Welcome to Mercy Joint Camp

Transcription

1 Welcome to Mercy Joint Camp

2 Your goals for your joint replacement surgery: Relief from pain Improved mobility Restored function all of which can provide you with a new outlook on life. Attitude is everything!! A positive upbeat attitude, a sense of humor and willingness to work hard will help make your recovery from surgery successful and renew your enthusiasm for life.

3 At-Home Camp Preparing for Your Surgery: Contact Your Insurance Company. The hospital and your surgeon s office will contact your insurance carrier. But you should also contact your insurance company prior to admission to varify benefits. Some companies require a second opinion or a referral form.

4 At-Home Camp Preparing for Your Surgery: Attend Your Physical Examination Appointment You need a complete physical by your family physician before surgery to assess your health and rule out any conditions that could interfere with surgery. Tests, such as blood, urine and an electrocardiogram, will be needed to assure it is safe to proceed with your surgery. Give the surgeon and your family physician a list of all your medications. This list needs to include prescription medications (including insulin) overthe-counter medcations (including Tylenol), and herbs or other supplements (including vitamins).

5 At-Home Camp Preparing for Your Surgery: If you are on Aspirin, Coumadin (Warfarin), or Plavix (or other blood thinners), visit with your medical doctor or cardiologist about the date to stop this medication. Seven days prior to surgery, stop any medications that can thin your blood, such as anti-inflammatory medications (N-SAIDS).

6 At-Home Camp Preparing for Your Surgery: Practice your mobility exercises Practice your breathing exercises Stop smoking prior to surgery Prevent infections Identify a Camp Buddy/Coach

7 Camp Buddy/Coach Your Camp Buddy is someone who will attend your entire camp experience with you, supporting you in the hospital and at home. It is preferred that your Camp Buddy will stay with you at home for the first few days after you leave the hospital. Your Camp Buddy will provide encouragement by being there for you and participating in your therapy sessions in the hospital and at home. They will be there in case you need a helping hand.

8 What does a Camp Buddy do? Attend the Day Camp with you to learn about the procedure and safety issues. Be the designated person who will have access to your condition and inform the rest of your family. Attend at least one of the Physical Therapy sessions before your discharge from the hospital to learn about your mobility needs and to assist you with physical therapy exercises. Be present at the time of discharge when home instructions and care are reviewed. **If you do not have a coach, our staff will help you during your hospital stay. If you have no one to help you after you leave the hospital, we will assess your home situation to assure safety after discharge. If you are not safe to go home by yourself, a social worker will talk with you during your hospital stay about the options availble.

9 Preparing Your Home Put clean linens on your bed. Move furniture as needed to provide easy access to the bedroom, bathroom and kitchen with a walker. You may need to ask someone to help you. Make sure all walkways are free of clutter. Pick up all throw rugs and tack down any loose carpeting. Remove electric/phone cords from walkways or tape them to the floor. Consider having nightlights in the bedroom, bathrooms and hallways. Your mattress should be firm. You may need to place a piece of plywood between the box spring and mattress to make your bed firmer. Prepare meals ahead of time and freeze them in single-serving containers. Put cooking supplies and utensils in a place that is easy to reach. Install permanent grab bars in bathtub/shower and by toilet. Obtain a non-slip mat for the bathtub, a tub bench/chair and purchase a hand-held shower head. If you have a tub/shower combo in your bathroom, consider taking off the doors and using a tension rod with a shower curtain. This will make it easier to get in and out of the shower. Find a chair in your home that will allow you to sit down comfortably and stand up easily (dining room chairs with arms are ideal). Make sure your chairs and bed are at a height so when you sit, your hips are higher than your knees.

10 Pre-Camp Phone Call Mercy s Surgery Department will call you for a pre-surgery assessment interview 1 2 days prior to your surgery. They are starting your hospital chart for you. What you tell them in this interview will be added to your chart. Have your current medication list available. Surgery staff will tell you when to arrive at the hospital. They will also tell which of your medications should be taken the morning of surgery with a sip of water. If you have a living will and/or medical power of attorney and did not provide it today at day camp, please bring a copy with you on the day of your surgery.

