Total Knee Replacement. Pre-operative Class Preparing for your surgery

Transcription

1 Total Knee Replacement Pre-operative Class Preparing for your surgery

2 Class Objectives The purpose of this presentation is to: Help you to feel more comfortable about your upcoming hospitalization Let you know what you can do to help in your own recovery 2

3 Preparing for your surgery 3

4 Education You will be getting a lot of education during your joint replacement journey. You have already got literature from your surgeons office including the joint replacement book You are here today at your preoperative class The nurse practitioner will give you more information when you attend your pre-operative appointment During your hospital stay you will receive information on your medications and discharge information Please try and make sure you and your family listen to all the staff providing the education and ask questions if you have them. It is important to us and for your recovery from surgery that you understand how you can help in your own recovery

5 Tips for Preparing your Home You and your family must consider these tips before your surgery to help make your home as safe and comfortable as possible for your return after surgery: Check every room for tripping hazards. Remove throw rugs and secure cords Arrange furniture to have unobstructed pathways while using walker Move items in lower drawers to height to eliminate excessive bending or reaching Plan on using a cordless phone or cell phone that can be tucked away inside a pocket Make sure stairs have handrails that are securely fastened to walls In homes with steep long stairs you may need a bed, portable toilet on first level If you have pets you may want to arrange boarding them first few days you are home A chair with a firm back and arm rests is recommended, NO chairs on wheels Prepare or purchase meals ahead of time to minimize cooking after surgery Install nigh lights in bathrooms, bedrooms, and hallways Avoid yard work for 10 days prior to surgery. Protect your operative site from injury Do laundry ahead of time Get a non-slip bathmat Put clean linens on your bed

6 Reduce Risks, Complications Stay active Exercises for before your surgery are in your book and will be explained further by PT Healthy diet - Before your surgery, avoid foods that increase inflammation in your body. Those foods include sugar and white flour; saturated fats from red and organ meat; trans fats from commercially baked cookies, cakes and pastries; and alcohol. Aim for fresh foods, including fresh fruits, vegetables and nuts Manage diabetes see your PCP if needed Reduce, eliminate tobacco. Smoking increases your risk of developing wound infection so we encourage you to try to stop before your surgery Quit-Now can offer free advice Reduce, eliminate alcohol. Hazardous alcohol use (3 or more drinks per day) can increase your risk of postoperative infections, cardiopulmonary complications and bleeding risk

7 Prevent Surgical Site Infection Dental work must be completed 1 week prior to surgery and delayed for 3 months after your surgery Shaving do not shave your legs or use any hair removal products near the surgical site 5 days prior to surgery You will have nasal swabs take pre-op they will rule out infection Hand washing Good hand hygiene is essential. Encourage your family and friends to utilize an antibacterial cleanser and to always wash their hand to prevent spread of infection. In pre-op you will receive nasal ointment to help prevent postoperative infection

8 What to bring into hospital with you If you have Advance Directives please bring them with you Personal care items Robe Slippers your leg/foot will be swollen following surgery so make sure they are not tight Loose shorts, T-shirt/top You don t have to bring a pillow if you want to bring your own pillow please make sure it is not in a white pillow case, easy to loose in hospital If you use a CPAP machine at home bring it with you, we have distilled water in the hospital for you to use

9 Surgery and Postoperative Recovery

10 5 East Orthopedic Unit 5 East is a 32 bed unit in the East Tower All of our rooms are private with their own bathroom The hospital is wireless, you are welcome to bring your electronic devices and cell phones Our nursing staff consists of registered nurses that wear navy blue and patient care technicians that wear a hunter green 10

11 Cooling Therapy Cooling machines are ordered for you by your orthopedic surgeons office, your health insurance is checked for coverage. The machines are rented from a company Compression Therapy Services, this company may contact you if they need further information or to inform you if you have a co-pay for the machine. The machine will be delivered to the hospital unit by the company ready for you to use on the day of your surgery. All of our unit staff are trained in the use of the machine. A representative will explain how to use the machine when you go home, you will take the machine with you when you discharge home and continue to use the machine for 2 weeks from the date of your surgery. If you have any concerns or difficulties with the cooling machine you can contact the company directly.

