Todays Coach

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(No Transcript)
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Doris Hamm, RNOrthopaedic and Neurology
NurseBenefis Healthcare
Todays Coach
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Your Other Coaches

• Pain Service Pharmacist
• Physical Therapist
• Occupational Therapist
• Unit Case Manager
• Welcome to our winning team.

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OUR AWARD WINNING PROGRAM

• HealthGrades
• Rated Among the top 5 in the Nation for Overall
  Clinical Excellence
• 4 years in a row 2005-2008.
• (No other hospital in Montana has accomplished
  this)
• Ranked top two in Montana for Overall Orthopedic
  Services
• for 4 years in a row 2005-2008

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Pre-Game Schedule

• Total Hip/Knee/Shoulder Surgery Background and
  Statistics
• Benefits and Goals of Joint Surgery
• Before Surgery and Day of Your Surgery
• Your Surgery
• Your Hospital Stay
• Going Home
• Questions Answers
• Class Evaluation

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Today youve received your Folderpacked with
education and other information you will need
throughout your stay, discharge and home
care.Remember to bring your folder with you on
your surgery day
Education Folder
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Total JointSurgery Facts

• Over ¾ of a million joint replacement surgeries
  are performed each year.
• Joint replacement surgery involves replacing the
  diseased parts of the joint with new, artificial
  parts.

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Total Joint Surgery at Benefis

• 2004 326 joint replacement surgeries
• 2005 427 joint replacement surgeries
• 2006 437 joint replacement surgeries
• 2007 386 joint replacement surgeries

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The Playing FieldThe Ortho/Neuro Unit

• 8th Floor of East Campus
• 26 beds for backs, bones, and brains
• Mix of private and semi-private rooms
• All staff wear name badges
• Dry Erase Boards Special Needs Card in all
  rooms
• Pastoral Care staff available

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Located in your room. A tool to track your
progress, goals, and discharge needs.
White Board
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Benefits and Goals of Joint Surgery

• Reduces or eliminates pain
• Improved strength
• Resuming many of your normal activities
• Getting back to work and play
• Restores range of motion
• Improves appearance of deformed joints

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Youve decided total joint surgery is the ticket
to a more active future.Heres YOUR
gameplan
PRE GAME JITTERS
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BEFORE SURGERY

• Diet and Fluids
• Increase protein (chicken, fish, egg whites,
  turkey,beans)
• Increase fluids by 4-8 glasses per day during the
  week prior to surgery
• Stop Smoking
• Donation of blood
• Pre-operative lab work
• Keep skin free of abrasions

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Before Surgery

• Diabetics
• Surgical scrub

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Your Surgery Day
GAME DAY
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Day of Surgery

• NPO Nothing by mouth
• Includes mints and gum
• No smoking or tobacco products of any kind

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Day of Surgery

• What to bring to the hospital
• Loose fitting clothes
• Non slip shoes/slippers
• Personal toiletries
• Razor (men)
• Button up the front shirt
• Bi PAP/CPAP
• Chargers for cell phones

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Day of Surgery

• Arrive in AM Admit area
• 2nd Floor across from Lab
• Inform anesthesiologist of any previous problems
• Family can remain with you until you go to the
  Operating Room
• Family can wait in OR waiting area or lobby.

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Anesthesia Reaction

• Todays anesthesia is safer than ever before
• It is very important to tell both the surgeon and
  the anesthesiologist if you have ever had a
  reaction to anesthesia or pain medication in the
  past

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More About Your Surgery..Joint Replacement
Animations.
GAME DAY
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After Surgery

• In Recovery Room for approximately one hour
• Then transferred to Ortho/Neuro Floor
  (8th floor)
• Visiting Hours 8am 8pm
• Access to the hospital after 930pm is through
  the ER entrance

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Potential Complications of Joint Surgery

• As with all major surgical procedures,
  complications can occur
• When complications occur, most are successfully
  treated
• Some possible complications include
• Pain
• Blood clots
• Anesthesia reaction
• Infection

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Pain Service

• Pain Management Specialist Pharmacist Lead
• Becky Allen, PharmD, RPh
• Provides specialized focus on pain control and
  side effect management for patients

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PAIN SERVICE

• Goals
• Increased Comfort
• Decreased Side Effects
• (ienausea/vomiting)
• Fewer Complications
• Enhanced Patient Satisfaction

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PAIN SERVICE

• Patient Responsibilities
• Discussing pain relief options
• Asking for pain relief when pain first begins
• Helping the healthcare team to assess pain
• Talking to your healthcare team about any
  worries/concerns regarding medications

