Download Before Surgery - OrthoCarolina

Before Surgery
To prepare for surgery we have created this check list for you, so that you do not
forget anything. Please review each item and check it off as it is completed.
____ Bring this book with you to all appointments and to surgery, so that you can record
instructions and take notes
_____ If you need a handicap parking placard please check with your state's Department of
Motor Vehicles to secure the application. Complete your part of the application and
bring it with you so that doctor can complete and sign it. You will then return it to
your state's DMV along with the appropriate payment to secure your parking placard.
_____ The night before surgery your meal should be light; you don't want to over-due it.
Your body works hard to digest a high fat, high calorie meal and this can contribute to
nausea after surgery.
_____ Your lab work must be current, that is within 30 days of your surgery. You may be
contacted by your doctor with your CBC results and given instructions on how to take
your medications.
Bring the following with you on the day of surgery:
____ Copy of your OrthoCarolina Coordinate Care Patient Card
_____ List of all medications you are taking and the dose
_____ Your medical history
______ Copy of Living Will and/or Power of Attorney (if you have one)
____ Medications to STOP before surgery: Review the list of medications on page 34.
Highlight the medications that you are currently taking and note when you need to stop
taking them. Medications stopped prior to surgery may be taken 48 hours after your
last dose of Coumadin.
_____ You are NOT to eat or drink anything after midnight the night before your surgery.
Remember this includes food, candy, gum, mints, or water.
Special Instructions: _________________________________________________________________
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_____You have been given a special cleansing solution called Hibiclens. Starting three (3)
days before surgery you need to bath using this solution. See more information in
section___.
_____You may only take the medications on the morning before surgery that the
Anesthesiologist tells you to take. You should take them with just enough water to
swallow them. List those medications here:
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_____It is suggested that you bring your walker, or one that has been provided for you, to the
hospital the morning of surgery. Please leave it in your car until after surgery. Your
care coach can bring it to you after you are settled in your room following surgery.
_____ The post-op instructions are important.
_____For any questions or concerns remember to contact your Patient Navigator between
the hours of 8:00 AM – 5:00 PM. After hours and on weekends call 704-323-2000. A
physician or the physician’s assistant will be directed to return your call promptly.
Remember if you call after hours to tell the operator that you are a Coordinated Care
Program patient.
Journal entries and questions regarding before surgery: ______________________________________
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MRSA
Methicillin-Resistant Staphylococcus Aureus (MRSA) are organisms (bacteria) that are
resistant to some antibiotics. It is possible for an individual to carry MRSA on their skin or
in their nose and be free from symptoms and never get the infection.
A simple nasal swab can determine if you are a carrier of the bacteria. If you have a history
of MRSA or have a positive culture extra precautions will be taken to prevent the bacteria
from becoming in infection. The following precautions may be taken:
•
•
Bactroban Ointment: You will be given a prescription for Bactroban Ointment that is
to be placed in your nostrils twice a day for five days. You will begin using it three (3)
days before surgery and continue to use it for an additional two (2) days while you are
in the hospital.
• Hibiclens Soap: Starting three (3) days before surgery you will wash from neck to
toe with Hibiclens soap (an antiseptic skin cleanser). This cleanser helps to kill germs
and bonds with your skin so that it continues killing germs after you use it. You will use
the Hibiclens soap for an additional two (2) days while you are hospitalized. Please see
the Pre-Op Hibiclens Bathing Instructions sheet.
Hand Hygiene: Everyone entering your hospital room (hospital staff, physicians, and
visitors) need to wash their hands or use a hand gel sanitizer. We encourage you to
make sure they do this by asking them if they have washed or used gel on their hands.
Journal entries and questions regarding MRSA and hygiene:
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Medications That Increase Bleeding or May Interfere with Anesthesia
Some medications impair the body’s ability to form a clot and stop bleeding. Obviously,
failure to normally form clot is undesirable around the time of surgery.
ASPIRIN:
Ideally, aspirin should be discontinued a minimum of 7 (preferably 10) days prior to
elective surgery. This advice includes products containing aspirin, like Percodan™.
Non-steroidal Anti-inflammatory Drugs (NSAIDs):
Non-selective COX inhibitors (NSAIDs, e.g. ibuprofen, ketoprofen, Advil, Motrin, many
others) should be discontinued a minimum of 5 (preferably 7) days before elective surgery.
