Pre-Op Spine Information

1. Pre-Op Spine Information Welcome!

2. 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. Sections Nursing Case Management Physical Therapy Occupational Therapy

5. Information From The Nurse About Care And Your Concerns

6. 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

7. 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 brand not provided by hospital)

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

9. 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

10. Orientation to Room Call bell TV Controls/Volume Thermostat

11. Equipment After Surgery

12. Oxygen • Used a short time • Let us know if you have sleep apnea or use oxygen or CPAP at home

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

14. Dressings and Drains • Drains and dressings removed 1st or second day after surgery • Dressing changed daily after that

15. 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

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 for you

17. 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

18. Rating Pain • 0 to 10 pain scale • Pain patterns • Mechanical Pain • Surgical Pain

19. 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) Know the Zone!

20. Preventing Pneumonia • Incentive Spirometer or Acapella • Perform breathing exercises while awake • Helps to expand air sacs in lungs

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

22. Coumadin and Lovenox***Your surgeon may or may not place you on a blood thinner afterspinal surgery • Will help to prevent blood clots from forming • Will need to learn how to take these medications safely • Will need to watch a video

23. 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

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

25. 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

26. 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.

27. 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

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

29. Case Management Joan Paramore RN Case Manager (919) 954-3878

30. Discharge Plan Goal: To get you home safely!!!

31. 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 2nd, 3rd, or 4th day after surgery • 11:00AM Discharge Time

32. 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

33. Discharge Plan Options:Home Health Equipment ordered… • Rolling Walker (if needed) • Bedside Commode (if needed) ***Your Case Manager will order your equipment for you from an agency of your choice

34. 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

35. Discharge Plan Options:Short-Term Rehab Two types of Rehab Facilities… • 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

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

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) 954-3921 • Use the Main Pharmacy on weekends or after 4:30PM (but make payment arrangements with Plaza Pharmacy Mon-Fri 9:00AM to 4:30PM

39. Physical Therapy

40. 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

41. Specific Exercises Your Therapy will involve a lot of walking with our staff

42. General Precautions No “BLT’s” !!! • No Bending • No Lifting • No Twisting Your Therapist will also teach you how to “logroll”

43. Homeward Bound Gym • Stair training • Car transfer exercises

44. Medical Equipment • Walker • Bedside Commode

45. Occupational Therapy

46. Treatment • Post-op Day 2 visit • Demonstration of equipment • Reacher • Sock aid • Bathing sponge

47. Helpful Tips • How to properly carry items in pockets and basket while driving a walker • Safety in the shower (have someone close by) • 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 day of discharge

48. 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

49. Thank YouWe want to hear from you! Please complete our simple form to let us know that you have viewed this presentation and to share any questions or concerns you may have.