Download Joint Venture - Optim Surgery Center

Joint
Venture
A Total Experience
247 South Main Street
Reidsville, GA 30453
912.557.1000
Table of Contents
Welcome...................................................................................................................... 3
Pre-operative (before surgery) Class....................................................... 4
The Importance of Your Coach.................................................................... 5
Pre-op Home Checklist...................................................................................... 6
What Should I Bring to the Hospital?...................................................... 7
For Your Family....................................................................................................... 8
Anesthesia.................................................................................................................. 9
Pain Management................................................................................................. 10
For Your Safety........................................................................................................ 11
Frequently Asked Questions.......................................................................... 12
Rehabilitation Services...................................................................................... 14
Beginning Your Exercise Program............................................................. 16
List of Adaptive Equipment............................................................................ 17
Total Hip Replacement Protocol................................................................. 18
Total Knee Replacement Protocol.............................................................. 19
Going Home.............................................................................................................. 20
Welcome
At Optim Medical Center - Tattnall, our mission is to serve our patients with compassionate, quality care that is
convenient, efficient and cost effective. Our vision is to be exceptional as your trusted partner and your best choice
for health care.
We are committed to bringing you and your doctor all the services and support needed to make your total joint
replacement surgery a success. We offer the following services as part of our Joint Venture Program:
• Free education class prior to your surgery. Our total joint nurse coordinator will fully describe the surgical
procedure and take you step-by-step through the entire process from registration to discharge. She will explain
how preparation prior to surgery can speed the recovery process.
• Following surgery, you will stay in our orthopedic unit. The nursing and therapy staff are specially trained in the
care of patients who have undergone total knee and hip replacement surgery.
• Comprehensive Physical and Occupational Therapy program during your inpatient stay after your surgery.
• Assistance with discharge planning needs provided by our Case Manager/Discharge Planners.
For more information or questions, please contact:
Janet Fleming, RN at 912.557.1269
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Pre-operative (before surgery) Class
The Importance of Your Coach
This is your opportunity to learn what is in store for you in the upcoming weeks and what you can do to make your
surgery a success.
Family and friends are a major part of everyone’s life and during this experience their involvement is very
important. We encourage you to choose a family member or close friend to act as your coach as you go through the
joint replacement process. Their help and support will make your journey easier.
Please feel free to ask any questions you may have. The more you know, the better you will feel.
Class Preview
• Meet and greet
• Preparing for surgery
• What to expect during the surgical experience
Here are the things your coach can do to help you through your joint replacement experience.
Before surgery
• Attend the pre-op education class with you
• Prepare for your return home by helping you complete the Pre-op Checklist following this section
• Rehabilitation after your surgery
• How to maximize your recovery
• Questions and answers
During this class, you will meet some of the staff as well as other patients and families. Questions will be addressed
and vital information will be discussed.
Do you have a coach?
We highly recommend that you designate your spouse, friend or family member who will be caring for you after
the surgery to be your official coach. The coach will be at your side, helping you with your exercises, keeping you
motivated and generally doing what is necessary to get you back on your feet again and enjoying life. Be sure to
invite your coach to attend your class.
At the hospital
• Offer support and encouragement during therapy sessions
• Keep your morale high by sharing time and doing things that you like (board games, watching movies, etc)
• Keep you focused on returning to a healthy life style
At home after discharge
• Make sure you do the exercises. NO EXCEPTIONS!
• See that you use your walker or cane according to your doctor’s orders
• Encourage you to increase your activity level and do things gradually as you gain your strength back
• Oversee that you are following post-op orders
Depending on your progress, you may be going directly home shortly after your surgery. Once home, you may
need special equipment or training to help with your recovery. The pre-op class is the perfect time for you and your
family to start preparing for your homecoming.
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Pre-op Home Checklist
What Should I Bring to the Hospital?
Preparing for your homecoming prior to your surgery will make your post-op days go much smoother. Being
prepared is the key to a relaxed recovery. Complete the list below:
A Positive Attitude!
❏ Make arrangements to have someone stay with you until you are comfortable being on your own.
❏ Have enough food on hand or arrange for someone to go shopping for you.
Personal Care:
❏ Toothbrush/toothpaste
❏ Do the laundry, change the linens, and complete other housework before leaving for the hospital.
❏ Shaving equipment
❏ Have a pair of shoes or slippers with good support and non-skid soles.
❏ Deodorant
❏ Have easy access to a bed and bathroom on the floor level that you will be spending most of your time. Choose
a bathroom with a door wide enough to accommodate a walker. There should be enough room for a commode or
an elevated toilet seat.
❏ Eyeglasses/contact lenses, dentures, hearing aides
❏ Install a handrail, if possible, for any steps you may be using routinely.
❏ Make arrangements for walking your pets, mowing the lawn and bringing in the mail.
❏ Remove any obstacles that may cause you to trip: throw rugs, extensions cords, pets, pet toys, or low hanging
bedspreads. Make sure you have adequate lighting especially at night.
Confidence in yourself and a desire to return to a more active lifestyle!
❏ Other personal comfort items
Clothing:
❏ Hospital patient gowns are the clothing of choice for the first few days after surgery due to the presence of
intravenous (IV) lines and drains
❏ Knee length light robes or gowns
❏ Fill your routine prescriptions.
❏ Loose fitting shorts and t-shirts
❏ Take care of any financial matters such as bills, having cash on hand, etc.
❏ Non-skid footies will be provided, however, you may bring tennis shoes or any non-skid shoes
❏ Arrange for plates, pans, and kitchen utensils to be within easy reach as well as any other items you may
frequently need. Plan how you will transport your food to the table using the walker (slide on counter, walker
basket, etc)
❏ Have a phone within easy reach with emergency numbers.
❏ Have a comfortable chair with arms to help you when rising. For hip replacements: NO low, soft, upholstered
chairs or couches.
❏ Tend to any scheduled procedures like teeth cleaning before surgery.
❏ Have a full tank of gas before leaving for the hospital.
