CJW Presents “Joint CJW Presents “Joint Venture” Education ClassVenture” Education Class

for Total Joint Replacement for Total Joint Replacement PatientsPatients

Use in conjunction with the patient education bookUse in conjunction with the patient education bookgiven to you at your surgeons officegiven to you at your surgeons office

PurposePurpose

• Educate our patients• Prepare you for your joint replacement• Reduce your anxiety level• Awareness of expectations- you are in charge of

your recovery

• Transition you to home- safely and quickly

Program GoalsProgram Goals

• 3-4 day hospital stay• Bring a coach for support and help• Relieve pain• Return you to more active lifestyle• Increase your quality of life• Make your hospital stay a quality

experience

Risk Factors for Total Joint SurgeryRisk Factors for Total Joint Surgery

• Blot clot (DVT)• Blood loss with risk of transfusion• Pulmonary embolism (PE)• Problems with anesthesia• Neurovascualar changes• Infection• Underlying medical conditions• Problems with wound healing

Stop Taking 7-10 days Before SurgeryStop Taking 7-10 days Before Surgery

• ASA (aspirin)• Motrin• Ibuprofen• Aleve• Herbal supplements• You can take tylenol for pain

• If you take Coumadin or Plavix– Ask surgeon before stopping medication

No Food Or Drink After Midnight the Night Before Surgery

Only take medications Pre-Only take medications Pre-admission testing tells you to take admission testing tells you to take the morning of surgery! With just a the morning of surgery! With just a

sip of water.sip of water.

NutritionNutrition

Iron RichIron RichProtein RichProtein RichLean MeatsLean Meats

Fruits & VeggiesFruits & VeggiesGrainsGrains

What to Bring to the HospitalWhat to Bring to the Hospital

• Knee length front opening robe• Personal hygiene products• Shoes with a good heel (tennis shoes)• Loose fitting pants (sweat pants)• Medical equipment (label with name)• Living will or advanced directive

What to Leave at HomeWhat to Leave at Home

• Button trousers• Tight fitting clothes• Valuables• Jewelry and credit cards• Large amounts of cash• Flip-flops or house shoes

Pre-Admission Testing (PAT)Pre-Admission Testing (PAT)Stop #1Stop #1

• One week before surgery• Bring list of medications or all medication

bottles you are currently taking– Prescription and over the counter

• History and physical- performed by NP or physician

• All necessary testing (blood work, EKG, x-rays etc.) will be completed day of visit. Plan to spend 2-3 hours at this visit.

• Insurance information

Same Day Surgery (SDS)Same Day Surgery (SDS)Stop #2Stop #2

• You will be instructed when to call for arrival time day of surgery

• Be on time-if your late so are we.

• Staff introductions– Nursing– Anesthesia

• Monitor hook up

• Start IV• Regional anesthesia• Site identification• Surgeon site marking• Questions for

surgeon

Operating RoomOperating RoomStop #3Stop #3

• Move to OR table• Apply monitors• Anesthesia administration• Foley catheter insertion• Surgical procedure• Possible wound drain• Wake up! Go to PACU

Post Anesthesia Care Unit (PACU)Post Anesthesia Care Unit (PACU)Stop #4Stop #4

• Nursing introduction-apply monitors• Vital signs every 5-15min• Wiggle toes move legs• Check level of spinal regression if applicable• Monitor pain level• Monitor drains• Fluids• Discharge to room

55thth Floor (orthopedic unit) Floor (orthopedic unit)Stop #5Stop #5

• Meet staff • Nursing assessment• Monitor vital signs every 4hrs x 24 hrs or until stable• Assess wound dressing, drains, pumps• Exercises-ankle pumps every 2 hours while awake

• Incentive spirometer-every two hours while awake

• Cough and deep breath-every two hours while awake

• Turn and Reposition self-every two hours while awake• Limit visitation-on the first day. You need to rest

• Private room

What You May SeeWhat You May See

• CPM- knee patients• CFN catheter- knee patients remove on POD #2 or when

anesthesia dictates• PCA (patient controlled anesthesia) pump for hips- hooked into IV line. Push

for pain relief. Patient controlled• Dressing

– Total Hip large bulky dressing to hip. Larger than incision– Total Knee ace bandage heel to thigh. Dressings removed 24-48hrs.

