Shoulder Spine

Pre-Operative Joint Replacement Education

Hip Knee

Total Joint Coordinator Registered Nurse since 2011

Graduated from Aurora University with Bachelor’s degree in Nursing

Graduated from Kansas State University with Bachelor’s degree in Public Health Nutrition

Certified Medical-Surgical Nurse

Member of National Association of Orthopaedic Nurses

Married with 2 dogs and 2 cats. Enjoys cheering on the Shockers and spending time outside.

Megan Neel BSN, CMSRN 316-962-3062 megan.neel@wesleymc.com

Topics Covered

Pre - Operative Info

• What to pack

Hospital Stay

• Physical & Occupational • Preparing your home

Surgery

• Checking In • Anesthesia • Recovery Time

Therapy • Preventing Complications • Pain Management

Discharge Planning

• Therapy Options after Discharge

• Equipment after Discharge

Pre Register

Call 316-962-7740 between 9:00 am – 5:00 pm.

OR

Pre-register online at www.wesleymc.com

Provide this information:

• Personal contact information

• Emergency contact information

• Name, address, phone number of primary care physician and surgeon

• Date of surgery

• Insurance company and policy number

• List of your medical conditions and medications you take

Pre-Op Assessment Clinic (POA)

• Call 316-962-9130 to schedule

• May take up to 2 hours can include map image

• Park in the south parking lot at Central and Rutan

• Common medical tests: – blood work – urinalysis – MRSA swab – EKG – Meet with anesthesia Nurse

Practitioner for review of medical history, physical, and receive personalized medication instructions

Pre-Op Assessment Clinic (POA)

• What to bring to your POA appointment: can include map image

• Photo ID • Insurance Cards • All medications with dosage

information (prescription and over the counter)

• Goal of POA: • Reduce delays or cancellations on the

day of surgery

Copy of Advance Directives/Living Will

Pack Your Suitcase

List of medications

• You do not need to bring your home medications • Do bring any respiratory inhalers, investigational, or compound

medications

Personal Items (please leave these in the car until after surgery)

• brush/comb, toothbrush/toothpaste, denture cup/cleaner, & deodorant • may use/bring laptops, smart phones, books, magazines or headphones • Clothes • Front-wheeled walker (if you have one)

Getting dressed is an important part of your recovery and will begin the day after your surgery.

Clothes For Therapy

Prepare Your Home

• Review the attached Home Safety Assessment sheet.

• It is important to prepare your home before your surgery so you will be able to get around safely!

Before Surgery Night Before • Bathe with

Hibiclens

• Do not eat or drink after midnight

• Do not smoke

• Do not shave your legs

Morning of

• Bathe with Hibiclens

• Do not eat or drink

• Take medications as instructed

• Get dropped off at main entrance

On Arrival

Arrival• Park in

parking garage atHillside and Murdock.

• Check in at North Registration (usually at least 2 hours prior to surgery)

Long-Term Expectations

• Decreased pain & increased range of motion by the end of recovery

• Most joint implants last approximately 20+ years

• Ongoing physical therapy or exercises after you leave the hospital

Recommendations

• Repetitive jarring activities are usually not recommended

• Antibiotics when having dental work

• BMI less 40, A1C less than 7-8, not smoking

What To Expect After Surgery

• 3 – 6 weeks - Most are back to fairly normal activities & converting from a walker to cane

• 4 – 6 weeks - Most are back to driving

• 6 -12 weeks - Most can return to work

Long Term Recovery

• 3- 6 months - Some swelling is normal

• 9 months – May have slight numbness

• 12 months – Full recovery/ stabilization

Timeframes can vary greatly. This is only intended to give you and idea.

Hospital Stay

Most patients leave the 2nd or 3rd day after surgery

• Monday surgeries stay until Wed/Thurs

• Tuesday surgeries stay until Thurs/Fri

• Wednesday surgeries stay until Fri/Sat

• Thursday surgeries stay until Sat/Sun

• Friday surgeries stay until Sun/Mon

• Occasionally patients discharge the day after surgery

To Surgery

Pre-Op Holding

• Talk to your surgical team, physician & Anesthesiologist

• Mark operative leg

• Antibiotic & relaxing medication administered

Anesthesia

Spinal

• “local” anesthesia administered in lower back

• Medication is given through a catheter, then removed

• Sedated with IV medications

OR General

• Deep sleep

If you are having a knee replacement,

the anesthesiologist will administer a

nerve block to help reduce your pain immediately after

surgery.

• Small breathing tube is placed down your windpipe

Operating Room & Recovery

Operating Room

• Surgeries are usually 1 – 2 hours long

• Patient status display screens located in waiting rooms, cafeteria

• Complimentary wi-fi available for patients and visitors

Recovery

• Close monitoring until you are fully awake

• Give pain and nausea medication, if needed

• Visitors will remain in the waiting room

• Recovery time is variable, 1+ hours

Ortho/Spine Unit

Total Joint Replacements, Broken Bones, Spine Surgeries

Care Team

• Medical needs will be managed by our hospitalist

• A resident, physician assistant or nurse practitioner will be partnering with them

• They will see you on a daily basis during your hospital stay

• Your surgeon will manage your pain and oversee your progress

• A resident, physician assistant or nurse practitioner will be partnering with them

• They will see you on a daily basis during your hospital stay

Physical Therapy

Day of Surgery

• Goal is to take steps

• Initial evaluation will take place on day of surgery if you are back to the unit by 3pm, or the next morning if you arrive after 3pm.