Other Important Information
• DO NOT eat, drink, smoke or take medications after midnight on the night before your surgery unless
otherwise instructed by your surgeon
• Talk with the pre-admission nurse about your diabetic medication adjustment for the day of surgery
• Talk with your surgeon about blood thinners and any other medication prior to the day of surgery
Miscellaneous Items:
❏ List of current medications; please bring your prescription bottles
❏ Insurance card
❏ Driver’s license or photo ID
❏ Contact phone numbers
❏ “Spare time” activities for your personal enjoyment and relaxation such as crossword puzzles, books, cards, etc
❏ You may bring personal cellular phones and small personal battery-operated electronic devises if desired
What should I leave at home?
• Do not bring cash over $10
• Valuable items such as keys, credit cards, jewelry, checkbooks, wallets
• Weapons are not permitted at Optim Medical Center – Tattnall
• Surgery usually lasts 2 hours for a single joint. Every patient is different. The surgery may take longer in
some instances.
• During your surgery, your family will be in the surgery waiting area
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For Your Family
Anesthesia
The Surgery Waiting Area
Anesthesia is the loss of feeling or consciousness. The Anesthesiologist is a medical doctor who administers the
medications in the operating room.
Waiting during a surgical procedure may seem like a very long time for your family. At Optim Medical Center Tattnall we strive to take excellent care of your family while doing the same for you!
The surgery waiting area is located directly outside the surgery suite.
Once you are admitted to the pre-op area your family will be able to see you before your scheduled procedure.
Your surgeon will speak with your family immediately after the surgery. You will remain in the Post Anesthesia
Care Unit (PACU) for about 1-2 hours before admission to your room. Your family is welcome to wait for you in your
hospital room.
Amenities
For your family’s enjoyment and comfort we provide the following amenities:
• Free coffee
• Wireless/Wi-Fi capability
• Television
• Conveniently located restrooms
• Magazines
• Cell phone use is permitted
Cafeteria Serving Times
Meals are available in the hospital cafeteria located on the main floor. We are open daily from 7:00 AM to 6:30PM.
Cafeteria serving times are:
• Breakfast 7:00 AM to 9:00 AM M- F (7:00 AM to 8:30 AM Sat-Sun)
• Lunch 11:30 AM to 1:30 PM
• Dinner 5:00 PM to 6:00 PM
Many medications and procedures are available to your anesthesiologist to prevent you from feeling pain during
your surgery.
General Anesthesia works best for most patients having joint replacement surgery. Your surgeon will plan to use this
technique for you unless a medical condition indicates otherwise.
Several different medications may be used for general anesthesia – some are inhaled and some are given through an
IV (intravenous line).
With general anesthesia, you may have a tube placed in your windpipe to deliver inhaled medication. This may cause
your throat to be sore following your surgery.
Your operating room anesthetist will monitor your breathing, heart rate and blood pressure during your surgery.
An IV will be started in the pre-op area prior to your surgery.
At Optim Medical Center-Tattnall, we value your safety and concerns. You do not need to worry that you will
wake up too early or that you will feel the surgery being performed. Your anesthesiologist will make sure you
wake up at just the right time!
To assist with post-op pain control, your anesthesiologist may administer a major nerve block for patients having a total
knee replacement. This nerve block will provide post-op pain control for many hours following your surgery.
Please feel free to talk with your surgeon or nurse if you have any questions or concerns about your anesthesia options.
Vending machines with drinks and snacks are located in the hallway outside the main entrance registration waiting room.
Visiting Hours
To maintain a more restful atmosphere, it is recommended no more than 2 visitors should be with the patient at
a time. Children under the age of 12 may be permitted with special permission from the doctor or Nursing Shift
Supervisor. General visiting hours are from 10:00 AM to 8:30 PM.
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Pain Management
Following a joint replacement surgery, pain is a consequence that needs to be managed adequately. Your team is
ready to help you; however, for them to help you, you MUST tell them about your pain. By telling us about your pain,
we can become partners in managing your pain. It is important to be realistic when dealing with pain. The amount
of pain that a person feels varies from one individual to another. No two persons are exactly alike.
It is important to think along the lines of “under control” as opposed to “no pain”.
Please tell your care team if you believe your pain is under control or hampers your ability to participate in your care
and rehabilitation. If you are unable to use the pain scale, your care team will rely on other signals of pain such as
facial expressions, activity, movement, and sweating to name a few. You will be assessed routinely for existing pain
and pain relief.
Other Possible Ways to Manage Pain
• Changing your position every 1-2 hours
• Walking
• Positioning your pillows for comfort
• Talking to family and friends
• Sleeping
• Reading
• Listening to music
• Breathing exercises
• Watching television
• Relaxation techniques
For Your Safety
At Optim Medical Center - Tattnall, patient safety and satisfaction is our number 1 goal. Here are some simple ways
that can help keep you safe:
Avoid Falls
• Do not attempt to raise or lower the bed rails or lean too far out of your bed. Call for assistance when you need it.
• Wear bedroom slippers with skid resistant soles when you get out of bed. The hospital provides socks with skid
resistant soles for your convenience.
• Do not walk on wet floors.
• Ask for assistance when getting in and out of wheelchairs.
• Ask for assistance when going to the bathroom.
• Before getting out of bed, sit on the edge of the bed for a few minutes before standing and starting to walk.
• Use your nurse
After Your Surgery
After your surgery is finished you will be taken to the recovery room called PACU or Post Anesthesia Care Unit
located across from the pre-op admission area.
Our staff will be with you when you wake up from surgery. The anesthesia drugs will most likely cause you to have
blurred vision, dry mouth, chills, and they may also cause some nausea. You may have a sore throat if a tube was
placed in your windpipe during surgery.
As you wake up, you will be aware of your nurse checking your bandage and blood pressure. Your nurse will also be
asking if you are having pain or nausea. Medication is available to make you comfortable. You will be attached to
a heart monitor and oxygen level monitor. You will hear these monitors beep. You will also receive oxygen through
clear plastic tubing in your nose.
You will remain in the recovery area from 1- 3 hours depending on the anesthetic you had and your individual
reaction to it.
Visitors are not allowed in the PACU area. Please be assured that your family will be updated on your progress.
When you are released from the PACU area, the surgery personnel will transport you to your hospital room. You will
already be in your hospital bed! Your family may visit you after the nurse checks you into your hospital room.
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Frequently Asked Questions
Why should I exercise before surgery?
Will I be awake during the surgery?