The selective COX inhibitor, Celebrex, CAN be continued. If you have a question about your
painkiller, ask your surgeon.
Vitamins, Supplements, Herbals:
Many herbal medications and supplements may increase bleeding and/or interact with
medications used for anesthesia. In many cases, the exact composition of herbal supplements
and the potential interactions are unknown. Specific recommendations cannot be given.
Therefore, DO NOT TAKE these medications for a minimum of 7 days prior to elective surgery.
Alcohol and Recreational Drugs:
Drink less alcohol as alcohol may alter the effect of the anaesthetic drugs. Do not drink alcohol
24 hours before surgery.
Stop taking recreational drugs before surgery as these may affect the anaesthetic drugs. If you
have a drug addiction please tell your anaesthetist.
Medications – Prior to Surgery
TAKE
DO NOT TAKE (Discontinue 7 Days
Prior to Surgery)
Cardiac medications (for the heart)
Chewable antacids (TUMS, Rolaids, etc.)
Anti-reflux medications (Prilosec, Nexium, Protonix)
Seizure medications (anti-convulsants)
Bronchodilators (inhalers and medication for the
Diuretics (water pills, furosemide,
hydrochlorotiazide)
Oral hypoglycemics (Glucophage, Avandia,
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lungs)
Steroids (prednisone)
Immunosuppressants
Thyroid replacement (Synthroid)
Anti-Parkinson medications
COX-2 antagonists (Celebrex)
Opiates (without aspirin; Tylenol #3,
Noreo, fentanyl, etc.)
Actos, DiaBeta, Mecronase, Glucotrol,
Amaryl)
Birth Control Pills & and male or female
hormones (including creams or
patches)**, such as Emcyt, Estraderm,
Estratest, Estrace, Estradiol, Estrogens,
Ogen, Premarin, Prempro, Testosterone
Aspirin (and aspirin-containing
compounds) such as: Alka-Seltzer, BC
Powder, Bufferin, Disalsid (Salsalate),
Dolobid (Diflunisal), Ecotrin or Uncoated
Aspirin* (81mg-325mg), Excedrin, Fasprin
(81mg), Goody Powder, Norgesic, Pepto
Bismol, Percodan
Antniplatelets such as: Aggrenox (aspirin +
dipyridamole), Plavix* (dopidogrel), Pletal
(cilostazol), Trental (pentoxil)
Antithrombotics such as: Ticlid
Anticoagulants, such as: Coumadin
(discuss the use of Lovenox with y our
surgeon—you will receive special
instructions and a prescription if you are
placed on this medication)
Non-steroidal Anti-inflammatory Drugs
(Ibuprofen, Motrin, Advil, Mobic, Orudis, etc.)
Weight reduction agents
Vitamins such as: A, C, E, K, Multivitamins,
Fish Oil, /Omega 3,6,9, Juice Plus, CoQ10
Herbs such as: Echinacea, Ephedra, Garlic,
Ginkgo, Ginseng, Kava, St. John’s Wort,
Valerian, Saw Palmetto
Supplements such as: Glucosamine
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Chondroitin, MSM
NOT TAKE (Discontinue 7 Days) PRIOR
TO SURGERY
Stop all non-steroidal anti-inflammatory
(NSAID) medications, such as: Advil
(ibuprophen), Aleve (naproxen), Anaprox
(naproxen), Ansaid (flurbiprofen),
Arthrotec (voltaren + cytotec), Cataflam
(diclofenac potassium), Clinoril (sulindac),
Daypro (oxaprozin), Diclofenac (voltaren),
Feldene (piroxicam), Ibuprofen (motrin),
Indocin (indomethacin), Lodine
(etolodac), Meclomen (meclofenamate),
Mediprin (ibuprofen), Mobic (meloxicam),
Naprelan (naproxen), Naproxyn
(naproxen), Nuprin (ibuprofen), Orudus
(ketoprofen), Oruvail (ketoprofen),
Relaten (nabumetone), Tolectin (tolmetin)
*If you have Heart Stents and take Plavix and Aspirin: DO NOT STOP ASPIRIN; DO NOT
STOP PLAVIX UNTIL SEEN BY A CARDIOLOGIST PRIOR TO SURGERY
** You may wish to use another form of birth control at this time.
CONTACT YOUR MEDICAL DOCTOR FOR INSTRUCTIONS if you take any of the following
medications: Adderall, Cytoxan, Enbrel, Imuran, Librax, Librium, Methotrexate, Remicade
Remember: Stop only the types of medications mentioned above—DO NOT STOP taking
other prescription medications.
