Pre-Op Knee Information Welcome! 1

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Goals Inform the patient about what to expect…  Before Surgery  During Surgery  After Surgery 3

Goals  Reduce anxiety  Answer questions  Help you become better-prepared 4

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Sections Nursing Case Management Physical Therapy Occupational Therapy 6

Information From The Nurse About Care And Your Concerns 7

We Care About You!!! In an effort to personalize your care while in the hospital, please let us know of any needs ahead of time Please complete the enclosed “Care Card” and forward it to the Patient Navigator at the end of class 8

What To Bring  List of medications and allergies  Glasses, hearing aids, dentures  Toiletry items Toothbrush Toothpaste  Flat, supportive, non-slip walking shoes (with a backing)  Incontinence products (you may prefer a specific product not provided by hospital) 9

What To Bring  Night clothes/pajamas, loose clothing  Books, magazines, hobby items 10

While in surgery…  CHG wipes will be used to cleanse and disinfect the surgical site before surgery begins  CHG reduces bacterial growth on the body  CHG will help reduce the chance of infection following surgery 11

Orientation To Room Call bell TV Controls/Volume Thermostat 12

Equipment After Surgery 13

Oxygen  Used a short time  Let us know if you have sleep apnea or use oxygen or CPAP at home 14

IV or Intravenous Therapy  May have one or two lines  Fluids-body water, blood, antibiotics, pain medication  Will leave it in until discharge 15

Dressings and Drains  Large dressing initially  Drains and dressings removed 1 st or second day after surgery  Dressing will be changed 16

Foley Catheter To Drain Urine  Stays in no longer than 2 days  Helps to keep track of fluid balance  Good initially when not moving well  Put in after you are asleep  Does not hurt to come out 17

PCA - Patient Controlled Analgesia  “Pain Button”  Administer to self  Close monitoring  NO ONE IS TO PUSH THE BUTTON EXCEPT THE PATIENT!!! ***Please ask your surgeon if this is an option for you 18

Femoral Nerve Block/Catheter ***Some surgeons prefer not to use this***  Numbs the front part of the leg from the groin to the knee  Stays in about two days  May cause you to have a “noodle leg”  Need to wear a knee immobilizer while standing or walking 19

Knee Immobilizer  May wear when out of bed if you have a nerve block/catheter (dependent on your Therapist)  May also wear at night to remind you to keep the leg straight  Used for safety reasons 20

Cryotherapy - “Polar Care” Device **Some surgeons prefer to use ice instead of the Polar Care Device** **Some surgeons may choose not to use the Polar Care Device or ice**  For total knee patients  Sends a cold signal to the brain to help with pain management  Helps with pain and swelling  You take this home with you ( if it is ordered by your surgeon ) 21

CPM Machine ***Some surgeons prefer not to use this***  Continuous Passive Motion machine  May be used for total knee patients ( if ordered )  Passively bends knee while in bed 22

Medications  Different color and number  Always ask nurse what meds are for  “Combination medications” that you may take at home may be given as separate pills while in the hospital 23

Rating Pain  0 to 10 pain scale  Pain patterns Mechanical Pain Surgical Pain 24

Know the Zone! Our staff will make every effort to help control your pain We will automatically give you pain medication around the clock We ask that you partner with us and ask for additional pain medicine if needed Alternative pain options may be used such as cold therapy and distraction Our goal is to keep you in the 3-4 Pain Zone (or less) 25

Preventing Pneumonia  Incentive Spirometer Breathe in times an hour while awake Helps to expand air sacs in lungs 26

Preventing Blood Clots  Medication (“Blood Thinners”)  “Calf/Foot Pumps”  Walking and Exercising 27

Coumadin and Lovenox ***Please check with your surgeon as to which blood thinner will be prescribed***  Will help to prevent blood clots from forming  Will need to learn how to take these medications safely  Will need to watch a video 28

Compression Devices  Foot or calf pumps  Help to push the blood back into circulation  Wear them when you are in bed or in the chair 29

Walking and Exercising  Helps to prevent blood clots from forming  Exercise in and out of bed  Ankle circles, foot pumps, tightening leg muscles 30

Diet  Initial diet is typically clear liquid unless otherwise designated by your physician  Diet will advance as tolerated  Constipation High fiber Increase activity Fluids  Nausea 31

Call for Help  Never get out of bed or chair unless you call for assistance  Call as soon as possible.  Try to ask for help when a staff member is already in the room. 32

Condition H (Help)  Dial 3111 and give room number  Gives family and friends a way to call a Medical Emergency team to the bedside  Call if… You notice a change in your loved one’s condition You still have serious concerns about your loved one’s condition after speaking to the healthcare team 33

Sleep  Dial L.O.U.D. (5683) on phone if sleep disturbed Anonymous call  TIGR TV Channels Relaxation/Meditation channels  Comfort Cart 34

Case Management Joan Paramore RN Case Manager (919)

Discharge Plan Goal: To get you home safely!!! 36

Discharge Plan  Everyone is assigned a Case Manager who will usually meet with you the day after surgery  Average Length of Stay: 2-4 nights That means you should be ready for discharge around the 2 nd, 3 rd, or 4 th day after surgery  11:00AM Discharge Time 37

