Transcript Pre-op Spine Class

Welcome
to the
Spine Class at
GBMC
Pre-op Spine Class
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Overview of the spine
Prepare you for your surgery
Decrease your anxiety level
The spine is divided into 3
sections:
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Cervical spine-7 vertebrae
Thoracic spine-12 vertebrae
Lumbar spine- 5 vertebrae
Spine Anatomy
Examples of disc problems
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Lumbar
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Cervical
Pre-op clearance
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All lab work and tests Tests needed before
need to be completed
surgery
within 30 days before
 CXR(if one has not been
completed within the past
your scheduled
6 months)
surgery. You will need
 Urinalysis, Blood work
to go to your Primary
 EKG
Care Physician who
 Other tests recommended
will order these tests.
by your specialists
You may need to go
see other specialists
that are treating you.
(Cardiologists, Pulmonologist)
Medications
Stop 7 days before surgery
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Anti-inflammatory drugs such
as: Aspirin, Motrin, Aleve,
Ibuprofen or Naproxen
Certain vitamins such as
Vitamin E and Glucosamine
All Herbal products-ex. fish oils
These medications may
cause increased
bleeding.
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DO NOT STOP
COUMADIN, PLAVIX
or any anti-platelet
drug without
speaking to your
cardiologist or the
physician who
prescribes it for
you.
Diabetics
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If you are taking Avandamet, Actoplus, Glucophage,
Metforman, or Glucovance – STOP TAKING 24
HOURS BEFORE SURGERY! These medications
can cause your surgery to be cancelled if taken within
this time period.
If you are on insulin, talk to your prescribing physician
about how many units you should take the evening
before surgery.
Night before surgery
•No eating after 8 p.m. However, you may drink up
until midnight. You may take your blood pressure, or
cardiac medications with a sip of water the morning
of your surgery (if instructed to do so by your
physician)
•If you keep a drink on your bedside table, remove it
before you go to sleep. Old habits are hard to break!
•No chewing gum or mints
Morning of surgery
Blood pressure medication: Should be taken as usual the
morning of surgery including diurectics (fluid pills). These
include Lasix (furosemide), Hydrochlorothizide (HCTZ)
and others
Heartburn or ulcer medicine: Acid blockers (Zantac,
Pepcid, Axid, Prilosec, Propulsid, Reglan) should be taken
on the morning of the surgery to reduce the risk of
aspiration pneumonia. Antacids like Maalox, Tums, or
Carafate should NOT be taken because they contain
particulate material that may damage the lungs if aspirated.
Preventing Infections and other
complications
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Control your blood sugar
before, during and after
your surgery
Exercise and healthy
weight loss
Try to stop smoking
Good nutrition with
adequate calories and
protein
Dental Health-make sure
you have had a dental
examine in the past 6
months
Mupirocin ointment for
infection prevention
All patients having surgery will be nasal
swabbed for MSSA/MRSA. If you have a
positive culture you will be given mupirocin
(antibiotic ointment) to start the 5 days prior
to your surgery.
Continue – Infection Prevention
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CHG wipes start 3
days prior to
surgery
AVOID CONTACT
WITH YOUR EYES,
EARS, MOUTH AND
GENITALS
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There are 6 wipes in
each packet.
#1 wipe neck, chest
and abdomen.
#2 wipe both arms
#3 wipe front of legs
#4 wipe back of legs
#5 wipe back
#6 wipe surgical site
CHG Wipes
Six cloths are provided for your use; one
for your neck, chest and abdomen; one
cloth for both of your arms; one cloth for
each of your legs; one for the back, and
one for the surgical site. Use all the
cloths in the packages. Preparing or
“prepping” skin before surgery reduces
the risk of infection at the surgical site.
Day of Surgery
•Bring to the hospital: Anything your surgeon has
asked for you to bring, medication list, green blood
donation cards (if donated blood)
•Be at the hospital 2 hours before your surgery time
•Follow directions on the purple hand-out in your
packet to the admitting area
Pre-op area
•Turn in the paperwork that you brought with you
•You will be given a hospital gown to change into
•Meet your surgical team – surgeon, nurse,
anestheologist, tech
•Many questions will be asked – “Do you know
why you are here?” Don’t panic, they do know.