11 Packing for In-Hospital Camp Please bring: Your smile, patience, determination and a positive attitude. Your Joint Replacement Manual Walker, if you have it. Personal hygiene products (deodorant powder, toothbrush, toothpaste, electric razor, comb), personal items, bathrobe, etc. Hospital staff will take these items to 5 West for you. Wear loose fitting clothes to the hospital. These can be the same ones you wear home. Three outfits of loose-fitting clothing (t-shirts and shorts or loungewear with elastic wastebands or drawstrings). Campers are both men and women so plan for modesty. Low heeled walking shoes (make sure they are wide enough to allow for some swelling on your operative leg and are not too loose). No flip-flop sandals or crocs, please. Incentive spirometer (breathing exerciser). Copy of your Durable Power of Attorney/Living Will, if you have not brought it with you to your pre-camp education visit. If you have these things, bring them: Eyeglasses and case Hearing aids, case and extra batteries. CPAP or breathing machine. Eye drops, inhaler. Laptop computer or tablet (ipad or Kindle), if you want.

12 Do NOT bring: Jewelry and valuables Credit cards Packing for In-Hospital Camp Cash or Checkbook Medicines other than eye drops and inhalers Mercy will provide any medications you need during your stay. Any valuables that you bring may be locked in the hospital safe when you arrive.

13 The Night Before Camp REMEMBER!!! Shower with antibacterial soap that is provided for you today. Shower neck to toes, rinse off, then dry with clean towel. Wear clean night clothes to bed. Nothing to eat or drink after midnight, including water, unless otherwise instructed. Normal evening medication may be taken before midnight. Do not use any tobacco products, chewing gum, candy or lozenges after midnight. Try to get plenty of rest.

14 The Big Day! Your arrival at camp. Report to the Surgery Waiting Room on the 2 nd floor at Mercy Medical Center North Iowa s East Campus at the time specified during your phone call. If problems arise on the morning of surgery to prevent you from your scheduled arrival time, please contact Same Day Surgery at Valet service is available for your convenience from 7:00 a.m. 5:00 p.m. at the main entrance. A nurse will complete your admission activities and any additional necessary preparations. Your nurse will update when you last took each of your medications and the last time you ate food or drank fluids. Compression devices will be applied on your lower legs to help prevent blood clots. IVs (intravenous catheters) will be started; these IVs may be used for two to three days following surgery. An anesthesia provider will visit with you and your family prior to you going to the operating room. General or spinal anesthesia will be discussed, depending on your health and preferences. Knee Replacement patients may have the option of a femoral block for post-op pain control. To ensure your safety, a surgical consent detailing your surgical procedure needs to be signed. In addition, on your day of surgery you and your surgeon must agree on the surgical procedure. Your surgeon will mark the correct surgical site before surgery.

15 The Big Day! - In the Operating Room. Going to the operating room is not a normal experience for most of us. We recognize the natural anxiety you may experience as you approach this step in the process of achieving your goal. When you go to the Operating room, the nurse will direct your family to the surgery waiting room. Operating Room personnel will do a time out to verify your surgical procedure and site. All of this is a serious safety procedure; please participate to ensure accuracy. The operating room will be cold, with bright lights and many machines. There will be many people in the operating room. The staff will do everything they can to help you feel comfortable and secure. Additional preparation in the operating room takes about 30 minutes before your procedure actually starts. Antibiotics will be started and continued after surgery. Your anesthesia provider will monitor your condition throughout the procedure. Medication will be given to help you feel more comfortable. The entire surgery will take about one and a half to two (1 ½ to 2) hours. After your surgery is completed, your surgeon will visit with your family or friends.

16 The Big Day! In the Recovery Room. When you wake up, you will be in the recovery room. You can expect to be there for about an hour. Nurses will take your blood pressure often and monitor your pain. You will be getting oxygen through a mask or nasal cannula. You will be asked to rate your pain on a scale of 0 10 and will be given pain medication as needed. No Pain Mild Pain Discomfort Distress Horrible Worst Pain You may also receive medicine for nausea. If you had a hip replacement, you will have an x-ray taken of your new joint. While you are in the recovery room, the doctor will speak to your family in the Surgery Waiting room. They will be informed of your hospital room number on 5W (5 th floor on the west side of the building).

17 In-Hospital Camp 5West Day of Surgery Your nurse will help you get settled in your room.. Initially you will be given water to drink. Your diet will be increased as you tolerate liquids. Pain medication will be given to you through a Patient Controlled Analgesia (PCA) pump through your IV. This pump will be started in the Recovery Room. Family is not allowed to push the PCA button. Anesthesia medications and pain medication may have side effects, such as nausea and/or vomiting. Your nurse will give you medications to relieve these symptoms, if necessary. An ice pack will be placed on your new joint. You may also have a drain tube near your incision to prevent the collection of fluids and swelling. This drain typically is removed the next day. You will have a big dressing on your incision. Additional IV antibiotics will be given to prevent infection. To help minimize the risk of blood clots and swelling, foot and ankle movements are encouraged immediately following your surgery and throughout your hospital stay. Also, you will continue to wear a compression device on your legs. It will be important to turn from your back to non-surgical side approximately every two (2) hours, especially the first and second day after surgery until you are up and moving. Nursing staff will assist you in making sure you are positioned so that your surgical precautions are maintained. This will help prevent pressure points and bed sores.