• Includes bed mobility (how to get in and out of bed) • Transfers (how to get up and down) • Gait (your ability to walk) • Establish Goals to address during Group Therapy

• Knee Replacement: Evaluate range of motion • Hip Replacement: Review hip precautions

Physical & Occupational Therapy

Days after Surgery

• Physical therapy twice a day • One individual session and one group session

• Occupational therapy once a day • Assesses and instructs on activities of daily living (ex. Getting dressed) • Helps you to maintain independence by utilizing adaptive equipment

Shower chair Stool riser Hip kit

What Is Group Therapy?

• Group therapy starts the day after surgery

• Therapy with other patients who had a knee or hip replacement

• 8 or less patients per session

• Group therapy room is located on the Ortho/Spine Unit

• Family welcome to attend group therapy to learn how to assist with exercises

Hip Precautions

• Patients having a hip replacement will need to follow hip precautions depending on the surgeon’s approach

• These precautions will help prevent hip dislocation

Posterior Approach Do NOT bend past 90 degrees at the hip Do NOT cross your legs Do NOT turn your operative leg inward

Lateral Approach Do NOT bring operative leg out to your side beyond a neutral position Do NOT hyperextend operative leg behind you Do NOT turn your operative leg outward past 80 degrees

Anterior Approach No positioning precautions required

Assistive Devices

Front-wheeled walkers are usually the safest mobility

•

device. • If you have a walker, please

bring it to the hospital so it can be checked for correct fitting and safety.

• If you do not have a walker, one will be provided to you during your stay.

• Gait belts are worn around your waist for walking and transfers

• These provide safety for you and staff members

Preventing Complications: Pneumonia

Incentive Spirometer

• Expands air sacs in lungs & clears air passages

• Helps prevent post-operative fever/pneumonia

• Use 10 times an hour while awake

• Coughing and deep breathing is helpful if this is not within reach

Preventing Complications: Constipation

• Stay hydrated!

Constipation is a common side effect of pain medication!

• Walking helps to relieve constipation

• Eat high fiber foods

• Most people need a stool softener or mild laxative to prevent constipation.

• These can be obtained over the counter.

• Talk to your doctor or pharmacist about what to use. Have some on hand prior to your surgery!

Blood Clot Prevention

• Blood Thinners • Will continue for 3-4 weeks after

discharge • If your surgeon has discussed

using Eliquis with you, call your insurance company to verify coverage

• Intermittent compression sleeves • Worn around your calves

• Exercises, including ankle pumps and walking

Preventing Complications: Infection

Keeping your hands clean is important for preventing infection!

The surgical dressings also help to prevent infection:

• Aquacel Ag Dressing (most common) • Stays in place until your follow up appointment, or 7

days • Has antimicrobial properties • Is waterproof, so you may shower over it (no soaking in

tubs) • Prevena Incisional Vac Dressing (less

common) • This dressing connects to a small

wound vac device that remains in place for 7-10 days.

Pain Management

• Pain is a part of the healing process and is expected following a joint replacement. Our goal is to partner with you to reduce your pain to a manageable level.

• Pain is rated on scale of 0 -10. Don’t wait to ask for pain medication when pain is a 10

• Let your nurse know if you feel like you need more/less pain medication

Pain management techniques:

• Ice packs or polar pack • Movement • Distraction • Meditation

Discharge

• On day of discharge you will have at least one physical therapy session

• Most patients are discharged in the afternoon

• Have plans for transportation

• Most patients discharge directly to home.

• Requirements for discharge:

• Cleared by surgeon and hospitalist • Cleared on stairs by physical therapy • Review instructions and medications

with nurse

Discharge

Nurse or Social Work Case Manager

• Will begin seeing you the day after surgery

• Helps arrange for post discharge needs (ex. physical therapy and/or equipment)

• Provides direction regarding insurance questions

Therapy after Discharge:

• A recommendation for the most appropriate option will be discussed amongst you, your physician, your therapist & RN.

• Specific criteria is required for each therapy option.

• The goal is outpatient therapy.

Therapy Options after Discharge

Outpatient • Clinic, similar to a gym/fitness center • 3 times per week for knees • Plan to have a ride to your appointments • Copay

Home Health • If unable to do Outpatient then

arrangements will be made for a therapist to visit your home.

• Often switch to Outpatient Therapy after follow up appointment with surgeon

Skilled Nursing • If you’re not safe to go directly home, you

may need a skilled nursing facility until you

Knee Replacements:

Plan for approximately 4 – 6 weeks of therapy

Hip Replacements:

Usually don’t need formal physical therapy.

