Hip Replacement Patient Education Memorial Hospital and Health Care Center is dedicated to restoring a higher quality of living to your life with a new joint. This patient guide will give you the necessary information needed for a safe and successful recovery.
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Memorial Hospital’s Orthopaedic Program Achieves Excellence! Memorial Hospital and Health Care Center has earned The Joint Commission’s Gold Seal of Approval® for its knee and hip replacement programs by demonstrating compliance with The Joint Commission’s national standards for health care quality and safety in diseasespecific care. The certification award recognizes Memorial Hospital’s dedication to continuous compliance with The Joint Commission’s state-of-the-art standards. Memorial Hospital underwent a rigorous on-site review in March 2015. A Joint Commission expert evaluated Memorial Hospital’s orthopaedic program for compliance with standards of care specific to the needs of patients and families, including infection prevention and control, leadership and medication management. The Joint Commission’s Disease-Specific Care Certification Program, launched in 2002, is designed to evaluate clinical programs across the continuum of care. Certification requirements address three core areas: compliance with consensus-based national standards; effective use of evidence-based clinical practice guidelines to manage and optimize care; and an organized approach to performance measurement and improvement activities. Founded in 1951, The Joint Commission seeks to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. An independent, not-for-profit organization, The Joint Commission is the nation’s oldest and largest standards-setting and accrediting body in health care. Learn more about The Joint Commission at www.jointcommission.org.
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Memorial Orthopaedic Center of Excellence
Welcome On behalf of Memorial Hospital and Health Care Center, our professional doctors, nurses, and all other staff members, I would like to welcome you and thank you for choosing us for your orthopaedic surgery. Our goal is to ensure the highest standards of medicine as well as achieve the best orthopaedic experience for our patients. We are committed to keeping you informed while providing comprehensive and compassionate care. It is our goal to make your stay with us as pleasant as possible. In this patient education binder, you will find important instructions and information to help prepare you for your surgery. We hope 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 as well as 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. Once again, thank you for choosing us for your orthopaedic surgery. Best wishes for a speedy recovery!
E. Kyle Bennett President and CEO
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Maps
and
Directions
Driving Directions From St. Louis, Missouri: Take Interstate 64 east to U.S. 231. Drive north on U.S. 231 to Jasper. Turn left on Hoffman Road toward West 6th Street/Hwy 56. Turn right on Dorbett Street. Turn right on Ninth Street. From Owensboro, Kentucky: Take U.S. 231 north to Jasper. Turn left on Hoffman Road toward West 6th Street/Hwy 56. Turn right on Dorbett Street. Turn right on Ninth Street. From Louisville, Kentucky: Take Interstate 64 west to U.S. 231. Drive north on U.S. 231 to Jasper. Turn left on Hoffman Road toward West 6th Street/Hwy 56. Turn right on Dorbett Street. Turn right on Ninth Street. From Indianapolis, Indiana: Take Indiana 37 south to Bedford. Take U.S. 50 west to Loogootee; then take U.S. 231 south to Jasper. Turn right on Ninth Street.
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Memorial Orthopaedic Center of Excellence
Maps
and
Directions
Orthopaedic Surgeon Office Locations 3 1 1. Brian Blessinger, M.D. 1900 St. Charles Street, Jasper (812) 634-1211 2. Daniel Eby, D.O. St. Thomas Medical Center 600 West 13th Street, Jasper (812) 482-7441
3. Randall Norris, M.D. 1900 St. Charles Street, Jasper (812) 634-1211 4. Brian Woebkenberg, M.D. 695 West 2nd Street, Jasper (812) 996-5950
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Memorial Orthopaedic Center of Excellence
Preparing
for
Your Surgery
Before Your Surgery Prepare your home for after surgery.
• Read the Home Safety Checklist (page 9) for details regarding home preparation.
You may have lifetime prophylactic (preventative) antibiotic use prior to certain procedures following your total joint replacement. Please check with your surgeon, doctor, and/or dentist for additional details. It is important to consider your discharge plans before you have surgery. If your goal is to return home upon discharge, plan to have someone available to care for you. The length of time you will need help varies with each type of surgery. However, plan on needing help for several days to at least one week after returning home, depending on progress. Plan to have someone available to be your driver. You will not be permitted to drive for several weeks following surgery. You will need a ride home when you are discharged, as well as to and from doctor and physical therapy appointments until you are cleared to drive. Begin your exercises as soon as possible. Refer to the “Rehabilitation” tab in this binder for exercises. You will be given an Incentive Spirometer. Begin using it as soon as possible. See “Using Your Incentive Spirometer” handout for additional details. Apply for a temporary disabled parking permit from the Bureau of Motor Vehicles. (Optional)
Call your surgeon if you become sick within 48 hours of your surgery.
(i.e. fever, flu symptoms, sore throat, rash, sore/infected tooth, or if you have an open skin break at or near your surgical site.) Page 7
Preparing
for
Your Surgery
Day Before Your Surgery Do not eat or drink anything after midnight (including water, chewing gum, and hard candy). You may take any medication instructed by your physician on the morning of surgery with just a sip of water. * Any other eating or drinking after midnight could result in your surgery being delayed or cancelled.
Leave jewelry and valuables at home. ALL nail polish must be removed. Do not have beer, wine, or other alcoholic drinks the day before surgery.
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Memorial Orthopaedic Center of Excellence
Preparing
for
Your Surgery
Home Safety Checklist To Minimize Fall Risks:
Other:
• Remove all throw rugs.
• If you sleep on the second floor, consider moving a bed to the main level. Avoid sleeping on the couch.
• Wear supportive shoes or non-slip socks. • All walking paths need to be wide and free of obstacles to allow you to walk with a walker. • A walker bag/basket may be used to carry items such as a cordless phone. • Be cautious of pets. They are a common trip hazard. • Use a night light to ensure good lighting throughout the house, specifically, from the bed to bathroom. • Make sure all handrails along stairs are secure.
• Sleeping in a recliner is okay, but avoid sitting on low, soft, surfaces. (Recliners can be built up with firm cushions or can be placed on a stable platform). • If your vehicle has cloth seats, plan to sit on a garbage bag to make getting in and out of your vehicle easier. Also, avoid travelling in a low profile vehicle. • Prior to surgery, apply for a temporary disabled parking permit from the Bureau of Motor Vehicles. • When you travel, stop and change positions hourly.
