Download Total Joint Replacement Patient Education Packet

Joint Center
Total Joint Replacement
Patient Education Packet
Joint Center
80 Seymour Street
P.O. Box 5037
Hartford, CT 06102-5037
ph 877.58.JOINT or 860.545.0034
fx 860.545.4193
hartfordhospital.org/orthopedics
Patient Guide
WELCOME TO THE TOTAL JOINT CENTER
at Hartford Hospital
On behalf of The Total Joint Center at Hartford Hospital, and our expert
doctors, nurses and other professionals, we would like to welcome you
– and thank you for choosing us for your total joint surgery.
Our goal is to ensure the highest standards of medicine – and a highquality experience for you. We are committed to keeping you informed,
and helping you become an active partner in your health care. We will
do everything we possibly can to make your stay with us as pleasant
as possible.
You will find important instructions and information to prepare you
for your surgery in this education packet. It will answer many of the
questions you may have, and clearly outline the things you need to do
before, during and after surgery. Planning tools, advice on medications,
diet, and exercise are also included. Please take the time to read the
materials carefully.
If you have further questions about your surgery, please call your
surgeon’s office or The Total Joint Center at Hartford Hospital at
(860) 545-6468. Once again, thank you for choosing us for your
orthopaedic care.
Sincerely,
Bruce D. Browner, MD, MS
Director, Department of Orthopaedics
1
Patient Guide
PURPOSE OF PATIENT EDUCATION PACKET
Preparation for surgery, recovery and a pre-planned discharge are an
important part of your care. For this reason we are providing an education packet to communicate important information to help you prepare
for your surgery. In addition, an education class is available at no
cost. In the class you will have an opportunity to have your questions
answered. Please remember this book is only a guide with recommendations. Please be sure to follow your physician’s orders first and ask
questions if you are unsure of any information.
Instructions for using the Education Packet
• Read Section I for general information
• Read Section II - Preparing for your surgery
- Use the Checklist provided to mark items when complete
- Use the Medication List to record medications you are
currently taking
- Follow the Bathing Instructions on the day before surgery
- Follow the instructions for Diabetes Medications the day before
and the day of surgery. It is important that you talk to your surgeon or diabetes physician if you have any questions.
• Section III provides information on your surgical experience and what
to expect after your surgery, including pain control.
• Read Section IV for information on going home.
• Section V includes exercise instructions to follow (before and after
surgery). The materials in this section are located in the back
pocket of the book.
Bring this book with you to:
• Office visits with your surgeon
• The total joint education class
• To the hospital on admission
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Patient Guide
TOTAL JOINT REPLACEMENT
Patient Education Packet Index
I.
General Information
Welcome Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Purpose of the Patient Education Packet . . . . . . . . . . . . . . . . . .2
Important Phone Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
II.
Preparing for Surgery
Total Joint Education Class . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Preparing for Surgery checklist . . . . . . . . . . . . . . . . . . . . . . . . . .8
Medication List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Preparing for Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Bathing Instructions (The Day before your Surgery) . . . . . . . . . .16
Patient’s Guide to Diabetes Medication . . . . . . . . . . . . . . . . . . .17
III. Your Surgical Experience
Day of your Surgery
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
After your Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Pain Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
IV. Going Home
Discharge Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Care of your Incision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
Nutrition after your Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
3
Patient Guide
TOTAL JOINT REPLACEMENT
Patient Education Packet Supplemental Material
1. Home Care Agencies by County and Town
2. Facilities with a Rehabilitation Program by County and Town
3. A Guide for Patients, Friends & Family of Hartford Hospital
4. Getting Ready for Total Hip/Knee Replacement, Pre-op Exercises
5. Total Hip/Knee Replacement, Improving Movement
6. After Total Hip/Knee Replacement, Living with your New Knee/Hip
4
Patient Guide
IMPORTANT PHONE NUMBERS
Orthopaedic Surgeon: __________________________________________
Your Medical Doctor: ____________________________________________
Hartford Hospital:
Total Joint Class Registration . . . . . . . . . . . . . . . . . . . .(860) 545-1888
Admitting Unit (Center 8) . . . . . . . . . . . . . . . . . . . . . . . .(860) 545-2578
Assessment Center . . . . . . . . . . . . . . . . . . . . . . . . . . .(860) 545-5355
Blood Donation Center . . . . . . . . . . . . . . . . . . . . . . . . .(860) 545-2484
Bloodless Surgery, Suzanne Russell, RN . . . . . . . . . . .(860) 545-4119
Integrative Medicine - (Massage, Reiki, etc.) . . . . . . . . .(860) 545-4444
Patient Accounts (Admitting) . . . . . . . . . . . . . . . . . . . . .(860) 545-2730
Pre-Admission Testing Center . . . . . . . . . . . . . . . . . . . .(860) 545-2334
Hours – Monday – Friday 8 AM to 5 PM
Surgery Time-Line . . . . . . . . . . . . . . . . . . . . . . . . . . . .(860) 545-3208
Call the day before surgery between 1 PM and 6 PM
TOTAL JOINT CENTER:
Conklin Building 4th Floor (CB4) . . . . . . . . . . . . . . . . . .(860) 545-6468
Case Coordinator, Discharge Planning/Home Care . . . .(860) 545-3432
Food and Nutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . .(860) 545-3663
Home Care Agency Listing, by County and Town
. .(See back pocket)
Hudson Suites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(860) 545-1111
Guest suites/overnight accommodations
Nurse Manager . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(860) 545-2384
Patient Relations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(860) 545-1400
Rehabilitation Department . . . . . . . . . . . . . . . . . . . . . . .(860) 972-2948
Facilities with a Rehabilitation Program,
by County and Town
. . . . . . . . . .(See back pocket)
Social Work Services, Extended Care Facilities . . . . . . .(860) 545-2966
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Patient Guide
DIRECTIONS TO HARTFORD HOSPITAL
Coming from I-84 East-Bound:
Take I-84 East to Hartford. Take the Capitol Avenue Exit 48-B (a right hand exit). At the
end of the ramp between the State Capitol Building and the Legislative Office Building,
turn left onto Capitol Avenue and turn right onto Washington St. (at the equestrian
statue of Gen. Lafayette) continuing south to the fifth traffic light (Connecticut Children’s
Medical Center and public garage on left). Turn into the drive at that light. The entrance
to the public garage is on the left.
