Welcome to Pre-Operative Patient Education Class SPEAKER : Hello everyone and welcome to joint class. Please make sure to sign your name on the sign on sheet. Tampa General Hospital Florida Orthopedic Institute USF Morsani College of Medicine

We are glad you are here! SPEAKER:Why are you here? You are scheduled to have a total knee or a total hip replacement surgery Your family member is having surgery Your MD asked you to come This educational class is for individuals who will be having total knee or total hip replacements. This time is for you and your family to learn a few things about these surgical interventions and for us to answer any questions you may have regarding yours or your families surgery. So we are very glad to have you here. As we give you this presentation, please feel free to interrupt us and ask any questions that you may have in the course of the presentation.

Class Outline What is a total knee and hip replacement? Preparing for your surgery What to expect during your hospital stay What to expect after discharge What to know about your insurance SPEAKER : Today we will tell you about total knee and hip replacements, introduce you to the different health care professionals who will be taking care of you while in the hospital and prepare you for your surgery

Total Knee Replacement SPEAKER :Total knee replacement Surgery to replace a painful/ damaged or diseased knee joint with an artificial joint. (prosthesis) Surgical incision Standard incision is vertical and approximately 6-8 inches long You probably have chosen to have TKR because you have pain, stiffness, weakness, deformity, limited range of motion in your knee joint. These symptoms have probably resulted in your inability to participate in daily activities or sports that you enjoy to do in life. There are many reasons for a joint to become damaged and cause the above symptoms. One common cause is osteoarthritis. An estimated 20 million adults in the US have OA. With this condition the joint space narrows and the bones around the joint undergo structural changes resulting in deformities, change of biomechanics and as a result limited ability to participate in activities. The other common causes for joint damage is rheumatoid arthritis, arthritis as a result of trauma. Total knee replacement is a surgery that is used to replace the damaged joint with an artificial joint. The typical incision is about 6-8 inches long and it goes along the front of your knee. The specifics of your surgery will be individualized and will be discussed by your surgeon.

Total Hip Replacement

Preparing your Home for Surgery Remove throw rugs Make sure pathways are clear Arrange for pet care Stock up on food, supplies, pre- made meals, medications etc. Stay as active and mobile as you can leading up to your surgery. Non slip bath mat and shower mat (when cleared to shower) Your home PT will assist you in other modifications. Speaker: After you have surgery and are sent home you may have some limitations in range of motion, pain and muscle weakness that may prevent you from doing your everyday activities independently. One important thing to do before surgery is to make sure that your home environment is ready for your return home. So we recommend the following: Remove any throw rugs or anything else that may slip under your feet. Remember you will be using a walker or crutches for a few weeks after surgery. So it is important to have your home environment clean of any slippery rugs. If you can purchase a raised toilet seat or place arm rests near your toilet on in the bathroom Purchase a shower chair. A high shower chair is better than a low one. Insurance does not cover the purchase of a shower chair. Add extra cushions to your couches and chairs for comfort and try to find a chair with armrests to use. It will make getting up from the chair much easier especially the first two weeks after surgery. If you do not already have equipment such as a walker or commode and think you may need it, it is best to attempt to arrange it before surgery. If you are unable to do so we can help arrange it while you are in the hospital. There is often some kind of co-pay or out of pocket expense.. Also tell patients that we will teach them exercises to do here so they can strengthen their legs

Preparing for Surgery SPEAKER :Make every effort to address any acute dental needs prior to your surgery Complete all primary care/cardiology clearances before your pre-operative visit at TGH TGH Preoperative visit will include: Meet with a nurse and anesthesia physician assistant Review your medical history and any allergies Review your current medications and supplements and advise on what to stop prior to surgery. (Bring an up to date list) Meet with a care coordinator to discuss your plans after you are discharged. Review your advanced care directive, health care proxy, living will Scheduled appointment with the preadmission testing Center Review your medical history important to bring a list of all med you currently take, The MD/RN will review to be sure nothing is missing Advanced Care Directive - this identifies who will make decisions for you if you are unable. If you have an ACD, please bring it with you when you come for surgery We have blank copies available and we can print copies of pervious ACD and review with you to ensure the information is up to date