The better the condition of your muscles prior to surgery, the easier and faster your recuperation is expected to be.
It is important to learn the exercises and be comfortable with them prior to surgery so that you can continue them
once you return home. Starting the exercises now will build muscle tone and pave the way to quicker recovery. Begin
doing the exercises immediately, unless you experience pain in your joint.
Most people will get both the general anesthetic and the regional anesthetic. You will not remember the surgery once
you awaken. You and your anesthesiologist will discuss which method is best for you prior to your surgery. Please feel
free to discuss any concerns you may have.
Are there any activities that I should avoid initially?
During the surgery, an anesthesiologist will administer an anesthetic that will provide total pain relief. There are
different types of anesthetics: a general anesthetic will put you into a deep sleep, while a regional anesthetic will
numb specific areas only.
Other than my scar, will my joint be any different?
Some people notice a major clicking sound when they bend their joints. This is a result of the prosthesis, or artificial
parts, coming in contact with each other. This is normal and is not a cause for concern. Most total knee patients
notice that the knee feels “different” but without pain. Most total hip patients feel like they have a normal hip again.
How long will I be at the hospital?
Joint replacement patients usually stay with us for 3-4 days, however, some may leave earlier. Before you leave, you
must meet certain functional goals. Physical and Occupational Therapy after surgery is very important.
Will I need a walker, crutches or cane?
People progress at their own rate. Normally, patients use an assistive device such as a walker and progress to a cane
afterwards. Your therapist and your physician will inform you on when you can stop using these devices.
Can I go home or do I have to go to a nursing home/rehab center?
Occasionally, some patients require a short stay in a rehab or nursing home facility BUT this is the exception rather than
the rule. Your care team will be monitoring your progress daily and will determine if you are ready to go home directly.
Will I need help at home the first week?
Although you will be well on your way to recovery when you leave the hospital or sub acute facility, arrange to have
someone assist you with meals, medications, dressing and all other daily activities for the first week or two. Be sure to
alert the joint care team if you live alone.
To make the transition to home easier, plan ahead. Prior to coming to the hospital, take care of such things as getting
prescriptions filled, changing beds, doing the laundry, washing floors, arranging for someone to cut grass, walk the
dog, stocking up on groceries, etc. Your job after surgery is to focus on your recovery, not household tasks. Will I need therapy when I go home?
For knee replacements, yes. For hip replacements, there is a possibility that you may need therapy. Therapy is a very
important component of your recovery. The number of therapy sessions is based on individual progress.
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To a large extent, your progress will be determined by how much effort you put into your exercise routines.
Your therapists will monitor your progress after surgery and will help determine your therapy needs after discharge.
Your discharge planner will help arrange for your therapy after going home.
Keeping your new joint moving will help your recovery process. However, you should return to your normal activities
gradually. In some instances, you may have to work your way to a particular activity. For example, taking a five mile
walk on your first time out is not realistic. Rather, walk until you begin to get tired. Add distance to each subsequent
walk until you have reached your goal.
You will be instructed by your joint care team to avoid specific positions of the joint. Avoid high impact activities
such as jogging, singles tennis, basketball, downhill skiing, football, etc. Consult your surgeon prior to participating
in any high impact or injury prone sports.
When can I return to work?
The physical demands required for your job, as well as your own progress, will determine when you can return to
work. Your surgeon will tell you when you can return to work.
When can I drive?
How soon you can resume driving will depend on several factors such as your progress, type of car you drive,
which side of your body was the joint replaced, and if you are still taking prescription pain medications. Your
return to driving is largely dependent on your progress as well as your commitment to your exercises and physical
rehabilitation. You should NOT consider driving until you are released to do so by your surgeon.
When can I resume having sexual intercourse?
After surgery, it will take time to regain your strength as well as your confidence in your new joint. Most people feel
able, physically and mentally, to engage in sexual activity about 4-6 weeks after surgery. Talk to your surgeon if you
have any questions regarding this.
Are there any positions that should be avoided during sexual
intercourse?
For total hip replacement patients, consult your surgeon prior to resuming this activity. For total knee replacement
patients, positions involving kneeling on your new joint should be avoided at least initially. It is best to use a side
lying position in the early recovery stages. Pillows maybe used to provide support and comfort to the affected leg. As
your recuperation progresses, lying face up using a pillow or two under the knees to create a comfortable bend is an
alternative to side lying position. For male joint replacement patients, consult your surgeon first prior to assuming
the top position.
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Rehabilitation Services
Occupational Therapy
Physical Therapy
Your Occupational Therapist will:
Physical Therapy will begin on your first day after your surgery, or what is called “post-operation day 1” or simply
“POD1”. Your physical therapist will be responsible for guiding your rehabilitation efforts towards recovery.
Your Physical Therapist will:
• Assess your physical and mobility status
• Instruct and assist you with your exercise program
• Teach you movement precautions
Occupational Therapy will begin on the first day after your surgery referred to as “post-operation day 1” or simply
“POD1”.
• Help you adapt to temporary lifestyle changes necessary following joint replacement surgery
• Instruct you in using adaptive devices if needed
• Teach you movement precautions
• Instruct you with safe transfers including getting in and out of bed.
• Make recommendations for your follow-up care after discharge from the hospital.
• Make recommendations for your follow-up care after your discharge from the hospital.
During your first treatment
Your Occupational Therapist will begin your assessment which will include determining your living arrangements
and unique needs.
During your first treatment
Your therapist will develop a comprehensive plan that may include activities of daily living (ADL) training, transfer
training, adaptive equipment training and other home management skills.
• Instruct you with safe transfer, walking and stair training
Your will begin by performing bedside exercises with the therapist’s assistance. Your therapist will provide you with
a list of exercises that you will perform in therapy. The exercises will help improve the movement in your leg and will
help stretch and strengthen your muscles.
You will be assisted to a sitting position at the side of your bed. You will then be taught how to stand using a walker
and you will be encouraged to take your first steps. Your Physical Therapist will instruct you on how much weight
you can place on your operated leg.
A walker will be provided for your use during therapy sessions. You are encouraged to bring you own walker from
home; however, if you do not have one, do not worry! The discharge planners can facilitate ordering one for you
when you are ready to go home.
