Pre-Op Total Joint Class

Report
Pre-Op Knee Information
Welcome!
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Goals
Inform the patient about what to expect…
 Before Surgery
 During Surgery
 After Surgery
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Goals
 Reduce anxiety
 Answer questions
 Help you become better-prepared
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Sections
Nursing
Case Management
Physical Therapy
Occupational Therapy
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Information From The Nurse
About Care And Your Concerns
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We Care About You!!!
In an effort to personalize your care while in the
hospital, please let us know of any needs ahead of
time
Please complete the enclosed “Care Card” and
forward it to the Patient Navigator at the end of
class
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What To Bring
 List of medications and allergies
 Glasses, hearing aids, dentures
 Toiletry items


Toothbrush
Toothpaste
 Flat, supportive, non-slip walking shoes (with a
backing)
 Incontinence products (you may prefer a specific
product not provided by hospital)
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What To Bring
 Night clothes/pajamas, loose clothing
 Books, magazines, hobby items
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While in surgery…
 CHG wipes will be used to cleanse and disinfect the
surgical site before surgery begins
 CHG reduces bacterial growth on the body
 CHG will help reduce the chance of infection
following surgery
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Orientation To Room
Call bell
TV Controls/Volume
Thermostat
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Equipment After Surgery
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Oxygen
 Used a short time
 Let us know if you have sleep apnea or use
oxygen or CPAP at home
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IV or Intravenous Therapy
 May have one or two lines
 Fluids-body water, blood, antibiotics, pain
medication
 Will leave it in until discharge
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Dressings and Drains
 Large dressing initially
 Drains and dressings removed 1st or second
day after surgery
 Dressing will be
changed
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Foley Catheter To Drain Urine
 Stays in no longer than 2 days
 Helps to keep track of fluid balance
 Good initially when not moving well
 Put in after you are asleep
 Does not hurt to come out
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PCA - Patient Controlled
Analgesia
 “Pain Button”
 Administer to self
 Close monitoring
 NO ONE IS TO PUSH THE BUTTON EXCEPT
THE PATIENT!!!
***Please ask your surgeon if this is an option for you
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Femoral Nerve Block/Catheter
***Some surgeons prefer not to use this***
 Numbs the front part of the leg from the
groin to the knee
 Stays in about two days
 May cause you to have a “noodle leg”
 Need to wear a knee
immobilizer while standing
or walking
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Knee Immobilizer
 May wear when out of bed if you have a nerve block/catheter (dependent
on your Therapist)
 May also wear at night to remind you to keep the leg straight
 Used for safety reasons
Note: You may or may not walk with the knee immobilizer on while
exercising with a Therapist. However, you should
ALWAYS continue to wear it with Nursing until
you are able to do a full straight leg raise (with no
bend at the knee)
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Cryotherapy - “Polar Care” Device
**Some surgeons prefer to use ice instead of the Polar Care Device**
**Some surgeons may choose not to use the Polar Care Device or ice**
 For total knee patients
 Sends a cold signal to the brain to help with pain
management
 Helps with pain and
swelling
 You take this home
with you (if it is ordered by your surgeon)
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CPM Machine
***Some surgeons prefer not to use this***
 Continuous Passive Motion machine
 May be used for total knee patients (if ordered)
 Passively bends knee while in bed
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Medications
 Different color and number
 Always ask nurse what meds are for
 “Combination medications” that you may take at
home may be given as separate pills while in the
hospital
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Rating Pain
 0 to 10 pain scale
 Pain patterns


Mechanical Pain
Surgical Pain
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Know the Zone!
Our staff will make every effort to
help control your pain
We will automatically give you pain
medication around the clock
We ask that you partner with us and ask
for additional pain medicine if needed
Alternative pain options may be used
such as cold therapy and distraction
Our goal is to keep you in the 3-4 Pain
Zone (or less)
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Preventing Pneumonia
 Incentive Spirometer


Breathe in 10-12 times an hour
while awake
Helps to expand air sacs in lungs
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Preventing Blood Clots
 Medication (“Blood Thinners”)
 “Calf/Foot Pumps”
 Walking and Exercising
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Coumadin and Lovenox
***Please check with your surgeon as to
which blood thinner will be prescribed***
 Will help to prevent blood
clots from forming
 Will need to learn how to
take these medications safely
 Will need to watch a video
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Compression Devices
 Foot or calf pumps
 Help to push the blood back into circulation
 Wear them when you are in bed or in the
chair
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Walking and Exercising
 Helps to prevent blood
clots from forming
 Exercise in and out of bed
 Ankle circles, foot pumps,
tightening leg muscles
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Diet
 Initial diet is typically clear liquid unless
otherwise designated by your physician
 Diet will advance as tolerated
 Constipation



High fiber
Increase activity
Fluids
 Nausea
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Call for Help
 Never get out of bed or chair unless you call for
assistance
 Call as soon as possible.
 Try to ask for help when a staff
member is already in the room.
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Condition H (Help)
 Dial 3111 and give room number
 Gives family and friends a way to call a Medical
Emergency team to the bedside
 Call if…


You notice a change in your loved one’s condition
You still have serious concerns about your loved one’s
condition after speaking to the healthcare team
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Sleep
 Dial L.O.U.D. (5683) on phone if sleep disturbed

Anonymous call
 TIGR TV Channels

Relaxation/Meditation channels
 Comfort Cart
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Case Management
Joan Paramore RN
Case Manager
(919) 954-3878
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Discharge Plan
Goal: To get you home safely!!!
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Discharge Plan
 Everyone is assigned a Case Manager who
will usually meet with you the day after
surgery
 Average Length of Stay: 2-4 nights