Preparing for Surgery SPEAKER :Pack for the hospital: Loose comfortable clothing to wear home, robe and slippers for the hospital Personal hygiene items Wide gym shoes or walking shoes with a rubber sole and heel back Identification/driver’s license Copies of your advance directive, living will and health care proxy Glasses, hearing aid, and any item you use every day CPAP machine from home and know your settings Any belongings brought to the hospital should be labeled with your name and locked in the room safe provided Walker: If you have a walker leave it in your car so it is available when you arrive home. Your incentive spirometer (provided by TGH at your pre-surgery appointment) Know your insurance coverage and bring insurance cards with you to the hospital on day of surgery basically talk about everything on the slide

Preparing for Surgery Acute dental needs Primary care/Cardiology clearances Pre op appt with Chronic Pain MD. Will need script for post op pain medication upon discharge and post op follow up visit for continued pain management. TGH Preoperative visit : Review your medical history and any allergies Review your current medications and supplements (Bring an up to date list) Meet with a care coordinator to discuss your plans after you are discharged. Review your advanced care directive, health care proxy, living will

Preparing for Surgery Try to stop smoking or at least cut in half No drinking alcohol 24 hours before surgery Identify someone to assist you at home after surgery for 2-3 days Arrange for a ride home If discharged day the day after your surgery, try to arrange for pick up between 2-4 PM If discharged two days after surgery, arrange for pick by 12 noon SPEAKER: Preop preparation Smoking Cessation –speak with your PCP regarding options Alcohol use – discuss this with your MD/Anesthesiologist. Alcohol use can affect your hospitalization / make sure to stop ETOH consumption a week before surgery Discharge Plan – start to consider Who is available to drive you home? Who will help you at home? Think of who will help you get a ride from hospital home, and someone who could help you, with grocery shopping meals etc. Now is the time to ask help from family or friends.

Preparing for Surgery Pack for the hospital: Loose comfortable clothing Personal hygiene items Wide gym shoes or walking shoes with a rubber sole and heel back Identification/driver’s license, Insurance cards Copies of your advance directive, living will and health care proxy Glasses, hearing aid, and any item you use every day CPAP machine from home ( know your settings) Any belongings brought to the hospital should be labeled with your name and locked in the room safe provided Walker: If you have a walker leave it in your car so it is available when you arrive home. Your incentive spirometer (provided by TGH at your pre-surgery appointment) Charge vena pro stockings if purchased for home

The Day Before Your Surgery Follow the bathing/prep instructions provided to you during your pre-operative visit including use of chlorhexidine gluconate (CHG) wipes and bactrobon ointment Stop eating/drinking at midnight the night before your surgery unless told otherwise by your doctor Take any medications your physician has indicated with a sip of water the morning of surgery

Questions QUESTIONS

What to Expect on the Day of Surgery SPEAKER :Arrive at TGH admissions at your designated time After surgery you will go to the recovery room for 2-4 hours Your family can wait for you during surgery and recovery in the waiting room next to the surgery suites (2nd floor West Pavilion) A liaison is available in the waiting area to answer your family’s questions You will be moved to the orthopedic floor when you are: Awake and alert Cleared by the anesthesia team A bed on the floor is available You will be assisted out of bed shortly following your surgery For Anesthesia: Do NOT go into specifics. Just indicate that this is a discussion between you your anesthesiologist and your surgeon and based on that the most appropriate anesthesia will be chosen for you. Post Anesthesia Care Unit: instead of saying PACU When in the PACU your vital signs are assessed by nurses and you are kept under a close eye. Once your vital signs (blood pressure, heart rate and oxygen saturation) are stable, your pain is well controlled and you have a stable fluid status and a respiratory rate you are ready for transfer to the floor. Because of the many patients who come to the hospital, you will be transferred to the floor when a bed becomes available. This may take a few hours and may result in you staying in the PACU a little longer than expected. Private rooms cannot be guaranteed depending on volume . While in the PACU you have a nurse at your bedside at all times who is there to address your needs.