Coming from I-84 West-Bound:
Take I-84 West to Hartford. Take the “Downtown Hartford” Exit 54 (a left hand exit)
over the Founders Bridge and guide your vehicle to the far left lane. At the bottom
of the bridge, turn left onto Columbus Boulevard; travel past the Convention Center
and across the Columbus Boulevard Bridge. Continue through five (5) traffic lights
(Columbus Blvd. will curve west and uphill, becoming Wyllys St.). At the fifth traffic
light, continue straight, crossing Main St. onto Jefferson Street. At the second traffic
light on Jefferson St., turn left onto Seymour St. At the front of Hartford Hospital, turn
right; the entrance to the public garage is on the right immediately past the Medical
Office Building and across from Connecticut Children’s Medical Center.
Coming from I-91 North-Bound:
Take 1-91 North to Hartford, follow “Capitol Area” signs to exit 29A
(a left-hand exit). Move immediately to the right lane and take the first exit (Columbus
Boulevard/Convention Center) and turn left crossing the Columbus Boulevard Bridge.
Continue through five (5) traffic lights (Columbus Blvd. will curve west and uphill,
becoming Wyllys St.). At the fifth traffic light, continue straight, crossing Main St.
onto Jefferson Street. At the second traffic light on Jefferson St., turn left onto
Seymour St. At the front of Hartford Hospital, turn right; the entrance to the public
garage is on the right immediately past the Medical Office Building and across
from Connecticut Children’s Medical Center.
Coming from I-91 South-Bound:
Take I-91 South to Hartford. Take the Capitol Area Exit 29A (a right hand exit). Keeping
in the right lane, take the first exit (Columbus Boulevard/Convention Center) and turn
left crossing the Columbus Boulevard Bridge. Continue through five (5) traffic lights
(Columbus Blvd. will curve west and uphill, becoming Wyllys St.). At the fifth traffic light,
continue straight, crossing Main St. onto Jefferson Street. At the second traffic light on
Jefferson St., turn left onto Seymour St. At the front of Hartford Hospital, turn right; the
entrance to the public garage is on the right immediately past the Medical Office
Building and across from Connecticut Children’s Medical Center.
Coming from Route 2 (Norwich Area):
Take the “Downtown Hartford” exit onto the Founders Bridge. At the bottom of the
bridge, turn left onto Columbus Boulevard; travel past the Convention Center and
across the Columbus Boulevard Bridge. Continue through five (5) traffic lights
(Columbus Blvd. will curve west and uphill, becoming Wyllys St.). At the fifth traffic
light, continue straight, crossing Main St. onto Jefferson Street. At the second traffic
light on Jefferson St., turn left onto Seymour St. At the front of Hartford Hospital, turn
right; the entrance to the public garage is on the right immediately past the Medical
Office Building and across from Connecticut Children’s Medical Center.
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Patient Guide
PREPARING FOR SURGERY
Total Joint Education Class
Preparation for surgery, recovery and a pre-planned discharge are an
important part of your care. For this reason, an Education Class is available at no cost. The class will give you a better understanding of what to
expect, before, during and after surgery. It is important that you attend
one of these classes.
The Education Class will review the material in this Education Packet
to include:
• A review of Total Joint Replacement
• Before surgery and after surgery information
• Written exercise instructions
• Nutritional information
• A view of your hospital and surgical experience
The classes are held weekly. You must make a reservation before
attending the class by calling (860) 545-1888.
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Patient Guide
PREPARING FOR SURGERY CHECKLIST
Schedule the following appointments 3-4 weeks prior to
your surgery date.
1. The results of these tests are required at least 48 hours prior to your
scheduled admission.
Physician/Lab Name
Date/Time
❑ History & Physical ______________________________________
________________AM/PM
❑ Lab Work______________________________________________
________________AM/PM
❑ EKG __________________________________________________
________________AM/PM
2. If you have a history of heart or lung problems, you will
need written clearance from your heart or lung doctor.
Schedule the following if necessary.
❑ Heart Physician ________________________________________
________________AM/PM
❑ Lung Physician ________________________________________
________________AM/PM
❑ Blood Donation (If determined by your physician) ____________________________ AM/PM
❑ Diabetes Physician ____________________________________
________________AM/PM
3. Education Class
❑ Schedule Total Joint Education Class (860) 545-1888 ________________________AM/PM
Classes fill quickly - please call as soon as you know the date of your surgery.
4. Forms to complete
❑ Mail pink hospital consent form to your physician’s office (located in back pocket)
❑ Mail yellow anesthesia questionnaire form in the envelope provided
(located in back pocket)
❑ Complete the medication list in preparation for your nursing interview prior to admission
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Patient Guide
PREPARING FOR SURGERY CHECKLIST
(CONTINUED)
5. Discharge Planning
If you plan to go directly home following surgery:
❑ Contact Home Care Agency Prior to admission
❑ Pre-book one (1) facility with a Rehabilitation Program as a back up.
If you plan to go to a Facility with a Rehabilitation Program following surgery
❑ Check with your insurance carrier regarding coverage of Durable Medical
Equipment (DME)
Please do not order/purchase until your discharge plans are confirmed
❑ Raised toilet seat / 3-in-1 commode / toilet seat with bars
❑ Walker / Crutches / Cane
❑ Hip Kit which includes:
Long handled (grabber) reacher
Sock aide application device and long handled shoe horn
(see page 11-15 for more information)
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Patient Guide
MEDICATION LIST
Name ______________________________________________________ Date of Birth___________________________________________________________________________________________________________________________________________
Name of medication
Dosage – How much do
you take? (mg)
Frequency – How often
do you take it?
