Joint replacement pre operative teaching
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JOINT REPLACEMENTPRE-OPERATIVE TEACHING

FOR THE

WHITE PLAINS HOSPITAL CENTER ORTHOPEDIC INSTITUTE PATIENTS


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WELCOME

We have prepared the following to provide you with information to make your stay in our Orthopedic Institute more comfortable and to let you know beforehand, what you can expect during your stay.

Our goal is that all patients should have a very goodexperience while they are here.


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  • Within 5 days of your surgery a blood testing procedure called a “Type and Cross” will need to be completed at White Plains Hospital. This is done in the Admissions Testing Department next to Admitting. No appointment is necessary. Just go to the Admitting Department and tell the receptionist what you are there to have done.


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Preparing thinners, anti-inflammatory, and aspirin products generally 7 days prior to surgery. Be sure to discuss this with your doctor.toleaveforthehospital

  • Discuss with your medical doctor which, if any, of your regular medications you should take before leaving for the hospital on the day of your surgery. Once taken, leave all medications at home. You will be given medications from the hospital while you are an in-patient here. Do not bring your own.

  • Remember to bring your medical history packet and your Medication Reconciliation pamphlet with you when you come to WPHC. Be sure you’ve put your name on it.


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Pre-operative procedures thinners, anti-inflammatory, and aspirin products generally 7 days prior to surgery. Be sure to discuss this with your doctor.

  • Pre-operatively, you will be given a surgical scrub. Use it as directed the night before and the morning of the surgery. This will help control bacteria prior to the surgery. This scrub will be given to you when you come for your pre-operative teaching class prior to surgery. (The instruction sheet for use can be found at the end of this presentation.)


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Understanding your admitting procedure: the surgical area. The surgical team will use clippers to remove hair just prior to surgery.

  • When you arrive at White Plains Hospital on the day of your surgery, GO DIRECTLY to the third-floor Ambulatory Surgery Department. The admissions process has been streamlined so you can by-pass the Admitting Department.


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  • Once in this department, your nurse will escort you to the pre-operative holding area where you will change into a gown in preparation for your surgery.

  • Your nurse will provide and reinforce pre-operative teaching and you will be given the opportunity to have any questions answered.

  • As an added measure to prevent infection, the nurse will use a pre-treated wipe to cleanse the surgical area once again.


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  • From the holding area, you will be wheeled on a stretcher to the operating area.

  • Once you are wheeled to the operating room area, your family/significant others who have accompanied you for the surgery can wait in the 3rd floor family waiting area. The doctor will come out to them once the surgery is completed to let them know your status. Generally, the surgery can be expected to last 1 to 2 hours.


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  • Prior to your surgery, you will meet with the anesthesiologist, your surgeon, and the nurses involved in your surgery.

  • You will have an IV started for the administration of fluids and necessary intravenous medications.

  • The anesthesiologist will give you an antibiotic before the surgery.

  • The surgical team will take you to the operating room and they will go through a process of site verificationto ensure that the correct procedure and site are identified.


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  • Generally you will be given spinal anesthesia to anesthetize your body from the waist down.

  • In addition to spinal anesthesia, patients having knee surgery may have a peripheral nerve block. If this applies to you, expect to have less leg control for about 24 hours. You’ll need to wear a knee immobilizer when you get out of bed.


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  • Once the procedure is completed, the surgeon will close the incision and you may have a drain placed into the surgical area. The drain will collect bloody drainage from the area. If it is felt that there is a large amount of bloody drainage, the drainage will be filtered and transfused back to you (auto-transfusion) to keep your blood volume up.


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Post-operative/Recovery Room incision and you may have a drain placed into the surgical area. The drain will collect bloody drainage from the area. If it is felt that there is a large amount of bloody drainage, the drainage will be filtered and transfused back to you (auto-transfusion) to keep your blood volume up.

  • After the surgery, you will arrive in the Recovery Room (Post Anesthesia Care Unit).

  • The Recovery Room nurses will monitor your vital signs and provide care and comfort measures until your anesthesia wears off. Let the nurse know if you are experiencing nausea or pain.

  • You can expect to be transferred to your room after you have regained sensation and movement in your legs.


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Pain Control after your surgery and during your hospital stay:

  • Starting in the immediate postoperative period and continuing throughout the day, the nursing staff will use a Pain Assessment Tool to evaluate your level of pain or discomfort. This will generally be a scale of 0-10.


