TOTAL JOINT REPLACEMENT PRE-OPERATIVE EDUCATION

The Joint Replacement

WILLAMETTE VALLEY Institute MEDICAL CENTER MCMINNVILLE , OREGON

Joint Replacement Institute Program Manager

• Pre-op education

• Daily rounds

• Patient concerns

• Follow-up Phone Call

Objectives for Today • Understanding your • Pain management

procedure • How to care for • What to expect during yourself at home

your hospital stay • Role of the “coach”• Physical/occupational • Discharge planning

therapy

Occupational Therapy (OT) • Begin on Post-Op Day 1• Activities of Daily

Living (ADL’s) – Bathing– Dressing– Personal Hygiene

Assistive Devices • Reacher• Sock Aide• Long handle shoe horn • Long handle sponge

Bathroom Equipment • Tub Transfer Bench• Shower Chair• Bedside Commode• Toilet Riser

Physical Therapy • Expectations • Exercises • Car Transfers

Equipment • Front-wheeled walker

– Measuring for correct fit – Sequencing

• Cane – Stairs – Progression to

Preparing your Home 1. Chair with arm rests 2. Check chair height 3. Remove throw rugs 4. Move electrical cords in walking space 5. De-clutter space and/or rearrange furniture

Preparing your Home (cont)

6. Make sure you have a safe path from car to entrance of your home

7. Check rails for safety, install if necessary

8. Prepare frozen meals 9. Arrange for someone to care for pets,

yard & garbage

Where to obtain equipment • Local pharmacies • On-line • Friends, family, church, civic groups • Vendor closet • Lion’s Club

What to Bring to the Hospital • Loose-fitting clothes (shorts, culottes, T-shirts) • Sweatshirt or jacket • Personal care items • Any shoe or leg orthotics • Your guidebook • Your walker, reacher, sock aide, etc. • Hearing aids • Leave valuables, cash and medications at home

Transition to Home Making the discharge plan: • Patient and family • JRIO Program Manager • Surgeon • Physical & Occupational Therapists • Discharge planner (if needed)

Role of the Coach at Home • Assist with showering/in and

out of bed • Remove bandage • Medication management • Assist with exercises • Provide encouragement &

reassurance to loved one

Understanding the Procedure • Total knee replacement (TKR)

• Total hip replacement (THR)

*Goal with surgery is to lessen pain and restore function

Procedures Total Knee Replacement • Removal of damaged bone and

cartilage from your thighbone, shinbone and kneecap with insertion of an artificial joint (prosthesis)

Procedures (cont)

Total Hip Replacement: • Removal of damaged bone and

cartilage from your thighbone and hip bone with insertion of an artificial joint (prosthesis)

Preparing for Surgery Read your guidebook Fill out orange form Start pre-operative

exercises today

Pre-operative Process • Optimized for surgery • Hospitalist evaluation and Pre-op class today • Anesthesia consult with Anesthesiologist or Certified Nurse

Anesthetist • Pre-op office appointment with surgeon • It is imperative that you follow the specific instructions given

during this process. • ASK QUESTIONS!!

Surgical Preparation • Shaving: do not shave legs 1 week before surgery • CHG Cloths: 2 evenings prior to surgery • You may eat a light meal until 8 hrs before surgery

scheduled to start • DO drink water/black coffee until 3 hours

before surgery scheduled to start

For your Financial Planning • FAQ by all patients - billing • Pre-operative

– Lab work – X-ray and radiologist to read x-ray – CT scan for some TKR and revision surgeries – Hospitalist visit – Any other specialty consultations

For your Financial Planning (cont)

• Surgery and hospital stay – Surgeon – Anesthesia provider – Hospital charges

Day of Surgery • Report to Information Desk • Go up to JRIO for

preparation for surgery • Family can wait in JRIO room and surgeon will

come up after surgery. May be 3-4 hours before you see the patient.