What to Expect on the Day of Surgery Need admissions picture!

What to Expect on the Day of Surgery

What to Expect on the Day of Surgery Pain Management Your recovery will not be pain free. This should NOT limit you from moving and gettingNursing care (nurse, nursing assistant) you will receive may include: Frequent monitoring Assisting you out of bed Educating about blood clot prevention out of bed This may include nerve blocks, and various pain medication If you have issues with chronic pain, the acute pain team may be consulted to assist with optimal pain control Infection Prevention Make sure everyone entering your room (physicians, nurses, family members etc.) washes their hands with soap and water or disinfectant hand gel

What to Expect After Surgery SPEAKER :Incentive spirometer (deep breathing to prevent complications) Intravenous fluids Heart and breathing monitoring Surgical dressing/incision Ice therapy Sequential compressive devices (to prevent blood clots) If ordered, TEDS/Jobst stockings will be utilized There will be many different medical equipment and devices around your bed and in your room when you arrive on the floor. Have on hand: O2 tubing O2 and apnea monitors SCD’s

Your Care During your Hospital Stay This is a tool we use to communicate with you and your family the care you will receive. At the start of a new shift, both RNs will come to your bedside and perform bedside shift report. This is a good time to review your plan for the day and goals for discharge. Please feel free to ask any questions during this time. Pain Meds are prn but request for routinely

Your Care During Your Hospital Stay Physical/Occupational Therapy Physical and Occupational therapists will evaluate you within 24 hours after surgery and help you with: Exercises Moving from your bed to a chair or other location Walking on level surfaces and stairs Any activity movement precautions (hips only)

Anterior Hip Dislocation Precautions INCORRECT INCORRECT

Posterior and Lateral Hip Dislocation Precautions INCORRECT CORRECT You will learn about your precautions post-operatively. You surgeon will give you specific precautions based on how they perform the surgery.

Posterior Hip/Lateral Hip Precautions INCORRECT INCORRECT

Posterior/ Lateral Hip Precautions CORRECT CORRECT

Hip Precautions INCORRECT INCORRECT

Hip Precautions Posterior/ Lateral CORRECT CORRECT

When Will I Go Home from the Hospital Post op day 1 – 2 Criteria for discharge include: Wound clean and dry Pain well managed Medically cleared Cleared by physical and occupational therapy Walking at least 50 feet safely Bed Transfers Independent toileting Most patients are able to safely go home with nursing and therapy.

Insurance Medicare will cover home care if you are home bound and if you have a skilled need e.g. nursing or physical therapy Medicare will not pay for among other things, walkers if you have had one within the last five years, hospital beds, commodes, companion care and home health aides Commercial insurance is highly variable and you will need to contact your insurer to understand benefits and coverage

What Happens if I need to go to a Skilled Nursing Facility (SNF) If you don’t meet the criteria for discharge to home your care coordinator will work with you on a discharge to a SNF. We request that you have 2 -3 facilities that you prefer. If your preferred SNF does not have a bed available when you are discharged, TGH will work to find an alternative SNF

Meds to Beds Takes most Insurance plans Copays the same Delivered to your bedside within 2 hours

Discharge Instructions Wound care: Symptoms of wound infection Blood clot prevention: Symptoms of blood clot in legs or lungs (DVT/PE) Pain management: Schedule Constipation Medication list for home TEDs/compression stockings as needed Follow up appointment No driving until off pain meds and cleared by your surgeon

What can I Expect if I go Home with Home Health Nursing and Physical Therapy usually within 24 hours of discharge RN Wound assessment Medication assessment Overall health and bowel regimen Physical therapist will determine frequency and duration depending on your progress ( average of 9 visits)

Questions QUESTIONS