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  • Once a level of pain or discomfort has been determined, the nurses providing your care will refer to the doctor’s orders for pain medications. They will administer the appropriate pain control medication to you.

  • It is our goal to help you achieve a tolerable and functional pain level.

  • It is your responsibility to inform the nurse if the pain control is not effective.


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You may also have an ice pack machine or ice bag applied to your operative joint to assist in controlling swelling and pain of the joint and surrounding area. Frequent use of an ice pack is helpful for pain control throughout your stay.Speak-upso staffcan provide this as needed.


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For your safety, the hospital has implemented a bar code scanning system for medication administration. On admission you will be given a bar-coded bracelet. Whenever you are given medication, the nurse will scan both your bracelet and the medication.

If you have questions, we encourage you to speak up and ask the nurse.


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Post-Operative Care-continued blood clots forming in your legs.

  • In the post-operative period you will have light-weight leg wraps called SCDs (sequential compression devices) placed on your legs. You are also encouraged to do the ankle pumping exercises throughout your stay and after. These will assist in diminishing your chances of having a problem with blood clots in your legs in the postoperative period.


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Incentive Spirometry blood clots forming in your legs.

  • After the surgery, you will need to actively work on breathing deeply.

  • As a tool to help you with this deep breathing, you will be given an incentive spirometer. This is a tube with a mouth piece attached to a casing with a small ball inside.


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  • You should be able to feel the bottom of your rib cage expand outwardly in all directions if you are doing this correctly.

  • It is important to do not only deep breathing, but to also cough up any phlegm that may be in your airways. You can help avoid having respiratory problems after the surgery if you follow these guidelines.


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Your Arrival on 4I-the Orthopedic Unit expand outwardly in all directions if you are doing this correctly.

Your room set-up on 4I will include:

  • Phone availability (at a small charge)

  • TV availability (at a small charge-and run by an outside company)

  • There will be a trapeze placed over the bed for you to use in positioning yourself


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  • A special orthopedic chair will be at your bedside for sitting.

  • A raised commode will be in the room to keep you at the proper height to protect your newly replaced joint.

  • As part of providing very good care during your stay on 4I, the staff will do hourly rounding to ensure that your needs are met.


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You will be provided with our “Joints are made for Walking” race track to record your progress.

  • Your Joints are Made for Walking…

START

FINISH


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Visiting hours are from 8:00am to 9:00pm. If friends and family are ill, please request that they not visit.

We encourage family members to be involved in patient care in collaboration with the hospital staff caring for the patient.


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An Orthopedic Unit Room, family are ill, please request that they not visit.the Dining Area and the Gym


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Good Hygiene family are ill, please request that they not visit.Preventing infections is important!

  • After your surgery, the 4I staff will provide you with a liquid hand-sanitizer to enable you to clean your hands when you are in the bed. Once you are able, you can clean your hands at the sink.

  • There is hand sanitizing foam at the doorway of each room. Caregivers should use this prior to rendering care. Speak up if your caregivers forget.


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Good Hygiene Continued.. family are ill, please request that they not visit.

  • Ask visitors from the outside not to sit on your bed.

  • Ask visitors not to use your hospital bathroom. There are public restrooms for visitors use.

  • If the dressing is not intact, ask the nurse to reinforce it.


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Activity family are ill, please request that they not visit.

  • You can expect to be assisted out of bed by the physical therapist on post-op day one, generally by noontime. If for some reason you are not out of bed and sitting in your chair by noon, you must let your nurse know. Your nurse will check with the rehabilitation department to determine when the therapist will make the first PT visit.


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  • On subsequent days, the nurse/nursing tech will assist you out of bed in the morning and have you ready for your morning therapy session. The 4I staff will bring you to the gym at the time designated for your therapy.

  • We expect that you will be out of bed walking with therapy or the nursing staff at least 4 times a day to aid in your recovery.


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Rehabilitation out of bed in the morning and have you ready for your morning therapy session. The 4I staff will bring you to the gym at the time designated for your therapy.

  • The first day after your surgery, you will be seen by the Physical Therapist. The therapist will evaluate how you are functioning and will get you out of bed. Depending on how you are moving, you will be assisted to the chair at your bedside or you may walk a short distance before returning to your chair.


