ORTHOPEDIC SURGERY ORIENTATION THE JOINT JOURNEY 1
Healthy Hip Joint 2
Degenerative Hip & Hip Replacement 3
Healthy Knee 4
Degenerative Knee and Knee Replacement 5
Preparing for Surgery Primary Care Physician Blood tests X-rays Clearances 6
Preparing for Surgery Dentist Check up regarding your teeth and gums. Be sure that there is NOT an infection present 7
Stop Smoking. Preparing for Surgery Write down all the medication you are taking including strength and frequency as well as over-the-counter drugs, i.e. baby aspirin glucosamine melatonin Get your lab tests and clearances done after your primary care visit. Stop blood thinners as directed by primary care physician 8
Preparing Your Home Arrange furniture & remove scattered rugs. Stock up on food and toiletries. Refill Prescriptions. Prepare meals and freeze them. Utilize your resources 9
PRE-OP VISIT BRING a list of ALL the medication you take to your visit. The pre op nurse will review your list of Medications and tell you which medication must be taken the day of surgery You may have your blood draw for a Type & Screen to determine your blood type. This can only be done within a week of surgery The exact time to report for Surgery is determined by the pre-op nurse. Call after 2pm the DAY BEFORE your scheduled surgery for the exact time. Please disregard the Dr s office surgery time. East campus 561.737.7733, ext. 84361 West campus 561.336.7036 DO NOT eat or drink after midnight, this includes No gum, mints, or lozenges. You may take the medication you are instructed to take the morning of surgery with a small sip of water. Anesthesiologist or Nurse Anesthetist will meet with you the day of Surgery. 10
Skin Preparation Wash the operative area with antibacterial soap the NIGHT before and the MORNING of surgery (Hibiclens or a Chlorahexidine Product). No dark or red nail polish DO NOT shave the operative site. 11
What should I bring? Grooming items: deodorant, toothpaste, comb, brush. Glasses, contact lens case with fluid, hearing aids, throat lozenges. Comfortable Closed Toe shoes Loose fitting clothes. Please be prepared to dress the day after surgery List of all meds & allergies 12
Do Not Bring Jewelry Wallet Keys Checkbook Purses After completing financial transactions, send all valuables & credit cards home. 13
MORNING OF YOUR SURGERY EAST CAMPUS - entrance to the left of the main building WEST CAMPUS - 2 nd floor Surgery center General Preparation: (remove ALL your clothing put on a surgical gown, remove glasses, dentures, underwear). Secure belongings with family member. Review and sign consent (if not already done). Transported to pre-op Holding area (East) Visit with surgeon surgeon will mark the operative site. Meet your anesthesiologist or nurse anesthetist. 14
Post-Operative Information Incision Closed with staples or skin glue. Wound drain for 1-2 days. Staples are removed 8-14 days after surgery in physician office. 15
Cool Ice Machine Your doctor may want you to use the cool ice machine. Used primarily for Knee Replacements. Cooling will help decrease pain, bleeding, and swelling. Cooling system will be used continuously for several days post op. At home, should be used intermittently after PT and exercise or as directed by your doctor. This is your machine. Please take all pieces home with you. 16
CPM for Total Knee CONTINUOUS PASSIVE MOTION SOME surgeons use it and some don t. Usage is scheduled throughout the day. Ask for pain medication approximately 30min prior to scheduled use. The flexion degrees are increased each time it goes on. 17
Post Hip Replacement Abductor Pillow - This foam pillow is sometimes used to prevent you from dislocating the operative hip. Prevents you from crossing your legs 18
Hemovac drain This drain is placed in the incision at the end of surgery. The drain will be emptied frequently The drain is usually removed the day after surgery, sometimes day 2 19
ConstaVac Drain - Blood Replacement This is a selfcontained blood replacement system. Sterile system and never open to air. Replaces your own blood that has collected in the chamber. 20
Home Care or Rehab? The case manager will visit you after surgery to discuss discharge plans. If possible, have your family attend this meeting. For the continuity of care of our patients, Bethesda offers both Home Care and Outpatient Rehabilitation services. Please also inquire with your physician. Any needed equipment will be ordered by your case manager/discharge planner. The type of walking assist equipment that you will need is determined by the physical therapist and ordered by the Discharge Planner/ Case Manager. Other assist devices can be purchased while in the hospital through the physical therapy department 21