Reason for Medication?
Lisinopril-HCTZ
20/25 Tab LUP
1 orally 2 times a day
Hypertension
Flexeril
10 mg oral tablet
1 orally once a day
Muscle spasm/pain
Examples:
Are you allergic to any medication? (Circle) YES
If yes, what
NO
______________________________________________________________________________________
______________________________________________________________________________________________
What was the reaction you had to each of the above? __________________________________________________
______________________________________________________________________________________________
Do you see any specialists? __________________________________________________________________________
Name/Town: __________________________________________________________________________________
10
Patient Guide
PREPARING FOR SURGERY
Home Planning and Preparation
The Day Before Your Surgery
It is a good idea to prepare your home for
your hospital discharge before you go to the
hospital. (See pg 9)
You will also be asked to complete a Nursing
Interview prior to your admission. A nurse in
the Pre-Admission Testing Center (PATC) will
call you to complete this interview one business day prior to your scheduled admission.
It is important to us to “get to know” you so
that we can anticipate your needs. Our goal is
to make your hospital stay as comfortable as
possible. The information you give us is greatly
appreciated. (See pg 15) Please have your
medication list completed as the nurse will
ask for this information. (See pg 10)
Nutrition
Good nutrition is important before surgery.
Eating healthy and avoiding any unnecessary
weight loss prior to your procedure is optimum. Many patients are asked to lose some
weight prior to their procedure; at this time we
recommend weight maintenance with a goal
of having adequate nutrition stores before
heading into surgery. This will help make sure
you will have the strength post surgery for
rehabilitation. (See pg 13)
Bathing Instructions
For instructions on use of the antibacterial
soap – Hibiclens. (See pg 16)
Discharge Planning
The plan for your discharge begins with your
decision to have surgery. Our goal is for you to
recover as soon as possible in the comfort of
your own home.
You need to discuss these options with your
doctor and family PRIOR to your surgery.
(See pg 14)
Make arrangements to attend the
Total Joint Education Class
(See pg 7)
Surgery Time Confirmation
Call the Surgery time-line at (860) 545-3208
between the hours of 1 PM and 6 PM to find
out what time your surgery is scheduled and
when to report to the hospital. If your surgery
is scheduled on a Monday or after a holiday,
call one business day before your scheduled
admission.
The Night Before Your Surgery
DO NOT eat or drink anything after midnight.
This includes water. No hard candy or gum
after midnight.
11
Patient Guide
PREPARING FOR SURGERY
The Morning of Your Surgery
Take ONLY those medications you were
instructed to take by your physician and/or
the nurse. Take these medications with a
small sip of water.
Diabetics please follow the instructions on
“Patient’s Guide to Diabetes Medications
the Day Before and Day of Surgery” on page
17, unless your diabetic doctor tells you
otherwise.
• You may shower and brush your teeth.
Do not swallow water.
• Do not use perfume, deodorant, powders,
creams, make-up or nail polish.
• Bring a case for your eyeglasses, hearing
aids, and dentures, do not wear/bring
contact lenses.
• Wear comfortable clothing that is easily
removed.
• Wear comfortable non-skid or rubber
soled shoes.
• Bring personal items, but please leave
valuables, money, and jewelry at home.
To avoid possible loss, please have your family
take your personal belongings with them while
you are in surgery. They can be returned to
you once you are in your hospital room.
12
Parking
• Valet parking - is provided in front of the
hospital’s main entrance, Monday through
Friday from 5:30 AM to 9 PM and is free
for patients being admitted and discharged
(one vehicle on day of admission and one
vehicle on day of discharge).
• Public parking is available in the garage
that is adjacent to the Medical Office
Building located on 85 Seymour Street.
• Please see “A Guide to Patient Parking” for
rates and hours of operation located in the
back of this booklet.
Patient Guide
PREPARING FOR SURGERY
Home Planning and Preparation
Recommendations
• If your bedroom is upstairs, you may need
to set up a temporary sleeping area on the
first floor. Stairs are not impossible but are
difficult until you have full mobility.
• Remove all throw rugs, loose rugs, electrical cords and clutter from hallways/walking
areas. These pose a risk for falling.
If you plan on going directly home after
surgery, medical equipment such as a raised
toilet seat, long handled grabber (reacher),
shower bench, and stocking application
device should be purchased prior to your
hospital visit. You may find these items at
medical supply companies or Home Depot.
If you are going to a facility with a rehabilitation
program, the facility will order the equipment
for you.
• Check your cabinets for items you routinely
use and place them at a level where you
will not need to bend or get on a step stool
to reach them.
Equipment such as walkers, crutches, and
canes will be coordinated through your case
coordinator in preparation for discharge.
• Have extra pillows or pads for chairs,
sofas, and automobile seats to elevate the
seat to insure proper hip alignment (not
greater than 90º).
Nutrition
• Install safety bars in the shower and near
stair railings.
Carbohydrates 6-11 servings a day
Breads, rice, pasta, and cereal, 3 or more
servings of whole grains.
• You will receive instructions on discharge
and need to consider the following: a longhandled sponge/brush and shower hose
for bathing, a shower chair or tub bench
so you are able to sit in the shower.
• A basket to attach to a walker, if
necessary.
• Prepare an area for supplies you will need,
such as a telephone, TV remote control,
radio, tissues, medication, reading
materials, etc.
• Make preparations for pets that may
be underfoot.
• Consider activities that you will be able to
engage in during your recovery such as
hand games, movies / DVDs, etc.
• Make arrangements to have a family
member or friend stay with you once you
return home for the first few days.
Prior to your surgery your diet should
include:
Fruits-2-4 servings per day
Choose a variety.
Vegetables 3-5 servings per day
Choose a variety.
Dairy/Milk 2-3 servings per day
Low-fat milk, cheese, and yogurt.
Fats - use sparingly
Some fat is a necessary part of our daily diets
but less is better. Avoid fats & trans fats when
possible.