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PAIN ASSESSMENT SCALE
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PAIN SERVICE

• Medication and Surgery
• What medications do I take prior to surgery?
• What medications do I stop taking 7 to 10 days
  prior to surgery?
• Blood thinners (Coumadin, Aspirin,
• NSAIDS, Herbals, Vit E)
• Decreasing pain medications prior to surgery
• Home medication list, herbals and OTC

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Controlling Pain

• Some temporary pain after surgery is common
• PCA (patient-controlled analgesia) provides a
  steady level of pain relief
• Medications and other treatments will help keep
  you comfortable at home
• Converting to oral pain medication

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Using Your PCA/CADD Pump

• The doctor will order the medication and will
  decide how often and how much of it can be given
• You should push the button when you start to feel
  pain.
• Do not wait until the pain is severe.
• It is very important that only you push the
  button.

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ORAL PAIN PILLS
PRESCRIBED BY PHYSICIAN FREQUENCY AND DOSE
WHITE BOARD PRESCRIPTION FOR DISCHARGE
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On Q Pain Buster

• Small round pump filled with local anesthetic
  medicine to treat your pain after surgery
• Automatically delivers the medicine at a very
  slow rate
• Your nurse will remove the pump when it is empty

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Specific Joint Surgery Information

• Knee
• Expected hospital stay 3-4 days

CRYO CUFF
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Specific Joint Surgery Information

• Hip
• Expected hospital stay 3-4 days
• Shoulder
• Expected hospital stay 1-2 days

CRYO CUFF
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Blood Clots

• After surgery, it is possible to develop a
  blood clot
• deep vein thrombosis (DVT)
• commonly in the veins of the leg

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Preventing Blood Clots

• To help reduce the risk of blood clots, your
  surgeon may recommend
• Getting back on your feet as soon as possible
• Take blood-thinning medication

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Preventing Blood Clots

• Wearing elastic stockings (TED
  Hose)
• Wearing inflatable foot/leg wraps that use air to
  enhance circulation
• Sequential Compression Devices (SCDs)
• A-V Impulse System (AVI)

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TED HOSE

• For your safety Do Not walk with just TED hose
  on

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SEQUENTIAL COMPRESSION DEVICES (SCD)

• For your safety Do Not walk with SCDs on

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A-V IMPULSE
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Infection

• Antibiotics are given
• Before surgery
• 1 to 2 days after surgery

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Infection Control

• Hand washing by staff
• Use of Antiseptic hand gel by staff

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Your Hospital Stay
The Post Game Program
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Your Hospital Stay

• Diet
• Repositioning in bed
• Abductor Pillow
• No Pillow under knee
• Circulation checks

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Your Hospital Stay

• Activity
• Importance of being out of bed
• Physical Therapy 1st day after surgery
• Occupational Therapy 1st day after surgery

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Your Hospital Stay

• Turn, Cough and Deep Breath
• Abdominal splinting
• Using your Incentive Spirometer (IS)

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Other Activities During Your Hospital Stay

• Elimination
• Lab work
• Bathing/showering
• Incision/drain care
• IV
• Suretrans

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Incision Care

• When you go home, your surgeon may request that
  you
• Keep the incision clean and dry
• Cover the incision with a small dressing or
  bandage if it is draining
• Change the bandage daily or when drainage makes
  it wet

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Physical Therapy

• Begins the day of your surgery OR the day after
  your surgery
• Continues throughout your hospital stay
• Receive exercise sheets
• Abductor pillow
• Hip precautions
• Stairs

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Show you the exercises you will be doing during
your stay and after. Show the correct way they
should be preformed.
Exercise Example
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Continuous Passive Motion Machine
Total knee replacement patients
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OccupationalTherapy

• Shower or bathtub needs
• A secure bench
• A long handled sponge
• A shower hose for bathing
• Have an elevated toilet seat
• For dressing have
• A dressing stick
• Sock aid
• Long-handled shoehorn
• Have a reacher/grabber to pick up objects

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Home Planning Checklist

• Temporary living area on ground floor if
  difficult to climb stairs
• Have a 2-armed chair with secure cushion and back
• Remove all loose rugs and electrical cords from
  living area
• Secure handrails (safety bars) on
• Stairs
• In shower or bath

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Discharge Planning

• Dena Sterling RN, Unit Case Manager
• Insurance
• Home equipment
• Nursing Home/Rehab/Home Care

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Remember to bring your folder with you on your
surgery day
Education Folder
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Questions?