• Use non-slip mats in your tub or shower.
• Stock your pantry, refrigerator, and freezer with plenty of easy, healthy snacks and/or commonly used items.
• Install grab bars near your tub/shower and toilet as needed.
• See the “Rehabilitation” tab for possible equipment needs.
Bathroom Safety:
• Do not use towel racks for support. • Store your most needed items in an easy-toreach location. Generally, this is NOT under the sink.
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Preparing
for
Your Surgery
Infection Prevention: your role Your Role in Infection Prevention
A Surgical Site Infection (SSI) is an infection that occurs after surgery in the part of the body where the surgery took place. Most patients do NOT develop an infection. If an infection does develop, most can be treated with antibiotics. However, some require additional surgeries. Memorial Hospital and Health Care Center’s number one priority is your health and safety. We strive to keep you safe by focusing on the prevention of such infections. All members of the health care team are important and need to be involved. This includes you, your family, and friends. We want you to have a voice in your care!
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Before Your Surgery
• Tell your surgeon about any medical problems you may have. Health problems such as diabetes and obesity could affect your surgery and treatment. • Tell your surgeon if you have any infections. • If you are diabetic, control your blood sugar. Research has shown better outcomes with decreased risk of post-operative infection when blood sugars are controlled before surgery. • If possible, lose the extra pounds if you are overweight. • Quit smoking. Patients who smoke get more infections. Talk to your surgeon about how you can quit before your surgery. • Make sure you are eating nutritiously. • Do not shave near the surgical area for at least 5 days prior to surgery. Shaving with a razor can irritate your skin and make it easier for germs to get into your body. • Change your bed sheets the night before surgery prior to using the provided skin wipes.
Memorial Orthopaedic Center of Excellence
Preparing
for
Your Surgery
Infection Prevention: your role Checking for Bacteria in the Nostrils
At your pre-assessment appointment, the nurse will swab your nostrils with a cotton swab to obtain a sample of the bacteria that grows there. Staphylococcus aureus is a type of bacteria commonly found on the skin and/or in the nostrils of healthy people. Although it is usually harmless at these sites, it may occasionally get into the body through breaks in the skin such as abrasions, cuts, wounds, surgical incisions, or indwelling catheters and cause infections. These infections may be mild, such as pimples or boils, or serious, such as infections of the bloodstream, bones, or joints. If this bacteria is found in your nostrils, an antibiotic ointment called Mupirocin (which will be provided to you) should be applied inside your nose twice a day – once in the morning and once in the evening – for five days before your surgery. This helps to decrease the bacteria and reduce the risk of the bacteria spreading to other sites on the body where they might cause infection.
Mupirocin Nasal Ointment
If you are contacted by the nurse to begin treatment, Mupirocin nasal ointment should be applied to the front of the nostrils twice a day for 5 days. It is very important these directions be followed. Surgery may be delayed if the steps are not completed as directed. 1. Place a match-head amount of ointment on a cotton swab and apply it to the inside of each nostril. 2. Squeeze your nostrils closed from each side to spread the ointment throughout your nostrils. 3. Avoid contact of the medication with your eyes. 4. Discard the container after using for 5 days; do not reuse. 5. Please read the information sheet provided with the Mupirocin. Discontinue usage of the medication and call your surgeon if the area becomes sensitive or severe local irritation occurs.
A nurse will call you at home to tell you whether or not you need to begin using the Mupirocin. If she tells you not to start it, throw it away.
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Preparing
for
Your Surgery
Infection Prevention: your role Skin Prep
To reduce the risk of infection at the surgical site, Memorial Hospital and Health Care Center has chosen chlorhexidine gluconate, also known as CHG, in the form of disposable wipes or bottled soap for showering. Because water and ingredients in personal care products can reduce the antiseptic effects of CHG, do not shower or bathe immediately following the application of CHG; do not apply lotions or moisturizers once you have started your skin prep. Please avoid makeup the morning of surgery. Temporary skin irritation such as an itching sensation and/ or redness may occur. In order to prevent additional irritation, do not shave areas closest to the surgical site at least two days before beginning your skin prep. If itching or redness persists, rinse affected area and discontinue use. If you have chosen the disposable wipes:
*Package instructions may differ from this orthopaedic binder instructions. Please follow the skin prep instructions that are below.
One cloth should be used every day beginning three days before your scheduled surgery and again on the morning of your surgery. Shower or bathe in warm (not hot) water at least one hour before skin prepping begins. Your skin should be completely dry and cool when applying the CHG wipe. Apply the cloth to the surgical area first, cleaning it thoroughly, then continue to use the cloth on the rest of your body closest to the surgical area. Do not use the wipe around your face, eyes, or Page 12
private areas. Allow area to air dry for one minute. Do not rinse. It is normal for the skin to feel tacky for several minutes after the wipe has been applied. Do not rinse off the solution. Allow it to dry before putting on clean clothes. This is to help reduce germs on the skin. The antiseptic solution continues to work as it remains on the skin. If you have chosen the bottled shower soap: Beginning three days prior to your surgery, you will need to take a shower each day, including the morning of your surgery, with this soap. Avoid getting the CHG soap in your eyes, ears, mouth, or nose. Also try to avoid your private areas if possible. If the soap gets on these areas, rinse well with water. With each shower, wash and rinse your hair first, using your normal shampoo. Completely rinse the shampoo from your hair and body. Wet your skin and turn off the water to avoid rinsing the CHG soap off too early. Apply a liberal amount of the CHG soap to a washcloth and gently lather your entire body from your neck to your toes (avoiding your eyes, ears, mouth, nose, and your private areas). Wash your whole body, but pay special attention to the surgical area. Let the lather stay in contact with your skin for at least 15-20 seconds. Rinse well. Do not rewash with regular soap. After each shower, pat yourself dry with a clean, freshly washed towel, and dress in freshly washed clothing. Do not apply lotions, perfumes, or makeup to the cleaned areas.
Memorial Orthopaedic Center of Excellence
Preparing
for
Your Surgery
Infection Prevention: your role While in the Hospital
• Make sure that anyone who comes in contact with you cleans their hands with either soap and water or an alcohol-based hand rub. This includes doctors, all staff of Memorial Hospital and Health Care Center, family, friends, and other visitors. If you do not see them clean their hands, please ask them to do so. • Family and friends that visit you should not touch the surgical incision or dressing. • Before you go home, make sure you know who to contact if you have questions or problems.