Dietary Supplements
The Anesthesia Department requires that all
herbal and diet products be stopped at least
2 weeks before your surgery and MAO drugs
such as Nardil need to be stopped three
weeks before surgery.
13
Patient Guide
PREPARING FOR SURGERY
Alcoholic Beverages
Medical Clearance
No alcoholic beverages 1 day prior to surgery.
You will need to be examined before surgery
by your medical doctor. Medical problems that
you may have can be identified and addressed
prior to surgery to help decrease your risks
during and after the procedure.
Exercise
Keeping your muscles toned will help you to
recover faster after surgery. Be sure to follow
the exercise program you have been given by
your doctor. An exercise booklet is located in
the back pocket (Getting Ready for Total Hip
or Knee Replacement).
Blood Donation
During or after total joint replacement,
you may need a blood transfusion. Hartford
Hospital stocks blood, blood products and
plasma expanders and has them available
should you need them.
Your physician will let you know if you will
need to consider donating your own blood.
One alternative to the use of these products
is donation of your own blood prior to surgery,
known as autologous donation.
Donor directed blood is also an option – a
family member or friend may donate blood
on your behalf if you have a medical condition
that makes it difficult for you to donate for
yourself. You will need to schedule your
own appointments.
Bloodless Medicine
The Center for Bloodless Medicine & Surgery
at Hartford Hospital provides surgical and/or
medical treatment without the administration
of blood or blood related products. Complex
procedures such as total joint replacements
have been performed without blood transfusions. For more information on Bloodless
Medicine, please call (860) 972-0737.
14
Discharge Planning
Your discharge from the hospital may be to go
home with home care services or to a facility
with a rehabilitation program. You need to
discuss these options with your doctor and
family PRIOR to your surgery.
VNA Healthcare’s (Corporate Affiliate of
Hartford Hospital) skilled rehabilitation staff can
care for you in the comfort and familiarity of
your own home. To be sure that your rehabilitation and care needs will be coordinated
before your surgery and throughout your recuperation, it is recommended that you identify
a Home Care Agency before your surgery.
In addition, it is recommended that you make
reservations at one (1) facility with a rehabilitation program as a back-up plan. (See listing
in back pocket)
Patient Guide
PREPARING FOR SURGERY
If you are going to a facility with a rehabilitation
program you should make reservations at a
minimum of two (2) facilities, prior to your
surgery. By waiting until after surgery you may
find that the facility you prefer may be full or
may not participate with your insurance carrier.
(See facility listing in the back pocket)
Pre-Admission Testing Center
(PATC)
An appointment for PATC will be made by
your surgeon’s office. This appointment will
be scheduled about two weeks before your
scheduled surgery. During this appointment
required tests will be done and further information will be obtained. If you will be having
your tests done at Hartford Hospital the PATC
area is located on the 1st Floor, Room 122.
Insurance Verification
Hartford Hospital Finance Department will be
calling you approximately one week prior to
your admission to verify your insurance and
personal information.
Medication
Be sure to inform your doctor of ALL the
medications you are taking, including vitamins,
over the counter drugs (such as, aspirin,
antacids, pain relievers, etc.), or even herbs
and “natural” products. These can all have
unwanted effects when combined with
medications or anesthesia.
In order to minimize the risk of blood loss
during and after surgery, you will be asked to
stop taking certain medications, many medications affect blood clotting. Aspirin, Ibuprofen,
Motrin, Advil, blood thinners, anti-arthritis
medications, diet pills, and MAO inhibitors
are some examples of medications that
can cause increased bleeding times.
The Anesthesia Department requires that
all herbal and diet products be stopped
at least 2 weeks before your surgery and
MAO inhibiter drugs such as Nardil need
to be stopped three weeks before surgery.
This will prevent any possible cancellation of
your procedure. Please discuss any concerns
you may have with your surgeon or prescribing physician.
In addition, if you have a condition called
“sleep apnea” and require special equipment
please bring the equipment with you when you
arrive for surgery.
You will also be instructed on which of your
routine medications you will need to take the
morning of surgery, when the Nurse calls you
the day before surgery.
Smoking
In preparation for your surgery, it is best not to
smoke. If you are a smoker, ask your doctor
what would work best for you to help you quit
smoking. The longer you are smoke free, the
healthier your lungs will be. You will also
heal better.
Dental Work
If you need dental work, it is a good idea
to get it done before your surgery. Tell your
dentist you will be having a total joint replacement so the information can be placed in your
dental record. Your dentist may want you to
take antibiotics before any future dental work.
15
Patient Guide
THE DAY BEFORE YOUR SURGERY
Bathing Instructions
Before surgery, you can play an important role
in your own health. Because skin is not sterile,
we need to be sure that your skin is as free
of germs as possible before your surgery.
You can reduce the number of germs on
your skin by carefully washing before surgery.
Following these instructions will help you to
be sure that your skin is clean before surgery
to help prevent infection.
4. Wet your body with water, apply the
CHG to your body and wash thoroughly.
Pay special attention to the area where
surgery will be done. Turn water off to
prevent rinsing soap off too soon. Gently
wash for 5 minutes, do not scrub the skin
too hard. Do not use regular soap after
the CHG is applied. Note: CHG does not
produce a rich lather.
Important
5. Turn water back on and rinse your
body thoroughly.
You will need to shower with a special antibacterial soap called chlorhexidine gluconate
(CHG). A common brand name for this soap is
Hibiclens, but any brand of CHG is acceptable
to use. The soap may come in a liquid form or
on a scrub brush applicator. Either form is
acceptable to use.
CHG is not to be used by people
allergic to chlorhexidine
You will receive Hibiclens wash at the Total
Joint Education Class. If you are unable to
attend the class you may purchase Hibiclens
at the local pharmacy. If you do not see it on
the shelf, ask the pharmacist if they carry it.
1. Shower or bathe with CHG the night
before surgery AND the morning of
surgery. DO NOT shave your body with
a razor before surgery.
2. Wash your hair as usual with your normal
shampoo with each shower or bath.
3. Than apply the CHG soap to your entire
body ONLY FROM THE NECK DOWN.
