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Pre-Op Hip Information Welcome! 1 2 Goals Inform the patient about what to expect… Before Surgery During Surgery After Surgery 3 Goals Reduce anxiety Answer questions Help you become better-prepared 4 5 Sections Nursing Case Management Physical Therapy Occupational Therapy 6 Information From The Nurse About Care And Your Concerns 7 We Care About You!!! In an effort to personalize your care while in the hospital, please let us know of any needs ahead of time Please complete the enclosed “Care Card” and forward it to the Patient Navigator at the end of class 8 What To Bring List of medications and allergies Glasses, hearing aids, dentures Toiletry items Toothbrush Toothpaste Flat, supportive, non-slip walking shoes (with a backing) Incontinence products (you may prefer a specific product not provided by hospital) 9 What To Bring Night clothes/pajamas, loose clothing Books, magazines, hobby items 10 While in surgery… CHG wipes will be used to cleanse and disinfect the surgical site before surgery begins CHG reduces bacterial growth on the body CHG will help reduce the chance of infection following surgery 11 Orientation To Room Call bell TV Controls/Volume Thermostat 12 Equipment After Surgery 13 Oxygen Used a short time Let us know if you have sleep apnea or use oxygen or CPAP at home 14 IV or Intravenous Therapy May have one or two lines Fluids-body water, blood, antibiotics, pain medication Will leave it in until discharge 15 Dressings and Drains Large dressing initially Drains and dressings removed 1st or second day after surgery Dressing will be changed 16 Foley Catheter To Drain Urine Stays in no longer than 2 days Helps to keep track of fluid balance Good initially when not moving well Put in after you are asleep Does not hurt to come out 17 PCA - Patient Controlled Analgesia “Pain Button” Administer to self Close monitoring NO ONE IS TO PUSH THE BUTTON EXCEPT THE PATIENT!!! ***Please ask your surgeon if this is an option for you 18 Medications Different color and number Always ask nurse what meds are for “Combination medications” that you may take at home may be given as separate pills while in the hospital 19 Rating Pain 0 to 10 pain scale Pain patterns Mechanical Pain Surgical Pain 20 Know the Zone! Our staff will make every effort to help control your pain We will automatically give you pain medication around the clock We ask that you partner with us and ask for additional pain medicine if needed Alternative pain options may be used such as cold therapy and distraction Our goal is to keep you in the 3-4 Pain Zone (or less) 21 Preventing Pneumonia Incentive Spirometer Breathe in 10-12 times an hour while awake Helps to expand air sacs in lungs 22 Preventing Blood Clots Medication (“Blood Thinners”) “Calf/Foot Pumps” Walking and Exercising 23 Coumadin and Lovenox ***Please check with your surgeon as to which blood thinner will be prescribed*** Will help to prevent blood clots from forming Will need to learn how to take these medications safely Will need to watch a video 24 Compression Devices Foot or calf pumps Help to push the blood back into circulation Wear them when you are in bed or in the chair 25 Walking and Exercising Helps to prevent blood clots from forming Exercise in and out of bed Ankle circles, foot pumps, tightening leg and buttocks muscles 26 Diet Initial diet is typically clear liquid unless otherwise designated by your physician Diet will advance as tolerated Constipation High fiber Increase activity Fluids Nausea 27 Call for Help Never get out of bed or chair unless you call for assistance Call as soon as possible. Try to ask for help when a staff member is already in the room. 28 Condition H (Help) Dial 3111 and give room number Gives family and friends a way to call a Medical Emergency team to the bedside Call if… You notice a change in your loved one’s condition You still have serious concerns about your loved one’s condition after speaking to the healthcare team 29 Sleep Dial L.O.U.D. (5683) on phone if sleep disturbed Anonymous call TIGR TV Channels Relaxation/Meditation channels Comfort Cart 30 Case Management Joan Paramore RN Case Manager (919) 954-3878 31 Discharge Plan Goal: To get you home safely!!! 32 Discharge Plan Everyone is assigned a Case Manager who will usually meet with you the day after surgery Average Length of Stay: 2-4 nights That means you should be ready for discharge around the 2nd, 3rd, or 4th day after surgery 33 Discharge Please remember that once the Physician has written orders to discharge you home, there are still many things that have to be completed before you will be leaving the hospital. We want to make sure you have everything you need-prescriptions, home health or rehab arrangements, and information about your home care. Sometimes this process can take up to 4 or 5 hours. We know you’ll be eager to leave the hospital, and we want to be sure everything’s in place to ensure a smooth and safe transition. 