Joint Replacement Information Class
PREADMISSION Important information to have available List of all medications you are currently taking This includes all vitamins, herbs and over-the counter medications Be sure to note medications you have recently stopped taking as well Have a complete list of all surgeries Please make sure your surgeon has correct phone numbers so we can reach you Have a list of your allergies and type of reaction
Day of Surgery Arrive two hours before surgery is scheduled to start Remove all body piercings prior to arrival Do not have deodorant, creams or powders applied when you come Remove all nail polish (acrylic nails) Wear glasses, not contacts Leave suitcase in your car Leave valuables at home Wear comfortable clothes and shoes * Shoulder patients consider a button-down shirt that you can wear over the sling
Other Tips Surgeons need to have a History and Physical written within 30 days of surgery, but updated within 24 hours of your surgery, so please remember events since your H&P was first written so your information will be accurate and up to date. If you ever were told you had MRSA,VRE or other chronic infection, please let us know
Surgical Entrance Entrance located on Center Street next to the Emergency Room entrance Refer to the map in the back of the book Valet Parking is provided at the door A receptionist will greet you and make arrangements for your family to stay informed Everyone is already Preregistered so we will have you sign a consent for care and put your ID bracelet on.
After Arrival A nurse will come and greet you and take you to an interview room. Your vital signs will be taken (blood pressure, pulse, and temperature) and you will be asked to review some of the preadmission information one more time. You will be given a hospital gown, robe, and slippers. Your clothing will be placed in a labeled bag and sent with your family or to your room on the 4 th floor. After this you will walk into the ambulatory surgery unit (ASU) stretcher area and assigned a stretcher. One family member can stay with you in ASU.
Ambulatory Surgery Unit Once your settled on your stretcher an IV will be placed in one of your arms. The IV is for hydration and anesthesia. If you have had difficulty in the past with IV s, please let us know. We have IV Therapy/Specialists. Next you will meet with your board certified anesthesiologist who will again review part of your medical history and discuss your options for anesthesia. If you are to have a spinal or a femoral block for your surgery you will be brought to the recovery room area for this procedure prior to the surgery.
Additional Information If you wear dentures or eye glasses you can keep them with you right up until you go to the operating room. If you request, your glasses and dentures can be given back to you immediately after arriving in the recovery room. All patients will see THEIR SURGEON before surgery and the surgeon will mark your surgical site with a surgical marking pen. Please let the staff know if you are cold or uncomfortable so that we can try to make your stay in ASU as comfortable as possible. If your family needs directions to the chapel or the cafeteria, please ask.
Operating Room You will be under the care of an Anesthesiologist for the entire procedure. They will be doing most of the talking to you in the Operating Room and will wake you up when it is time to go to the Recovery Room. It may seem very quiet or noisy depending on what is being done at the time of your arrival. Many of our monitors make beeps and noises; this is normal. You will be covered with blankets, including a warm air heating blanket, to keep you comfortable. In addition to your surgeon, your care team also includes a circulating nurse, surgical assistants, physician assistants, nurse practitioners or first assists, and distributor.
Arriving in Recovery After your surgery you will be taken to the recovery room, also known as PACU Post Anesthesia Care Unit You will already be in your own bed, not a stretcher. Your anesthesiologist and circulating nurse will give report of your procedure to the recovery room nurse.
Recovery Room You will be with a registered nurse, RN, at all times in the recovery room. You will never be alone. While in the recovery room, you will be on an EKG monitor and your vital signs are constantly monitored (blood pressure, respirations, pulse, and oxygen saturation). The RN will check you frequently for changes in your status. Checking your pulse, bandages/dressings, drains, lung sounds, IV sites, pain/nausea levels. Do not be alarmed - this is performed on ALL recovery room patients.
Recovery Room Depending on your surgeon and procedure you may arrive in the recovery room with a CPM (continuous passive motion machine) or a knee immobilizer in place. It is the surgeons choice, each has their own techniques. Most of you will have sequential hose in place on your legs. These are important for circulation and helping to prevent blood clots until you are up and moving around on your own.
Recovery Room Most patients will be drowsy on arrival to the recovery room and all will have oxygen in place. Usually a mask at first and when you are fully awake it will be removed. Our job in the recovery room is to wake you up, monitor you for changes in your condition, and keep you comfortable and stable. The pain scale that was initiated in ASU will restart now. There is NO exact time when your recovery room experience will end. When you are comfortable and alert you will be transferred to the 4 th floor. Your recovery room nurse will transfer you to the 4 th floor in your bed and introduce you to your floor nurse.