Please refer to the attached Total Joint Protocol for a brief summary of your rehabilitation schedule.
Your Occupational Therapist, Physical Therapist and Discharge Planner work closely together to make sure your
discharge needs are identified and addressed. This makes your transition from hospital to home as smooth and
worry-free as possible.
Please discuss any particular concerns or any special situations you may have with your therapists. We are
more than happy to assist you in any way we can!
You will be transferred to a chair out of bed. You are encouraged to sit for 1-2 hours. Once you are ready to go back
to bed, inform your nurse by using your call button. Nursing staff or the aides will then transfer you back to bed. DO
NOT attempt to get in or out of bed without staff assistance.
Our goal is for you to be more independent each day. As such, your therapist will slowly progress your therapy to
your tolerance.
Your therapist will provide lesser physical assistance each day to encourage you to use your own strength and be
more independent. Your therapist will also encourage walking farther each day. Depending on your progress, stair
training will begin on the second or third day after surgery.
Please refer to the Total Joint Protocol for a brief summary of your rehabilitation schedule.
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Beginning Your Exercise Program
List of Adaptive Equipment
Important Tips
You may need some equipment to help you during your recovery. Some of the equipment is optional and insurance
coverage varies. Because each patient recovers differently, your therapist will recommend the equipment that is best
suited for your needs. Your surgeon will prescribe the equipment you will need.
• Take short rest periods between exercise if needed
• Use slow steady movements while exercising
• Take slow deep breaths while exercising. Breathe out during the most difficult part of the exercise. Counting
your repetitions out loud will help you remember to breathe
• DO NOT over exert yourself
Equipment recommended by your health care team may not be covered by your insurance plan. Your Case Manager/
Discharge Planner will help you understand your equipment coverage and will also assist you in ordering the
prescribed equipment. Equipment may include:
• DO NOT exercise in a cold room or immediately after meals
1. Two-wheeled walker
• DO NOT continue with the exercise if it causes increased pain or discomfort. However, you may be able to
“modify” the exercise without completely eliminating it. As an example, if a particular exercise causes increased
pain with 10 repetitions, then try doing lesser repetitions and gradually add more repetitions as you are able
2.Reacher
• Stop exercising and contact your doctor if you notice chest pain, dizziness, or excessive perspiration while
exercising
3. Long-handle sponge
4. Sock aid
5. Long-handle shoehorn
6. Elastic shoelaces
Before your Surgery
• It is recommended that your perform the exercises 1-2 weeks prior to your scheduled surgery
7. Three-in-one bedside commode
8. Tub transfer bench or shower chair
• Perform the exercises 1-2 times daily
• Begin with 10 repetitions of each exercise. Gradually increase them by 1-2 repetitions each day as tolerated until
you can perform 20-30 repetitions of each exercise. Continue with 20-30 repetitions until your surgery
• A word of caution: You should be aware that there will be limitations to the range of movement available at
your arthritic joint while exercising before surgery. This limit is signaled by pain. Therefore, when exercising
your arthritic joint before the replacement surgery, stay within the limits of your pain tolerance.
After Surgery
• You will continue to perform the exercises after you leave the hospital. Please refer to any specific instructions
given by your therapist
• Taking your pain medications 30 minutes to1 hour prior to performing your exercises will help minimize pain
and discomfort
• Apply ice for 10-15 minutes after completing your exercises
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Total Hip Replacement Protocol
Pre-Op Teaching
1. Hip Anatomy
2. Hip Precautions
3. Pre-op and Post-op exercises, goals
For questions, call Optim Medical Center - Tattnall
Therapy Department • 912.557.1253
Pre-Op Teaching
Physical and Occupational Therapy is provided two
times daily, for the duration of your hospital stay.
2. POST-Op activity/expectations, goals
4. Equipment needs
1. PRE-OP exercise
3. Equipment needs
For questions, call Optim Medical Center - Tattnall
Therapy Department • 912.557.1253
Physical and Occupational Therapy is provided two
times daily, for the duration of your hospital stay.
4. Answer questions
Day 1 After Surgery
Day 3 After Surgery (May be discharged)
Day 1 After Surgery
Day 3 After Surgery (May be discharged)
PHYSICAL THERAPY (AM)
• PT evaluation
• Exercise per protocol
• Transfer training
• Gait training as tolerated with walker
• Review hip precautions
PHYSICAL THERAPY (AM)
• Exercise protocol
• Transfer training
• Gait training 200 feet with walker
• Stair training as needed
• Review hip precautions
PHYSICAL THERAPY (AM)
• Exercise PT evaluation
• Exercise per protocol
• Transfer training
• Gait training as tolerated with walker
• Knee ROM measurement
PHYSICAL THERAPY (PM)
• Gait training
PHYSICAL THERAPY (PM)
• Gait training
PHYSICAL THERAPY (AM)
• Exercise protocol
• Transfer training
• Gait training 200 feet with walker
• Stair training as needed
• Knee ROM measurement
• Discharge planning recommendation
OCCUPATIONAL THERAPY (AM)
• OT evaluation
• Review hip precautions
OCCUPATIONAL THERAPY (AM)
• ADL equipment training
• Home management/discuss equipment needs
• Review hip precautions
• Upper extremity exercise
Day 2 After Surgery
Day 4 After Surgery
PHYSICAL THERAPY (AM)
• Exercise Protocol
• Transfer Training
• Gait Training 100-200 feet with walker
• Review hip precautions
PHYSICAL THERAPY (AM)
• Exercise per protocol
• Transfer training
• Gait training at least 200 feet with walker
• Stair training as needed
• Review hip precautions
PHYSICAL THERAPY (PM)
• Gait training
OCCUPATIONAL THERAPY (AM)
• Transfer training
• ADL equipment training
• Review hip precautions
• Upper extremity exercises
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Total Knee Replacement Protocol
PHYSICAL THERAPY (PM)
• Discharge
OCCUPATIONAL THERAPY (AM)
• Finalize equipment needs
• Home management
• Patient/family will be independent with
ADL’s, transfers & upper extremity home
exercise program
• Able to verbalize hip precautions
PHYSICAL THERAPY (PM)
• Exercise protocol
• Gait training
OCCUPATIONAL THERAPY (AM)
• OT evaluation
• Transfer training
PHYSICAL THERAPY (PM)
• Exercise training
• Gait
OCCUPATIONAL THERAPY (AM)
• ADL equipment training
• Home management
• Discharge planning recommendation
• Upper extremity exercises
Day 2 After Surgery
Day 4 After Surgery
PHYSICAL THERAPY (AM)
• Exercise Protocol
• Transfer Training
• Gait Training 100-200 feet with walker
• Knee ROM measurement
PHYSICAL THERAPY (AM)
• Exercise per protocol
• Transfer training
• Gait training at least 200 feet with walker
• Stair training as needed
• Knee ROM measurement
PHYSICAL THERAPY (PM)
• Exercise Protocol
• Gait training
PHYSICAL THERAPY (PM)
• Discharge
OCCUPATIONAL THERAPY (AM)
• Start ADL training
• Identify equipment needs
• Transfer training
• Upper extremity exercises
OCCUPATIONAL THERAPY (AM)
• Finalize adaptive equipment
• ADL training as needed
• Home management
• Patient/family will be independent with upper
extremity home exercise program
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Going Home
Before You Go Home
At Optim Medical Center-Tattnall, the Case Management/Discharge Planning Department will assist you with
any discharge needs. You will be contacted by our Discharge Planning Nurse prior to your surgery to discuss your
options. Our staff is available to help you and your family plan for your care after you leave the hospital. They will
not make decisions for you and your family but will provide information to allow you to make the best decision
about your care after discharge. We offer a variety of services and can help coordinate community services to assure
continuing care after leaving the hospital. In addition, they can assist you in understanding your insurance coverage
options.
