharge plan
 Physical/Occupational Therapy begins, exercise is important
 Any drains or catheters are removed by your nurse
Ask for pain medications when you need them, pain should be
at or below a 3
 Use your call bell and wait for nurse before getting out of bed
Physical Therapy. (PT)
Physical Therapy is important for your recovery
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During PT, you will be doing exercises laying down, sitting and standing
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You will learn how to use an assistive device (as needed) and practice
getting in and out of a chair, laying down, getting into a car and using stairs
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A therapist will come to meet you at your bedside
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You will receive PT once on the day of your surgery
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You will receive PT twice a day thereafter
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Your nurses will get you up to walk and encourage you to do your exercises
throughout the day
Occupational Therapy. (OT)
Occupational Therapy teaches you strategies to:
 Perform self-care tasks (dressing, bathing and toileting)
 Use adaptive equipment as needed for self-care tasks
 Function safely in your home
 Address barriers to movement precautions
 You will receive OT one time each day
Adaptive Equipment for
joint replacements.
 After surgery you will need extra support
 Use adaptive equipment as needed for self-care
tasks
Your Occupational Therapist
will determine if you need
adaptive equipment and what
would be most helpful to you
Time to start moving.
Remember, your surgeon will put your
new joint in, but you are the one who
has to move it!
It is important that you are an
active participant in your
recovery!
What to expect
the second day after surgery.
DAY 2:
 PT will continue, 2 times a day
 Occupational Therapy, 1 time a day
 Your nurse will help you walk in the hall
 You will continue to be monitored and assessed
 Pain level should be at or below 3
 You may be discharged on this day, depending on your progress and
recommendations from your physician and physical therapist
Discharge to home.
You may heal better in your home
Arrange for someone to assist you at home (your Coach)
 If you need home care services, your Case Manager
may arrange for visits from a nurse, physical therapist
and/or home health aides
 Most people are able to begin outpatient physical
therapy immediately upon discharge
Outpatient Physical Therapy.
 You will require outpatient physical therapy
 Arrange for someone, such as your coach, to assist you at home
and with transportation to Physical Therapy
 Most people are able to begin outpatient physical therapy
immediately upon discharge
 Rome Memorial Hospital’s physical therapy services:
Chestnut Commons Physical & Occupational Therapy
107 E. Chestnut St., Suite 104, Rome
Discharge to
Short-term Rehabilitation.
 Short-term Rehab may be an option for those who still require help getting in and
out of bed and for those who may not have support at home (please talk to your
Case Manager for current rules and criteria)
 Rome Memorial Hospital provides short-term rehabilitation on the hospital’s third
floor. Easy transition from your hospital room may be an option
 Transportation to short-term rehab is NOT covered by insurance, and many
transport companies require payment upfront with a credit card
 We do not recommend having family or friends transport patients to a rehab facility
What to expect
on your discharge day.
 In the morning, your Nurse Practitioner will see you and assess if you are
able to be discharged
 Your Physical Therapist may visit you, depending on your discharge time
 Your Nurse will review instructions and medications with you
 Discharge time varies, we do our best to coordinate a timely discharge
 Patients are discharged through our Bartlett Wing entrance, please ask
your ride to meet you there
What to expect after discharge.
 Continue with your PT and exercise regiment
 Increase activity based on your tolerance
 Use assistive devices until no longer needed
 Keep your follow-up appointment
 Drive only with your doctor’s approval
 Resuming sexual activity
- Knee replacement: as soon as you feel able
- Hip replacement: 4-6 weeks (or sooner)
- Ask your doctor, physical therapist or nurse for more information
 Your patient booklet has more information
Thank you.
 Thank you for choosing Rome Memorial Hospital and
Rome Orthopedics & Sports Medicine for your joint
replacement needs
 Do not hesitate to ask our knowledgeable team of
physicians, nurses and therapists any questions you may
have as you recover from your surgery
Important phone numbers.
• Rome Orthopedics & Sports Medicine
315-338-9200
• Rome Memorial Hospital
Pre-op Coordinator
315-338-7355
• Chestnut Commons Physical & Occupational Therapy
315-337-7952