12 Pain Management Your caregiver will do everything they can to get you comfortable enough to participate in your recovery. Caregivers will often ask you to rate your pain level on a scale of 0-10 Our goal is to Always keep your pain level at a 4 or less Your pain will be managed with different medications including epidurals, local nerve blocks, IV medications and oral medications

13 Anticoagulation Therapy Your surgeon will prescribe an anticoagulant to help prevent blood clots There are many different medications we use for this, the anticoagulant will begin to be administered on post op day one and will continue as prescribed by your surgeon You will receive information and instructions on how to take this medication from your nurse before you are discharged home

14 Surgery and Postoperative Recovery 14

15 Day of Surgery Meet anesthesiologist to discuss options for anesthesia Only 2 members of your family are allowed in to pre op with you. All family members can wait in the surgical waiting room during your surgery. It is unlikely you will be able to see your family member until they leave recovery and arrive on the unit Surgery will take between 1-2 hours and the patient will remain in the recovery room for 1-2 hours so from the beginning of the surgery to arriving on the unit may be up to 4 hours

16 Recovery Room You will wake up after your surgery in the recovery room. Your nurse will ask how your pain is on the pain scale of 0-10, 0 no pain, 10 worst pain imagined When you wake up you will have a urinary catheter to drain urine, a dressing over your incision, SCD s (sequential compression devices) on your legs, oxygen in your nose and IV fluids connected to an IV in your arm

17 Sequential Compression Devices (SCD s) Sequential Compression Device (SCD) is a method of DVT prevention that improves blood flow in the legs. SCD s are shaped like sleeves that wrap around the legs and inflate with air one at a time. This imitates walking and helps prevent blood clots. You should wear your SCD s any time you are in bed or sitting in a chair

18 When you arrive on the orthopedic unit You will be able to eat/drink juice, jello, crackers, water, ginger ale when you get to the unit Again your nurse will ask your pain level 0-10 We will show you how to use an incentive spirometer and encourage you to use in 10/hour You will have your cold machine delivered to your hospital room to use on your knee You may be seen by physical therapy today. If not nursing staff will help you sit on the side of the bed. Your nursing staff will have to check on you frequently tonight so please be prepared

19 Incentive Spirometer Sit in an upright position Inhale slowly and deeply to raise the indicator When you can t breathe in any longer take out mouthpiece and hold breath for 3-5 seconds Exhale and repeat 10 times an hour

20 First day after surgery You will have blood drawn and your urinary catheter removed Your orthopedic surgeon/pa will round on you and remove your dressing/check your incision. your incision may be closed with surgical glue, sutures or staples depending on surgeon preference Your nurse will continue to assess your pain level and work on a plan with you to ensure it is controlled using scheduled Tylenol and opioid medication A side effect of the pain medication is constipation so you will also be started on a bowel management program Physical Therapy will continue to work with you today and nursing staff will help you to the bathroom and with your hygiene needs Our discharge planners will meet with you today to discuss your discharge and any equipment needs you may have

21 Second Day After Surgery You will again be seen by your orthopedic surgeon/pa, they will give you instructions for your discharge today You will be able to shower today with help from the nursing staff Physical therapy staff will work with you on exercises to regain strength and mobility needs to help you when you are discharged home Please make sure you arrange to have someone available to drive you home today Discharge instructions will be given to you by your nurse and prescriptions given to you which can be filled in our pharmacy, just ask your nurse to do this

22 Possible complications following surgery Blood clots follow your surgeons instructions carefully to minimize this potential risk. Make sure you take your anticoagulation medication as instructed by nursing staff and continue doing your ankle exercises Infection follow instructions given at discharge to prevent infection. Do not use any creams or lotions on your incision Constipation Your pain medication can make you constipated. Make sure you take laxatives following your discharge and eat a diet high in fiber and drink lots of water Pain - Make sure you take your pain medication as instructed. Elevate your leg higher than your heart. Your leg will swell and this can add to your discomfort

23 Post-Operative Guide It is normal for your leg to be swollen and the incision to be warm and swollen with red edges. IF YOUR LEG IS SWOLLEN: IF YOU ARE HAVING PAIN: 1. Elevate your leg: Lie down 4x/day for minutes and position your leg above your heart. 2. Ice your leg: Apply an ice pack or cold machine throughout the day (20 minutes on, 20 minutes off). Make sure you have something between your skin and the ice, unless using the prescribed ice machine. 3. If swelling does not improve in 24 hours, call your surgeons office. 1. Take pain medications as directed by your surgeon. 2. Elevate and ice your leg as instructed above. 3. Please refer to your Total Joint Patient Guide pages 22 and If pain does not improve in 24 hours, call your surgeons office. 1. Take an over-the-counter stool softener and laxative each day you are taking pain medication. IF YOU ARE 2. Eat a high fiber diet and drink plenty of water. HAVING 3. Walk as tolerated. CONSTIPATION: 4. Please refer to your Total Joint Patient Guide page If no bowel movement by the 3 rd day after surgery call your surgeons office

24 Equipment Needed For Discharge You will need a walker when you are discharged If you have one at home or have borrowed one, you do not need to bring it to hospital with you Most insurances will pay for a walker, your discharge planner will assist you in obtaining this before you are discharged home

25 Discharge We want you to go home after your surgery Patients recover better in their own home environment Home physical therapy will be provided if necessary to provide additional assistance with physical therapy and your mobility Your orthopedic surgeon can continue to manage your care with your PCP Your coach will be invited to attend the Coaches Class on the unit before discharge. This is held daily in the Family Consult Room on 5 East at 11:00am