After Returning Home
• Before you go home, your doctor or nurse should explain how to care for your wound. Make sure you understand. If you don’t, ask questions! • Continue the practice of good hand hygiene. This is the best way to prevent an infection. Handwashing with soap and water for at least 15 seconds and/or using alcohol-based hand rubs must be a habit before eating, after using the bathroom, and before and after any dressing changes or procedures. • Cover your mouth/nose with a tissue or with your sleeve when coughing or sneezing. Throw away used tissues and
wash your hands or use alcohol-based hand rubs. • Avoid clutter to limit areas where dust and dirt can collect. • Avoid touching your eyes, nose, or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches the eyes, nose, or mouth. • Ask friends and family members to stay away from you if they are sick. • Change soiled linens and wash promptly and separately in hot water with detergent and bleach. • Dispose of soiled dressings in a double plastic bag. • Keep pets away from the surgical incision until it is completely healed. • Avoid sharing personal items such as towels or razors. • Infections can occur from days to months after surgery. If you have symptoms of an infection, call your doctor immediately. Some of the common symptoms of a surgical-site infection are redness and pain around the area where you had surgery, drainage of cloudy fluid from the surgical wound, and/or fever.
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Preparing
for
Your Surgery
Anesthesia Information You will be seen by an anesthesiologist or CRNA (Certified Registered Nurse Anesthetist) and a preoperative nurse before your total joint replacement surgery. They will review your medical history and perform a brief physical exam. At that time, the anesthesia provider will discuss with you the options you have for anesthesia during surgery. In general, there are two types of anesthesia used: spinal anesthesia or general anesthesia. Based on your history, physical exam, type of surgery, and other factors, your anesthesia provider may suggest one particular anesthetic technique. There are also several options for pain control following surgery. These include intravenous pain medications and oral pain medications.
Spinal Anesthesia:
The most common anesthesia for total joint replacements at our hospital is spinal anesthesia. Spinal anesthesia temporarily takes away the ability to feel pain and move from the abdomen to your toes. This is done in the operating room, usually after intravenous sedation has been given. You will be placed in the sitting position or lying on your side after all appropriate monitors are placed on you. A sterile solution will be used to clean your back and a sterile drape will be placed. A numbing medication will be used to numb your skin; usually only a minor sting is felt during this step. Once you are numb, a small needle is used to inject the anesthetic into your back. Once this medication is injected, you will be positioned on your back. The anesthesia provider will make sure you have no feeling, and that surgery can be performed safely without pain. You will also be sedated so that you are comfortable and unaware of your surroundings. You may be numb
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for several hours after the spinal anesthesia is performed. Spinal anesthesia is sometimes used with general anesthesia as well. Advantages of Spinal Anesthesia: There are several advantages of spinal anesthesia. This method is fairly easy to perform and provides excellent operating conditions for the surgeon. With spinal anesthesia, the use of a breathing tube is avoided, which decreases the chance of lung complications that are more common with general anesthesia. Spinal anesthesia also decreases the chance of blood clots in your legs as well as those that may travel to your lungs. In general, your blood pressure is lowered with spinal anesthesia which results in less blood loss during surgery, reducing the need for blood transfusions. In addition, spinal anesthesia helps to avoid the common side effects related to general anesthesia such as, nausea, vomiting, somnolence (sleepiness), and confusion (especially in older patients). Spinal anesthesia also reduces the need for intravenous pain medications which can have similar effects.
Memorial Orthopaedic Center of Excellence
Preparing
for
Your Surgery
Anesthesia Information Disadvantages of Spinal Anesthesia: There is a possibility that your spinal anesthetic may not work, even under skilled hands. If that were the case, general anesthesia would then be used. A headache may develop after spinal anesthesia for some patients. Your anesthesia provider will be able to evaluate your headache and determine if the cause is from the spinal anesthesia. Other rare events include: spinal hematoma (bleeding), backache, infection, seizure, high block (you are numb above your abdomen), low blood pressure, nerve injury, or a medication reaction. Your anesthesia provider can discuss these risks in more detail if needed.
General Anesthesia:
General anesthesia is a technique during which you will be unconscious, generally referred to as “being put to sleep.” General anesthesia is started in the operating room. You will be asked to breathe oxygen through a mask for several minutes once the monitors are placed on you. You will then be given a medication through your intravenous line (IV) that will put you asleep. At this point, a breathing tube or a device known as a laryngeal mask airway (LMA) will be placed on you. You will stay asleep by an inhalational gas (a gas in which you breathe), IV medications, or a combination of both. Once surgery has finished, the medication will be discontinued, and the breathing tube or LMA will be removed.
certain types of blood thinners or patients with low platelets cannot have spinal anesthesia due to the risk of bleeding. Patients with certain neurological conditions also may not be candidates for spinal anesthesia. General anesthesia causes unconsciousness; therefore, you will not be aware of your surroundings during surgery. Disadvantages of General Anesthesia: There are side effects related to general anesthesia. The most common side effect is nausea and vomiting. This occurs more frequently in patients who have a history of nausea and vomiting after anesthesia, those who have motion sickness, females, or smokers. You may also have a sore throat from having the breathing tube/LMA placed. Confusion is commonly seen in elderly patients after general anesthesia. During placement of a breathing tube, there are several rare risks such as aspiration (contents from your stomach going into your lungs), pneumonia, or dental injury. Lung risks such as hypoventilation (not breathing well), blood clot traveling to your lungs, or the need to be placed on a breathing machine may also occur.