Do not use CHG near your eyes or
ears to avoid permanent injury to
those areas.
16
6. Pat yourself dry with a clean, soft towel.
7. DO NOT use perfume, deodorant, powders or creams after showering.
Patient Guide
THE DAY BEFORE AND DAY OF SURGERY / PROCEDURE
Patient’s Guide to Diabetes Medication
1. Find the medication you are taking on this page and follow those instructions unless your
diabetes provider tells you differently.
2. Check blood sugar before meals and bedtime for at least 2 days prior to procedure or
surgery (if you check more often, continue your routine). Call your doctor if your blood
sugar is higher than 150 twice.
3. Combination pills are not listed below. If you are taking a pill that combines two medications,
and if one of the medications is listed as “Do not take” or “stop”, do not take the combination pill.
Day BEFORE Surgery/Procedure
Day OF Surgery/Procedure
You may take the following medications:
Do not take these medications in the morning:
Actos (Pioglitazone)
Amaryl (Glimiperide)
Avandia (Rosiglitazone)
Byetta (Exenatide)
Glucophage, and others (Metformin)
With normal kidney function –
Take as usual
Glucophage, and other (Metformin)
If unknown or decreased kidney
function – Stop 48 hours before surgery
Glucotrol (Glipizide)
Januvia (Sitagliptin)
Micronase, Diabeta, and others (Glyburide)
Prandin (Repaglinide)
Starlix (Nateglinide)
Amaryl (Glimiperide)
Glucophage, and others (Metformin)
Check with your doctor when to restart
Glucotrol (Glipizide)
Micronase, Diabeta, and others (Glyburide)
Do not take the medications below in the morning,
but may resume after surgery or procedure
Actos (Pioglitazone)
Avandia (Rosiglitazone)
Byetta (Exenatide)
Januvia (Sitagliptin)
Prandin (Repaglinide)
Starlix (Nateglinide
Symlin (Pramlintide)
INSULIN ON DAY/NIGHT BEFORE
SURGERY or PROCEDURE
INSULIN IN AM OF SURGERY
or PROCEDURE
Type 1 diabetes mellitus (T1DM) may need a
decreased dose of insulin you take at bedtime.
Please discuss with your diabetes provider.
Type 1 diabetes mellitus (T1DM) may need a
decreased dose of insulin you normally take.
Please discuss with your diabetes provider.
Take the following insulin as usual
(please see above if you have T1DM):
Apidra, Exubera, Humalog, Novolog, Lantus,
Levemir, NPH, Regular, 70/30, 75/25,
and 50/50 insulin.
Type 2 diabetes mellitus take full dose of Lantus or
Levemir. Discuss with your diabetes provider about the
dose of NPH, 70/30m, 75/25, or 50/50 insulin.
Do not take Apidra, Exubera, Humalog, Novolog, or
Regular insulin.
INSULIN AFTER SURGERY or PROCEDURE
Restart when you are eating your normal diet:
Apidra, Exubera, Humalog, Novolog, or Regular insulin.
Take as usual: Lantus, Levemir, NPH in PM after
surgery or procedure.
17
Patient Guide
YOUR SURGICAL EXPERIENCE
Day of Surgery
Anesthesia
Arrive at the hospital on time.
There are several choices of anesthetic
techniques that may be chosen for total joint
replacement surgery. One specific technique
may potentially be advantageous for a specific
patient depending upon the medical condition
of the patient. In addition, you probably will be
placed on blood thinners after the surgery to
minimize the risk of blood clots. The type of
blood thinning medication that is chosen by
your surgeon may have an effect upon the
anesthetic technique that may be considered.
When you speak to the nurse the day before
your surgery, she will let you know where to
report to on the day of admission.
Upon arrival:
• You will be taken to a room and asked to
undress and put on a hospital gown.
• Your family/friend will be asked to wait in the
waiting area while the nurse prepares you
for surgery.
• Your preoperative nurse will start your intravenous (IV), ask questions and perform a
physical assessment.
• You will be given IV antibiotics at this time.
General Anesthesia
• Your family/friend will be allowed to join you
while you wait to go to surgery.
In this case you are completely unaware of
your surroundings and will not respond to stimulation. This can be provided in many different
ways. The most common ways include:
• Your surgical site will be identified and
marked prior to your surgery.
Family Waiting Area
When you are transferred to the operating
room, your family/friend may wait in the
surgical waiting areas on the 5th floor, (Bliss
Wing and South Building). There is a Computer
Room, equipped with two computers connected to the internet on The Total Joint Center
Unit, located in the Conklin Building 4th Floor
(CB4), near the gym. Hartford Hospital has a
wireless visitors network that can be accessed
from your personal wireless laptop in the main
lobby, cafeteria or family lounges. The internet
is not available in patient rooms.
Refreshments are available in the coffee shop
located in the main lobby or the cafeteria
located on the ground floor.
• If your family/friend plans on leaving the
hospital, they should notify the nurse and
provide contact information.
18
You and your anesthesiologist will discuss all
these factors prior to surgery and agree upon
a plan for your anesthetic.
• A continuous intravenous infusion that
“keeps you asleep”;
• An intravenous medicine that “puts you to
sleep”. A breathing tube is then placed either
into the back of your throat or further down
into your trachea (windpipe) to protect your
airway. This is done after you are asleep so
that you are unaware of this process. While
breathing through one of these tubes you will
be breathing an anesthetic gas to keep you
asleep. The type of airway tube chosen
depends upon your medical condition and
the type of surgery.
Patient Guide
YOUR SURGICAL EXPERIENCE
Regional Anesthesia
This is a technique that will anesthetize a particular area or region of the
body. Examples of these include:
• Spinal anesthesia
• Epidural anesthesia
• Peripheral nerve blocks
A spinal or epidural will make you numb from about your waist to your
toes. A spinal lasts only a few hours. An epidural catheter can be utilized
to allow the epidural to provide pain relief for up to two days after
the surgery.