Thank you for choosing
If you need additional rehabilitation after your acute hospital stay, we will be more than willing to assist you with
alternative arrangement.
There are different levels of care available including extended care facilities, transitional care units and acute
rehabilitation units. All the units provide 24 hour care for patient. Placement is determined by the level of care you
need, physician order, bed availability and payment source.
When it becomes apparent that you will have care needs that cannot be provided at home, we will begin the process
of assisting you and your family in making alternative decisions.
The Case Management/Discharge Planning staff is available Monday through Friday from 8:00 a.m. to 4:30 p.m.
They may be reached at 912-557-1206.
Your doctor will order your discharge from the hospital and provide you with specific discharge instructions.
These instructions will include:
• Information on how to take your medications
For questions or for more information about our
Total Joint Replacement Program please contact:
Janet Fleming, RN at 912.557.1269
• Managing your pain and how to minimize swelling
• How to care for your dressing and incision
• Follow up appointment with your surgeon and physical therapy
• Activity and diet information
• Warning signs of problems like infection and blood clots
optimhealth.com
00207-7
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Joint
Venture
A Total Experience
Patient Guide to Total
Shoulder Replacement
247 South Main Street
Reidsville, GA 30453
912.557.1000
Welcome
This booklet provides valuable information for you and your family regarding your shoulder replacement surgery.
The goals of our staff are to restore your shoulder to a painless, functional status and to make your hospital stay as
beneficial, informative, and comfortable as possible.
Table of Contents
The Shoulder Joint............................................................................................................................... 3
Front View of Shoulder....................................................................................................................... 4
Back View of Shoulder........................................................................................................................ 5
Arthritis of the Shoulder.................................................................................................................... 6
X ray View of Arthritic Shoulder.................................................................................................... 7
Benefits of Total Shoulder Replacement.................................................................................... 8
Total Shoulder Arthroplasty............................................................................................................. 9
X ray Conventional Total Shoulder Replacement................................................................... 10
X ray Reverse Total Shoulder Replacement.............................................................................. 11
Preparing for Your Surgery.............................................................................................................. 12
Readying Your Home.......................................................................................................................... 13
The Day Before Your Surgery.......................................................................................................... 14
Day of Surgery....................................................................................................................................... 15
After Your Surgery............................................................................................................................... 16
Resuming Normal Activities............................................................................................................ 17
The Shoulder Joint
In the normal shoulder, the humeral head (“ball”) at the top of the arm rotates smoothly inside the glenoid cavity
(“socket”), see figure 1.
On an x-ray of a normal shoulder, a slight space can be seen between the humeral head and the glenoid cavity. This
indicates a smooth, gliding joint surface, see figure 2.
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Arthritis of the Shoulder
Benefits of Total Shoulder
Replacement
Osteoarthritis
The most common form of shoulder arthritis typically develops in older patients after a lifetime of wear and tear.
Posttraumatic arthritis
Occurs after a broken bone or injury.
• Eliminate or reduce pain
Inflammatory arthritis
An autoimmune disease that destroys the joint.
• Improve quality of life
Rotator Cuff Arthropathy
If the muscles surrounding the shoulder are severely damaged, the altered shoulder motion can wear out the
gliding surfaces.
• Low-impact sports and activities
Arthritic shoulder
• Enhance movement and mobility
• Return to normal activity
The technique for total shoulder replacement, also called arthroplasty, removes damaged bone and cartilage in the
joint. The bone is replaced with implants made of metal alloy and polyethylene (plastic), recreating the smooth
gliding surfaces that were once intact.
There is no space between the shoulder’s ball and socket, indicating that the normal surfaces are likely destroyed.
Also, the Osteophyte (bone spur) is probably causing additional pain and stiffness.
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Total Shoulder Arthroplasty
Total Shoulder Replacements
Conventional Prosthetic
The conventional prosthesis mimics the natural anatomy of the shoulder. The head of the humerus is replaced
with an artificial ball (usually metal) and glenoid is replaced with an artificial socket (usually plastic). The goal is to
remove the damaged cartilage and bone and restore the normal function of the shoulder joint.
Reverse Prosthetic
The reverse prostheis actually reverses the anatomy of the shoulder. A metal ball is attached to the glenoid and a
plastic socket component replaces the head of the humerus. Because this procedure is performed on people with a
poorly functioning rotator cuff, the prosthetic is designed with a deeper socket to help hold the joint in place.
Conventional
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Reverse
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Preparing For Your Surgery
Preparation for your shoulder replacement surgery begins several weeks before the date of your surgery itself. To
begin with you will be asked to keep the following appointments:
Pre-Admission Testing: This is an interview with our preadmission nurse and a series of tests ( x-rays, blood work
etc.) in preparation for your surgery. You may request to meet with the anesthesiology staff member to discuss the
type of anesthesia you will undergo.