Discharge Plan Options: Home Health You will choose agency (list provided)  RN (if on Coumadin)  Physical Therapy (2-3 times/wk)  Occupational Therapy (if ordered by Doctor) ***Your Case Manager will set up a Home Health Agency (of your choice) for you 38

Discharge Plan Options: Home Health Equipment ordered…  Rolling Walker  Bedside Commode  CPM (if ordered by Doctor) ***Your Case Manager will order your equipment for you from an agency of your choice 39

Discharge Plan Options: Short-Term Rehab If not safe to return home, Short-Term Rehab may be an option. Based on… 1. Your insurance 2. How well you progress with Therapy while in the hospital 40

Discharge Plan Options: Short-Term Rehab Two types of Rehab Facilities… 1.SNF: 1 to 3 hours of therapy/day Average Length of Stay: 1-2 weeks-as needed 2. Acute: 3 to 5 hours of therapy/day Average Length of Stay: 5 days 41

Discharge Plan Options: Outpatient Therapy  Usually set up after Home Health is completed  Rarely set up at time of discharge from hospital 42

Discharge Plan Transportation (depends on what is medically necessary)  Car  Wheelchair Van Not covered by insurance Cost: $55-$120  Ambulance Covered by insurance if “medically necessary” ***Your Case Manager will set up your Wheelchair Van or Ambulance for you (if needed) 43

If You Are Going Home… You may fill your prescriptions at our Plaza Pharmacy (Located on the First Floor of the hospital) Hours of Operation: Mon-Fri (9:00AM-4:30PM) (919) Use the Main Pharmacy on weekends or after 4:30PM (but make payment arrangements with Plaza Pharmacy Mon-Fri 9:00AM to 4:30PM 44

Total Joint Wellness Class  This free class addresses methods of maximizing the Health and Wellness of your new knee or hip joint  The class outlines… Creative ways to perform aerobic, strength, and resistance exercises within the home setting Healthy nutrition choices while eating at home and restaurant  You are welcome to bring a spouse, friend, or Coach to the class  Class is held once a month on Tuesday from 3:30 to 4:30 in the Wellness Center behind Duke Raleigh Hospital  Please register with the Patient Navigator at

Physical Therapy 46

Treatment Sessions  Seven days/week  One or two sessions per day with the Therapist  Your therapeutic activity will also involve walking with Nursing staff  Typical treatment session Post-op Days 1, 2, and 3 47

Precautions Knee Replacement  Do not stay in one position for longer than an hour without standing up, walking a short distance, and straightening and bending your knee  Do not sleep or rest with a pillow or anything under your knee  Operated leg out in front while sitting or standing 48

Homeward Bound Gym  Stair training  Car transfer exercises 49

Medical Equipment  Walker Proper use  Bedside Commode Proper use 50

Occupational Therapy 51

Treatment  Demonstration of equipment ***Knee patients rarely need this equipment at discharge. The Therapist will determine your specific needs. Reacher Sock aid Bathing sponge 52

Helpful Tips  How to properly carry items in pockets and/or basket while driving a walker  Safety in the shower (have someone close by)  While at home prior to surgery, move low- and high-lying items to waist level (i.e. in kitchen/bathroom cupboards, refrigerator)  Make arrangements to have appropriate-sized car available for your discharge 53

Before Surgery… Assess your home environment and let the Therapist know the following once you are in the hospital…  Tub/Shower (location, height, grab bars)  Number of steps (outside of home and upstairs)  Height of bed 54

Assessment The following slides contain questions based on the Powerpoint. 55

Question 1 One risk of a blood thinner medication is: ___________?____________ 56

Answer Increased bleeding (Can also be increased bruising) 57

Question 2 You should call your Doctor immediately if you notice any sign of a blood clot. Name a symptom of a blood clot in your leg: _____________________ Name a symptom of a blood clot in your lung: ______________________ 58

Answer Leg: Pain in the back of the leg (usually in the calf, but can radiate throughout the leg) Lung: Difficulty breathing (may also have a rapid heart rate) 59

Question 3 True or False When standing up or sitting down, you should keep your operated leg slightly in front of your non-operated leg. 60

Answer True 61

Question 4 True or False When lying in bed, you should keep your operated knee in a straight position as much as possible. You should never place a pillow or rolled-up towel under the knee. 62

Answer True 63

Question 5 Some pain is normal and expected after surgery, but the best way to keep your pain at a manageable level is to: 1.Take pain medication when it reaches a “5” on a “0 to 10 pain scale” 2.Take pain medication only when the pain is unbearable 3.Use medication as well as other methods to control pain. For example: ice, positioning, etc. 4.Try distracting yourself from the pain by watching television for an hour or two 64

Answer Use medication as well as other methods to control pain. For example: ice, positioning, etc.

Question 6 The best and safest way to raise the height of a chair in your home is to: 1.Stack pillows on the chair 2.Stack folded blankets on the chair 3.Place a small book under each leg of the chair 4.Place two large telephone books on the chair 66

Answer 2. Stack folded blankets on the chair 67

Question 7 One side effect of pain medication is constipation. List 3 ways to prevent it: 68

Answer 1.Increase fiber 2.Increase fluids 3.Increase activity You may also take a stool softener or laxative if needed. 69

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