18 In-Hospital Camp 5West Day of Surgery Nurses will remind you to use your incentive spirometer (breathing exerciser) every hour while awake. Take five to ten (5 10) slow deep breaths, followed by a deep cough. This exercise will help prevent congestion or pneumonia. Your bed is set up with a trapeze bar. This bar will help you in your activities and movements. Active participation in your own care helps maintain muscle strength and decreases complications. Therapy staff may refrain from utilizing this in later sessions to promote independence prior to discharge home. You will probably have oxygen going through your nose overnight. Your nurse may also place a sensor on your finger to monitor your oxygen level. Your vital signs will be checked often while you are in the hospital, and most frequently in the first 24 hours. Your nurse will check on you frequently and monitor your blood pressure, pulse, temperature, oxygen level, and pain level. You may use a bedpan, commode, or stand to urinate. If unable to urinate, a catheter may be temporarily inserted to empty your bladder. Difficulty in urinating after surgery is not unusual. When able, you will be walking to the restroom, accompanied by nursing staff. Knee patients if your doctor believes you will benefit from a continuous passive motion (CPM) machine to help bend your knee, it will be applied after arrival to 5W Remember: DO NOT cross your legs at the knees or ankles at any time!!!

19 In-Hospital Camp 1 st Day After Surgery Diet advanced (what does this mean?) PCA pump continues. Pain pill started to control discomfort Knee patients-femoral block will be wearing off, but surgical leg may remain weak. DO NOT TRY TO GET OUT OF BED OR WALK BY YOURSELF. Surgical drain will be removed within hours after surgery. A sponge bath will be set up for you and assistance given as needed. Compression devices on your legs will continue while you are in bed throughout your hospital stay. Additional medication may also be started to prevent blood clots Your discharge plan will be discussed with you by your therapists and nurse. Physical therapy staff will assist you to sit up on the side of the bed, stand and walk with you. Moving about is very good for your breathing and circulation to help prevent lung congestion and blood clots. Exercises will be started and progressed as you are able. Getting up in the chair for lunch and dinner with assistance of the staff. Incentive Spirometry (breathing exerciser) continues every hour while awake throughout your hospital stay. Occupational Therapy will be ordered for you if you have had one hip or both knees replaced. Their staff will work with you to ensure that you are able to move about safely and are following the restrictions necessary during your normal activities of daily living. Your oxygen levels will continue to be monitored and oxygen given if needed.

20 In-Hospital Camp 2 nd Day After Surgery Physical Therapy staff will continue to help you with your exercises. This time is good for your coach to be present to learn how to assist and encourage you when you are at home. Occupational therapy may continue to teach you additional ways to be safe while moving around and caring for yourself in your home. Your dressing will be changed daily after removal of the surgical drain. Pain medication will continue, usually in pill form. Pain medications are given routinely to control pain and discomfort. Stool softeners are given to promote bowel activity. Your health care team will evaluate your progress and plan your discharge if you are close to meeting your goals. A social worker will assist in helping make final arrangements for discharge. A shower and/or shampoo of your hair may be done if your incision is dry.

21 In-Hospital Camp 3 rd Day After Surgery This is usually discharge day, although some patients may be discharged on the 2 nd day after surgery if goals are met and a coach is available to assist them at home. Your health care team will evaluate this information and decide if this is the best plan for you. Both Physical Therapy and Occupational Therapy will work with you to help you gain strength and practice the activities you will need to do at home. You will practice climbing steps, if you haven't already done so with PT. Increased activities, such as out of bed for meals, ambulation in halls and showering, all aid in helping you recover your strength and ability to care for yourself. Continue pain medication, breathing exerciser, and exercises of your surgical leg as instructed by your therapists.

22 In-Hospital Camp Discharge Day 80% of all patients go directly home, as they have the ability to : Walk 100 feet safely with a walker or crutches Transfer in and out of bed safely and independently Go up and down stairs safely Eat and drink without difficulty Bowels and bladder are functioning Pain is controlled with pain medication No signs of infection at surgical site or lungs. Knee patients-bending 90 degrees or close to 90 degrees Hip patients-able to follow hip restrictions If unable to meet the goals, other options are decided upon. Home with outpatient therapy Home with home care nurse Transfer to skilled facility closer to your home or on Mercy s West Campus Discharge instructions will be reviewed with you before you leave and a copy sent home with you. A follow-up appointment will be made for you with your surgeon. A Prescription for pain medication will be sent home with you also. This may be filled at the pharmacy of your choice.