A common peripheral nerve block technique for knee replacement
surgery is the combined Femoral/Sciatic Nerve block. Local anesthetic
can be injected around these two nerves to provide pain relief for about
18 hours after the surgery. You will be given some intravenous sedation
prior to the nerve blocks to minimize any anxiety or discomfort. Once
you enter the operating room, you will be “asleep” for the operation.
Hip Replacement
Typically either general or spinal anesthesia is chosen.
Knee Replacement
General, Spinal, Epidural or Femoral/Sciatic nerve block may be chosen.
The most common techniques utilized are Femoral/Sciatic nerve block
and epidural anesthesia.
Duration of Surgery
Your surgery will last approximately 2- 3 hours. If you are having
bilateral joint replacement it may be 1- 2 hours longer.
19
Patient Guide
AFTER YOUR SURGERY
Recovery – PACU
Pain Control
• The Post Anesthesia Care Unit is also
referred to as PACU.
To help us minimize your pain after surgery
you will be asked to rate the intensity of your
pain through the use of a pain scale of 0-10
(0 is no pain, 10 is excruciating pain). Knowing
that after surgery 0 is not attainable, a score
between 2-3 is an attainable and acceptable
score for most patients (chart on page 23).
It is best if you obtain medication when your
pain level starts to rise. Do not allow your pain
to get severe. If you maintain pain control,
it takes less medication and less time to
manage the pain.
• After your surgery you will be brought to the
PACU, where you will be closely monitored
as anesthesia wears off.
• The length of stay in the PACU will be determined by many factors including the type of
procedure and the nature of the anesthetic
used. You may be in the PACU between
2-4 hours. If you are having bilateral joint
replacement you will stay overnight in
the PACU.
The nurses will monitor your blood pressure,
pulse and respiration(s); assess and manage
your pain; monitor your IV intake, urine output
and your dressings; and encourage you to
take deep breaths, cough, and move your
feet and ankles. Family/friends are not allowed
in the PACU unless you are required to stay
in the PACU overnight or under special
circumstances.
When you are ready to leave the PACU, you
will be transferred to your room in the Total
Joint Center, located in the Conklin Building
on the 4th Floor.
Pain medication is available in various forms:
intravenously, by injection into the muscle or
subcutaneous tissue, by patient controlled
analgesia (PCA), epidural, or by mouth.
The Integrative Medicine Services provides
pain management without the use of medications. Interventions such as Reiki, Massage,
Guided Imagery, and Acupuncture may be
beneficial to patients. Some of the benefits
are as follows:
• Pain reduction
• Relaxation and stress reduction
• Relief of muscle spasm and soreness
• Improved range of motion and flexibility
Intravenous Fluids and Medications
Your IV will remain in place for 1- 3 days.
You will receive IV fluids until you are able to
eat and drink without nausea or until your
doctor decides. You will receive IV antibiotics
for the first 24 hours. Your IV access is also
used for IV pain medication such as with
Patient Controlled Analgesia (PCA).
20
• Improved sleep and digestion
• Increased circulation and tissue healing
• A general sense of well-being
Patient Guide
AFTER YOUR SURGERY
Therapeutic Massage and Acupuncture are
offered on a fee for service basis. Guided
Imagery, Reiki and Art for Healing are
offered free of charge. Also available is Peggy
Huddleston's “Prepare for Surgery, Heal
Faster” book/CD of mind-body techniques
to help patients feel calmer before surgery,
have less discomfort and recover faster.
To purchase the Book/CD, please call
(860) 545-4444. Please see “A Guide for
Patients, Friends & Family” for more
information on these services located on
page 53 of the guide.
Dressings/Bandages
You will have a dressing over your incision
to protect your wound and promote healing.
Your doctor or physician's assistant will
change your dressing on the first or second
day after your surgery, and then daily until your
wound is no longer draining (or as directed by
your physician). You may have skin staples
in place.
Ice Application
Relaxation and diversion are also helpful in
decreasing pain. Bring a CD player, headphones and music to help you with this
relaxation and diversion.
Your doctor may order ice application for a
few days over your dressing to help decrease
bleeding and swelling. You may also request
the ice packs for comfort reasons. When the
ice melts, be sure to ask the nurse for
fresh ice.
Eating and Drinking
Drainage Tubes
You will be assessed by your nurse who will
let you know when you can begin to eat and
drink. It is best to start with sips of clear fluids
until you are sure you are not experiencing any
nausea. Gradually increase your intake until
you are able to tolerate solid foods.
A drainage tube may be inserted into your
wound during surgery. This allows blood
to be collected and measured after surgery.
Collection of drainage also decreases bruising
in the surrounding wound tissue and promotes
healing. Once you begin to ambulate, the
drain and collection device will be removed,
usually by the second day after your surgery.
There is some discomfort as the drain is
being removed.
Food Service
At any time during your stay a member of the
Food & Nutrition staff is available to you. If you
need assistance during your stay or need to
speak with a Registered Dietitian or dietary
staff member, please let your nurse know or
you can dial 5-FOOD on your hospital room
phone and a staff member will be made
available to you.
A urinary catheter will be inserted into your
bladder during surgery while you are sedated.
This helps the doctor monitor how well your
kidneys are working. The catheter is usually
removed by the second day after surgery.
You will feel the catheter as it is being
removed, but it is not painful.
21
Patient Guide
AFTER YOUR SURGERY
Sequential Compression Stockings
Blood Transfusion
Sequential compression stockings inflate and
deflate automatically. Some types are worn
from just below the knee to the foot. These
simulate muscle activity that occurs when
walking. Some are made to wear on your feet
only. Your surgeon will decide which type is
appropriate for you. These stockings assist
in the prevention of blood clots, or what is
known as deep vein thrombosis (DVT). They
are worn while you are in bed, until you
are ambulating.
If your blood count is too low your surgeon
may decide that you need a transfusion.