Pre-op Nurse/Operating Room Staff • Preparation for surgery

– IV started – Antibiotic given within hour

prior to start of surgery

– Verify patient identity – Double check allergies and

site of procedure

Recovery Room…PACU • Stabilize vital signs • Assess status and patient

will move back up to Joint Replacement Institute unit when safe to do so

Preventing Post-op Complications • Blood Clots / Pulmonary Embolus

Ankle pumps, early ambulation, compression devices • Pneumonia

Incentive spirometer, cough & deep breathing

Preventing Complications (cont.) • Infection

Vital signs, inspect incision, antibiotics • Nausea and Vomiting

Medications • Constipation

Medications & frequent mobility

Anticoagulation (cont) • Aspirin 325mg x 6 weeks

• Lovenox, x 7-10 days – Daily injection – No lab tests – If no insurance, $500-$700

Pain Scale • 0 No Pain • 10 Worst Possible Pain

• >4 Discomfort prevents: - Sleeping - Conversation - Mobility

Remember… • We can’t make the pain go completely away

• We aim to manage the discomfort so that you can eat, sleep and move around • The sooner you can move around, the better

for your recovery • Use a combination of medication & activity

to help with pain

Swelling and Bruising

• Will get WORSE the weekend after your surgery

• Treat with compression, elevation and ice • Important to keep moving!

Additional Comfort Measures • Cold therapy

- Compression gel wraps

• Move, Move, Move! – Position changes – Get up and walk with staff – Ok to walk with family when cleared

by therapy staff

Patient Responsibility • Intercept the pain; ask for medication when the pain

starts to escalate to 4/10 – do not wait until 10/10.

• Ask questions; be sure you understand the pain management efforts that are in place.

• Prepare yourself to use multiple ways to manage pain

• Read handouts provided to you in advance

Private Rooms—You are a WELL patient

Post-op Activity on Surgery Day • Goal: walk 60 feet the day of surgery • Evaluation by PT if possible, if not work with

nursing • Knees – no pillow under operative knee, heels

off bed • Hips – follow all hip precautions that will be

posted in your room • Catheter removed

Post-op Day 1 • Rise and shine early—5:30 am! • Dressed and up to recliner chair for breakfast at

7:30 am • Ready to begin PT/OT at 8:30 am • Catheter removed (if still in place) & IV capped

Group Therapy • Group exercise in activity room • 10:00am &1:00 pm POD1 • 10:00 am and 1:00

remaining days if still here • Coach participation is needed!

When do I leave the hospital? • Generally patients leave after group PT

– 11:00am or 2:00pm – Have transportation ready

Caring for Yourself at Home • Change positions and walk often • Follow your joint precautions • Walk daily and steadily; gradually increase your

distance • Perform your home exercise program 2x/day

Nutrition

• Pre-surgery: • Increase protein intake, emphasize fruits, vegetables

and liquids. • You DO NOT want to be constipated going in to

surgery • Limit coffee and alcohol

Nutrition (cont)

• Post-surgery: Eat small, low-fat meals throughout the day

• Increase your protein intake • Fiber: prunes, prune juice, figs, apricots, berries,

vegetables, legumes and whole grains

Nutrition (cont)

• Water: drink at least 8 8 oz glasses per day unless you have been instructed to restrict water. • Herbs: Echinacea, Ephedra, Garlic, Gingko,

Ginseng, kava, St. John’s Wort and Valerian can have a negative effect when mixed with other drugs and may limit incisional healing

Nutrition (cont)

• Probiotics • Acidophilus and Bifida before and after

surgery as directed on label. Important for digestive system function when antibiotics are used.

Reunion Luncheon

• Postcard Invitation • 2-3 months after surgery • Provide feedback, reunite

with staff and other patients

WITH YOUR SURGERY!

THANK YOU FOR COMING

The Joint Replacement InstituteWILLAMETTE VALLEY

MEDICAL CENTER MC M I N NVILL E, OR EGON