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STOP
7 days before
Surgery
Date:
STOP
Ok to take 7 days
Before Surgery
3 days before
surgery
Ok to take 3 days
Before Surgery
Date:
Journal entries and questions regarding medications:
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Dr. ______________________ would like you to take Acetaminophen (Tylenol) before surgery
because it allows your body to tolerate pain better. Taking it for 24 hours before surgery
will help you to feel less pain after the surgery and decrease the need for IV pain medication
after surgery.
You will take two regular strength Acetaminophen (Tylenol) to equal 650 mg, by mouth
every 6 hours, starting the day before your surgery.
ATTENTION: DO NOT TAKE TYLENOL IF:
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•
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You are taking any medicine that already contains Acetaminophen (Tylenol). Please
check with your doctor or pharmacy if you are not sure.
Please let your surgeon know if you have ever been advised not to take Acetaminophen
in the past
You have liver disease.
Date of Surgery: _________________________________
Date to Start Acetaminophen (Tylenol): _______________________________
Check off Time Taken
Time of day
11:00 am
5:00 pm
11:00 pm
5 am day of surgery
If your surgery is at 7 am take your 5 am dose with a small sip of water
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Please keep this record until after your 1st Post-Op Visit, unless
directed otherwise:
1. Medications
First, list the medications that you are taking, and when you take them:
Name of Medication
Example: Aspirin
Dose
2 – 80 mg tablets
Frequency
Every 6 hours
Week 1: Record the following information when you have taken your medication:
Medication Sunday
Monday
Tuesday
Wednesday Thursday Friday
Saturday
Date/Time Date/Time Date/Time Date/Time
Date/Time Date/Time Date/Time
Aspirin
2/9 8am
2 tabs
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Week 2: Record the following information when you have taken your medication:
Medication Sunday
Monday
Tuesday
Wednesday Thursday
Friday
Saturday
Date/Time Date/Time Date/Time Date/Time Date/Time Date/Time Date/Time
Aspirin
2/9 8am
2 tabs
2. Track the following items as well:
Week 1: Record the following information:
Fluid Intake
Urine /
Bowel
Movements
Temperatur
e
1 x/day
Waling with
walker/
distance
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Date/Time
2/9 10am
8 oz water
2/9 2pm
1 can
ginger ale,
etc
2/9 6 am
Urine light
yellow
2/9 12 pm
b.m.
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
Date/Time
2/9 12 pm
99.9
2/9 12 pm
50 ft
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Week 2: Record the following information:
Fluid Intake
Sunday
Date/Time
Monday
Date/Time
Tuesday
Wednesday Thursday
Date/Time Date/Time Date/Time
Friday
Saturday
Date/Time Date/Time
Urine /
Bowel
Movements
Temperature
1 x/day
Waling with
walker/
distance
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Extra record sheets if needed:
Sunday
Date/Time
Monday
Date/Time
Tuesday
Date/Time
Wednesday
Date/Time
Thursday
Date/Time
Friday
Date/Time
Saturday
Date/Time
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Extra record sheets if needed:
Sunday
Date/Time
Monday
Date/Time
Tuesday
Date/Time
Wednesday
Date/Time
Thursday
Date/Time
Friday
Date/Time
Saturday
Date/Time
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Extra record sheets if needed:
Sunday
Date/Time
Monday
Date/Time
Tuesday
Date/Time
Wednesday
Date/Time
Thursday
Date/Time
Friday
Date/Time
Saturday
Date/Time
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Extra record sheets if needed:
Sunday
Date/Time
Monday
Date/Time
Tuesday
Date/Time
Wednesday
Date/Time
Thursday
Date/Time
Friday
Date/Time
Saturday
Date/Time
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Preparing Your Skin Before Surgery
General
•
Pre-Op Hibiclens® Bathing Instructions
Because the skin is not sterile, it is important to make sure that your skin is as free
of germs as possible before surgery. You can reduce the number of germs on your
skin by carefully washing before surgery.