Support Stockings
Support stockings are also used to help
prevent blood clots from forming. Elastic kneehigh stockings are often ordered after your
surgery. You will need to wear support stockings during your recovery at home. You will
need assistance with the use of a sock aide
or arrange for assistance– refer to Checklist
on Page 8. Support stockings should be
removed for a brief time a couple of times
each day to bathe and for heel/skin assessment. Be sure to let the nurse know if your
heels burn or are sore. This discomfort is
associated with a decreased blood flow to
the heel and can cause damage if pressure
is not removed. It is best to keep your heels
elevated to avoid pressure of the heels on
the mattress. You will have support stockings
on both legs even if you have only one total
joint replacement.
Oxygen
After surgery, you may receive oxygen through
a tube (nasal canula) under your nose. This is
usually supplemental (unless you have other
respiratory difficulties) and is common practice
during the postoperative period. A monitor,
called an oximeter, may be placed on your
finger periodically to measure the amount
of oxygen in your blood.
22
Anticoagulation
Prevention of clotting is extremely important after
total joint replacement. Different medications are
used for anticoagulation. These medications
may be injected or taken by mouth, depending
on the type of anticoagulant your physician
orders. Your blood will be drawn daily for an
INR, which is a test for blood clotting, and your
anticoagulation therapy will be adjusted according to these results if you are on an oral blood
thinner. If you are on anticoagulation medication
during your hospital stay, your doctor will prescribe this medication, or a substitute such as
aspirin, upon discharge. Most patients take this
medication for about one month after discharge.
Coughing and Deep Breathing
You will be encouraged to take deep breaths
and cough after your surgery. This exercise will
help keep secretions in your lungs from accumulating. When fluids accumulate it can cause
pneumonia or a condition called postoperative
atelectasis. You will be given a device called
incentive Spiro meter to help with deep breathing. It is best to use it 5-10 times every hour
when awake for the first few postoperative
days. Make yourself cough after each use.
The respiratory therapist or nurse will show
you how to use it.
Patient Guide
AFTER YOUR SURGERY
Constipation
Patient Controlled Analgesia (PCA)
Constipation often occurs when you are taking
pain medication and are less active, as in your
postoperative period. Drinking plenty of water
and other fluids such as prune juice is helpful
in preventing constipation. If you do not have
a bowel movement by the second or third day
after surgery, please let your nurse know. You
may need a laxative, suppository or enema to
relieve the constipation.
Once the general anesthetic or spinal anesthetic has “worn off”, you are usually placed
on a PCA (patient controlled analgesia) device.
This allows you to give yourself pain medicine
through your intravenous line when you require
it. YOU press the button. This signals the
pump to deliver the medication. Most often,
there is a continuous dose of medication
ordered as well as an “on demand” dose for
optimal pain management. Do not worry, the
pump is set to limit the amount of medication
received to avoid overdosing.
Pain Control
To help us minimize your pain after surgery
you will be asked to rate the intensity of your
pain through the use of a pain scale of 0-10
(0 is no pain, 10 is excruciating pain). Knowing
that after surgery 0 is not attainable, a score
between 2-3 is an attainable and acceptable
score for most patients.
Visual Analogue Scale for Pain Intensity ENGLISH
Please tell us: Where is your pain? When did it start? Does anything make it
better or worse? What does it feel like (dull, stabbing, shooting, burning, numbness,
throbbing, sore or pressure)?
Choose a number from 0-10,
that best describes your pain.
•
”
“
’
‘


Ž

Œ
‹
Be sure to let your nurse know if the PCA is
not effective or if you are having side effects,
such as nausea and itching. You may need a
different dose of medication or different medication to achieve pain control and decrease
side effects.
When you are eating or drinking well, the PCA
is discontinued and oral pain medication will
be started.
Epidural
Excruciating–unable to do any activities
because of pain
Patients with an epidural will have the PCA
turned off early in the morning, and then given
oral medication.
Severe–unable to do most activities
because of pain
Femoral/Sciatic Block
Unable to do some activities because
of pain
Moderate
Can do most activities with rest periods
Mild pain–does not limit activity
No pain
Those patients with a Femoral/Sciatic nerve
block will be aware of the block wearing off
in the morning after surgery. They will then
be placed on a PCA for intravenous pain
medicine or an oral pain medicine if they
are eating well.
Most relatively healthy patients may have
any anesthetic technique. The choice really
depends upon your medical condition, the
type or method of anticoagulation chosen,
and your preference. These and other issues
should be discussed with your Anesthesiologist.
HH-F-029_eng_b&w Mar07
23
Patient Guide
AFTER YOUR SURGERY
Oral Pain Medication
You will be given oral pain medication once you are able to tolerate
liquids and solid food. It is best to request oral pain medication when
your pain level starts to increase. Remember not to wait until the pain
is severe. Keep in mind that it takes about 20-30 minutes for oral
pain medication to start working and it also takes time for the nurse
to check your chart and obtain the medication. The sooner you request
pain medication when your pain starts to increase, the better you will
manage your pain. Pain medicine will usually be available to you as
often as every four hours.
Mobility
Your therapy will take place in the rehabilitation gym and in special cases
may begin bedside. It is best to take your pain medication prior to your
therapy session. It allows better participation.
Mobility will begin on your first day after surgery with your nurse sitting
you up on the edge of your bed. Next you will be transported to the
rehabilitation gym located on the same floor as your room. You will
receive a Physical or Occupational Therapy evaluation and a customized
therapy program will be developed.
You will be instructed in precautions, the proper way to move around in
bed, the correct way to transfer from sitting to standing and vice versa.
Together with your therapist, you will choose the most appropriate assistive device to use for walking. In some cases you will be instructed on
how to go up and down a set of stairs, a ramp or a curb. You will also
be instructed in a home exercise program. If you are going directly
home, your equipment needs will be discussed with your therapist
and your Case Coordinator. The Case Coordinator will work directly
with your insurance provider to obtain approval.
Length of Stay
You will be a patient in the Total Joint Center until you are ready for
the next phase of your recovery. The average length of stay on the unit
is three days. The next phase of your recovery may include inpatient
rehab, home care, and sub-acute rehabilitation or outpatient rehabilitation. The amount of time needed for this next phase is dependent on
your individual needs and progress.