• Wound drain remove POD #1-if you have one. Surgeon will determine if you get a drain

• Foley catheter remove POD # 1-2. Depends on surgeon. Everyone who gets a total joint gets a foley catheter

• Blood pressure monitor and/or pulse oxygen monitor

PainPain

• Pain after surgery will be different than pain you are feeling now

• Muscle healing, incision pain, bone pain, swelling of joint

• Pain scale 0-10. “0” none “10” the worst• “4” is the magic number to achieve-stay ahead of your pain

• Medication every 3-6hrs. Take routinely for the first week.

• Meet therapy goals• Medicate 30 minutes before therapy or activity

– Increase chances of success

Anti-CoagulationAnti-Coagulation• You will be put on medication to decrease your

risk of blood clots and pulmonary embolism• Daily blood work for coumadin dosage while in

hospital – Coumadin dose calculated by pharmacist daily

• Continue for up to 3 weeks after discharge-surgeon will tell you when and if you can stop taking medication

• Some receive Lovenox injections-this will be determined by your surgeon.

• Surgeon will discuss with you if a blood transfusion is a necessary procedure related to your blood work during hospital stay

Side Effects of Coumadin TherapySide Effects of Coumadin TherapyIf you notice any of the following:If you notice any of the following:

• Increase in drainage from wound• Bloody, black tarry stool• Coughing up blood• Blood in urine• Nose bleeds• Bleeding gums• Vomiting blood/coffee grounds

*STOP Coumadin IMMEDIATELY* and call your surgeon!

Physical TherapyPhysical Therapy

• Physical therapy– Start date depends on Dr. order and time of

arrival to 5th floor– Early arrival therapy day of surgery– Late arrival therapy POD #1– Therapy twice daily– Walk 50-100ft– Clear stairs– CPM for knees twice daily for 2 hours as tolerated– Walkers, canes etc.

Occupational TherapyOccupational Therapy

• Start POD #1• Assist with activities of daily living

– Assistive devices– Reachers, grabbers, sock-aides, long shoe

horns, seat cushions etc.• Bathing-sink bathing until surgeon tells you that you can take a

shower

• Toileting

Case Manager/Social WorkerCase Manager/Social Worker

• Visit in hospital• Arrange home health or discharge to

skilled nursing facility or rehab if necessary

• Arrange medical equipment needed at home if any

• Review advanced directive if you do not have one

DischargeDischarge

• Home medications and new prescriptions• Home health agency and physical

therapy• Follow-up appt-you will need to call and make your

appointment. Number and approximate date will be on your discharge instructions

• Have someone stay with you for at least one week after surgery

Things to Know and DoThings to Know and Do

• Remove all throw rugs and cords from floors at home-you want to prevent falls

• Basket on walker-this helps you keep important items close to you during your recovery (phone, remote control, medicine etc.)

• Exercise– Do not sit for more than 45 min at a time (stiffness and swelling)– Walk frequently but not long distances. Walk on flat surfaces and wear good

shoes– Apply ice frequently. This helps with pain and swelling– Elevate your leg frequently– Lie down twice daily for at least one hour

• If you go to the Dr. or Dentist-let them know that you have a joint replacement. You may need pre-medicated before procedures

Signs and Symptoms of InfectionSigns and Symptoms of InfectionIf you experience any of the following:If you experience any of the following:

• Sudden increase in pain, tenderness, or swelling in surgical leg

• Increase in temperature 101 or above• Increase in amount of wound drainage• Shortness of breath or chest pain• Persistent nausea or vomitingCall your doctor!!!!!!!Some swelling, pain and slight temperature increase are not uncommon

after joint replacement surgery. If symptoms persist call your doctor

Important Phone NumbersImportant Phone Numbers

• West End Orthopedics Clinic Chippenham Campus – 804-320-1339

• West End Orthopedic Clinic Johnston Willis Campus– 804-379-8088

• Joint Coordinator CJW-Nicole Hartman– Office 804-323-8794– Pager 804-759-7459– Cell phone 804-304-6840