26 Skilled Nursing Facility You need 3 choices Following best practice your length of stay in SNF will be 8-10 days You will be discharged home when safe to do so, you may not be back to your previous level of function and may need home care or other help at home You may not see your orthopedic surgeon prior to your discharge from the SNF

27 Total Joint Hotline If you have any questions about anything you have heard today, or have any concerns about your surgery please do not hesitate to contact us on the Total Joint Hotline You can leave a message and we will return your call as soon as possible If you have urgent questions please call your orthopedic surgeons office

28 Physical Therapy

29 What do you want to do?

30 Pretend you just boarded a plane for California What is the health risk of taking a long flight? Why? What can you do about it? What is a health risk after your surgery? What can you do about it?

31 Everyone stand up! Make it a habit to interrupt your sitting every hour or so take a short walk Sitting is the new smoking Our bodies are designed for movement! Now stay standing

32 Pre-op Exercises Rise up on your toes 5 times - Hold on with your hands if you need to Squat down as if to sit in your chair, but don t go all the way down, stand back up - Keep your back straight, use both legs - Repeat 5 times Chair push-ups - Use mostly your arms - Do 5 times Practice getting up from your chair without using your surgical leg!

33 Pre-op Exercises See Pre-op exercise pp. 11 & 12 of your patient guide booklet Start with 5 reps, increase to 15 as able We ve targeted functional exercises We also target your thigh muscle quads - Do these exercises on a bed, no need to get on the floor!

34 Pre-op Exercises Word of Caution: Don t hold your breath Don t aggravate anything Don t strain -If an exercise hurts too much or you are straining too hard, move on to the next one. Do you have a heart condition, other concerns? -you may want to check with your MD about exercise

35 Exercise Log Look at the knee exercise log pp. 13 & 14 -write in 5x under standing ex and chair push-ups for today Starting tomorrow, do them twice/day Increase reps every day as you are able Try to get. Strong for Surgery

36 Activity Log Any pre-op exercise or activity can help your body to be more resilient - It can also improve your mood! Use the Activity log to keep track of any activity or exercise - stationary bike, swim exercise, etc. - get an activity tracker and track your steps

37 Physical Therapy in the Hospital PT will see you Day of surgery most likely Post-op day 1 - morning and afternoon Some of you will go home this day Post-op day 2 - as needed Some of you will be going home this day

38 Post op Walking Walkers - Use either standard or front-wheeled walker - Avoid 4-wheeled walkers (ok to use later) Crutches Weight-bearing as tolerated Gait : step first with your surgical leg

39 Stairs Does a walker fit on your entry steps? This is a very good option! You will lead with the stronger leg going up and the weaker leg going down

40 1 rail and 1 crutch works well! If your walker does not fit on each step we strongly recommend you have a railing installed We will practice stairs in the hospital Most people can manage stairs inside the home assuming you have a railing

41 Post-op Exercises You will have pain and swelling If you don t get your knee moving, it will freeze up, early motion is important You have to respect the pain, don t force it Correct post-op exercise is critical No exercise = bad outcome Too much exercise bad outcome It is important to balance the type and amount of exercise you do

42 Home Exercise Program You will do circulation exercises after surgery - RN will have you start ankle pumps in recovery Your PT will instruct you in your home exercise program we will practice these in hospital Exercises and household walking will be your rehab for the first 2 weeks your knee can t handle more than that! You will do best by making steady, small gains daily by doing your exercise Remember balance! Don t do exercises until we ask you to

43 OUTPATIENT PT Outpatient PT will usually start 2 weeks after your surgery determined by your surgeon You can go to a St Joe s facility (now named Probility) or a place of your choice Click on the Probility link for a list of the St. Joe s outpatient facilities in the area

44 Other Online Resources stjoeshealth.org/ortho-help Pre-op exercises Post-op exercises Post-op exercise video PowerPoint slides of this class presentation (all in PDF format, so you can print them)

45 Planning your surgery Having your knee replaced is a big event in your life Consider a support person especially for - pre-op visits - day of surgery/pre-op holding - day you are discharged from the hospital

46 Discharge Planning We recommend you ask a friend or family member to stay with you for several days up to a week We are glad to instruct family and friends how to help

47 Equipment Walker standard or front-wheeled Single crutch or cane for stairs with a rail Raised toilet seat try getting off your toilet without using your surgical leg; taller people more likely to need them Reacher very helpful, may want to get one ahead of time Consider getting a pedometer/activity tracker

48 Assignment 1. Start the pre-op exercises Start at a level that is comfortable 2. Stay active walk, stationary bike, etc. 3. Arrange for help after your surgery 4. Get a railing for your entry steps! 5. Visit our website 6. Plan your equipment needs

49 Enjoy your new knee! Your preparation and hard work will pay off You ll be very glad you had the surgery We wish you well!