Medical Clearance for Surgery: Approval for you to undergo surgery may be required from your primary physician.
This examination, along with Pre-Admission Testing, is necessary to review your overall health and identify any
medical condition that could interfere with your surgery or recovery.
Readying Your Home
There are several thing that you (or a friend or family member) can do before entering the hospital to make your
home safer and more comfortable upon your return:
• In the kitchen and elsewhere, place items that your use regularly at arm level so you do not have to reach up or
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bend down.
As you will be wearing a sling, rearrange furniture if necessary to give yourself enough room to maneuver.
Get a good, firm chair, preferably one that allows you to recline.
Remove loose carpets and rearrange electrical cords in the areas where you will be walking.
Set up a “recovery center” in your home, with the phone, television remote control, radio, facial tissues,
wastebasket, pitcher and glass, reading materials, and medication within reach.
In the weeks before your surgery you may also be asked to:
Have a dental examination: Although infections in joint replacements are not common, one can occur if bacteria
enter the bloodstream somewhere else in your body. Therefore, you should plan to have dental procedures such as
extractions or periodontal work done before your surgery.
Stop taking certain medications: Your surgeon can advise you which medications to stop taking before your
surgery. Be certain to tell your surgeon all the medications that you are taking, including over-the–counter
medications, because some of these may increase your bleeding during surgery.
Evaluate your needs for at-home care after discharge from the hospital: Most shoulder replacement patients will
need help at home for the first few weeks, including assistance with preparing meals and transportation.
Review your insurance: Contact your insurance company well ahead of time to familiarize yourself with the
benefits available to you. For example, different insurance providers have different rules for determining the medical
necessity of rehabilitation, and most do not provide a benefit for your transportation home. Also, be aware that you
will be billed separately by the hospital, your surgeon, and your anesthesiologist and that different insurance plans
have different formulas for determining payments for these services.
The Day Before Your Surgery
The day before your surgeryYou will receive a telephone call from the hospital between 2:00 and 4:00 PM on the
weekday before your surgery telling you what time to arrive for your surgery. For example, if your surgery is
on a Tuesday, the hospital will call you on Monday afternoon; if your surgery is on a Monday, the call will be on
Friday afternoon. Your arrival may be scheduled for as early as 6:00 AM, so be sure to get a good night’s sleep. It is
important that you arrive on time because if your are late, your surgery may have to be rescheduled.
About Diet: You may eat normally on the day before your surgery, but do not drink alcohol. DO NOT EAT OR DRINK
ANYTHING AFTER MIDNIGHT.
Surgery preparation checklist
Night before your surgery:
❏ Shower ( may be done day of surgery if time permits)
❏ Apply skin prep solution using the supplied skin prep clothes to your shoulder, arm, upper back and chest.
❏ Nothing to eat or drink after midnight (includes chewing gum, hard candy, ice chips)
The day of your surgery:
❏ Take routine medications with a sip of water - as instructed by the pre admission nurse.
❏ Brush your teeth and rinse - without swallowing.
❏ Wear clean, comfortable clothing.
❏ Leave valuables at home
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The Day Of Surgery
• Your pre op nurse will escort you to the pre op department. Your family will be invited back to be with you once
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you are ready for your procedure.
You will change into a hospital gown and asked to lay down on a stretcher bed. Your nurse will cover you with
warmed blankets.
Your nurse will confirm the correct shoulder and your consent for the surgical procedure.
The staff will perform an assessment of your vital signs (temperature, blood pressure, heart rate and rhythm) and
start your IV.
Your surgeon will place his/her initials on the shoulder to be replaced as an extra precaution.
Your anesthesiologist will explain the type of anesthesia to be used for your surgery. Prior to going to the
operating room, he/she will perform an interscalene nerve block using mild sedation. This nerve block will
make your arm and hand feel numb for several hours after your surgery. You will be given general anesthesia
to keep you sound asleep during your operation and be assured that your operating room experience will be a
painless and tranquil one.
After Surgery
Resuming Your Normal Activities
After surgery most shoulder replacement patients experience a dramatic reduction in joint pain and a significant
improvement in their ability to participate in the activities of daily living. Be aware, however, that recovery takes
time. Expect to feel a bit more tired than usual for a few weeks and give yourself time to regain your strength and
endurance.
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Once you are home, you will want to keep track of your general health for several weeks. In particular:
Notify your doctor if your temperature exceeds 101 F
Take all medications as directed.
Notify you doctor immediately if you notice tenderness, redness or pain in your calf, chest pain, and/or shortness
of breath. These are all signs of possible blood clot.
• Keep your incision clean and dry. You will be given instructions on how to change the dressing.
• Your nurse will review signs and symptoms of complications and when to call your surgeon.
Because you have an artificial joint, it is especially important to prevent bacteria from entering your bloodstream
that could settle in your joint implant. You should take antibiotics whenever there is a possibility of a bacterial
infection, such as when you have dental work. Be sure to notify your dentist that you’ve had a joint implant; they are
trained to prescribe antibiotics for you to take by mouth prior to a cleaning, an extraction, periodontal work, dental
implant or root canal.
• When your surgery is complete you will be taken to the recovery room by hospital bed for about 1 hour for close
monitoring.
• Once stable, you will be admitted to the hospital for in-patient monitoring for at least 24 hours.
• Your arm will remain in a sling for 4 – 6 weeks. If you had a nerve block it will take about 12-18 hours to wear off,
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during which time your hand and arm will be numb.
When your are able to move your hand, begin making a fist and hold it for 5 seconds. This small exercise will
help keep your blood circulating and should be done frequently.
While in the hospital, you will receive medication to control your pain and your health will be carefully
monitored.
When you are ready to be discharged home, your nurse will review and provide you with all of the instructions
which include: hygiene, incision care, pain medication, do’s and don’ts based on your surgeon’s requirements and
proper arm sling application.
You may experience swelling and bruising of the hand and arm. This is normal and results from the swelling and
bruising from the shoulder, which travels down the arm. It is recommended that you bend and straighten your
elbow and make a fist to help keep circulation moving.