Chlorhexidine gluconate (CHG) is a special soap that is often used to cleanse the skin before
surgery. One common brand is Hibiclens® If you are allergic to Chlorhexidine use betadine
or whatever your physician has directed you to use.
Bathing
•
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Start date: ____________________
Shower or bathe with Hibiclens® 3 days prior to your surgery including the night
before your surgery and the morning of your surgery. (A total of 5 showers or 5
baths with Hibiclens®)
Do not shave the area of the body where your surgery will be performed
With each shower or bath, wash your hair as usual with your normal shampoo
Rinse your hair and body thoroughly after you shampoo to remove all shampoo
residues
•
Apply Hibiclens® soap (chlorhexidine) to your entire body ONLY FROM THE NECK
DOWN
•
Do not get Hibiclens® near your eyes, ears, nose, mouth or genital areas.
•
•
•
•
•
Wash thoroughly, paying special attention to the area where your surgery will be
performed
Turn the water off to prevent rinsing the soap off too soon
Wash your body gently for 5 minutes. Using a soft wash cloth do not scrub your
skin too hard
Do not wash with your regular soap after Hibiclens® is used
Turn the water back on and rinse your body thoroughly
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•
•
•
Pat yourself dry with a clean, soft towel
Do not use lotion, cream or powder the day before and the day of your surgery
Wear clean clothes
Where to get Hibiclens
•
Your Patient Navigator will help you get Hibiclens.
Pre-Op
You have completed the Hibiclens at home prior to arriving for surgery.
After arriving at your facility for surgery you will be taken to the pre-op area and the nurse will
help you prepare for surgery.
Sage Wipes will be given to you by your nurse.
Do not allow this product to come in contact with your eyes, ears, mouth and mucous
membranes.
•
•
Remove two cloths at a time with the foam holder and place onto a clean table.
Use one clean cloth to prep each area of the body in order as shown in steps 1 through 6
below. Wipe each area in a back-and-forth motion. Be sure to wipe each area
thoroughly. Assistance may be required. Use all cloths in the packages. Pay special
attention to the area you will be having surgery on.
1.
Wipe your neck and chest.
2. Wipe both arms, starting with the shoulder and ending at the fingertips. Be sure to
thoroughly wipe the armpit areas.
3. Wipe your right and left hip followed by your groin. Be sure to wipe folds in the
abdominal and groin areas.
4. Wipe both legs, starting at the thigh and ending at the toes. Be sure to thoroughly
wipe behind your knees.
5. Wipe your back starting at the base of your neck and ending at your waistline.
Cover as much area as possible. Assistance may be required.
6. Wipe the buttocks.
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•
•
•
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Do not rinse or apply any lotions, moisturizers or makeup after prepping.
Discard cloths in trashcan.
Allow your skin to air dry.
Put your hospital gown on and tie it in the back.
You will remove dentures, contact lenses/glasses and jewelry.
Journal entries and questions regarding your skin preparation before surgery:
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Pre-Op at the Facility where you are having surgery:
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Your vital signs (temperature, pulse, blood pressure) will be taken.
An IV will be started to hydrate your body.
The nurse will review your medical/ surgical history and medications as well as the
results of your pre-surgery testing. Additional testing might be required at this time if
ordered by your physician.
You will be greeted by the OR staff and transported to the Pre-Op Holding Area. At this
time your family/ friends will be escorted to the Surgical Waiting Area. They will be
asked to sign in at the reception desk. If your family and/ or friends decide to leave the
surgical waiting area, they should tell the receptionist how they can be reached.
Pre-Op Holding Area
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•
•
•
•
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The Pre-Op holding area is where you will meet and talk with your surgical team.
The nurse in this area will go over your medical history with you and give you any
additional instructions.
You will meet your Operating Room (OR) nurses.
Your surgeon will be there to answer any last minute questions. Then with your
assistance, the surgeon will mark the body part that they will be operating on.
An anesthesiologist will speak to you about your anesthesia options.
Then to help you relax you will be medication and the you will be transported into the
operating room.
Operating Room (OR)
•
•
You will be prepared for surgery by the anesthesiologist and OR nurses.
It is not unusual for surgery to be delayed or changed due to emergencies or
cancellations. You and your family will be updated by the hospital staff when these
changes occur.
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Journal entries and questions regarding the Pre-Op preparations:
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