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Slide 2 Pre-Op Knee Information Welcome! 1 Slide 3 2 Slide 4 Goals Inform the patient about what to expect Before Surgery During Surgery After Surgery 3 Slide 5 Goals Reduce anxiety Answer questions Help you become better-prepared 4 Slide 6 5 Slide 7 Sections Nursing Case Management Physical Therapy Occupational Therapy 6 Slide 8 Information From The Nurse About Care And Your Concerns 7 Slide 9 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 8 Slide 10 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) 9 Slide 11 What To Bring Night clothes/pajamas, loose clothing Books, magazines, hobby items 10 Slide 12 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 11 Slide 13 Orientation To Room Call bell TV Controls/Volume Thermostat 12 Slide 14 Equipment After Surgery 13 Slide 15 Oxygen Used a short time Let us know if you have sleep apnea or use oxygen or CPAP at home 14 Slide 16 IV or Intravenous Therapy May have one or two lines Fluids-body water, blood, antibiotics, pain medication Will leave it in until discharge 15 Slide 17 Dressings and Drains Large dressing initially Drains and dressings removed 1 st or second day after surgery Dressing will be changed 16 Slide 18 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 17 Slide 19 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 18 Slide 20 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 19 Slide 21 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 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) 20 Slide 22 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 ) 21 Slide 23 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 22 Slide 24 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 23 Slide 25 Rating Pain 0 to 10 pain scale Pain patterns Mechanical Pain Surgical Pain 24 Slide 26 Know the Zone! 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) 25 Slide 27 Preventing Pneumonia Incentive Spirometer Breathe in 10-12 times an hour while awake Helps to expand air sacs in lungs 26 Slide 28 Preventing Blood Clots Medication (Blood Thinners) Calf/Foot Pumps Walking and Exercising 27 Slide 29 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 28 Slide 30 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 29 Slide 31 Walking and Exercising Helps to prevent blood clots from forming Exercise in and out of bed Ankle circles, foot pumps, tightening leg muscles 30 Slide 32 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 31 Slide 33 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. 32 Slide 34 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 ones condition You still have serious concerns about your loved ones condition after speaking to the healthcare team 33 Slide 35 Sleep Dial L.O.U.D. (5683) on phone if sleep disturbed Anonymous call TIGR TV Channels Relaxation/Meditation channels Comfort Cart 34 Slide 36 Case Management Joan Paramore RN Case Manager (919) 954-3878 35 Slide 37 Discharge Plan Goal: To get you home safely!!! 36 Slide 38 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 2 nd, 3 rd, or 4 th day after surgery 37 Slide 39 Discharge Please remember that once the Physician has written orders to discharge you home, there are still many things that have to be completed before you will be leaving the hospital. We want to make sure you have everything you need-prescriptions, home health or rehab arrangements, and information about your home care. Sometimes this process can take up to 4 or 5 hours. We know youll be eager to leave the hospital, and we want to be sure everythings in place to ensure a smooth and safe transition. 38 Slide 40 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 39 Slide 41 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 40 Slide 42 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 41 Slide 43 Discharge Plan Options: Short-Term Rehab Two types of Rehab Facilities 1.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 42 Slide 44 Discharge Plan Options: Outpatient Therapy Usually set up after Home Health is completed Rarely set up at time of discharge from hospital 43 Slide 45 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) 44 Slide 46 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 45 Slide 47 Physical Therapy 46 Slide 48 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 47 Slide 49 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 48 Slide 50 Homeward Bound Gym Stair training Car transfer exercises 49 Slide 51 Medical Equipment Walker Proper use Bedside Commode Proper use 50 Slide 52 Occupational Therapy 51 Slide 53 Treatment Demonstration of equipment ***Knee patients rarely need this equipment at discharge. The Therapist will determine your specific needs. Reacher Sock aid Bathing sponge 52 Slide 54 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 53 Slide 55 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 54 Slide 56 Assessment The following slides contain questions based on the Powerpoint. 55 Slide 57 Question 1 One risk of a blood thinner medication is: ___________?____________ 56 Slide 58 Answer Increased bleeding (Can also be increased bruising) 57 Slide 59 Question 2 You should call your Doctor immediately if you notice any sign of a blood clot. Name a symptom of a blood clot in your leg: _____________________ Name a symptom of a blood clot in your lung: ______________________ 58 Slide 60 Answer Leg: Pain in the back of the leg (usually in the calf, but can radiate throughout the leg) Lung: Difficulty breathing (may also have a rapid heart rate) 59 Slide 61 Question 3 True or False When standing up or sitting down, you should keep your operated leg slightly in front of your non-operated leg. 60 Slide 62 Answer True 61 Slide 63 Question 4 True or False When lying in bed, you should keep your operated knee in a straight position as much as possible. You should never place a pillow or rolled-up towel under the knee. 62 Slide 64 Answer True 63 Slide 65 Question 5 Some pain is normal and expected after surgery, but the best way to keep your pain at a manageable level is to: 1.Take pain medication when it reaches a 5 on a 0 to 10 pain scale 2.Take pain medication only when the pain is unbearable 3.Use medication as well as other methods to control pain. For example: ice, positioning, etc. 4.Try distracting yourself from the pain by watching television for an hour or two 64 Slide 66 Answer 65 3. Use medication as well as other methods to control pain. For example: ice, positioning, etc. Slide 67 Question 6 The best and safest way to raise the height of a chair in your home is to: 1.Stack pillows on the chair 2.Stack folded blankets on the chair 3.Place a small book under each leg of the chair 4.Place two large telephone books on the chair 66 Slide 68 Answer 2. Stack folded blankets on the chair 67 Slide 69 Question 7 One side effect of pain medication is constipation. List 3 ways to prevent it: 68 Slide 70 Answer 1.Increase fiber 2.Increase fluids 3.Increase activity You may also take a stool softener or laxative if needed. 69 Slide 71 Thank You!!! 70