You will work on exercises at home.

are able to return to your home environment

Outpatient Physical Therapy

• If you plan to do outpatient therapy: • We recommend you make your first appointment prior to your surgery • This increases your opportunity to get the date/time, location, and therapist

you prefer • Make your first appointment for the day following your anticipated

dismissal date or first available.

WESLEYCare Physical, Occupational, & Speech Therapy

Wesley Outpatient Therapy is located at: 3243 E. Murdock, Suite 601

Call 316-962-9835 to make your first appointment.

Pre-Operative Class

• Still feeling nervous about your surgery??

• Come to our free pre-operative class! We will review this information in more detail, allowing you to ask questions!

• Call 316-962-2735 to register

• At the pre-operative class you will have the opportunity to meet the Joint Replacement Coordinator, a therapy staff member, and a case manager

• Patients report decreased anxiety and decreased uncertainty following the class.

• Can’t make it, but still have questions? • Contact Megan Neel, Joint Replacement Coordinator

316-962-3062 megan.neel@wesleymc.com

WESLEY Healthcare

HOME SAFETY ASSESSMENT

RECOMMENDED CHANGES TO INCREASE SAFETY AROUND THE HOUSE

BATHROOM:

1.) Remove containers/ clutter from behind the bathroom door. This will allow the door toopen further.

2. ) Remove the RUG from the bathroom floor.3.) Install a grab bar on the wall or on the side of the tub. Towel racks are unsafe to grab.4. ) Recommend putting on a pair of house shoes to prevent slipping when getting out of

the shower/ tub.5.) Place non-slip strips in the bottom of the shower/ tub to prevent slipping

HALLWAY BETWEEN BEDROOM/ BATHROOM:

1. ) Remove small table(s) and / or clutter to allow a clear path to the bathroom.2. ) Remove rugs on the floor, as they are potential trip hazards.3. ) Recommend placing night light(s) in the hallway to increase visibility.

BEDROOM:

1.) Remove clothes from the door. This will allow the door to open wider.2.) Remove any furniture/ clutter that are blocking the light switches.3.) Make as much room as possible in the walking paths.4. ) Remove throw rugs.5.) Use a portable / cell phone while in the bedroom.6.) Remove clutter from around the plug-ins so as not to trip when plugging in items.

KITCHEN:

1.) Leave night-light or stove light on to increase visibility.2.) Keep food and dishes on the lower cabinets. Falls increase greatly when standing on a

chair, stool, etc.

BASEMENTS/ UP-STAIRS:

1.) Always use handrails when going up/ down the steps.2.) Add night lights (stick on photo cells) along the steps.3. ) Do not try to carry all the laundry up/ down the stairs.

If you would like someone to come out and do a Home Safety Evaluation, please call (316) 962-2875.

Evaluación de Seguridad en el Hogar

Cambios Recomendados para Aumentar la Seguridad en Su Hogar Sugerencias Generales: • Si tiene un teléfono celular, manténgalo consigo todo el tiempo (por ejemplo: en su bata/bolsillo de la

camisa o en una bolsa amarrada a su andadera). Baño: • Quite cualquier artículo que se encuentre detrás de la puerta; esto permitirá que la puerta se abra más. • Quite cualquier tapete en el piso del baño. • Considere el uso de un elevador del asiento del inodoro o la instalación de un inodoro elevado. • Instale barras de seguridad en la pared cerca del inodoro y en la ducha. Recordatorio: las barras de los

toalleros son inseguras para agarrarse de ellas. • Considere ponerse un par de zapatos/pantuflas antiderrapantes cuando salga de la ducha. • Coloque tiras antiderrapantes en el piso de la ducha para ayudar a prevenir una caída.

Vía de Acceso entre la Recámara y el Baño: • Retire las piezas pequeñas de muebles y/u otros artículos para despejar un camino de acceso desde y hacia

el baño. • Retire los tapetes del piso, ya que estos son potenciales riesgos de resbalones. • Coloque luces de noche en el camino de acceso para incrementar la visibilidad en la noche.

Recámara: • Retire cualquier artículo que se encuentre detrás de la puerta; esto permitirá que la puerta se abra más. • Retire cualquier artículo que dificulte su acceso a los interruptores de luz y tomas de corriente eléctrica. • Reorganice muebles y otros artículos en la habitación para permitirle un camino de acceso más amplio • Retire cualquier tapete • Retire cualquier cordón eléctrico en el camino de acceso; estos presentan un riesgo para tropezarse.

Cocina: • Deje encendidas las luces de noche para aumentar la visibilidad cuando esté oscuro afuera. • Almacene los artículos necesarios (comida y trastes) a un nivel donde pueda alcanzarlos fácilmente. NO se

pare sobre un banco o silla. Sótanos/Segundo Nivel: • Utilice siempre barandales cuando suba o baje escaleras • Considere añadir luces de visión nocturna (por ejemplo: pegar celdas fotoeléctricas) a lo largo de las

escaleras • Mantenga desocupadas sus manos; NO cargue artículos, como lavandería, al bajar o subir escaleras.

Si desea que alguien vaya a realizar una Evaluación de la Seguridad en Su Hogar, por favor, llame al 316-962-9835.

Ultima revisión 08/2017