Joint Replacement Surgery Pre-operative Education 2012

Objectives Prepare for the day of surgery Describe plan of care Learn how to prevent complications after surgery

Pre-operative (Pre-op): What happens before surgery? Pre-op appointment Home preparation Infection prevention Constipation prevention Daily medications Exercise Outline of topics to be covered

What to bring to your pre-op appointment at the hospital A FULL list of medications (including over-the-counter and herbal medications) Driver’s license Health insurance card including medication card Results of a recent EKG if you have it You will be asked about your medical history and allergy status

Notify your surgeon before surgery if… You have a history of blood clots You are taking anticoagulants (blood thinning medication) You are taking herbal medications or vitamins You are or have been a smoker within the past 5 years You have diabetes or pre-diabetes You have sleep apnea You had a heart stent placed in the last year Tell your surgeon this information at your pre-op appointment or no later than 1 week before surgery

Home medications You may be asked to stop blood thinning medications to avoid bleeding too much during or after surgery Included: glucosamine, vitamin E, and anti-inflammatories (i.e. Motrin) Possible: Plavix, Aspirin, Coumadin

Stop smoking today Smoking makes your heart beat faster, raises your blood pressure, makes your blood clot easier, and makes your blood vessels smaller All these things increase your risk for blood clots, slower healing, and infection

Quiz question What should you tell your surgeon about before surgery? (click the correct letter) You are taking blood thinning medication You are a smoker You have diabetes All of the above

Click the smiley to continue Great job! Click the smiley to continue

There is a better answer Click on the smiley to return

Preparing your home You need help after returning home until you feel safe doing daily activities You will likely need help for exercises Stairs to climb? Any way to keep activities on one level? Quick-cook meals prepared ahead of time Throw rugs picked up and put away Remove electrical cords from walkways Handrails by stairs and in the bathtub/shower Short-term pet care

We can help with plans before surgery What if I can’t go home? Let us know if you feel you are not able to go home after surgery Can you go to someone else’s home? Short term nursing home rehab (a few days to a few weeks) is an option We can help with plans before surgery

Infection prevention Shower the night before surgery Special soap provided at your pre-op appointment You will wipe down your body with antiseptic cloths the day of surgery at hospital Swab both nostrils the day of surgery (the nose is a common route of infection)

How do I prevent constipation? 2-3 days before surgery Increase your fluid intake (Water, fruit juice, etc.) Consider having laxatives handy when you get home Constipation is a common nuisance after total joint surgery. Constipation occurs because of a slowing of bowel activity. This happens due to decreased physical activity, possible decreased food and fluid intake and as a side effect of narcotic pain medication.

Exercise before surgery? Yes… please start the exercises today! We want you to: Strengthen your legs and arms to help with your recovery Learn the exercises to prepare for after surgery Please click here for exercises

Day of surgery: What to bring Loose-fitting clothing (avoid long sleeves) Equipment you plan to use after surgery - Walker and/or crutches - Raised toilet seat - Reaching device - Other adaptive equipment Well-fitting, flat shoes or slippers Breathing machine for use while sleeping, if you have one Activities to pass time (reading materials, music player, etc.)

About your surgery Have your questions ready for your surgeon at your pre-op appointment Please click here to watch a short video about your surgical procedure.

Post-operative (Post-op): What happens after surgery? Pain Management Complication Prevention Wound Care Exercises & Mobility Goals

Pain Management Surgeons give injections during surgery to help with pain immediately after surgery Keep moving! Your leg or hip will get stiff and sore sitting in one place Change your position every couple of hours throughout the day

Prevent pain & swelling Do not wait for pain - Stay ahead of it Pain pills take about 45- 60 minutes to work Take pain medication before exercise sessions and as instructed to keep pain at 3 or less on a 0-10 scale Cold packs or ice to your knee/hip 5-6 times each day for 20 minutes at a time Rest and elevate lower leg and foot above heart level 5-6 times each day for 20 minutes at a time