Advantages of General Anesthesia: General anesthesia is a good option when spinal anesthesia cannot be performed. Patients on
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Memorial Orthopaedic Center of Excellence
Day
of
Your Surgery
What to Bring Day of Surgery While you are in the hospital, we understand there are certain belongings that you will NEED to ensure your recovery goes smoothly. However, there are some things that may be better left at home. Below are suggestions of things to bring and others that should be left at home. Don’t forget! When you arrive for surgery, you will be prepped in a separate area that is different from your inpatient room during your stay. If you have personal belongings, please leave them with your family/friends or in the car until after you are taken to your inpatient room. If you have a Health Care Power of Attorney, Advanced Directive, and/or Living Will, and you did not bring a copy to your preassessment appointment, please bring it with you the day of surgery. Items to bring to use while you are prepped for surgery: • Glasses • Hearing Aids • Dentures • Incentive Spirometer (breathing device/volumetric exercises): Do not forget to bring your incentive spirometer with you as you will need it after surgery
Items you may bring but leave with a family member/friend until you need them: • Personal hygiene products (shampoo, toothbrush, deodorant, etc.) • Loose-fitting shorts and t-shirts or loose shirts to wear once IV is removed • Shoes from home that fit well, such as walking shoes or sneakers (Non-skid slipper socks will be provided for you to wear during your hospital stay.) • CPAP machine (breathing machine for sleep apnea) if you normally use one required • Cell phone/charger – you may use it in the hospital. • This patient education handbook
Items you should leave at home on day of surgery: • Cash • Keys • Credit cards • Jewelry and other valuables • Wedding rings may be left on but will be covered with tape by staff • All medications
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Day
of
Your Surgery
General Information
Pre-Op Holding Area
• Take only the medications as instructed by the nurse during your preassessment testing appointment. * If you have heart stents and currently taking a blood thinner, do not stop taking blood thinner medication until instructed to do so by your cardiologist or the medical doctor at your preassessment appointment.
• A nurse will perform an assessment and an evaluation.
• Do not use any lotions, powders, or perfumes. • Do not shave the area of the body where the surgery will take place. • Do not wear makeup, jewelry, hairpins, or nail polish to hospital. • Wear loose fitting clothing that is easy to get on and off. • Remove all piercings. • Please arrive at the time you have been instructed. This may be 2-3 hours before your surgery starts. This gives us time to get you ready for your surgery.
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• You will change into a hospital gown; underwear must be removed. • An IV will be started. • Your skin will be prepped with a CHG cloth as a final infection prevention step. • Vital signs will be taken. • Lab work or additional testing will be completed if necessary. • Medications will be given as needed. • From here you will go to a holding area in surgery where an anesthesia provider will discuss your anesthesia plan and review your medical history. Your family will go to the surgery waiting area at this time, or they may take this opportunity to visit the Tower Café for something to eat. • From here, you will go to surgery!
Memorial Orthopaedic Center of Excellence
Day
of
Your Surgery
Surgery • You will be placed on monitors. • Warm blankets will be available. • The correct patient and procedure will be confirmed. • You will be positioned for your surgery. • Family members will be updated during your surgery by both the waiting room attendant and the large monitor screen. • Following the surgery, the surgeon will talk with your family.
Post-Anesthesia Care (Recovery room) • You will be monitored closely by a registered nurse. • Monitors will be placed to check your vital signs frequently. • Oxygen may be applied to help your breathing. • An X-ray may be taken of your new joint. • Pain and nausea medication will be available. • Normal recovery time in this area is 45 minutes to one hour. • You will be moved from the recovery room to your patient room when you meet criteria based on your condition.
Post-Operative Care • • • • • • • • • • • •
You will be moved on a cart to your room in the Post-Surgical Unit. Your family will be able to see you after staff has been able to get you settled and evaluate you. You may need to wear oxygen after surgery. Your vital signs will be checked frequently for the first few hours, then every four hours. You will have a surgical dressing at the surgical site. Ice may be applied to your surgical site. You may have special sleeves on your legs attached to a pump at the end of your bed to help move the blood from your legs back to your heart. You will have an IV in place for one to two days. You will be asked to turn and reposition every 2 hours. You will be asked to take deep breaths every 2 hours while you are awake. You may eat a light meal later in the day. You may have your first physical therapy session which could include getting up and walking in your room.
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Day
of
Your Surgery
Quiet Time
We understand how important rest is for healing, and we also know how busy you can be as a patient! The Post-Surgical Unit is happy to be able to offer you a quiet time each day from 1:00 p.m. – 1:30 p.m. This is your time to use however you prefer. Feel free to take a nap, watch TV, or just relax knowing you will not be bothered during this time! Please know, you may call for assistance at any time if it is needed.
Pain Management
We are committed to managing your pain! During your stay, staff will ask you about your pain level. We rate patient pain level on a scale from 0 to 10. The staff will ask you frequently, “On a scale of 0 to 10, how would you rate your pain?” The 0 is equal to no pain and 10 is the worst possible pain you can imagine. Another way to visualize the pain scale is by the FACES pain rating scale:
Wong-Baker FACES® Pain Rating Scale
No Hurt
Hurts Little Bit
www.wongbakerFACES.org
Hurts Little More
Hurts Even More
Hurts Whole Lot
Hurts Worst
©1983 Wong-Baker FACES® Foundation. Used with permission.
Why is pain management important during your stay at Memorial Hospital and Health Care Center? It is important to control your pain to a tolerable level in order for you to carry out functions comfortably and participate in your rehabilitation. Pain that is managed allows for walking, doing breathing exercises, and performing other activities that promote strength and prevent complications during your hospital stay. You can be involved in your pain management by doing the following: • Discuss pain management options with your physician or nurse. • Let your physician know what pain medications have worked best for you in the past or if you had any adverse reactions to any medications that should be avoided. • Discuss any concerns that you have about taking pain medications. • Let your physician and nurse know what makes your pain more tolerable and what makes the pain worse. • Discuss your comfort goal. This is the level of comfort you need to be at in order to carry out your activities of daily living, deep breathing, getting in and out of bed, and walking. Every person has an individualized response and reacts differently to pain medication. It is important to let your physician and/or nurse know if you are not getting pain relief to a tolerable level with the medications that are given.
