Your Pathway to Recovery Division of Nursing Patient Education Programs
Patient Educators Lisa Briskie, BS, RN, ONC Briana Damora, BSN, RN Kelsey Vukov, MSN, RN Jack Davis, MSN, RN, ONC (212) 606-1263 2
Welcome to HSS! Top ranked in U.S. Teaching institution Research oriented IRB approved Voluntary Magnet designation Patient-centered care 3
Your Healthcare Team Multidisciplinary team input Surgeon, Medical MD, Anesthesia, Physician s Assistant, Nurse, Physical therapist, Case Manager, Dietician and other support staff 4
Webinar Objectives Highlight topics to prepare you for surgery & your hospital experience (typically a 1 night stay) Identify areas of focus to reduce potential risks Safety & falls prevention Infection & blood clots Immobility & pain Describe self-care management tips to optimize recovery Patient & Family Involvement = Best Results 5
Overall conceptual goals Provide information Facilitate understanding Encourage you to take action and participate in your care Provide a highly satisfactory experience 6
Safety & Falls Prevention Hospital environment Equipment & Medications Falls brochure highlights safety Call don t fall ALWAYS use call bell Safety brochure RRT, Speak up, Identification checks 7
Hip Anatomy 8
Hip Arthritis 9
The preserved bone is sculpted to accept a metal cap with a short stem. 10
Pre-op Pathway Surgeon consultation Specific issues & protocols Medical doctor appointment Reduce risk of complications Health history and list of medications Pre-op education class/webinar Pre Surgical Screening appointment Health history, medication & instruction 11
Pre-Surgical Screening (PSS) 3 rd Floor of Hospital aka Pre Admission Testing (PAT) Nurse consult (database and paperwork) EKG, blood and urine specimen X-rays? 12
Pre-Surgical Screening Paperwork Information materials Your Rights booklet and Healthcare Proxy/Living Will Packet of pre-op prep materials Fleet enema Surgical wash Participation & self-care management 13
General Information Important Number that You Call 212 606-1630 No less than 48 hours before surgery Recording Instructions to prepare you 14
Nurse Call Center Nurse will call you with instructions between 1p-7p day before surgery Diet reminder No solid food after Midnight before surgery Clear liquid diet up to 3 hours before surgery Nothing to drink or eat after arrival to HSS Medication review Final instructions and time to report 15
What to Bring? Photo ID Credit card Shoes Flat supportive Non-slip walking shoes Closed toe Paperwork Should all fit into 1 small bag No luggage please! 16
Day of Surgery Check in Main Lobby- Patient Access Services 4 th Floor Family Atrium 1 family member / support person Generally 3 hours before surgery 5:30am arrival for 1 st case 17
Same Day Surgery Unit Team approach Prep nurses, IV start, OR team Anesthesia team Surgical team All checking for correct patient All checking for correct site Safety first 18
Anesthesia Consult Epidural/spinal IV sedation Pain management Antibiotics 19
You are taken to the OR Surgical team (infection prevention) Space suits Surgery takes about 90 minutes Bulky ace dressing 20
Transferred to the PACU Wake up from sedation Still probably numb from waist down Pain consult Vital signs monitored Visitation is limited Start your exercises 21
Inpatient Units Patients transferred to floors: 6, 7, 8, 10 or 11 Hourly Comfort Rounds Vital Signs routinely White Board for communication in each room 22
Pain Management Team Goal is to keep you comfortable Pain Scale 0-10 (aim for 5 or less) Cold therapy and positioning Decrease swelling Local injection in OR Oral tablets Discharge meds 23
Managing Side Effects Goal is comfort and able to do physical therapy Balance medication dose to reduce adverse effects Nausea Itch Drowsiness Constipation Dizziness 24
Need to Keep You Moving! Immobility can increase risk of complications and delay recovery Skin irritation and breakdown Digestive system Blood clots Muscle weakness Call for assistance before getting out of bed 25
Constipation Prevention Pain medication and immobility Stool softener & laxative Colace 100mg 3 times a day Senna 374 mg 2 times a day Increase fluid intake Fresh fruits and vegetables 26
Physical Therapy Goals Regain independence with mobility Teach an independent walking/exercise program Teach proper body mechanics Safely return to functional activities Assist with meeting discharge criteria within the 1 night hospital stay 27
Ambulation/Walking Walking will begin with a rolling walker and progress to crutches when you are comfortable and safe Walk 2 to 3 times a day Stairs will be reviewed using crutches and a handrail before you leave the hospital 28