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Post-operative days 2 + 3: minimum of an hour is the goal.

  • On the second and third post-operative days, the physical therapist will see you in the 4I Gym area in the morning where you will do exercises and walking. This session will include stair climbing on the 3rd day, if not sooner.

  • In the afternoon, the therapist will see you for another session of walking and/or exercises.


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In addition to walking and exercises, your therapy sessions will include instruction and practice in:

  • getting in and out of bed

  • getting up and down to/from a chair

  • getting in and out of a shower

  • using special equipment for dressing and reaching while maintaining hip precautions


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Further post-operative days: will include instruction and practice in:

  • It is anticipated that you will be discharged on the 3rd postoperative day. If you need to stay longer for medical reasons, then on the fourth post-operative day, the therapy frequency will become once daily, and will remain as such, unless your medical status dictates otherwise.

  • These sessions will include exercises and/or ambulation as indicated by your need.


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Precautions to observe if you are having a will include instruction and practice in:Total Hip Replacement (to minimize the risk of dislocating your hip)

  • DO NOT bend the operative hip more than 90 °.

  • DO NOT rotate the operative leg inward. As you lie in bed, the toes should remain pointing up toward the ceiling or rotated outward slightly. They should not rotate inward toward each other.

  • Keep the legs apart. DO NOT cross your legs.


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Further hip precautions to observe after will include instruction and practice in:

Hip Replacement surgery are:

1. You must avoid twisting your body around either while in the bed, in your chair, or while standing. Position items close to you in bed or in the chair so you can avoid reaching or twisting to get them.

2. You will need to avoid leaning forward when seated in a chair.


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3. To turn while walking with the walker, turn incrementally. Place the walker a little to the side and move your feet in small steps in the direction of the walker. Keep repeating this until you are turned around. Avoid pivoting around on your operative hip.


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4. Sit in a firm, upright chair with a pillow or extra cushion to raise the height of the seat. A chair with armrests is suggested. DO NOT sit on a soft or low chair.

5.Use a raised toilet seat or place a raised commode directly over the toilet. DO NOT sit on a standard height toilet.


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6. cushion to raise the height of the seat. A chair with armrests is suggested. Youmust avoid bending at the operative hip and using your hands to pick items up off the floor.

  • Use a reacher to pick up light items, or ask for assistance.


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7. You must use adaptive equipment to dress your lower body. cushion to raise the height of the seat. A chair with armrests is suggested.

  • Use a sock aid to put on your socks.

  • Use a dressing stick or reacher to put on your underpants and slacks.

  • Use elastic shoelaces for your shoes or use slip-on loafer style shoes with a back to them.

  • Use a long handled shoe horn to put on your shoes.


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8. cushion to raise the height of the seat. A chair with armrests is suggested. You must useadaptive equipment to wash your lower body.

  • Use a long handled sponge or back scrubber to wash below your knees.


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9. cushion to raise the height of the seat. A chair with armrests is suggested. You may not shower until the staples are out and your doctor has given permission.

  • Hold on to a safety bar in order to enter the bath tub for showering. Step over side of tub by bending your knee up behind you to clear the tub side. (Donot bend at the hip). Straighten knee once it has cleared the tub side. You will only be able to shower.

  • You must not sit down in the tub. A bath seat for ease of showering may be recommended by your therapist.


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10. cushion to raise the height of the seat. A chair with armrests is suggested. You will not enter a car as you did before your surgery. As a passenger:

  • Sit in the front passenger seat.

  • Have the car seat positioned as far back and as high as possible. You may place 1-2 pillows on the seat if needed.

  • Open the passenger car door as wide as possible.

  • Using walker/crutches walk up to car door, then, turn facing away from the car and back up to car seat. Place one hand on dashboard or car door and the other on the seat back. Sit slowly. With legs separated, pivot onto the seat.


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11. cushion to raise the height of the seat. A chair with armrests is suggested. For kitchen tasks, keep the following in mind:

  • Place all items used frequently in storage areas from hip level to any easy reach above your chest.

  • Sidestep along counter top, keeping walker or crutches within reach.

  • Use a walker basket or the counter top to transport items.

  • To reach lower surfaces, extend operated leg behind you as you bend at your waist.