34 Discharge Plan Options: Home Health You will choose agency (list provided) RN (if on Coumadin) Physical Therapy (2-3 times/wk) Occupational Therapy (if ordered by Doctor) ***Your Case Manager will set up a Home Health Agency (of your choice) for you 35 Discharge Plan Options: Home Health Equipment ordered… Rolling Walker Bedside Commode ***Your Case Manager will order your equipment for you from an agency of your choice 36 Discharge Plan Options: Short-Term Rehab If not safe to return home, Short-Term Rehab may be an option. Based on… 1. Your insurance 2. How well you progress with Therapy while in the hospital 37 Discharge Plan Options: Short-Term Rehab Two types of Rehab Facilities… 1. SNF: 1 to 3 hours of therapy/day Average Length of Stay: 1-2 weeks-as needed 2. Acute: 3 to 5 hours of therapy/day Average Length of Stay: 5 days 38 Discharge Plan Options: Outpatient Therapy Usually set up after Home Health is completed Rarely set up at time of discharge from hospital 39 Discharge Plan Transportation (depends on what is medically necessary) Car Wheelchair Van Not covered by insurance Cost: $55-$120 Ambulance Covered by insurance if “medically necessary” ***Your Case Manager will set up your Wheelchair Van or Ambulance for you (if needed) 40 If You Are Going Home… You may fill your prescriptions at our Plaza Pharmacy (Located on the First Floor of the hospital) Hours of Operation: Mon-Fri (9:00AM-4:30PM) (919) 954-3921 Use the Main Pharmacy on weekends or after 4:30PM (but make payment arrangements with Plaza Pharmacy Mon-Fri 9:00AM to 4:30PM 41 Physical Therapy 42 Treatment Sessions Seven days/week One or two sessions per day with the Therapist Your therapeutic activity will also involve walking with Nursing staff Typical treatment session Post-op Days 1, 2, and 3 43 General Precautions Hip Do not bend hip past 90 degrees Do not cross middle of your body with operated leg Do not lie on stomach for at least 6-8 weeks after surgery Do not stay in one position for more than an hour or two 44 Homeward Bound Gym Stair training Car transfer exercises 45 Medical Equipment Walker Proper use Bedside Commode Proper use 46 Occupational Therapy 47 Treatment Demonstration of equipment *** Most hip patients need this equipment at discharge. The Therapist will determine your specific needs. Reacher Sock aid Bathing sponge 48 Helpful Tips How to properly carry items in pockets and/or basket while driving a walker Safety in the shower (have someone close by) While at home prior to surgery, move low- and high-lying items to waist level (i.e. in kitchen/bathroom cupboards, refrigerator) Make arrangements to have appropriate-sized car available for your discharge 49 Before Surgery… Assess your home environment and let the Therapist know the following once you are in the hospital… Tub/Shower (location, height, grab bars) Number of steps (outside of home and upstairs) Height of bed 50 Assessment The following slides contain questions based on the Powerpoint. 51 Question 1 One risk of a blood thinner medication is: ___________?____________ 52 Answer Increased bleeding (Can also be increased bruising) 53 Question 2 You should call your Doctor immediately if you notice any sign of a blood clot. Name a symptom of a blood clot in your leg: _____________________ Name a symptom of a blood clot in your lung: ______________________ 54 Answer Leg: Pain in the back of the leg (usually in the calf, but can radiate throughout the leg) Lung: Difficulty breathing (may also have a rapid heart rate) 55 Question 3 True or False You will not be permitted to bend at the waist following hip surgery. 56 Answer True 57 Question 4 You may NOT do the following with your new hip (choose two): A B C D 58 Answer B and D 59 Question 5 Some pain is normal and expected after surgery, but the best way to keep your pain at a manageable level is to: 1. 2. 3. 4. Take pain medication when it reaches a “5” on a “0 to 10 pain scale” Take pain medication only when the pain is unbearable Use medication as well as other methods to control pain. For example: ice, positioning, etc. Try distracting yourself from the pain by watching television for an hour or two 60 Answer 3. Use medication as well as other methods to control pain. For example: ice, positioning, etc. 61 Question 6 The best and safest way to raise the height of a chair in your home is to: 1. 2. 3. 4. Stack pillows on the chair Stack folded blankets on the chair Place a small book under each leg of the chair Place two large telephone books on the chair 62 Answer 2. Stack folded blankets on the chair 63 Question 7 One side effect of pain medication is constipation. List 3 ways to prevent it: 64 Answer 1. Increase fiber 2. Increase fluids 3. Increase activity You may also take a stool softener or laxative if needed. 65 Thank You!!! 66