Surgical Floor Arrival The Surgical Floor is located on the 4 th floor of the hospital. There are only 4 semi-private rooms on the floor the rest are all private rooms each with their own toilet, shower, and sink. Visiting hours are from 1-8pm * This is flexible, however, if you have someone entering before 6:30am or after 8:00pm be sure to have them enter through the ER doors because the main entrance doors will be locked. * Family and friends play an important role in the healing process and are encouraged to visit.
Room Devices and Equipment Call bell for assistance Bed/TV controls Dinamap (vital signs machine) frequency may vary IV Pumps for IV fluids or blocks Drains to remove excess fluid from the surgical site (if ordered) * Will be emptied every 8 hours or as needed Incentive Spirometry * 10 times every hour while awake Pillow * We use many pillows don t be alarmed - maintain posterior hip precautions, elevation of affected limb, body positioning for comfort Cpap/Bipap plan to use our machines while your in the hospital but you need to bring your own machine to rehab
Room Devices and Equipment Sequential Stockings * Air pumps worn on your legs to aid in circulation Knee Immobilizer * Only for total hip patients having posterior hip precautions Shoulder Sling * Only for shoulder patients to be worn at all times except to shower or do therapy exercises Ice if ordered * Ice packs or Polar Care System (ice water cooling machine) Continuous Passive Motion (CPM) Machine * Dr. Martins patients will use the machine for 2 hours twice a day * All other surgeons patients will use the machine 2 hours three times a day - Usually at 10am 2pm 6pm
Pain Assessment and Management Pain Scale (0-10)
Medication Options IV Medications - short term pain management Femoral Nerve Block continuous infusion directly de-stimulating the femoral nerve * Placed in groin by anesthesiologist prior to surgery * Infusion started in PACU Epidural continuous infusion into the spine * Generally used only for bilateral knee replacements Marcaine Infuser subcutaneous infusion to de-stimulate the surgical site for 48 hours, then removed by RN when emptied Oral medication preferred form due to longevity and even pain control Pain is subjective and specific to each individual Patients and caregivers must work together to maintain optimal pain control
Your Diet Nausea Protocol * Nausea Prevention starts pre-op Post Surgical Light Diet * Start with ice chips, water, crackers, toast, then soup and sandwich * Advance to usual diet as tolerated * Shoulder patients you may use the arm immediately to feed yourself Snacks available on request * Diabetics are given routine snacks between meals * Any patient may have a snack at any time * A refrigerator is available if you would like to bring your own food in How does my family get food?? * Cafeteria is located on the 2 nd floor and open from 7am-630pm * Visitor trays are available on request ($5 fee)
Prevention of Complications Blood Clots 1) Sequential Stockings on opposite limb in OR, placed on operative limb after surgery is finished 2) Dorsi/Plantar Flexion of Feet start practicing before surgery 10 times per hour 3) Early Exercise & Ambulation out of bed day of surgery 4) Blood Thinners Coumadin - requires regular lab work for INR levels Pneumonia * Cough and deep breath exercises * Incentive Spirometer Infection Aspirin 325mg 2 tablets twice a day for 2 months Lovenox subcutaneous injection daily for 2-4 weeks * Usually a total of 3 doses of antibiotics (1 pre-op, 2 post-op) * Daily dressing changes per surgeon orders
Prevention of Complications Constipation * Stool softeners, laxatives, high fiber diet, prune juice Dislocation * Follow hip precautions for posterior approach * Follow shoulder precautions keep your hand in front of you at all times DO NOT lift anything heavier than a glass of milk with your operative arm Skin Breakdown ( bedsores ) * Inspect your skin everyday for redness or signs that sores may be forming especially bony prominences or places of pressure and/or friction * Keep your skin clean and dry * Protect your bony areas with pillows * Change positions in your bed or chair every 1-2 hours St. Joseph staff will conduct routine skin checks and make sure you have a personalized skin care plan.
Physical Therapy What to expect * PT generally begins the afternoon of or morning after surgery. * PT will be offered 2 times a day For mobility training and exercise * Hip/Knee patients - you will begin walking with a standard walker and will progress as able. * Hip/Knee patients you will be walking in your room as well as in the hallways. * Shoulder patients you will begin doing limited exercises with your shoulder and full motion with your elbow, wrist, and hand. * Our GOAL for you is to begin stretching and strengthening your muscles and become as independently mobile as possible.
Occupational Therapy What to expect * OT will begin the first or second day after your surgery. * OT will be offered once a day. * They will address the activities of daily living you need to return to being independent in your personal care. (bathing, dressing, toileting, hygiene) * Should adaptive equipment be needed they will provide it and train you in its use.
Physical/Occupational Therapy Plan Ahead * Pack comfortable footwear that provides good support and stays on your feet. * Pack personal clothing, keep it cool, comfortable and loose fitting. * Button up shirts for shoulder patients * If you have your own walker/crutches/cane have your family member bring it to your room after surgery.