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If you are having a cushion to raise the height of the seat. A chair with armrests is suggested. Total Knee Replacement-

  • Your surgeon may order a CPM or Continuous Passive Motion machine to be used on your operative knee. This is a machine that will gently move your leg through an easy range of motion. If ordered, it will be used 1 to 3 hours daily from the day it is ordered. The therapist will set it up on the first day of use. The nursing staff will set it up thereafter.


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Walking Devices: cushion to raise the height of the seat. A chair with armrests is suggested.

  • Generally patients who have had total joint replacements will begin ambulating with a walker. They may progress to using crutches before discharge.

  • Stair climbing is taught using 2 rails and progressing to a railing and cane/crutches.


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Safety Tips home environment with your therapist.

Do a safety check of your home before you come to the hospital:

  • Remove potential hazards like throw rugs and electrical cords from the floor area.

  • Have a clear path from your bedroom to your bathroom.

  • Have a sturdy chair with arms and a firm seat available for your use.


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Safety Tips home environment with your therapist.Continued-

  • Place items that you use often within easy reach of the chair.

  • If you have a commode, raised toilet seat, or tub bench at home, check that the equipment is in good condition.

  • If you have crutches or a walker at home, check that the equipment is in good condition.


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Items to bring for your stay: home environment with your therapist.

  • Under shorts/underpants, and if desired, loose fitted clothing such as shorts, T-shirts, sweats, pajamas or short bathrobe

  • Eyeglasses, hearing aids, if used

  • Any braces or orthotics you normally use

  • Personal toiletries

  • Shoes and sweat suit/loose fitting clothes for going home-these can be brought in at a later date

  • Leave valuables home


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If you have any further questions about therapy, call the home environment with your therapist.

White Plains Hospital Center

Physical Medicine Department at:

(914) 681-2430


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For Outpatient Physical Therapy before or after your surgery, consider our

expertly staffed White Plains Hospital

Physical Therapy Center at Rye Brook

111 South Ridge Street, Rye Brook, NY

(Across from the Rye Ridge Shopping Center)

(914) 681-1116


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Discharge Planning surgery, consider our

  • We expect your length-of-stay in the hospital will be 3 days or less.

  • Once you have had your surgery, the staff responsible for discharge planning will begin to make arrangements for your discharge.


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Discharge Plan surgery, consider our

  • The discharge plan is formulated based on the following factors:

    -your post-operative medical status

    -how mobile you are around the time of discharge and whether you have anyone who can assist you at home

    -your insurance and financial considerations


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Discharge Plan – Insurance Considerations surgery, consider our

The discharge process is heavily dependent on what arrangements your insurance company agrees to cover. Some insurance companies rule out some of the discharge options.


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Discharge Plan – Insurance Considerations cont. surgery, consider our

  • Prior to your admission you should familiarize yourself with your own insurance benefits related to discharge options.

  • Be aware that the customer service representatives you contact by phone do not always give the accurate discharge options. These are decided by the insurance company case manager assigned to your admission once you are a patient and are based on your level of functioning.


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Discharge Options surgery, consider our

The options may include:

  • Returning home with Home Care services being provided by a Certified Home Health Agency.

  • Going to a facility for sub-acute physical therapy services. This is generally a service offered in a nursing facility that has beds set aside for short-term rehabilitation.

  • Going to a rehabilitation center.

  • Going home with out-patient therapy.


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Discharge Considerations surgery, consider our

  • Many people are functioning well enough after their hospital stay to go home. Home care services would start the next day after you return home. These would include physical therapy, a nurse if indicated, occupational therapy, if indicated, and some home health aid hours if needed.

  • Alternatively, you could go home and receive therapy on an out-patient basis.


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Discharge Considerations Continued.. surgery, consider our

  • Sub-acute rehabilitation is less demanding than the therapy in a rehabilitation center. Generally there will be one daily physical therapy and one daily occupational therapy session 5-7 days per week, depending on the facility. Some facilities upon patient assessment may provide more sessions.

  • Therapy at a rehabilitation center will involve more extensive and intense therapy sessions.


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Discharge Considerations Continued.. surgery, consider our

  • For any facility transfer, patients must be screened for eligibility and approved by the receiving facility.


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Final Discharge- surgery, consider our

  • The discharge planner submits the required information to your insurance case manager in order to obtain authorization to cover your discharge plan option.