That means you should be ready for discharge
around the 2nd, 3rd, or 4th day after surgery
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Discharge
Please remember that once the Physician has written orders to discharge you
home, there are still many things that have to be completed before you
will be leaving the hospital. We want to make sure you have everything
you need-prescriptions, home health or rehab arrangements, and
information about your home care.
Sometimes this process can take up to 4 or 5 hours. We know you’ll be
eager to leave the hospital, and we want to be sure everything’s in place
to ensure a smooth and safe transition.
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Discharge Plan Options:
Home Health
You will choose agency (list provided)

RN (if on Coumadin)
Physical Therapy (2-3 times/wk)

Occupational Therapy (if ordered by Doctor)

***Your Case Manager will set up a Home Health Agency (of your
choice) for you
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Discharge Plan Options:
Home Health
Equipment ordered…



Rolling Walker
Bedside Commode
CPM (if ordered by Doctor)
***Your Case Manager will order your equipment for you from an
agency of your choice
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Discharge Plan Options:
Short-Term Rehab
If not safe to return home, Short-Term Rehab may be
an option.
Based on…
1. Your insurance
2. How well you progress with Therapy
while in the hospital
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Discharge Plan Options:
Short-Term Rehab
Two types of Rehab Facilities…
1. SNF: 1 to 3 hours of therapy/day
Average Length of Stay: 1-2
weeks-as needed
2. Acute: 3 to 5 hours of therapy/day
Average Length of Stay: 5 days
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Discharge Plan Options:
Outpatient Therapy
 Usually set up after Home Health is
completed
 Rarely set up at time of discharge from
hospital
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Discharge Plan
Transportation (depends on what is medically necessary)


Car
Wheelchair Van



Not covered by insurance
Cost: $55-$120
Ambulance

Covered by insurance if “medically necessary”
***Your Case Manager will set up your Wheelchair Van or Ambulance for you
(if needed)
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If You Are Going Home…
You may fill your prescriptions at our Plaza Pharmacy
(Located on the First Floor of the hospital)
 Hours of Operation:

Mon-Fri (9:00AM-4:30PM)
 (919) 954-3921
Use the Main Pharmacy on weekends or after 4:30PM (but
make payment arrangements with Plaza Pharmacy
Mon-Fri 9:00AM to 4:30PM
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Physical Therapy
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Treatment Sessions
 Seven days/week
 One or two sessions per day with the Therapist
 Your therapeutic activity will also involve walking
with Nursing staff
 Typical treatment session

Post-op Days 1, 2, and 3
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Precautions
Knee Replacement



Do not stay in one position for longer than an hour
without standing up, walking a short distance, and
straightening and bending your knee
Do not sleep or rest with a pillow or anything under
your knee
Operated leg out in front while sitting or standing
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Homeward Bound Gym
 Stair training
 Car transfer exercises
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Medical Equipment
 Walker

Proper use
 Bedside Commode

Proper use
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Occupational Therapy
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Treatment
 Demonstration of equipment
***Knee patients rarely need this equipment at discharge. The Therapist will
determine your specific needs.

Reacher

Sock aid

Bathing sponge
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Helpful Tips
 How to properly carry items in pockets and/or
basket while driving a walker
 Safety in the shower (have someone close by)
 While at home prior to surgery, move low- and
high-lying items to waist level
(i.e. in kitchen/bathroom cupboards, refrigerator)
 Make arrangements to have appropriate-sized car
available for your discharge
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Before Surgery…
Assess your home environment and let the Therapist know the
following once you are in the hospital…
 Tub/Shower (location, height, grab bars)
 Number of steps (outside of home and upstairs)
 Height of bed
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Assessment
The following slides contain questions based
on the Powerpoint.
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Question 1
One risk of a blood thinner medication is:
___________?____________
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Answer
Increased bleeding
(Can also be increased bruising)
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Question 2
You should call your Doctor immediately if
you notice any sign of a blood clot.
Name a symptom of a blood clot in your leg:
_____________________
Name a symptom of a blood clot in your lung:
______________________
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Answer
Leg: Pain in the back of the leg (usually in the
calf, but can radiate throughout the leg)
Lung: Difficulty breathing (may also have a
rapid heart rate)
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Question 3
True or False
When standing up or sitting down, you should
keep your operated leg slightly in front of
your non-operated leg.
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Answer
True
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Question 4
True or False
When lying in bed, you should keep your
operated knee in a straight position as much
as possible. You should never place a pillow
or rolled-up towel under the knee.
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Answer
True
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Question 5
Some pain is normal and expected after surgery, but the
best way to keep your pain at a manageable level is to:
1.
2.
3.
4.
Take pain medication when it reaches a “5” on a “0 to 10 pain scale”
Take pain medication only when the pain is unbearable
Use medication as well as other methods to control pain. For example:
ice, positioning, etc.
Try distracting yourself from the pain by watching television for an
hour or two
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Answer
3. Use medication as well as other methods to control pain.
For example: ice, positioning, etc.
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Question 6
The best and safest way to raise the height of a
chair in your home is to:
1.
2.
3.
4.
Stack pillows on the chair
Stack folded blankets on the chair
Place a small book under each leg of the chair
Place two large telephone books on the chair
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Answer
2. Stack folded blankets on the chair
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Question 7
One side effect of pain medication is
constipation. List 3 ways to prevent it:
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Answer
1. Increase fiber
2. Increase fluids
3. Increase activity
You may also take a stool softener or laxative
if needed.
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Thank You!!!
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