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Memorial Orthopaedic Center of Excellence
After Your Surgery Post-Op Day of Surgery
Post-Op Day One
• After your surgery, once your anesthesia has worn off, the nurses and physical therapists will work with you to get you out of bed. Part of our goal for you is getting you out of bed on the day of surgery (always with staff assisting you). • We may even have you sit up in a chair later that evening for your meal. • Rehab will work more with you in the following days. • You will be on mediations to help control your pain. It is important that you are aware of your pain goal in order for staff to help you best control your pain at an acceptable level. Your pain medication will be continued throughout your stay and will be managed accordingly. • Your blood will be drawn early in the morning around 4 or 5 a.m. This is to ensure that your results will be available when your doctor comes to see you so he/she will have all of the necessary information to best care for you. • You will be started on blood thinner medication to prevent complications from blood clots. • Continue your exercise program and breathing exercises. • You will be assisted with bathing as needed. • You will have a physical therapy session in the morning and afternoon. • You may have an occupational therapy session if ordered by your surgeon. • Your surgeon will visit you, as well as a medical doctor if needed. • You will have time to rest after lunch from 1:00-1:30 p.m. during Quiet Time. (See Quiet Time information, page 20)
Post-Op Day Two Post-Op Day Three Going Home
• You may sit up in a chair during the day and/or evening. • A Social Service/Discharge Planner will meet with you to discuss the plan of care tailored to your needs. • Most activities from day one will be repeated. Each day you will become more independent. • You will be increasing the distance you walk each day. • You may need a laxative if you become constipated, which is a common side effect of narcotic pain medications. • Depending on your progress, you may be discharged on day two.
• You will repeat activities from previous days in order to regain strength. • You will be preparing for discharge on day three. • Someone will need to drive you home. • You will receive written instructions about your follow-up care needs. • We will assist in making arrangements for any follow-up therapy or equipment needs. • If going home is not the best option for you, other options for extended recovery will be discussed with you by Social Service/Discharge Planner on the Post-Surgical Unit.
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After Your Surgery Your After Surgery Goals 1. Your orthopaedic team will assist in getting you out of bed on the day of surgery once your anesthesia has worn off. • Early activity reduces your risk for postoperative complications (which may include: pneumonia, blood clots, urinary tract infection, and constipation) and will also improve mobility.
2. Your orthopaedic team will help you walk an average of 150 feet with very little assistance before you are discharged. Your physical therapist will help set your personal goal based on your prior level of function. • Walking encourages independence, increases your active range of motion, and improves muscle strengthening.
3. Return to normal bowel regimen.
This will be discussed with you in further detail while you are in the hospital. • Constipation is common after surgery. This is due to pain medications and decreased movement. It is recommended to stay on stool softeners as long as you are taking pain medication (including after hospital discharge) and/or until your bowel regimen has returned to normal. You may need a laxative if you become constipated. If you do not return to your normal bowel regimen, contact your primary care provider. • While you are in the hospital, you are welcome to order prune juice on your meal tray when you place your orders. • Some over-the-counter laxatives may include: Milk of Magnesia (MOM) 3060ml daily as needed, Bisacodyl (Dulcolax) 10mg daily as needed, Miralax 1-4 capfuls daily as needed.
4. The average hospital length of stay is 2 - 3 days. A shorter stay is possible once your goals are met and your surgeon approves discharge. However, your length of stay may be dependent on insurance. Our case manager and discharge planner will review this while you are in the hospital. • A decreased length of stay can reduce the incidence of postoperative complications. Recovering at home reduces your risk of infection, promotes independance, and may reduce your hospital fees.
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Memorial Orthopaedic Center of Excellence
After Your Surgery 5. Discharge to home, if appropriate. • Plan to have someone available to care for you for several days upon returning home. • Recovering at home reduces your risk of infection, promotes independence, and may reduce your hospital fees. • Your discharge time will most likely be later in the afternoon/early evening; your surgeon may request a second therapy session before you go home. • The ultimate goal is to be discharged home. However at times, a Skilled Nursing Facility (SNF) will be more appropriate. You, your surgeon, and the orthopaedic team will determine whether it is appropriate for you to return home upon discharge from the hospital or if a SNF will be ideal for you. • If you have commercial insurance or managed Medicaid/managed Medicare, please call your insurance provider prior to surgery regarding your benefits and which SNF facilities are in your network.
These goals may not always be met due to unforeseen circumstances; however, your orthopaedic team will modify these goals to meet your personal needs.
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After Your Surgery POLAR CARE® CUBE
Prescription Form
TM
Treatment Awake/ Period Asleep
OPERATING INSTRUCTIONS
Day:
for Patients and Medical Professionals WARNING The Polar Care Cube can be cold enough to seriously injure the skin. Follow these Operating Instructions, Product Insert (in the pouch on side of unit), and the Polar Pad Fitting Instructions (provided with each Polar Pad).
Inspect Skin Every:
Frequency/Duration
Awake
Through
Day: Day:
Asleep
Awake
Through
Day:
Asleep
Day:
Awake
Through
Day:
Asleep
1 Discuss Treatment with your Licensed Health Care Practitioner Provide a complete medical history including any reactions to cold. Certain medical conditions make cold-induced injury more likely. Ask your practitioner about potential adverse reactions and cold induced injuries. 2 Use Only As Prescribed Use only according to your practitioner’s instructions regarding the frequency and duration of cold application and breaks, how and when to inspect the skin, and total length of treatment. Federal law restricts this device to sale by or on the order of a licensed health care practitioner.
3
3 Apply Insulation Barrier & Polar Pad Always use an insulation barrier (such as Breg Polar Dressing, Webril, Kerlix, cast padding or elastic bandage) between the Polar Pad and skin. Do not let any part of the Pad touch skin. If a sterile dressing has been applied to the treatment site that does not completely cover the skin under the pad, use an additional insulation barrier. Use only Breg Polar Pads designed for the body part, sold separately. Other pads may be colder, increasing the risk of skin injury. 4
Set Up Unit
6 Skin Inspection Inspect the skin under the Polar Pad (by lifting the edge) as prescribed, typically every 1 to 2 hours. Do not use the Polar Care Cube if dressing, wrapping, bracing, or casting over the Polar Pad prevents skin checks.
6
Stop using and contact your practitioner immediately if you experience any adverse reactions, such as: increased pain, burning, increased swelling, itching, blisters, increased redness, discoloration, welts, other changes in skin appearance, or any other reaction identified by your practitioner. 7 Ending Session To stop the pump, disconnect electrical power. To disconnect the Polar Pad from the pump hose, depress the two metal tabs on the hose coupling and gently pull apart.