  • The discharge planner at White Plains Hospital will advocate for the plan developed by the team. However, our staff can only work within the constraints of what your insurance company, represented by your case manager, will approve.


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Post Discharge Concerns surgery, consider our

Signs and symptoms to be concerned about are:

  • Fever

  • Redness

  • Increased swelling

  • Calf pain

  • Drainage from your incision

  • Trouble breathing

    Call your physician if you have any of these or other unusual symptoms.


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Long term issues after joint replacement surgery, consider our

  • After you have had joint replacement surgery, you will need antibiotic prophylaxis (prevention) for any dental work-even cleaning. Ask your physician for a prescription and coordinate this with your dentist.

  • Your surgeon may suggest antibiotic prophylaxis for other times when infection prevention is important. Ask about this.


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Pain management at home for an infection (i.e. a urinary tract infection or infected wound), be sure to remind the attending doctor that you have had a joint replacement.

  • Use your prescribed medication as directed. If pain is not relieved, speak with your doctor.

  • As pain diminishes, try decreasing your pain medication.

  • Pain medication becomes effective about 20 minutes after taking it. Plan ahead so the medication will have taken effect by the time you need it.


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If you will not be able to tell others that your stay at White Plains Hospital Center was VERY GOOD, please speak to us about it before you leave. We are continually trying to improve our program and would very much appreciate your input on how we could make it better.


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  • We hope this information has been helpful. It is meant as an overview of what your hospital stay will entail. The staff will be going through the process with you step by step upon your arrival and will answer your questions as you go along.

  • If you need further information about what to expect, you can call Carol Smullen, RN, ONC, at 681-2259.

Prepared by W.C.Busch, M.S., PT and Anila George, MSPT

Contributions by: Carol Smullen, RN, ONC; Betty Leung, RN, MSN, ONC; Sally Tortora, RN, ONC; Janet Gaynor, RN; Maria Hood, CSW; and other members of the following: Discharge Planning/Social Services Dept. , PACU, PM&R Dept., Orthopedic Institute Committee members.


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  • WHITE PLAINS HOSPITAL an overview of what your hospital stay will entail. The staff will be going through the process with you step by step upon your arrival and will answer your questions as you go along.

  • Pre-Surgical Testing-Surgical Site Skin Antisepsis

  • Information Sheet-

  • ADULT PATIENTS ONLY

  • It has been proven by the Centers of Disease Control that washing the surgical site area with an antiseptic antimicrobial solution (Hibiclens) the night before, and the morning of surgery, is extremely important to promote good patient outcomes.

  • White Plains Hospital Center is committed to providing you with every opportunity to have a safe and speedy recovery from your surgery. In an effort to do just that, we are supplying you with two 15 ml. Packets of Hibiclens.

  • Please follow the directions below.

  • Shower both the evening before and the morning of surgery with Hibiclens:

  • Using a freshly laundered washcloth, shower with warm water from the neck down.

  • Rinse the washcloth with warm water.

  • Apply a small amount of Hibiclens to the washcloth with warm water and then squeeze the cloth until it becomes sudsy.

  • Wash from the neck down.

  • Rinse the area and the washcloth with warm water.

  • Re-apply a small amount of Hibiclens to the washcloth with warm water and then squeeze the cloth until it becomes sudsy.

  • Again, wash from the neck down and rinse thoroughly.

  • Allow to air dry or, if necessary, gently pat dry with a clean towel.


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Hibiclens use continued an overview of what your hospital stay will entail. The staff will be going through the process with you step by step upon your arrival and will answer your questions as you go along.

Following each preoperative shower:

* The skin should be thoroughly rinsed;

* Dry the with a fresh clean dry towel

* You should don clean clothing.

If you are allergic to Chlorhexidine (Hibiclens) or any other soap preparation- DO NOT PERFORM THE WASH OF THE SURGICAL SITE AREA.

If you have a history of any skin condition such as eczema, psoriasis, contact dermatitis, etc.-DO NOT PERFORM THE WASH OF THE SURGICAL SITE AREA.

Caution should be exercised to avoid Hibiclens contact with the eyes, inside the ears or other mucus membranes.

(If you have been unable to pick up your packets from the hospital, you should be able to obtain Hibiclens from your local drug store. You will need only 2 ounces. Speak to the pharmacist if you have trouble locating it.)


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