Quiz question Which of these statements is true (click the correct letter) A. Elevate your lower leg 5 to 6 times per day B. Do not take your pain medication until your pain is a 3 C. Pain and swelling should not be expected after surgery D. Staying still will prevent you from being sore

Click the smiley to continue Great Job! Click the smiley to continue

Click on the smiley to return Oops… Try again Click on the smiley to return

Complication prevention Possible complications: Infection Constipation Blood clots Pulmonary embolism

Infection prevention Surgical site: Appropriate wound care is needed (wound care instructions ahead) You will take antibiotics while in hospital You will need to take antibiotics before future invasive procedures Tell dentist, family doctor and others that you see regularly that you have a new joint replacement

Surgery site infection Monitor for signs Increased pain Fever of 100.5 degrees or more lasting longer than 24 hours Smelly drainage Increased swelling and redness at incision

Surgery site infection You are at higher risk for infection if: You smoke You are diabetic You are overweight You have a weakened immune system (such as cancer or organ transplant) You are malnourished

Infection prevention Pneumonia: Use a breathing exercise machine (incentive spirometer) every hour while awake for one week post-op (machine and instructions will be provided) We prefer that you get out of bed ASAP – you breathe better and deeper when sitting and standing

Prevent constipation Be sure you are drinking enough fluids Water! Minimum of eight, 8 ounce glasses each day Physical activity promotes bowel activity Consider: Fruit juices Stool softeners daily Laxatives as needed to have regular bowel movements Avoid caffeine

Quiz question How can you prevent constipation (click on the correct letter)? Drink lots of coffee Take a daily laxative even if you are having bowel movements regularly Drink at least eight 8-ounce glasses of water per day

Click the smiley to continue Great Job! Click the smiley to continue

Click on the smiley to return Oops… Try again Click on the smiley to return

Prevent blood clots All patients will be given blood thinning medication post-op until the surgeon stops it Engage in ankle pumps with both feet multiple times each day (such as during TV commercials) Continue exercises and walking each day (increase as tolerated)

Signs of a blood clot Swelling in your leg that does not go away with raising your leg above heart level Pain, tenderness in the calf Homan’s sign – increased pain in the calf when toes are pulled up toward head * Keep in mind that your leg will likely have some natural swelling and will already be painful – monitor for increased symptoms *

Pulmonary embolism (PE) The pulmonary artery in the lung becomes blocked (or a branch of it) usually occurs when a blood clot from a vein travels from where it formed Symptoms: Difficulty breathing Shortness of breath Chest pain Rapid breathing Sweating Confusion Anxiety

Wound care Keep your incision dry- do not apply lotions or creams to your incision until your surgeon says you can Keep incision covered until drainage stops, then you may leave uncovered Avoid touching the incision Keep pets away from incision area Do not shower or tub bathe until your surgeon says you can

Quiz question Which of the following statements is false about infection prevention (click the correct letter) A. Apply cream daily to your incision B. Do not touch your incision C. Tell your dentist and family doctor that you have a new joint replacement D. Do not shower or bathe until your surgeon tells you can

Click the smiley to continue Great Job! Click the smiley to continue

Click on the smiley to return Oops… Try again Click on the smiley to return

Perform 10-30 repetitions of each exercise 2 times per day Exercises Perform 10-30 repetitions of each exercise 2 times per day Please click here for instructions on post-op exercises

Mobility You will be given instructions in the hospital about any limits to movement. Surgeons use 3 surgical approaches for hip replacement surgery. Your instructions will be related to which was used.

Goals Resume walking without assistive device Continue therapy at home or at a therapy center Strengthen your leg and hip muscles to assist with walking and provide support to your new joint Full range of motion for the new joint

Thank you for participating in the Borgess Online Joint Camp program Great job! Thank you for participating in the Borgess Online Joint Camp program Please be sure to complete the patient intake form provided on our web site, for our records

Contact Information Linda Brown, MSN, RN, ONC Clinical Nurse Specialist Borgess Joint Replacement Center Phone: (269) 226.5746 Pager: (269) 513.2746 E-mail: lindabrown@borgess.com