Your follow up appointment will be scheduled within 1-2 weeks after surgery.
The specifics of your rehabilitation will be determined by your surgeon based on your condition.
Therapy may continue for 4-6 months after your surgery.
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Don’t Get Behind:
Constipation from Narcotic
Pain Medication
Did You Know?
Narcotic pain medicine causes constipation in most people. This medicine slows down the natural motion
(peristalsis) in the intestinal tract and this causes the stool to become hard. If you have hard bowel movements,
have trouble passing bowel movements, and the movements are not often enough, then you have constipation
Constipation Prevention
Make a plan and stick to it as long as you are taking narcotic pain medication. Here are some things to include
in your plan:
• Eat foods that have helped you to relieve constipation in the past.
• Eat foods high in fiber or roughage. This includes foods such as uncooked fruits, raw vegetables, and whole
grain breads and cereals.
• Drink plenty of liquids. Eight to ten 8-ounces glasses of fluid each day will help keep your stools soft. Warm
liquids often help your bowels to move. Try warm prune juice.
• Take a daily stool softener that contains the compound docusate (for example, Colace). This increases the water
absorption in the stool and keeps it soft.
• Bulk laxatives, like Metamucil®, absorb water and expand to increase bulk and moisture in the stool. They may
not be the best to use for constipation from narcotics. They should only be used if you are able to drink plenty of
fluids throughout the day.
• Three “active” laxatives that may be taken daily:
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Milk of Magnesia: Take 2 tablespoons at bedtime. If you do not have a bowel movement the following
morning, then take another 2 tablespoons that morning. This is to be followed that evening by 2 more
tablespoons. Normally, you will have a response to the MOM by the 2nd or 3rd dose.
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Dulcolax®, (bisacodyl): Take one capsule at bedtime. If you do not have a bowel movement the following
morning, then take another one that morning. This is to be followed by another capsule at night. Again, you
should have a response to the Dulcolax by the 2nd or 3rd dose.
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Senokot® (senna): Take 2 capsules at bedtime. If you do not have a bowel movement the following
morning, then take another 2 capsules that morning. This is to be followed by another 2 capsules at night.
Again, you should have a response to the Senokot by the 2nd or 3rd dose.
• If the above medications do not work, you may need a more “active” laxative.
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Magnesium Citrate: Drink one, full bottle, “chilled”. It will taste like a salty, lemon-lime soda and drinking
through a straw may make it easier to tolerate. You may notice some abdominal gurgling and it should
work anywhere from 1 to 12 hours. It is recommended that you stay near a bathroom if you take this
laxative.
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POUR:
Post Operative
Urinary Retention
Urinary retention is the inability to empty the bladder and is fairly common following anesthesia and surgery.
The medical and nursing staff at OMC- Tattnall follow standard guidelines to identify individuals with risk factors
for POUR. All surgical patients are evaluated for early signs of urinary retention and procedures for managing
patients with urinary retention are initiated.
Preoperative Risk Factors
Intraoperative or Postoperative Risk Factors
Age over 50
Prolonged length of surgery
Male
Excessive exposure to cold
Diabetes
Narcotic pain medications
Excessive alcohol intake
Pain
Constipation
Anesthesia
Elevated serum creatinine (kidney function)
Immobility
Renal insufficiency or kidney disease
Fluids consumed by mouth or IV infusion
Urethral narrowing (BPH, prostate cancer, tumor
prostatitis)
Cystocele, rectocele, bladder suspension (female)
History of chronic Urinary Tract Infections
Medications: antihistamines (allergy medicine), antidepressants, anticholinergics/antispasmostics (treat muscle
spasms, stomach cramps and urinary incontinence).
Bladder Basics
The lower urinary tract includes the bladder, a balloon shaped muscle
that stores urine, and the urethra , a tube that carries urine from the
bladder to the outside of the body during urination. A healthy bladder
can hold up to 16 ounces or 2 cups of urine comfortably for 2 to 5
hours.
Muscles called sphincters help keep urine from leaking. The sphincter
muscles close tightly like a rubber band around the opening of the
bladder, which leads to the urethra.
As the bladder fills and stretches, nerves located in the bladder muscle
will send a signal to the brain that the bladder is full and the urge to
empty your bladder intensifies.
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Bladder Basics continued
When you urinate, the brain signals the bladder muscle to tighten, squeezing urine out of the bladder while at the
same time, the brain signals the sphincter muscles to relax. As these muscles relax, urine exits the bladder through
the urethra. When all signals occur in the correct order, normal urination occurs.
Urinary retention can be caused by an obstruction (blockage) in the urinary tract or by nerve problems that
interfere with signals between the brain and the bladder. If the nerves aren’t working properly, the brain may not
get the message that the bladder if full. Even if you know that your bladder is full, the bladder muscle that squeezes
urine out may not get the signal that it is time to push, or the sphincter muscles may not get the signal that it is
time to relax. A weak bladder muscle can also cause retention.
Urinary retention can be acute, a short term but serious complication, or it can be chronic, an ongoing problem that
can persist for weeks or months.
Symptoms of acute urinary retention include bladder discomfort or pain, having the urge to urinate but can’t, and
your lower abdomen bulging above the pubic bone.
Symptoms of a less serious form of urinary retention that can happen after surgery include a delay in getting the
urine stream started or feeling as the though the bladder is still full after urinating.
The inability to urinate after surgery is usually caused by a condition called neurogenic bladder, a type of bladder
dysfunction that interferes with the nerve impulses from the brain to the bladder. When the bladder does not
receive the signal to empty, it will continue to fill causing pain and eventually cause the urine to back up into the
kidneys.
For patients with no history of having difficulty urinating prior to surgery, the problem is often attributed to a
combination of risk factors that include anesthesia, pain medications and fluids given by IV during surgery.
Following your surgery, the nursing staff will be measuring your INTAKE (the amount of IV fluids you receive and
the fluids you drink) and measuring your OUTPUT (amount of urine, collected drainage from your wound, and if
you should vomit).
