CJW Presents “Joint Venture” Education Class

for Total Joint Replacement Patients

Use in conjunction with the patient education book given to you at your surgeons office

Purpose

• Educate our patients

• Prepare you for your joint replacement

• Reduce your anxiety level

• Awareness of expectations- you are in charge of

your recovery

• EARLY AMBULATION-“Get up get moving and get

out of here” MOTION IS LOTION!

• Transition you to home- safely and quickly

Program Goals

• 1-3 day hospital stay

• Bring a coach for support and help

• Pain Management-assessment/reassessment/move/medicate

• Return you to more active lifestyle

• Increase your quality of life

• Make your hospital stay a quality experience

Risk Factors for Total Joint Surgery

• Blood clot (DVT) • Pulmonary embolism (PE) • Problems with anesthesia • Infection • Blood loss with risk of transfusion • Underlying medical conditions • Problems with wound healing

Stop Taking 5-10 days Before Surgery

• ASA (aspirin) • Motrin • Ibuprofen • Aleve • Herbal supplements • You can take tylenol for pain

• If you are on blood thinner:

– Ask doctor before stopping medication

No Food Or Drink After Midnight the Night Before Surgery

• Hydrate before and after surgery

• IV for 24 hours or less

• Body 70% water

• Narcotics metabolized by kidneys or liver

• Nausea cased by dehydration, not eating before pain medications, or

hypersensitivity to narcotics

Nutrition

Iron Rich

Protein Rich(50-100gm/day)

Men 70-100 gms/day

Women 30-50 gms/day

Lean Meats

Fruits & Veggies

Grains

What to Bring to the Hospital

• Personal hygiene products

• Shoes with a good sole (tennis shoes)

• Loose fitting pants (sweat pants)

• Medical equipment (mask for CPAP machine)

• Copy of Living will or Advanced Directive

What to Leave at Home

• Button trousers

• Tight fitting clothes

• Valuables

• Jewelry and credit cards

• Large amounts of cash

• Flip-flops or house shoes

Pre-Admission Testing (PAT) Stop #1

• 3 to 4 weeks before surgery

• Bring list of medications or all medication bottles you are currently taking – Prescription and over the counter

• History and physical- performed by NP or physician

• All necessary testing (blood work, EKG, x-rays etc.) will be completed day of visit. Plan to spend 2-3 hours at this visit.

• MRSA screening, Cleansing wipes, Number to call for time of arrival and time of surgery.

• Insurance information

Same Day Surgery (SDS) Stop #2

• You will be instructed when to call for arrival time day of surgery

• Be on time-if you’re late so are we.

• Staff introductions – Nursing – Anesthesia

• Monitor hook up

• Start IV • Regional

anesthesia/spinal • Site identification • Surgeon site marking • Questions for

surgeon

Operating Room Stop #3

(1-1 ½ hrs single joints/ 2- 2 ½ hrs bilateral joints)

• Move to OR table • Apply monitors • Anesthesia administration • Foley catheter insertion • Surgical procedure • Possible wound drain • Wake up! Go to PACU

Post Anesthesia Care Unit (PACU) Stop #4

• Nursing introduction

• apply monitors frequent vital signs

• Wiggle toes move legs

• Check level of spinal regression if applicable

• Monitor pain level- attach q-ball for knees

• Monitor drains administer fluids

• Stay 30 min to 1 hour

• Discharge to joint replacement unit

Orthopedic Units 5th floor Chippenham 3rd floot JW

Stop #5 • Meet staff • Nursing assessment • Physical Therapy Evaluation/ sit up on side of bed with nursing • May walk if ready • Monitor vital signs-every • Assess wound dressing, drains, IV fluids • Exercises-ankle pumps every 2 hours while awake • Incentive spirometer-every two hours while awake • Cough and deep breath-every two hours while awake • Turn and Reposition self-every two hours while awake • Limit visitation-on the first day. You need to rest • Private room

What You May See

• Dressing – Total Hip large bulky dressing to hip. Larger than incision – Total Knee ace bandage heel to thigh. Dressings removed 24-48hrs.

• Wound drain remove POD #1-2-if you have one. Surgeon will determine if you get a drain and when it will be removed

• Foley catheter remove POD # 1 Depends on procedure. Everyone who gets a total joint gets a foley catheter

• Female bilateral knee patients may have foley for 2 days post op

• Blood pressure monitor and/or pulse oxygen monitor • CPM machine if surgeon uses • Compression devices on lower legs or feet • IV fluids 24hrs or less

Pain

• Pain after surgery will be different than pain you are feeling now

• Muscle healing, incision pain, bone pain, swelling of joint

• Pain scale 0-10. “0” none “10” the worst • “5” is the magic number to achieve-stay ahead of

your pain

• Medication every 4-6hrs. Take routinely for the first week.

• Meet therapy goals

Your Responsibilities With Pain Control After Joint Replacement Surgery

It is important that you know that pain assessment, management and control after joint replacement

surgery is in large part the patient’s responsibility. We as healthcare providers will be there every step of the

way to help you but we can’t treat you if you do not participate. The “Pain” is yours and only you can feel it.

Unless you tell us how you are feeling we cannot treat you to the best of our abilities.