Exercise Programs Ankle pumps Isometric quad strengthening Heel slides Gluteal sets Hip rotation to neutral Heel slides Dangle stretch and Figure 4 leg crossing 29
Ankle Pumps Isometric quad strengthening
Gluteal Setting ( Glut Sets ) Hip Rotation (to neutral)
Heel Slides
Dangle A simple exercise to help increase flexion Use a stool or lower chair Place knees at shoulder width Bring hands down towards your ankles and hold when you feel the stretch Don t bounce or continue if you have a lot of pain Repeat for a set of 10 33
Figure 4 crossing of legs Designed to increase the rotation in your hip joint In a sitting position, gently grab your operated foot and bring it to rest on your unoperated knee It will be difficult at first, and you may feel some pain around the incision site 34
Figure 4 crossing of legs If it is too stiff to accomplish this early on, you may turn your body at an angle to the chair/bed, and bring the foot onto the chair/bed instead of your opposite knee Gently press on your operated leg to flatten it. 35
Hip precautions? You may hear staff remind you to maintain hip precautions as they apply to many hip replacement patients, but not to you Dr. Su s hip resurfacing patients are allowed to sit up and bend greater than ninety degrees as tolerated 36
Reduce risk of complications Although they do not occur frequently we are always on look out for signs of Infection & Blood clots You should be aware and participate in care to prevent them 37
Keeping Lungs Clear Deep breathing Incentive spirometer helps expand lungs Increases oxygen to tissues Promotes circulation Lowers risk of pneumonia Relaxation technique 38
Measures taken to prevent blood clots include Timely surgery Regional anesthesia Early mobility and exercises Mechanical compression devices Medication Buffered aspirin 325mg, twice a day 6 weeks or as per doctor 39
Things to Look Out For Symptoms of blood clots that should be reported to the doctor include: Unexpected swelling, especially in the calf Continuous low-grade fever Unexpected pain, especially in the calf Chest pain/shortness of breath 40
Help prevent infection Wound care Observe wound for signs of infection Drainage, increased redness? Temperature >101 Keep incision area clean and dry Have everyone wash hands If absorbable stitches then ok to shower If staples then No showers until staples are removed 41
Long Term Protection Against Infection Remember that you need to take antibiotics before Dental & urologic procedures Antibiotics 1 hour before procedure This is for the rest of your life Alert all your health providers about hip resurfacing Infections in other areas need to be treated promptly to protect your new hip 42
Discharge Instructions Pain management Take medications as needed and prescribed Usually every 4hrs and then taper Use icepack or cold therapy 15 minutes 4 times a day Follow PT instructions and do not overdo activity Leg swelling Normal in leg, knee, ankle & foot Take frequent rest periods Avoid sitting longer than 30-45 minutes Use support hose (TEDs) 43
Follow-up Care Surgeon appointment Appointment about 4 weeks Communicate any needs, keep in touch if any complications or issues Nurse will call you following your return home to check on progress 44
Discharge Planning at the Hospital Case manager support 212 606-1271 Pre-op call & ongoing evaluation Daily updates on rounds Get any necessary equipment PRIOR to day of discharge Parking out front for family pick up 45
Discharge Plan to Home Home exercise program to be provided Home care services RN: evaluation & staple removal if needed PT: 2-3x s a week Transportation home typically not covered by insurance so plan for family to pick up 46
Day of Discharge Process Family member or friend can pick you up in front of the hospital Discharge instructions reviewed Prescriptions and instructions provided 47
At Home Recovery Walking is # 1 exercise for recovery Use both crutches 2-3 weeks after surgery Wean to 1 crutch (opposite arm) for short distances at 4-6 weeks after surgery Early stretching exercises recommended to regain motion Be safe and prepare home environment and assistance before surgery 48
Conclusion Read & Review information in the slides Ask questions! Speak up! Prepare yourself and your home Focus on Increasing Safety falls prevention and risk reduction Preventing infection Preventing blood clots Managing Pain Keep moving You are a partner in Your Pathway to Recovery 49
Your Pathway to Recovery Patient Education Programs (212) 606-1263 Thank you and Questions?