23 Discharge and Recovery Walking Use your walker or crutches until you are given further instructions from your surgeon. Although you may feel you can do without these devices, remember that healing continues for the next six to eight (6-8) weeks. Protect yourself by using a supportive device, such as a walker or crutches. If you are not bearing full weight after surgery, progress your weight bearing as your surgeon has advised. Walk as much as you can every day, within your comfort level. Follow the instructions given by your Physical Therapist. Walk frequently on level ground. Go out-of-doors if weather permits, or choose a large area, such as a shopping mall. Sitting/Traveling Do not sit longer than 45 minutes at a time. You must get up, walk, and change your position. DO NOT travel a long distance (over one hour) until cleared by your surgeon. During long car trips, stop at 45-minute intervals, get out, and move around. If you don t take breaks, you will become uncomfortably stiff and experience swelling, which may lead to blood clot formation. Your new joint may activate metal detectors required for security in airports and some buildings. You will be provided with a card validating your total joint replacement by the orthopedic surgeon. However, many airports and secure buildings may seek additional information from you.

24 Discharge and Recovery Exercises Exercising is very important. It is better to walk short distances and exercise more often during the day than to only do it one to two (1-2) times each day. You must balance exercise and rest periods each day. Follow your home exercise program daily, as instructed by your Physical Therapist. Exercise is not a temporary program, but continuous and ongoing. DO NOT use exercise equipment until approved to do so by your surgeon or therapist. Sleeping Driving At your first postoperative office appointment, ask your surgeon when you can sleep on your surgical side or stomach. Usually driving begins when your joint bends easily so you can enter and sit comfortably in the car, and when your muscle control provides adequate reaction time for braking and acceleration. Do Not drive until your surgeon has cleared you and you are NOT taking any pain medication. This may be a liability issue with your insurance company. This varies, based on the type of surgery you had and also which leg was operated on. Generally, patients whose surgery was on the left side can return to driving sooner.

25 Discharge and Recovery Avoid falls Your surgeon and physical therapist will help you decide what assistive devices will be required following surgery and when these devices can be safely discontinued. A fall can damage your new joint and may result in further surgery, even years later. Stairs, showers, and bathtubs are particular hazards until your joint is strong and mobile. You should use a cane, crutches, walker, handrails, or someone to help you with the stairs until you have improved your balance, flexibility, and strength. Sometimes pets can cause falls; be careful around your pet(s) or make other arrangements for your pet(s) for a few weeks. Bathing When your incision is no longer draining, you may shower. Do not scrub the incision area; allow the soap and water to run over the incision. Depending on the type of shower you have, you may stand or use a shower chair to bathe. Grab bars may be helpful. Do not soak your incision by sitting in a bathtub, whirlpool, hot tub, pool, or spa until your surgeon gives you the okay. The incision needs to heal completely.

26 Discharge and Recovery Diet Some loss of appetite is common for several weeks after surgery. A balanced diet is important to promote proper tissue healing and restore muscle strength. Pain medication may cause constipation. Eat foods high in fiber, drink additional fluids, and take an over-the-counter laxative or stool softener as needed until your bowels become regular. Pain Control/Cold Packs Continue to take your pain medication around-the-clock when awake to keep your pain under control for the first few weeks. Cold packs can be used over the operative joint. Cold packs are helpful if used minutes before or after your exercise program. Never use ice directly on skin; use a barrier such as a towel to protect skin. Do not use heat on your incision area unless instructed to do so by your surgeon.

27 Discharge and Recovery Wound Care (Incisional Care) Sutures with steri strips or staples close your incision. A two to three (2-3) week post-op appointment will be made with your surgeon to inspect your incision and remove staples if needed. Keep a clean, dry, small dressing over the incision to prevent the incision from rubbing or catching on clothing. Reapply the dressing daily after your shower until after your first post-operative appointment with your surgeon. Do not use any ointments or creams over your incision. Sexual Activity Sex following joint surgery is possible and can resume quickly. Initially, the bottom position, maintaining your legs abducted (spread apart) and slightly flexed will be the safest and most comfortable position, which will also require the least energy expenditure by you, the patient. As you progress, you will be able to pursue a more active role in sexual intercourse. Remember, if there are any questions or concerns that you or your partner may have, feel free to ask your surgeon, nurse, and/or physical therapist. Refer to the Q&A in your handbook for more details.