The expectation is that you participate. That means that every hour that you are awake, beginning

when you can start to feel your leg, that you bend your leg and ask yourself; does it feel the same, worse, or

better. If it feels the same or better no medication intervention is needed at that time. If it is starting to feel

worse remember that it won’t feel better unless you take some pain medication. Remember you can have

pain medication every four to six hours; ask for it and take it! The catch is that you stay ahead of your pain and

ask for your pain medication routinely. We will not bring the medication to you unless you ask for it. This is

how you are in charge. If your pain gets out of control your assessment and management of your pain is not

going very well and you need to reevaluate. If what we are doing for you is not working please let us know so

we can find something that works for you. Everyone is different.

The pain scale is 0-10. “0” is how you feel now and “10” is the worst pain you have ever felt. We want

to always keep you below a five. If you are doing a good job at hourly pain assessments and medicating

routinely you should be able to keep yourself around a “2” on that pain scale. Also, never take your pain

medications without eating first. Narcotics have a side effect of nausea, so eat before taking them. If you are

nauseous please tell us. We can medicate you for that also. If the narcotics are making you itchy, another side

effect, we can medicate you for that too.

Just remember when you are lying still you will probably be very comfortable. Your surgical leg will

only be painful when you move. This is why participating by moving your leg helps with pain assessment. If

you are a total knee patient we need to know when you bend your leg if it hurts in the front around the knee

or in the back behind the knee. This lets us know if the block we gave you is working. The front of your leg

should be pretty comfortable while the block is in place. Pain in the back of the knee is expected. Oral pain

medications and ambulation will help improve the pain behind your knee.

If you are a hip replacement patient you will be more comfortable walking or sitting in a chair verses

lying in bed. You may experience muscle spasms or cramps when your spinal wears off. This is the time to start

taking your oral pain medications and doing hourly assessments of your pain.

When we wake you in the middle of the night to do lab work and check your vital signs, take this

opportunity to take pain medication. We do not want you sleeping for 6-8 hours and not taking pain

medication. You need to be ready for therapy in the early morning.

Be prepared to rate your pain using the number scale 0-10. This is how we medicate your pain. You are

here to learn to manage your pain, do therapy and go home. If your pain is out of control this will not happen

and you will miss your therapy session for the day. The importance of controlling your pain cannot be stressed

enough.

Anti-Coagulation • You will be put on medication to decrease your

risk of blood clots and pulmonary embolism • Daily blood work if put on Coumadin® dosage

while in hospital. Coumadin dose calculated by pharmacist daily if you are put on Coumadin.

• Continue for up to 3 weeks after discharge-surgeon will tell you when and if you can stop taking medication

• Some receive Lovenox® injections, Xarelto®

or Aspirin. This will be determined by your surgeon.

Possible Side Effects of Blood Thinners If you notice any of the following:

• Increase in drainage from wound • Bloody, black tarry stool • Coughing up blood • Blood in urine • Nose bleeds • Bleeding gums • Vomiting blood/coffee grounds

*STOP IMMEDIATELY* and call your surgeon!

Physical Therapy

• Physical therapy – Start date depends on time of arrival to 5th floor

– Early arrival therapy day of surgery

– Late arrival therapy POD #1 but nurse will

Sit you up on side of bed on the day of surgery

– Therapy twice daily M-F, 1x day S-S.

– Walk 100-200ft

– Clear stairs

– Walkers, canes etc.

– Exercises yourself 3x more a day alone

Occupational Therapy

• Start POD #1

• Assist with activities of daily living – Assistive devices

– Reachers, grabbers, sock-aides, long shoe horns, seat cushions etc.

• Bathing-sink bathing until surgeon tells you that you can take a

shower

• Toileting

Case Manager/Social Worker

• Visit you while in hospital

• Arrange home health or discharge to skilled nursing facility or rehab if necessary

• We want you to be prepared to go HOME. Patients do much better at home. Please plan ahead to have someone there to help you for a while.

• Arrange medical equipment needed at home – Roller walker

– 3-1 bedside commode

• Review advanced directive if you do not have one

Discharge

• Home medications and new prescriptions

• Home health agency and physical therapy

• Follow-up appt-you will need to call and make your

appointment. Number and approximate date will be on your discharge instructions

• Have someone stay with you for at least one week after surgery

Things to Know and Do

• Remove all throw rugs and cords from floors at home-you want to prevent falls

• Basket on walker-this helps you keep important items close to you during your recovery (phone, remote control, medicine etc.)

• Exercise – Do not sit for more than 45 min at a time (stiffness and swelling) – Walk frequently but not long distances. Walk on flat surfaces and wear good

shoes – Apply ice frequently. This helps with pain and swelling – Elevate your leg frequently – Lie down twice daily for at least one hour

• If you go to the Dr. or Dentist-let them know that you have a joint replacement. Some procedures require pre-medication with antibiotics.

Signs and Symptoms of Infection If you experience any of the following:

• Sudden increase in pain, tenderness, or swelling in

surgical leg

• Increase in temperature 101.5 or above

• Increase in amount of wound drainage

• Persistent nausea and vomiting

• Call your doctor!

• Chest pain with shortness of breath

• Call 911!

Some swelling and tenderness and slight elevation in temperature is expected. If persistent notify physician.

Important Phone Numbers

• (Ortho Virginia) West End Orthopedics Clinic Chippenham Campus – 804-320-1339

• (Ortho Virginia) West End Orthopedic Clinic Johnston Willis Campus – 804-379-8088

• Joint Coordinator CJW-Nicole Hartman – Office 804-323-8794 – Cell phone 804-304-6840