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Page 24
Memorial Orthopaedic Center of Excellence
Over
After Your Surgery Trouble Shooting Guide
POLAR CARE CUBE Your problem is:
• • •
Pump is not running Water is not flowing to the pad Pad is not getting cold
Possible solutions:
• • • • • • • • • •
Make sure the power outlet is working and the plug is fully engaged with the unit. Make sure there is plenty of ice left and the water level is at or above the indicated line. Note: water line may not be visible. Confirm the pad and unit connectors are fully engaged. Ensure there are no kinks in the blue insulation hose or the pad. Decrease the tension on any bandages or straps securing the pad. Raise unit off the ground and place it on a table or chair to reduce backpressure. Disconnect the pad from the unit, rotate the connection 180˚, then reconnect the pad to the unit. Remove pad and fill it while the pad is lying flat; then reapply. Disconnect pad and place lid upside down on a flat surface. Remove filter cap and rinse filter cap. Remove dime-size foam filter and rub between fingers under running water until free of debris. Reassemble. Depress both plus-shaped, black plungers inside the Cube’s connector with a blunt object to release air trapped in the line.
Your problem is:
• •
Unit is leaking Condensation (Note: Some condensation on the lines and pads is unavoidable, especially in warm, humid climates. Minimizing air exposure will reduce condensation. To minimize air exposure, wrap an easily removable material over the pad and tubing. To prevent condensation from reaching the wound, use a sterile dressing with a water impermeable barrier. The Breg Polar Dressing is an example of an appropriate insulation barrier as well as a water impermeable barrier).
Possible solutions:
• If a leak exists (other than condensation on lines), disconnect pad couplings. Make sure the release clips on the couplings •
are depressed prior to reconnecting the pad to the pump hose. Confirm couplings are securely connected. If a leak is detected in the pad, or if leaking continues after the connection between the couplings has been checked, stop using the unit and contact Breg Customer Care at 800-321-0607.
Other Notes:
• • • •
Allow the unit to run for 10 minutes to achieve stable flow and pad pressure. Use large cubed ice for optimal performance. Never run pump without water, as this will cause permanent damage to your unit. If you are unable to resolve the problem, please contact Breg Customer Care at 800-321-0607.
Scan QR code for Breg’s Cube instructional video. breg.com/PCC
© 2012 Breg, Inc. All rights reserved. AW-1.96015 Rev B 0712 Polar Care is a registered trademark and Cube is a trademark of Breg, Inc.
Page 2 of 2
Breg, Inc. 2885 Loker Ave. East, Carlsbad, CA 92010 P: 800.321.0607 F: 800.329.2734 www.breg.com
Page 25
After Your Surgery
Caring for your wound
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Memorial Orthopaedic Center of Excellence
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• You may shower with this dressing in place
• This dressing will not stick to your wound
Mepilex® Border (ag) is a dressing that has been ordered by your healthcare provider. It will help your wound to heal
Border (ag)
• If the area around the wound gets red, swollen or painful to touch • If the wound color changes from pink or red to a tan, brown or black color • If you get a fever, or if the wound odor gets worse • If you have questions
c Gently press the dressing onto your skin being sure all edges are flat. This will help it to be waterproof
B Center the dressing over the wound, place the tacky side down on top of your wound
a Remove the release papers
The Mölnlycke Health care, Mepilex, and safetac names and respective logos are registered trademarks of Mölnlycke Health Care AB. Distributed by Mölnlycke Health Care US, LLC, Norcross, Georgia 30092. © 2012. Mölnlycke Health Care AB. 1.800.882.4582. 11-0217a
the suggested topical management options and change rates are the treatment choice of XXXXXXX and may not reflect the opinions of Mölnlycke Health care.
note: The recommendation and information in this material should not be considered a substitute for medical advice or diagnosis. See package insert for full instructions and precautions. Please contact your healthcare provider with any questions regarding the care or condition of your wound.
• A ny change in the wound that is a concern to you • If the drainage from the wound increases • If you have a sudden increase in pain, or new pain in your wound
(doctor, nurse, therapist)
WHen to call tHe HealtHcare ProviDer
clean cloth
Dry the skin around your wound with dry gauze or a
Patient Directions
Clean your wound using wound cleanser as listed under
step ➌. Cleaning your wound:
Discard in a plastic bag and remove your gloves Wash and dry your hands
lifting a corner and peeling away from your wound
Remove the Mepilex® Border (ag) dressing by gently
dressing:
step ➋. Removing your soiled Mepilex ®
Clean your work area before changing your dressing Gather your supplies as listed under Patient Directions Wash and dry your hands
step ➍. Applying your new Mepilex® Border (ag) dressing:
DisPosaBle gloves sHoulD Be Worn to Protect yourself anD otHers
step ➊. Preparing to care for your wound:
Patient inforMation sHeet for use of:
Discharge WounD care instructions
notes:
812-996-0495
Post-surgical unit:
Fac Rev 07.12
You may shower with dressing in place. Pat dressing dry, do not rub. Use foam tape around edges
note: The dressing should be changed if you see the wound fluid is present at the edges of the gray pad.
Rub border into skin for about 10 seconds; make sure the border is smooth with no wrinkles or rolled edges.
Pat skin dry and apply Mepilex® Border (ag).
Clean skin surrounding incision with soap and water or normal saline.
Follow up with Doctor on _______ .
Change dressing on Day 7.
at hoMe patient Directions
After Your Surgery
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After Your Surgery Special Instructions • You will be on a blood thinner for 4 weeks, unless otherwise specified by your physician (your physician will determine which blood thinner is best for you). • You may consider an over the counter stomach acid reducer (Zantac, Pepcid, Prilosec, etc.) if your blood thinner causes you stomach irritation. • Take your pain medication as instructed. Do not stop taking your pain medications abruptly. Wean off of them to prevent withdrawal symptoms. • If you take a bisphosphonate (Fosamax, Boniva, Actonel, Reclast, etc.) for osteoporosis, ask your surgeon when it can be resumed (you may have to stay off of it for 6 weeks to 6 months). • Numbness around the incision is normal. It will decrease over time but won't completely go away. • Wear elastic hose on involved leg for 4-6 weeks following hip surgery. May remove for shower. • Incentive Spirometry every one hour while awake. • Now that you have had joint replacement surgery, antibiotics are advised prior to dental procedures (including dental cleanings) and all procedures done in the operating room for the rest of your life. It is always best to let your physician and your dentist know that you have had your joint replaced prior to any procedure. • If you take estrogen (hormone replacement), wait 2 weeks after surgery before continuing. • An over-the-counter multi-vitamin / iron supplement is encouraged for 2-4 weeks after hip surgery. • Since you are not as active and may be taking prescription pain medication, you may use a stool softener or laxative, if needed for constipation until you are off your pain medications and/or you have returned to normal bowel movements. Some over-the-counter laxatives you may use include: Milk of Magnesia 30-60ml daily as needed, Bisacodyl (Dulcolax) 10mg daily as needed, Miralax 1-4 capfuls daily as needed.