They want to make sure you are in agreement to
what procedure is being done
•Vital signs and IV will be started
Recovery Room
 Wake
patient
 Monitor Vital Signs
 Control Pain
PCA
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Pain pump connected to your IV
Only the patient should push the button to
receive medication
Programmed to only allow a certain
amount of medication in a period of time
Pain scale 0 (zero) -10
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0 (zero) means no pain and 10 the worst pain that
you have ever had
Equipment used
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Foley catheter
Drains- Hemavac or JP drains
Oxygen
SCD’s or AV Boots(DVT Prophylaxis)
Abdominal Binder
Aquacel dressing
IS (incentive spirometry)
Braces
Pulse ox
Spinal Precautions-BLT
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No Bending
No Lifting
No Twisting
Spinal Precautions
B
L
T
No Bending
No Lifting
No Twisting
Log roll in and out of bed
While on your back, bend you knees. Roll onto your side.
Keep your shoulders and hips together as a unit as you roll.
Slowly raise your body as you lower your legs toward the floor.
No Bridging
PATIENT SAFETY
Fall Prevention
“Do not get up
without the help
of staff!”
HAVING KNEE OR HIP REPLACEMENT MAKES YOU A
FALL RISK
SO FOR PATIENT SAFETY….
“Do not get up
without the help
of staff!”
AND
Orange or Red non-skid socks will be placed on you when you
are admitted to GBMC to signal you are a fall risk.
Day of Surgery
You will probably feel sleepy for most of
the day
Vital signs checked frequently, every 4
hours
Continuous pulse ox placed on finger to
monitor your oxygen level
You will start on a clear liquid diet and if
tolerated will be advanced to a soft diet
Post-op Day 1
•You will be evaluated by a Physical Therapist
(PT) and an Occupational Therapist (OT).
•Initially, they will get you up to the chair with an
abdominal binder if your brace isn’t here yet. If
your brace is present, they may walk you into the
hallway.
Case Management
After you are seen by PT/OT,
one of our case managers will
come in to see you to start
working on discharge planning.
Post-op Day 2
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Physical Therapy and Occupational therapy will work
with you individually. They will walk you in the hallway
and may have you do some stairs. OT will take you
down to the gym and work with you getting in and out of
a tub and the car.
Your PCA will be discontinued and oral pain medication
will be started.
Foley catheter (if one is in place) will be discontinued.
Your drain will be discontinued depending on the
amount of drainage. It may stay in until the third post
operative day.
Post-op Day 3
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Discharge Day
PT will need to clear you for discharge
You need to know your Spinal Precautions
OT will teach you how to get in and out of
the car maintaining your precautions
Braces
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Cervical patients- Usually, the patients are
only ordered a soft collar for comfort. If
your surgeon orders a hard collar, Northern
Pharmacy will bring it in for you.
Lumbar Braces
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If you are having a lumbar fusion, your
surgeon will order a brace for you to wear
when you are out of bed. Northern
Pharmacy will bring this in for you the day
after your surgery.
Positions for comfort
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Cervical patients: Pillows placed under
each arm, may help alleviate some of the
discomfort in your neck and shoulders.
Lumbar patients: Pillows placed under the
knees while on your back, and between
your knees when you are on your side,
may help with your pain.
Average length of stay
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Cervical Fusion: Anterior approach (from
the front), 23 hour stay
Cervical Fusion: Posterior approach (from
the back), 2 days
Lumbar Fusion: 2- 3 day stay
Maryland Medical Orders for
Life Sustaining Treatment
(MOLST)
What is MOLST
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Maryland MOLST is a portable medical order form
covering options for cardiopulmonary resuscitation
and other life-sustaining treatments
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The medical orders are based on a patient’s wishes
about medical treatments
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The original, copy, or faxed MOLST form are all valid
orders
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MOLST orders are still valid even if written by a
practitioner who is NOT on their medical staff
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MOLST orders do not expire
•Who Needs a MOLST FORM
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MOLST will be necessary for all
admitted/observation patients
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All patients that are transferred to another
facility will also require a MOLST form prior
to EMS transport
Thank You for attending the
Spine Class at GBMC. Please
feel free to contact us with any
questions or concerns.
443-849-6261