Physical/Occupational Therapy Home Assessment * It is our goal to be sure you can do everything you need to independently and safely in your own home. We will be asking you about your home to determine what your needs are. * Take a look around your home before you come to the hospital so you can best explain your needs to us. - Do you have stairs to get into your home? How many? - Railings? On which side are rails? - Is the flooring carpet, laminate, wood, etc? - How many levels to your home? - Is the bedroom upstairs or down? - Is the bathroom upstairs or down? - Do you have pets under foot? - Do you have a tub? Shower? Combination? - Does anyone live with you? Is there anyone to help? - Would you be alone during the day?
Physical/Occupational Therapy YOU are a key member of your healthcare team! YOU are critical to your own rehabilitation! Honestly assess your pain and be pro-active in managing it with your healthcare team. Mobility is key to the healing process participate to the best of your ability with therapy, as well as getting about your room with the nursing staff. Get a good nights sleep, stay well hydrated, and maintain a nutritional diet. Be open minded about discharge planning and actively participate in discharge planning discussions with therapy, Case Management and your entire healthcare team. We want you to BE SAFE and make the BEST POSSIBLE GAINS in your rehabilitation process.
Discharge Planning A discharge planner will be in the day after your surgery to discuss with you your options for discharge. Your options include * Discharge to Rehab * Discharge to Home with Home PT * Discharge to Home with Outpatient PT
Discharge Planning Discharge to Rehab * PT and OT several times a day * Gradual increase in exercise to promote flexibility and ease of ambulation * Monitoring blood work * Help with planning for discharge to home * Assistance with bathing, dressing, and meals provided Discharge to Home with Home PT * If you are homebound, PT will come to your home to provide services. A home health nurse may also visit you if you need bandage/dressing changes or medication adjustments. Discharge to Home with Outpatient PT * If you are able, you may visit an outpatient therapy center to receive services.
Discharge Planning Questions to ask yourself when considering REHAB * Where do you want to go? * Are you familiar with your choices? - Take an unannounced tour of any facilities your are considering before you come in for surgery * If you find a facility you prefer to go to upon discharge, ask them about pre-booking. Many facilities will allow you to pre-book a room in advance to guarantee a bed when you are ready for discharge from the hospital. Questions to ask yourself when considering a safe discharge HOME * Will you be alone at all during the day or is there 24 hour care for you? * Will you have transportation to outpatient PT if you require it?
Transfer to Rehab Ambulance * Most bilateral knee patients * Total knee/hip patients that are not fully ambulatory or able to get in and out of a vehicle. Private Vehicle * Total knee/hip patients that are doing well ambulating * Shoulder replacement patients Wheelchair Van * Total knee/hip patients that do not qualify for ambulance transfer but are unable to go by private vehicle * Certain rehab facilities have their own private vans for free transfer to their facility or Capital Ambulance has a community van for approximately $50 locally
INSURANCE INFORMATION MEDICARE * Authorized Days * DRG Payment * Discharge Appeal Rights * Equipment * Medications
INSURANCE INFORMATION COMMERCIAL INSURANCE Any payer other than Medicare/Medicaid * Pre-authorization * Co-Pays are your responsibility Your Responsibility * Call your insurance company for Pre-authorization give the information to your doctor s office * Know what your deductible is * Bring a copy of your Insurance Card to the hospital
TAKING CHARGE OF YOUR HEALTH CARE also known as Living Wills and Durable Health Care Powers of Attorney
TAKING CHARGE OF YOUR HEALTHCARE YOU have the RIGHT to decide on the type of treatment you want YOU have the RIGHT to appoint the person of your choice to make healthcare decisions for you in the event that you cannot do so DISCUSS your wishes with a family member or friend SIGN an Advanced Directive and bring a copy with you when you come to the hospital GIVE a copy to your primary care doctor Advanced Directives are NOT required to be notarized in the State of Maine Florida does however require notarization
THANK YOU for choosing ST JOSEPH HOSPITAL
Driving Map From points SOUTH Traveling northbound on I-95: take exit 185 (Broadway). Then use the center lane on the off-ramp. At the traffic signal at the end of the ramp, proceed straight through the intersection, and then make an immediate left turn onto Center Street. The Ambulatory Surgery entrance is about.25 mile ahead on the left. From points NORTH Traveling southbound on I-95: take exit 185 (Broadway), and use the left-hand lane on the off-ramp. At the traffic signal at the end of the ramp, turn left onto Broadway. Then just before the next traffic signal, bear right onto Center Street. The Ambulatory Surgery entrance is about.25 mile ahead on the left.