Pain Management Exparel is a local pain medication administered in the OR. It is injected into the operative site and may last up to 72hrs. A femoral block may be used, instead of exparel for patient having a total knee Intravenous pain medication may be used on the first day post-op Pain Pills may take up to 30min to work Pain Scale will be used to assess your pain 0 10, ten being the Worst pain The goal is to keep you as comfortable as possible, however, you should NOT expect to be completely pain free post operatively. It is the expected outcome for your pain level to be a minimum of four post operatively. Bring sore throat lozenges 22
Pain Scale You will be asked if your pain control is satisfactory before you leave the Recovery Room. Upon arrival to your room you will be asked if your pain control remains satisfactory. The goal is to keep you comfortable. Question: When you left the RR, your pain was controlled. Is it under control NOW? Answer: YES 23
Pneumonia Prevention Incentive Spirometer will be your new best friend Deep Breathe & Cough as often as possible You will be assisted to dangle your legs the same day of surgery You will be up early and walking the next day 24
DVT Prevention: Blood clots SCD s (sequential compression devices may be used to prevent the formation of clots Anti-embolism hose or Ted Hose may be used on opposite leg w/knee and may be used on both legs with a total hip Blood Thinners will be used Xarelto Coumadin Lovenox Aspirin These medications may be continued post operatively as your doctor orders. (possibly 30 days post op) 25
Foley Catheter You may or may not have a foley catheter. Catheter will be inserted in the Operating Room while you are asleep. Catheter is removed within 24hrs after surgery. 26
Activity Take Pain Meds up to 30 minutes prior to Exercise The Physical Therapist will assess your activity level. Safety is of upmost importance. Physical Therapist will assist you to improve and increase your walking tolerance and distance by using the appropriate devices. 27
Case Manager will evaluate your need for: Raised toilet seat Cane Reacher/grabber Long handled sponge Shoehorn Sock aide Walker Bedside commode (3in1) can be used as a 1.bedpan 2. remove pail and add to your toilet 3. shower chair (do not place in a tub) 28
Personal Safety Pain meds can dull your senses, be careful, do not sign any legal documents. Wear shoes that give you good support. Avoid poorly lit areas. Use a night light Do not lift heavy objects or strain. Straining can cause you to faint. Follow your hip/knee precautions when you need to pick something up 29
Personal Safety Continued Don t use chairs or standing stools to reach things. Check for loose rugs or mats or cords. Always know where your pet is. Use caution in everyday tasks. Be aware of electrical cords that lie across the floor 30
Personal Safety Continued Be aware of electrical cords that lie across the floor. Wet floors - especially in the bathroom. Condensation can cause you to slip Have a chair handy in the kitchen to sit down when preparing meals. 31
Doctor notifications Ask your doctor which stool softener he recommends. Alert Dr. if you do not have a BM for three days. 32
Family-Initiated Bee Team Bethesda Emergency Evaluation Team BEE Team is a RAPID RESPONSE TEAM. Implemented in April 2005: Used to prevent a Code Blue. Empowering the family to alert staff of a SERIOUS CHANGE in the patient s condition. Family should be instructed by nursing on admission to dial 83111 from any hospital phone if someone is not IMMEDIATELY available. Operator will call a bee team or direct the concern to the floor if it is not an emergency. 33
FAQ s When can I drive? Approximately 4 to 6 weeks after surgery; CHECK with your surgeon. When can I bathe? Do not soak in a bath tub, shower is fine, pat the incision dry afterward. How long will I be in surgery? Typically, surgery lasts 1-3 hours. Your surgeon will come and talk to your family after the procedure. 34
FAQ s Can I sit in my recliner? Yes, if your knees are not higher than your hips. Does Medicare pay for equipment? Yes, once every 5 years. Rolling walker and commode are covered. Cane will be paid for within 30 days later. What kind of commode should I get? 3-in-1 commode. 35
FAQ s Can I use a lift chair? Yes, they can be purchased or rented for $100/month. Does Medicare pay for PT at home? Yes, even on weekends. Can I get a home health aide? Yes, but the home health aide can only be used for bathing. What s the hardest thing I ll have to do? Putting on your shoes. 36
Questions Call (561) 737-7733, ext. 84549 *Please complete and print the certificate on the next page* 37
Certificate of Completion is hereby awarded to for completing the Joint Journey course on. 38