Morning of surgery Follow pre-admission instructions: For your safety, please remember to follow all the instructions you were given by the nurse during the pre- admission phone call. It is very important not to eat or drink after the time you were instructed. If you were instructed to take medications, please take them with a very small sip of water. No chewing gum, candy, mints or ice chips. These items can increase your gastric juices and cause possible aspiration during surgery. Checklist of items to bring day of surgery: Current medications in the original bottle Assist device: walker or crutches Insurance cards and photo ID Case for contacts and/or glasses Personal belongings 10
Arrival at the center Reception Area: Upon arrival to the surgery center you will check in at the reception desk. You will be asked to present your insurance card and photo identification. Pre-Op: You will be escorted to pre op where we will start your admission process and meet your healthcare team. Medical Assistant: You will be weighed and your vital signs will be taken by the medical assistant. In order to prep your skin appropriately your surgeon has ordered another SAGE wipe to be used around your surgical area. This will help reduce your chance of developing an infection. Pre-op RN: The nurse will review your labs, allergies and you will be asked a series of questions concerning your health history. Your surgical procedure will be reviewed and you will sign your surgical permit. Before and after your surgery, elastic stockings and leg wraps will be placed on your legs to help your blood circulate and prevent blood clots. You will continue to wear your stockings for about 2 weeks after surgery. The nurse will start an IV for administration of fluids and medication for your surgery. You will be given some oral medications that your surgeon has ordered for you before your surgery. 11
Arrival at the center Anesthesia Provider: You will meet your anesthesia provider in the pre op area. Your health history and past surgeries will be discussed. Tell the anesthesia provider if you have ever had any problems with anesthesia or medications. Your provider will explain the anesthesia you will receive and any questions you may have will be answered. Spinal Anesthesia with Sedation: You will receive local anesthetics (numbing medicine) and pain medication through a small needle briefly placed in the spine in the middle of your back. Local anesthesia blocks the nerves that give you feeling in your legs and hips. Sedative medications are mixed with your intravenous fluids before and after surgery. Benefits for you include: 1. More effective pain control 2. Less blood loss/fewer blood re-infusions 3. Lower risk of blood clots in the legs 4. Less drowsiness Side effects: 1. Nausea-treated with IV medication 2. Itching-controlled with IV medication 3. Urinary retention-a urinary catheter may be used after surgery General Anesthesia: You are given intravenous medications that put you to sleep for your operation. These medications produce complete loss of sensation and perception. You will wake up quickly when surgery is over. Side effects 1. Nausea-treated with IV medication 2. Urinary retention-a urinary catheter may be used after surgery 3. Sore throat from airway tube. 12
Arrival at the center Surgeon: The surgeon will mark and initial the operative area before your surgery. You will also have an opportunity to ask questions at this time. OR Nurse: The OR nurse will introduce herself and review your health history. You will have to answer questions that you have already been asked. This is part of our surgical safety checklist program to ensure your safety while at our facility. Operating Room: The OR nurse will escort you to the operating room and the rest of the healthcare staff will greet you and introduce themselves. At that time the entire team will verify your name, birthdate, surgeon and procedure. You will be transferred to another bed and a blood pressure cuff, pulse oximeter and EKG patches will be applied. Medication will then be administered through the IV to start your anesthesia. The average length of time of your surgery is 1-1 ½ hours long. 13
Day of surgery Recovery area: Once surgery is complete you will be taken to the recovery room. We will inform your family/care giver when surgery is done and they will be able to join you in recovery. Your surgeon will talk to them about the surgery and answer any questions they may have. You will wake up feeling groggy from the anesthesia and your recovery room nurse will continuously monitor your vital signs and evaluating your pain level during your stay. Your family or caregiver will be welcomed at your bedside. Pain medications and pain control: While you are in the surgery center, you will be asked to rate the intensity of pain you are experiencing through the use of a pain scale. A pain scale is a line numbered from 0 to 10, with each number representing a degree of pain. Your surgeon has ordered several pain medications to help keep your pain at a tolerable level. Please feel free to communicate with your nurse if you are feeling discomfort, nausea or anything you need to make you feel more comfortable. A sample of a pain scale can be seen below. 14
Day of surgery Intravenous Fluids, Antibiotics: You will be provided with fluids through an intravenous tube. It will be removed on the first post-operative day if you are drinking fluids. Antibiotics are also given intravenously to prevent infection. Dressing: You will have a waterproof bandage over your surgical area. This bandage will stay on for 7 days post operatively. Urinary Catheter: You may have a catheter inserted into your bladder during or after your surgery to empty your bladder. The catheter will be removed early in the morning after your surgery in order to allow your bladder to fill, so that you will have the sensation of fullness, and can urinate on your own before discharge. Physical Therapy: Participating in physical therapy strongly influences your recovery. While you are in the center, you will receive physical therapy as much as two times before discharge. The exercises you learned in the weeks before your surgery will be resumed by physical therapy. In the days following, you should progress to more advanced exercises and walking with the assistance of crutches or a walker. Your therapist will determine which of these is best for you. For your safety, during your stay at our center it is very important that you do not get out of bed on your own or with family members. We do not want you to hurt yourself or fall. Our staff want to help you get up and a gait belt will be used to keep you safe. 15
Day of surgery Medications your surgeon may prescribe for you after your procedure Prescription medications: Depending on your health history and current medication list you may not be prescribed all of the medications listed below, substitutions may be given. Dilaudid Pain medication for moderate to severe pain. Hydrocodone Pain medication for moderate to mild pain. Both of these pain medications will be prescribed for use depending on the degree of pain that you are experiencing. Meloxicam-Medication used for inflammatory pain. Protonix Medication used to protect stomach discomfort. Zofran Medication used as needed for nausea and or vomiting. Over the counter medications: Aspirin 325mg tablet-to help prevent blood clots from occurring, you will be directed to start on Aspirin therapy for 60 days. It is best to purchase enteric coated 325mg aspirin to protect your stomach. Benadryl 25mg, one tablet by mouth every 8 hours as needed for itching Colace-A stool softener to take until your first bowel movement after surgery, then modify as needed. Milk of Magnesia-Another remedy to prevent constipation until your first bowel movement after surgery, then modify as needed. Narcotic medications and the lack of normal activity may cause constipation. If constipation becomes a problem, even after the use of Colace and Milk of Magnesia, please report this to your surgeon. 16