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Memorial Orthopaedic Center of Excellence
Rehabilitation Total Hip Replacement Home Exercise Program
Pre Surgery: Below are some exercises to begin before surgery to strengthen your muscles and help with your recovery. Begin at 10 repetitions and progress to 20 repetitions (twice a day) as tolerated. Continue these exercises following surgery as instructed by your therapist. Post Surgery: After surgery, continue doing these exercises twice a day, 20 repetitions each. Be sure to apply ice after you exercise (at least for the first few weeks and longer if needed). 1. Ankle Pumps Bend and straighten ankle.
2. Quad Sets Press knee into bed, tightening muscle on top of thigh. Hold 5 seconds.
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Rehabilitation 3. Buttock Squeezes Squeeze bottom together and hold 5 seconds.
4. Hip Abduction Slide leg out to side and back.
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Memorial Orthopaedic Center of Excellence
Rehabilitation 5. Heel Slides Bend and straighten knee.
6. Short Arc Quads With knee bent over bolster, lift foot up, straightening knee. Be sure to keep back of knee on bolster.
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Rehabilitation 7. Straight Leg Raises Tighten muscles on top of thigh, then lift leg straight up off bed, approximately 12 inches. Lower slowly. Your therapist will advise you whether to continue this exercise following surgery.
8. Sitting Knee Extension Bend and straighten knee.
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Memorial Orthopaedic Center of Excellence
Rehabilitation Special Instructions for Total Hip Replacement
To minimize the risk of dislocating your hip following surgery, you will need to comply with the following hip precautions for a specified amount of time. • Do NOT bend your hip more than 90o. • Do NOT lift your knee higher than your affected hip. • Do NOT cross your legs. • Do NOT turn your affected leg inward.
90o
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Rehabilitation Transfer - Toilet You may need a commode extension or bedside commode over your toilet after surgery. When sitting down on the toilet: • Take small steps and turn until your back is to the toilet. Never pivot. • Back up to the toilet until you feel it touch the back of your legs. • If using a commode with armrests, reach back for both armrests and lower yourself onto the toilet. If using a commode without armrests, keep one hand on the walker while reaching back for the toilet seat with the other. • Slide your operated leg out in front of you when sitting down. When getting up from the toilet: • If using a commode with armrests, use the armrests to push up. If using a commode without armrests, place one hand on the walker and push off the toilet seat with the other. • Slide operated leg out in front of you slightly prior to standing. • As you stand, bring operated leg back.
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Memorial Orthopaedic Center of Excellence
Rehabilitation Transfer - Tub
Getting into the tub using a tub transfer bench: 1.) 2.) 3.) 4.) 5.) 6.)
Place bench in the tub facing the faucets. Back up to the bench until you feel it at the back of your knees. Reach back for the bench and slowly lower yourself onto the bench, keeping the operated leg straight. Move the walker out of the way but keep it within reach. Lean back and lift your legs over the edge of the tub. Scoot further into tub via bench.
Getting out of the tub using a tub transfer bench: 1.) 2.) 3.) 4.)
Scoot out towards edge of the bench. Lift your legs over the outside of the tub. Scoot out further on the edge of the bench if needed. Push up with one hand on bench while holding onto walker or grab bar with the other hand.
Please Note: * Although bath seats, grab bars, long-handled bath brushes and hand-held showers make bathing easier and safer, they are typically not covered by insurance. * Always use a rubber mat or non-skid adhesive on the bottom of the tub or shower. * To keep soap within easy reach, make a soap-on-a-rope by placing a bar of soap in the toe of an old pair of panty hose and attach it to the bath seat.
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Rehabilitation Transfer - Tub Getting into tub by stepping over tub edge after hip surgery: 1.) Position self parallel to the tub. 2.) Hold onto grab bar with one hand and walker with the other hand, as you bend your knee so that your foot goes behind you and not in front of you. 3.) Step over the tub edge. 4.) Bring other leg into the tub by bending your knee so your foot is behind you while continuing to hold grab bar. * If a shower chair is needed, hold onto grab bar and/or reach back for chair as you lower yourself down onto chair. Keep the operated leg out straight.
Getting out of tub by stepping over tub edge after hip surgery: 1.) Hold onto grab bar as you bend your knee so that your foot goes behind you. 2.) As you are holding onto grab bar with one hand, hold onto walker with other hand and then step over tub edge. 3.) Bring other leg over tub edge by bending your knee so your foot is behind you. * If a shower chair is needed, push up from chair and/or use grab bar to stand from chair.
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Memorial Orthopaedic Center of Excellence
Rehabilitation Durable Medical Equipment (DME) These items may be used to increase ease and safety of transfers if needed.
Tub Transfer Bench
Commode Extension Page 37
Rehabilitation
Toilet Safety Frame
Bedside Commode over Toilet
Shower Chair Page 38
Memorial Orthopaedic Center of Excellence
Rehabilitation Lower Body Bathing • • • •
You can use a long-handled sponge to bathe your feet. A towel wrapped around the sponge can be used to dry your feet. A hair dryer could also be used to dry your feet. You can place a washcloth on the floor to bathe the bottoms of your feet.
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Rehabilitation Lower Body Dressing Pants/Underwear (Total Hip Replacement)
Putting on pants or underwear: • Sit down for task. • Put your operated leg in first and then your unoperated leg. Use a reacher to guide the clothing over each foot. • Pull the clothing over your knees using the reacher. • Stand with the walker in front of you to pull your pants up the rest of the way.
Taking off pants or underwear: • Back up to the chair or bed where you will be undressing. • Unfasten your pants and let them drop down over your hips. • Push your pants down to your knees. • Lower yourself down, keeping your operated leg out straight. • Remove clothing from the unoperated leg first, and then from the operated leg, using a reacher to assist if needed.
