The Center for Orthopedics

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1 The Center for Orthopedics

2 The Center for Orthopedics 16 Board-Certified Orthopedic Surgeons Working jointly with Flathead Orthopedics with offices in Whitefish, Kalispell and at NVH Clinics in Eureka and Columbia Falls; Northwest Orthopedics in Whitefish Specialties include: Hip and Knee Joint Replacement Shoulder stabilization and reconstruction ACL, PCL and meniscal surgery Rotator Cuff repair Hand, foot and ankle surgery Hip resurfacing Arthroscopy Spine Performing >500 total joint replacement surgeries per year.

3 Leading Edge Technology Stryker Computer Navigation for enhancing precision in knee replacement surgeries.

4 Specialized Orthopedic Team Orthopedic Coordinator: A Certified Orthopedic RN guides the patient from pre-op through discharge. This coordinator works closely with all heath care team members, the patients and their families to attain the best possible outcomes. RN: Manage your bedside nursing care following your surgery. RN s use the surgeon s instructions to guide your care. RN s will provide education to you and your family about your health and safety needs. CNA: Assist with activities of daily living, taking vital signs, transfer, meals, toileting. Respiratory Therapist: Assists with incentive spirometer or oxygen use.

5 Specialized Orthopedic Team Physical Therapy Your Physical Therapist is on your team to help you achieve safety and independence with getting in and out of bed, walking, using stairs, and doing your exercises. CPM Machine (continuous passive motioning) will be started the day of your surgery. Rehab Goal Chart: your progress will be documented as you accomplish each of your goals. This goal chart is kept at patient s bedside. Hip Precaution Education Assistive Devices: we will help you acquire any assistive device you may need for going home.

6 Specialized Orthopedic Team Occupational Therapist Will focus on safety while performing daily activities. Hygiene Needs Shower or bathtub needs, secure bath bench, long handled sponge shower hose, elevated toilet seat Dressing Needs Dressing stick, sock, long handled shoe horn Reacher or grabber to pick up objects

7 Specialized Orthopedic Team Chaplain Provides spiritual care Clergy-on-call program Massage Therapist Complimentary massage program

8 Specialized Orthopedic Team Discharge Planning / Care Management Provides information on financial resources. Assists with home arrangements. Outlines options for care within North Valley Hospital and/or the community. Arranges follow-up home care with home health agencies. Assists with transfers to referral hospitals and rehabilitation facilities. Advocates with insurance programs and meet the requirements for insurance certification and review. Coordinates long-term care and assisted living if needed.

9 Lab Work Periodic labs will be drawn to monitor your recovery following surgery. Bathing/Showering Safety oversight by Occupational Therapy and Nursing Incision & Drain Care and Instruction Keep incision clean and dry. Cover the incision with aqua guard or press/seal when showering. If there is drainage, change the dressing daily to inspect incision. You will be provided dressings for home use. Bowel Program Specialized Orthopedic Team Stool softener, diet and fluids customized to your needs

10 Accomplishing Patient Goals Hip Knee Shoulder 3-4 days 2-3 days 1-2 days Look at accomplishing patient goals rather than expected days.

11 What to bring to the hospital? (Items that you will be responsible for) Loose fitting clothes - loose shorts, sweats, tops Non-slip shoes/ slippers with backs Personal toiletries CPAP machine with settings, and tubing Chargers for cell phone, computers Eyeglasses, hearing aids Make sure to bring your patient education packet the day of surgery. Copy of advanced health care directive Books, magazines

12 Getting Ready for Surgery

13 Day of Surgery NPO (Nothing by Mouth-includes mints and gum) No smoking or tobacco products of any kind. Pre-op nurse will review medications with you and will give you directions for which of your own medications you will take the night before and in the am prior to surgery as well as which medications to stop taking. Arrive at time specified by pre-op at admissions (The South Entrance).

14 Day of Surgery Surgery staff will escort you and your family to Same Day Surgery to meet with nursing staff, anesthesia and the surgeon. Meet with Anesthesiologist to discuss anesthesia concerns, past reactions and anesthesia experiences and start IV. Meet with surgeon who will mark surgical site. Your family can remain with you until you go into the operating room. Your family will wait for you either in a patient room or in the waiting area.

15 After Surgery Transferred right to your own bed after surgery is complete. You will be in the recovery room for approximately 1 hour. You will be taken to your room in the Medical- Surgical unit after recovery in PACU.

16 Pain Management Pain control is important for healing and recovery and will help in the following areas: Optimizes Functional improvement. Reduces risk for post operative complications. Decreases side effects (example, nausea and vomiting). Enhances patient satisfaction.

17 Patient responsibilities Discuss pain relief options. Communication between patient and nurse is important for facilitating adequate pain management and any other medication concerns.

18 On Q Pain Buster Small round pump filled with local anesthetic medicine to treat your pain after surgery. Automatically delivers the medicine at a very slow rate. Your nurse will remove the pump when it is empty, usually 2 days after surgery.

19 Pain Relief Options Intra- articular pain pump (On Q pain buster) Narcotic analgesics (oxycodone or hydrocodone) Routinely scheduled oral pain meds to bridge pain relief IV pain relief (Intermittent/PCA) Non steroidal anti inflammatory drugs Helps relieve pain Decreases inflammation in the joint to improve healing. Use of the Pain Scale

20 Blood Clots After surgery it is possible to develop a deep vein thrombosis (DVT) commonly known as a blood clot.

21 Blood Clot Prevention To help reduce the risk of blood clots, your surgeon may recommend: Getting back on your feet as soon as possible. Taking blood thinning medications. Wearing elastic stockings or ace wraps (remember to wear your shoes, the stockings can be slippery). Using sequential compression devices that use air to enhance circulation (remove before walking). Ankle pumps

22 Sequential Compression Devices

23 Antibiotics are given: Infection Prevention Within 1 hour of surgical incision Within 24 hours after surgery Review of hand hygiene program at NVH Using good hand washing and antiseptic hand gel by all staff members.

24 Prevention of Respiratory Complications Use of incentive spirometry Early mobility Coughing and deep breathing

25 Your Hospital Stay- General Information Diet & Meal Selection You will be encouraged to start with ice and clear liquids, but can start eating in a short time if there are no problems with nausea and vomiting. Positioning Hourly rounding checks Use of hip precautions and abductor pillows No pillows under the knee CMS checks (circulation, motion, sensation) IV Therapy Foley Catheter (if needed)

26 Discharge Information No dental procedures for 3 months and no dental procedure without antibiotic therapy for life. Continue exercise program as instructed. Review Discharge Medication Instructions. Review Discharge instructions specific to surgical procedure. Wear Ted hose until follow up appointment to prevent blood clot formation. Call if you see signs and symptoms of infection. Fever, drainage from incision, warm/red incision, increased pain not relieved by pain medication Call if you see signs and symptoms of a blood clot. Increased swelling, pain, redness of operative leg/site Inability to flex foot and operative leg without intense pain. Orthopedic Coordinator completes follow up and call back at one day and one week post discharge.

27 Home Planning Checklist At your pre-op Total Joint class you will be given 2 home safety checklists and a home/equipment questionnaire to complete prior to your hospital stay. Temporary living area on the ground floor if difficult to climb stairs. Remove all loose rugs and electrical cords from living areas. Secure handrails in showers and stairs. Secure a comfortable chair with arms for you to use after surgery.

28 The Center for Orthopedics at North Valley Hospital Thank you! Dr. Albert Olszewski Board-Certified Orthopedic Surgeon

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