If you are unable urinated within 4-6 hours after surgery your bladder volume may be checked using device called
an Ultra Sound bladder scanner. This device is moved over your lower abdomen and it will read the amount of
urine in your bladder. If there are 400- 600 ml (13 – 20 ounces) your nurse will initiate some interventions such as
assisting you out of bed, offer toileting or bedside commode, standing with urinal at bedside (males) and providing
privacy. If these don’t work then a soft flexible tube called a catheter will be placed into your bladder to drain the
urine and relieve the pressure in your bladder. The catheter may be left in for 24 hours to allow time for your nerve
impulses to “wake up” after surgery or it may be removed as soon as the bladder is drained.
You should inform your nurse of any pre-existing problem with urination so measures to avoid urinary retention
can be started early. Many times this involves taking medicine and the use of the urinary catheter can be avoided.
Warning Signs of
Complication and Infection
Warning Signs of Infection
Notify your surgeon if you experience:
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Fever of 101 or higher
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Persistent redness and drainage from the surgical incision (pus, foul odor)
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Increase in pain and/or localized tenderness and swelling
Warning Signs of DVT (Deep Vein Thrombosis)
Notify your surgeon if you experience:
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Increased pain in your calf or thigh
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Tenderness or redness above or below the incision
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Increased swelling in your calf, ankle or foot that does not decrease with elevation
Warning Signs of PE (Pulmonary Embolism)
Call 911 and go to the nearest medical facility if you experience:
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Sudden increased shortness of breath
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Sudden onset of chest pain
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Localized chest pain with coughing
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Prophylactic Antibiotics
Dental care and invasive procedures can potentially cause an infection in your artificial joint. Prophylactic
antibiotics may be required prior to, during and after certain procedures.
Notify your physician or dentist if you are having any of the following:
• Any dental procedure (cleaning, cavities filled, teeth pulled, root canal)
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Gum disease or irriation
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Genitourinary procedures (urinary catheter insertion)
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Colonoscopy, gastroscopy, barium enema
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Liver biopsy
•Bronchoscopy
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Any infection
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Exercising Your Lungs
Deep breathing can help prevent pneumonia or other problems that can slow down your recovery and lengthen
your hospital stay.
Your doctor will want you to use a device called an Incentive Spirometer, which helps you breathe in and out
correctly. It is important to perform your breathing exercises every 1-2 hours while you are awake.
Incentive Spirometry Technique:
1. Sit up as straight as possible.
2. Hold the incentive spirometer in an upright position.
3. Exhale normally.
4. Place your lips tightly around the mouthpiece.
5. Breathe in slowly and as deeply as possible, raising the volume indicator toward the top of the column.
Keep the yellow flow rate guide in the “best” range. This coaches you to breathe not too fast or too slow.
6. Hold your breath as long as possible (for at least 5 seconds).
7. Remove the mouthpiece from your lips and exhale slowly.
8. Allow the volume indicator to return to the bottom of the column.
9. Rest for a few seconds and repeat at least 10 times every hour while you are awake.
After you complete your breathing exercises you should cough to help remove any fluid that may be in
your lungs.
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Exercise Program:
Total Joint Replacement
Patients
Elevated ankle pumps
(enhances leg circulation and ankle motion)
• Lie on back with foot elevated up on pillow.
• Move foot up and down, pumping the ankle.
Perform 3 sets of 10 repetitions, 2 times a day.
Rest 1 minute between sets.
Perform 1 repetition every 4 seconds
Knee extension (strengthens front of thigh)
• Sit with leg extended.
• Tighten quad muscles on front of leg, trying to push
back of knee downward.
• SPECIAL INSTRUCTIONS: Do not hold breath.
Perform 3 sets of 10 repetitions 2 times a day.
Hold exercise for 5 seconds.
Rest 10 minutes between sets.
Short lever extension (strengthens inner thigh)
• Lie on back, with involved leg bent to 45 degrees,
supported with a pillow as shown.
• Straighten leg at knee.
• Return to start position.
Perform 3 sets of 10 repetitions, 2 times a day.
Rest 1 minute between sets.
Perform 1 repetition every 4 seconds
These exercises are to be used only under the direction of a licensed,
qualified professional.
Signature:_________________________________________
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Exercise Program:
Total Joint Replacement
Patients
Straight leg lift (strengthens hip and thigh)
• Lie on back with uninvoled knee bent as shown.
• Raise straight lef to thigh level of bent leg.
• Return to starting position.
Perform 3 sets of 10 repetitions, 2 times a day.
Rest 1 minute between sets.
Perform 1 repetition every 4 seconds
Out and in (strengthens inner and outer thigh)
• Lie on back on firm surface, legs together.
• Move leg out to side, keeping knee straight.
• Return to start position.
• SPECIAL INSTRUCTIONS: Use a pillow case to reduce
friction.
Perform 3 sets of 10 repetitions 2 times a day.
Hold exercise for 5 seconds.
Rest 10 minutes between sets.
Thigh squeezes (strengthens inner thighs)
• Lie in bed or on firm surface with towell roll or pillow
between knees.
• Squeeze legs together.
• SPECIAL INSTRUCTIONS: Do not hold breath.
Perform 3 sets of 10 repetitions, 2 times a day.
Hold exercise for 5 seconds.
Rest 10 minutes between sets.
These exercises are to be used only under the direction of a licensed,
qualified professional.
Signature:_________________________________________
Exercise Program:
Total Joint Replacement
Patients
Heel slide (increase knee and hip bend)
• Lie on back with legs straight.
• Slide heel up to buttocks.
• Return to start position.
• Repeat with other leg.
Perform 3 sets of 10 repetitions, 2 times a day.
Rest 1 minute between sets.
Perform 1 repetition every 4 seconds.
Glut squeezes (strengthens rear-end muscles)
• Lie on back with legs straight.
• Squeeze buttocks together.
• Hold and repeat.
Perform 3 sets of 10 repetitions, 2 times a day.
Hold exercise for 5 seconds.
Rest 10 minutes between sets.
Seated leg extension (strengthens front of thigh)
• Sit with involved leg bent to 90 degrees, as shown.
• Straighten leg at knee.
• Return to start position.
Perform 3 sets of 10 repetitions, 2 times a day.
Rest 1 minute between sets.
Perform 1 repetition every 4 seconds.
These exercises are to be used only under the direction of a licensed,
qualified professional.
Signature:_________________________________________