1. Pre-Op Total Joint Class
Welcome!

3. Goals Inform the patient & family what to expect…
Before, during & after surgery
Reduce anxiety
Answer questions
Help you become better-prepared

4. 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 turn it in at the end of class

5. 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 (if you use and prefer a specific product that may not available at the hospital)

6. What To Bring Night clothes/pajamas, loose clothing
Books, magazines, hobby items

7. Day of Surgery
- Park in parking deck P-2 (To the left of the hospital)

8. Infection Prevention
Chlorhexidine Gluconate (CHG) wipes will be used to cleanse and disinfect the surgical site before surgery begins
Constant handwashing/use of anti-bacterial lotion
IV antibiotics (before, during, after surgery)

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

10. Your Surgery Surgery is about 1-2 hours long
Recovery is about 1 ½ hours
Staff will page family/visitors once patient is out of recovery and give the room number. This is where you will meet your family/visitors after surgery.

11. Welcome to your room!

12. After Surgery - Oxygen Only used a short time
Let us know if you have sleep apnea or use oxygen or CPAP at home
If so, bring CPAP manual with settings as prescribed by MD

13. Dressings and Drains Large dressing initially
Drains and dressings removed 1st or second day after surgery
Dressing changed daily
after that
Cell Saver

14. Foley Catheter To Drain Urine
Stays in about 1 day
Helps to keep track of fluid balance
Good initially when not moving well
Put in after you are asleep

15. Pain Management
Our goal is to keep you comfortable and functional. It is unlikely that your pain will be 0.
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 relaxation
Our staff will make every effort to best manage your pain.

16. 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 he will use for you

17. 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

18. Knee Immobilizer
May also wear at night to remind you to keep the leg straight
Used for safety reasons
Note: You may or may not walk with the knee immobilizer on while exercising with a Therapist. However, you should
ALWAYS continue to wear it with Nursing until
you are able to do a full straight leg raise (with no
bend at the knee)
"ALWAYS WEAR IT WITH NURSING UNTIL YOU ARE ABLE TO DO A FULL STRAIGHT LEG RAISE WITH NO BEND AT THE KNEE"?
Tara Jennette
Acute Rehab Team Leader
From: Patrick C Krejci
Sent: Monday, January 03, :16 PM
To: Elizabeth Jackson; Pamela Laumakis; Sherry Foster; Tara Jennette
Subject: Knee Immobilizer
Is the following worded correctly? I will add this to the knee immobilizer slide in the Powerpoint for the Pre-Op Class....
Thanks
Note: You may or may not walk with the knee immobilizer on while exercising with a Therapist. However, you should ALWAYS continue to wear it throughout your hospital stay whenever getting out of the bed or chair with assistance.

19. Cryotherapy - “Polar Care” Device
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**
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)

20. While You Are Here

21. 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

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

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

24. Coumadin, Xarelto, Lovenox
Coumadin, Xarelto, 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

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

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

27. Bedside Shift Report Takes place @7:00AM and @7:00PM at shift change
Promotes patient safety
Opportunity for patients and/or Caregiver(s) to ask questions and address patient needs

28. Diet Initial diet is typically clear liquid
Diet will be advanced as you can tolerate
First tray is “house tray”, then you will order
Constipation because of pain meds
High fiber
Increase activity
Fluids
Nausea

29. 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.

30. 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 after speaking to the healthcare team
You notice a change in your loved one’s condition
You still have serious concerns about your loved one’s condition

31. Sleep / Relaxation Dial L.O.U.D. (5683) on phone if sleep disturbed
Anonymous call
TV Channels
Relaxation/Meditation channels
Free WiFi

32. Case Management & Discharge Planning
Goal: To get you home safely!!!

33. Discharge Plan
Everyone is assigned a Case Manager who will usually meet with you the day after surgery
Average Length of Stay: 2-3 nights
That means you should be ready for discharge around the 2nd or 3rd day after surgery

34. Discharge
Sometimes the discharge process can take up to 4 or 5 hours. We know you’ll be eager to leave the hospital, and we want to be sure everything’s in place to ensure a smooth and safe transition.

35. Discharge Plan Options: Home Health & Equipment
You will choose agency (list provided)
RN (if on Coumadin)
Physical Therapy (2-3 times/wk)
Occupational Therapy (if ordered by Doctor)
Equipment ordered…
Rolling Walker
Bedside Commode
CPM (if ordered by Doctor)
***Your Case Manager will set up a Home Health Agency (of your choice) for you

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

37. 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)

38. 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)
Pick up from the Main Pharmacy on weekends or after 4:30PM (but make payment arrangements with Plaza Pharmacy during M-F business hours)

39. Physical Therapy

40. Treatment Sessions Seven days/week
Will typically begin the day after surgery
One or two times per day with the PT
Goals will be simply to get you up walking, start you on an exercise program, and teach you any appropriate precautions

41. Treatment Sessions (cont)
Sessions will typically be brief, lasting approximately 30 minutes
Sessions are tailored for each patient and therefore will vary from patient to patient
A few of you may do well enough to walk with family, but only if approved by your therapist!
Last visit will usually be morning of discharge

42. 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

44. 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

45. General Precautions Hip Replacement Do not bend hip past 90 degrees
Do not cross middle of your body with operated leg
Do not lie on stomach for at least 6-8 weeks after surgery
Do not stay in one position for more than an hour or two

46. Homeward Bound Gym

47. Preparing for Therapy Now
General strengthening for arms and legs
Don’t do anything that would make your symptoms worse or irritate any other problem you may have
Chair push-ups can be useful for strengthening arms and preparing to use a walker or crutches
Walking or riding a stationary bike can improve your endurance

48. Occupational Therapy

49. Treatment
Sessions will usually begin Post-Op Day #1 (the day after surgery)
You may not have a session every day
Instruction will include: lower body dressing, bed transfers, bedside commode transfers, tub bench/shower transfers, personal hygiene, and use of ADL equipment if needed

50. Treatment (cont) Demonstration of equipment Reacher Sock aid
***Knee patients rarely need this equipment at discharge while most hip patients do need this equipment at discharge. The Therapist will determine your specific needs.
Reacher
Sock aid
Bathing sponge

51. 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

52. 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

53. Thank You!!!