Total Shoulder Replacement Pre-operative Class Preparing for your surgery

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

Education You will be getting a lot of education during your joint replacement journey. You have already received literature from your surgeon You are here today at your preoperative class The nurse practitioner will give you more information when you attend your pre-operative appointment After surgery 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. ©2015

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: Prepare your house: Remove any fall hazards from your home including rugs, cords and furniture that might make moving around difficult and make sure items you use often will be easily accessible and within reach. Plan on using a cordless phone or cell phone that can be tucked away inside a pocket Install night lights in bathrooms, bedrooms, and hallways If you have pets you may want to arrange boarding them for the first few days you are home Prepare or purchase meals ahead of time to minimize cooking after surgery 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 ©2015

Reduce Risks, Complications Stay active – Stay as active as possible before your surgery. Postoperative exercises will be reviewed later in class. 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 primary care physician if needed Reduce, eliminate tobacco. Smoking increases your risk of developing wound infection so we encourage you to try to stop before your surgery 1-800-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, heart and lung complications and bleeding risk ©2015

Exercise Practice these daily tasks before your surgery without using the arm you will be having surgery on Getting in and out of bed Getting up and down from a chair Getting dressing Going to the bathroom Bathing ©2015

Prevent Surgical Site Infection Dental work – must be completed 1 week prior to surgery and delayed for 3 months after your surgery You will have nasal swabs taken to rule out infection before your surgery Hand washing – Good hand hygiene is essential. Encourage your family and friends to utilize an antibacterial cleanser and to always wash their hands to prevent spread of infection. In pre-op you will receive nasal ointment to help prevent postoperative infection ©2015

What to bring into hospital with you Large front button-up-shirt that you can wear with a sling Loose fitting, elastic bottoms Slip on shoes If you are staying in hospital bring toiletries and a robe ©2015

Anatomy of the Shoulder Joint The shoulder joint is a ball and socket joint. The ball on the upper end of your arm bone (humerus) rests against your shoulder socket (glenoid). The shoulder joint is lined with a layer of smooth cartilage. This cartilage serves as a cushion and allows for smooth motion of the shoulder. ©2015

What is arthritis ? Arthritis is a wearing away of the smooth cartilage in the shoulder joint. At some point, it may wear down to the bone. Rubbing of bone against bone causes discomfort, swelling, and stiffness. Many patients need surgery to replace the damaged joint. ©2015

Shoulder Replacement Surgery In a shoulder replacement surgery the damaged joint is replaced with a new, artificial joint. The head of the humerus is removed and replaced with a metal prosthetic ball. The prosthesis continues down into the shaft of the humerus. Certain activities will be restricted to allow the repair time to heal. For shoulders with severe rotator cuff problems, reverse shoulder replacements are implanted with the ball and socket reversed. ©2015

Prosthetic or artificial components ©2015

Pain Management Your nursing staff will do everything they can to get you comfortable enough to participate in your recovery. Your nursing staff will often ask you to rate your pain level on a scale of 0-10 Your pain will be managed with different medications including local nerve blocks and/or oral medications

Nerve Block Your anesthesiologist may talk with you about placing a nerve block catheter(tiny soft tube) to help with pain relief after your surgery. The block is put in just before surgery . The nerve block is connected to a portable pump that delivers numbing pain medication around the bundle of nerves that leads to your operative shoulder and arm. Depending on the dose you need, the pump will run for 3 to 4 days. You may still have pain with a nerve block and need to take additional pain pills as prescribed by your doctor. ©2015

Nerve Block Placement ©2015

For same day discharges In order to have a nerve block catheter, your caretaker must come to the hospital with you to receive more nerve block and pump instruction. You will receive a patient instruction guide today. In the recovery room, a nurse will review information on the pump, how to remove the catheter and answer any other questions you may have. Once you are home, a 24-hour patient hotline is available to contact for any questions or concerns. In addition, an anesthesia staff member will be calling you to check on your pain relief. ©2015

Nerve Block Equipment ©2015

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. Surgery will take between 1-3 hours, the patient will then be transferred to the recovery unit. Your family will be brought to the recovery unit when you are awake enough and you are ready for discharge Discharge instructions will then be given to you and your family ©2015

Incentive Spirometer Sit in an upright position Inhale slowly and deeply to raise the piston 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 ©2015

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. 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. ©2015

What to Expect After your Shoulder Replacement Washing/Dressing – You can take your sling off to wash. Wear easy to get on clothes Grooming – Before surgery, pay attention to your daily grooming habits. Keep in mind that you will not be able to use your operated arm for chores such as brushing your teeth, flossing or hair styling. A disposable electric toothbrush, pre-strung flossers and a low-maintenance haircut may help out Eating – As you prepare food and sit down to a meal, you will have to use utensils with your non-operated hand Toileting - you will need to use only your non-operated arm for wiping yourself after using the toilet. If your surgery is on the arm you are used to using, you will need to practice using your other hand before coming in for surgery. Household chores – Avoid lifting anything with your operated arm and nothing heavy with your non-operated arm. Housework will also need to go on hold until after your first post-op visit. Writing checks may be difficult, so plan to pre-write some if needed. When climbing stairs, hold the banister with your non-operated arm.