Be sure to discuss your discharge needs with your surgeon and family
prior surgery. The Case Coordinator or Social Worker will assist you and
your family in finalizing these plans before you leave.
24
Patient Guide
GOING HOME
Discharge Transportation
Insurance companies DO NOT COVER
transportation to a facility with a rehabilitation
program or home after total knee replacement.
Most insurance companies cover transportation via ambulance to a facility with a rehabilitation program after total hip replacement
or bilateral total knee replacements. If you
are going home, please plan to have a friend or
family member provide you with transportation
upon discharge from the hospital.
If you do not feel comfortable being transported in a car with a friend or family member,
you may opt to pay for a wheelchair van
transport.
If you are going to a facility with a rehabilitation
program you may want to get specific instructions from the facility prior to admission.
Care of Your Incision
• Your incision should remain dry and clean.
Do not get your incision wet until after your
staples are removed. Most patients have
staples in place for approximately 10 days.
• Do not apply creams, lotions or powders
to your incision while the staples are in or
drainage is present.
• Do not remove the steri-strips. They will fall
off on their own.
When to Call your Doctor
• Fever above 101.0º
• Abnormal bleeding of any kind, such as
increased bleeding from the incision,
nosebleed, etc.
• Blood in the urine
When to Call Emergency Medical
Services (EMS)
• Difficulty breathing or shortness of breath.
• Chest pain
• Localized chest pain with coughing or when
taking a deep breath.
Showering/Bathing
• You may shower when your physician
instructs you to, usually after your staples
are removed. When you are able to shower,
do not rub the incision.
• No tub baths, hot tubs or spas
Home Care Services
VNA Healthcare (Corporate Affiliate of Hartford
Hospital) provides rehabilitation services as
follows:
• Make a home visit within 24 hours
of discharge.
• Provide care on weekends
Medicare and most private insurers will pay
for daily physical therapy when you initially
come home from the hospital. (See Home
Care Agency Listing, by County and Town
in back pocket)
• Uncontrolled shaking or chills
• Increased redness, heat, drainage or
swelling in or around the incision.
• Increased pain or significant decrease in
motion during activity and at rest.
• Increased swelling, pain or tenderness of
the thigh, calf, ankle or foot.
25
Patient Guide
GOING HOME
Nutrition After Your Surgery
Iron Needs
Calorie and protein needs are greater after
your surgical procedure. It is recommended
that you aim for 3 meals a day and snacks
as tolerated. Also aim to include 1-2 protein
sources at each meal. This will help to ensure
that you are consuming adequate protein and
calories for healing.
The smallest amount of blood loss during
surgery can deplete your iron levels. Therefore
your doctor may prescribe supplements.
Below is a list of high iron foods that you
can consume to improve your levels.
Protein Sources
• 3-4 ounces of Beef
• Oysters, clams, scallops, shrimp
• Organ meat, like liver
• Lean beef, pork, lamb
• Poultry
• Eggs
• Chicken, turkey
• Fish
• Dried apricots, dried peaches,
prunes, raisins
Vegetarian protein sources
• Soy
• Legumes, dried beans
• Beans
• Tofu
• Nuts
• Whole grain and enriched breads
• Wheat germ
• Fortified breakfast cereals
• Seeds
• Peanut butter
• Prune juice
• Dark green leafy vegetables
Dairy protein Sources
• Milk
• Yogurt
• Egg (yolk)
• Dark molasses
• Cheese
Protein is the building block to healing.
Try to include 1-2 sources at each meal
or at snack time.
Iron is needed to help carry oxygen throughout your body. If your iron is low you may feel
tired, dizzy, get headaches, not be able to
sleep and feel somewhat irritable.
Iron is best absorbed if you take your iron
supplement or eat iron rich foods with foods
that are high in vitamin C like orange, grapefruit, cranberry or tomato juice.
26
Patient Guide
GOING HOME
Other Vitamin C Rich Foods Include:
• Citrus juices
• Oranges, lemons, limes
• Cantaloupe, papaya
• Remind your physician of any medications
you were on before your surgery, that were
not prescribed for you after your surgery.
• Remember to check with your physician
before you begin taking any over-thecounter medications or herbals.
• Strawberries, kiwi
• Broccoli, cauliflower, brussels sprouts
• Potato
• Spinach and other greens
• Sweet peppers, chili peppers
• Tomatoes
Do not take your iron supplement with milk,
tea, or coffee.
Activity
Please follow the exercise plan that your
doctor and physical therapist have established
for you. Your recovery process and continued
health depends on good nutrition, rest and
proper exercise. (A guide is included in the
back pocket “After Total Hip or Knee
Replacement”).
Other Important Information
• You will need to wear elastic stockings for
4-5 weeks after surgery.
• Swelling is not uncommon after total joint
surgery. Elevation, ice and motion are helpful
in decreasing the swelling. If swelling
persists, call your doctor.
• You will most likely return to all your normal
activities about 6-8 weeks after surgery.
• It is essential that you inform your dentist
that you have had a total joint replacement,
as you may need prophylactic antibiotics
prior to having your teeth cleaned or other
dental procedures.
• If you have any surgical procedures following
your total joint replacement, inform the
physician that you have an implant.
Medication
• Take all medication as prescribed by your
doctor. You may need to take your anticoagulation medication for about one month after
discharge.
• Many people are discharged home with a
prescription for injections to prevent blood
clots. It is important that you or a family
member learn how to perform these injections prior to leaving the hospital. Home care
will not come to your home every day for
every dose. You must learn how to perform
these injections.
27
Patient Guide
NOTES:
28
Joint Center
Total Joint Replacement
Patient Education Packet
Joint Center
80 Seymour Street
P.O. Box 5037
Hartford, CT 06102-5037
ph 877.58.JOINT or 860.545.0034
fx 860.545.4193
hartfordhospital.org/orthopedics