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Pre-Op Knee Information

Pre-Op Knee Information. Welcome!. Goals. Inform the patient about what to expect… Before Surgery During Surgery After Surgery. Goals. Reduce anxiety Answer questions Help you become better-prepared. Sections. Nursing Case Management Physical Therapy Occupational Therapy.

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Pre-Op Knee Information

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  1. Pre-Op Knee 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 product 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 • Large dressing initially • Drains and dressings removed 1st or second day after surgery • Dressing will be changed

  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. 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 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

  19. 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)

  20. 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

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

  23. 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!

  24. Preventing Pneumonia • Incentive Spirometer • Breathe in 10-12 times an hour while awake • Helps to expand air sacs in lungs

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

  26. 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

  27. 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

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

  29. 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

  30. 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.

  31. 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

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

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

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

  35. 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

  36. 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

  37. 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

  38. 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

  39. 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

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

  41. 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)

  42. 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

  43. 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 866-552-9357

  44. Physical Therapy

  45. 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

  46. 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

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

  48. Medical Equipment • Walker • Proper use • Bedside Commode • Proper use

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