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Memorial Orthopaedic Center of Excellence
Rehabilitation Lower Body Dressing Socks
Putting on socks using a sock aid: • Slide the sock onto the sock aid. • While holding onto the ropes, lower the sock aid to your foot. • Slide your foot into the sock aid. A reacher can be used to get the sock aid started onto your foot. • Straighten your knee, point your toe down, and pull on the ropes to pull the sock on. • Keep pulling on the ropes until the sock aid pulls out of the sock. * A sock aid can be used to put on compression stockings, also. Page 41
Rehabilitation Lower Body Dressing Socks
Taking off socks using a reacher or dressing stick: • While sitting, slide the reacher or dressing stick inside of the sock by your ankle. • Move the reacher or dressing stick behind your heel while it is still down inside your sock. • Push straight down with the reacher or dressing stick to remove your sock. * A dressing stick can be used instead of a reacher. * Compression stockings can be removed with the use of a reacher or dressing stick, also. Page 42
Memorial Orthopaedic Center of Excellence
Rehabilitation Lower Body Dressing Shoes
Using a long-handled shoehorn to put on shoes: • Use your reacher or long-handled shoehorn to slide your shoe in front of your foot. • Place the shoehorn inside the shoe against the back of the heel. Have the curve of the shoehorn match the curve of your shoe. • Lean back, if necessary, as you lift your leg and place your toes in your shoe. • Step down into your shoe, sliding your heel down the shoehorn.
Using a long-handled shoehorn or reacher to take shoes off: • You can use your reacher to unfasten Velcro, if needed. • Place either your reacher or shoehorn at the back of your heel. • Push down on the back of your shoe to slide shoe off. * A dressing stick can also be used. Note: Wear sturdy slip-on shoes, or shoes with Velcro closures or elastic shoe laces. Do not wear high-heeled shoes or shoes without backs.
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Rehabilitation Personal Care Equipment
Depending on your progress, the following equipment may be provided to you while in the hospital. Upon discharge, these items may be purchased to help you complete your personal care at home. * Please note: These items are not typically covered by insurance.
Reacher
Long-handled sponge
Dressing stick
Sock aid
Long-handled shoehorn
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Memorial Orthopaedic Center of Excellence
Rehabilitation Stair Climbing 1. When ascending stairs, step up with your non-operative leg first. 2. When descending stairs, step down with your operative leg first.
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Rehabilitation Transferring In and Out of a Car
1. Prior to getting in the car, move the seat of the car as far back as possible. You may even want to recline it, but return it to the upright position for traveling. 2. Back up until you feel the seat of the car against the back of your legs. 3. Reach back for the car seat or door frame to provide support for lowering yourself down. DO NOT use the car door - it may move! Remember to keep your operated leg out in front of you and be watching for the roof of the car so you do not hit your head. 4. Turn to the front, leaning back as you lift your operated leg into the car.
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Memorial Orthopaedic Center of Excellence
Your Family Visitors Policy Memorial Hospital and Health Care Center recognizes that most of our patient’s time in the hospital is spent receiving care and treatment. Memorial Hospital and Health Care Center allows for the presence of a support person of the patient’s choice, unless the individual’s presence infringes on others’ rights, safety or is medically or therapeutically contraindicated. The individual may or may not be the patient’s surrogate decision maker or legally authorized representative. However, a limited number of visitors may be necessary for the patient’s safety. Visitation will not be restricted based on race, national origin, religion, sexual orientation, color, sex or disability. Memorial Hospital and Health Care Center encourages families to be involved in the health care of their loved one. Therefore, we observe open visiting hours. Inpatient Rehab Center patients spend numerous hours in therapy each day, therefore the amount of time for visitation may be limited. Visitors are encouraged to stay with the patient for emotional support during the course of the stay, unless the patient’s condition or treatment requires a limitation to visitors. Visitation will be limited only if it infringes on the patients or others rights and/or safety.
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Your Family Visiting Hours Critical Care, Medical, Post-Surgical Unrestricted Visitation Inpatient Rehab Center Unrestricted Visitation Hours
Patients spend numerous hours in therapy each day. Therefore the amount of time for visitation may be limited.
Skilled Caring Center Unrestricted Visitation
*Inquire at the nurses station prior to visitation between 9:00 p.m. and 7:00 a.m.
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Memorial Orthopaedic Center of Excellence
Your Family Hotel Information 1. Hampton Inn (812) 481-1888 355 3rd Avenue Jasper, IN 47546
2. Holiday Inn Express (812) 482-3344 2000 Hospitality Drive Jasper, IN 47546
4. Econo Lodge
3. Jasper Inn and Conference Center
5. Days Inn
(812) 481-2008 75 Indiana Street Jasper, IN 47546
(812) 482-5555 951 Wernsing Road Jasper, IN 47546
(800) 329-1073 272 Brucke Strasse Jasper, IN 47546
Be sure to ask if the hotel offers special discounted rates for families of patients at Memorial Hospital and Health Care Center.
Memorial Hospital and Health Care Center
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Your Family Tower Café (Lower Level of LCM Tower)
Monday through Friday (Except Holidays*) 6:30 a.m. - 6:30 p.m. Saturday and Sunday 7:00 a.m. - 2:00 p.m. * Easter, Thanksgiving, and Christmas 11:00 a.m. - 6:00 p.m.
Gift Shop (Level 1) Monday - Friday: 9:00 a.m. - 7:00 p.m. Saturday 10:00 a.m. - 4:00 p.m. Sunday 11:00 a.m. - 4:00 p.m. Hours are subject to change.
Chapel Schedule MASS:
Every Wednesday at 4:30 p.m.
WORSHIP SERVICE:
Every Sunday at 9:00 a.m.
The Chapel is open twenty-four hours every day for private prayer and reflection.
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Memorial Orthopaedic Center of Excellence
Notes
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Please Note:
Take the following medication(s) the day of surgery with a sip of water:
Stop the following medication(s) prior to surgery:
• If you tested positive for Staphylococcus aureus, MRSA, MSSA (bacteria in the nostrils) - see page 11 for Mupirocn Nasal Ointment instructions. • Complete CHG Skin Prep 3 days before your surgery and the morning of your surgery - see page 12 for skin prep instructions. • If it’s necessary that you stay in a Skilled Nursing Facility and you have commercial insurance or managed Medicaid/managed Medicare please call your provider prior to surgery to see what your benefits are and which facilities are in your network. * Don’t forget to bring your Incentive Spirometer (breathing device) and this binder. See page 17 for additional items to bring.
Memorial Orthopaedic Center of Excellence
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