Pre Admission Education Session - PowerPoint Presentation

Slide1

Pre Admission Education Session

National

Orthopaedic

Hospital

Cappagh

Slide2

Welcome

Slide3

You have chosen to have a joint replacement to relieve your pain and to improve your mobility.

The aim of today is to explain the importance of planning ahead and preparing yourself and your family for your operation.

Topics for discussion:

Preparing for SurgeryDischarge PlanningYour Hospital StayPotential Complications

Welcome

Slide4

Preparing yourself for Surgery

Slide5

Introduction to

Joint

Replacement Surgery

Slide6

Introduction to

Joint Replacement Surgery

Slide7

Helps

assist surgeons to decide which joint replacements are performing well

Aims to improve the quality of services, safety and care

INOR will collect and record your personal information and details of your surgery and implants You must complete a questionnaire today Followed up 6 months after your surgery and at 2 and 5 year intervals in a nurse led clinic

Irish National

Orthopaedic

Register (INOR)

Slide8

The National Bone

Bank was established in 1996 to retrieve bone from suitable consenting donors undergoing total hip replacement surgery

During total hip replacement surgery the damaged femoral head is removed to allow the new hip to be fitted, this bone is often suitable to be used as bone graft

Bone graft is used to strengthen or replace lost bone for another patient during their surgeryThe Bone Bank co-ordinators, Eimear and Ken will meet with suitable, potential bone donors and invite them to participate in the bone donor programme

Bone Bank

Slide9

What you need to do

Slide10

Organise your lift to and from Hospital

Remember you may be discharged from day 1onwards

Arrange help for home, if you need it (e.g. washing feet, putting on shoes/socks etc.)

You may want to ask a friend or relative to stay for a few nights after dischargeWhat you need to do

Slide11

It

is important that you plan for discharge before you come into

hospital

Your discharge date will be decided by the team of Health Care professionals caring for you in discussion with you and your family. This normally occurs when you have reached your goals such as distance you can walk or that your wound is healing wellPatients generally return to their own homes after discharge from hospital as they typically do better in their own familiar environment

In exceptional circumstances there may be times when there are challenges for a patient to return home after surgery. If you think you may be unsuitable for discharge home please inform us today as this will give the team time to assist you in planning for your discharge home

What you need to do

Slide12

You should stop smoking at least four weeks prior to your surgery

Speak to your GP for smoking cessation advice

Reduce Alcohol intake

What you need to do

Slide13

There is strong evidence of high risks and worse surgical outcomes when a patient continues to smoke

Higher risk of chest infection and heart complications

Higher risk of post-operative infection

Have impaired would healingRequire longer hospital stay and high drug doses

Stop smoking

Slide14

This is one of the

most effective

things you can

do to reduce the symptoms of arthritisIf you are overweight losing just 10% of your body weight can reduce your pain levels by up to 50%

Maintain a healthy weight

Slide15

Walking transmits x 3 – 5 times

body weight across the hip and knee joint

.

It has been estimated that over-eating just 60 calories a day will lead to obesity in 10 years!Maintain a healthy weight

Slide16

Any exercise you do is beneficial. It is proven that increasing exercise before an operation improves your fitness and recovery. It also makes you feel happier and healthier

.

Examples of exercise – Swimming, walking, cycling, dancing

Aim for 20mins each dayWhat you need to do

Slide17

Dress for success

Loose comfortable clothes and trainers for the day

Long night dress or loose pyjamas are best for night time

Comfortable shoes –without a heel!

Light dressing gown

Slide18

Please eat & drink as

normal

Have a good meal the night before

surgeryNo food after 12 midnight water up until 0600 hours (unless you are instructed otherwise) If you eat and drink after these cut off times your surgery will be cancelledPlease ensure you are not constipated prior to your admission

Eating and Drinking

Slide19

Your stay at hospital

Slide20

Admitted to St Catherine’s Ward (Admissions Ward

)

Shower at

homeClean clothesPlease let us know as soon as possible if you feel unwell

No valuable items or large sums of money

Ad

mission day

Slide21

Spinal Anaesthetic

Approximately 2 hours in theatre

Recovery room after surgery for close monitoring

Pain relief if requiredPorter and nurse will transfer you to wardTheatre and recovery

Slide22

Back to the ward post surgery

Drip/oxygen

Dressing to hip bulky dressing to knee

Fluids and antibiotics

Regular pain relief and anti nausea

Pain score

Sips of water

Get up walking in afternoon

Visiting hours 2-4 and 6.30 to 8pm

Slide23

Get dressed in your comfortable clothes

Physio

X-ray

Aim to sit out for your mealsShower when the nurse advises its safe to doBloods

Surgical Team will review

Drip will be removed and oxygen discontinued

Day 1 and 2 Post Op

Slide24

Potential Complications

Slide25

Joint

Infection

Chest

infectionDeep vein thrombosis (DVT) – Leg Clot

Pulmonary embolism (PE) –

Lung Clot

Constipation

Difficulty passing urine

Your

anaesthetist and Surgeon will discuss other serious potential complications

Risk of surgery

Slide26

Shower before

admission

Keep visitors to a

minimum

Patient and relatives to use hand gel on

ward

Eat and drink

well

Stop smoking

Reducing Infection

Slide27

Stop

smoking

Deep breathing exercises

hourlySit out or up in bed as soon as possible after surgeryAvoiding chest infection

Slide28

Reducing the risk of leg/lung clot

Slide29

Bruising

Slide30

Discharge Planning

Slide31

Eat and drink well

Take medication as advised

Some form of exercise every 2 hours

Exercises (10 of each, 3 times a day)Apply ice - 15 minutes max, every two hoursArrange appointment with the nurse at GP practice

Review 6 weeks & INOR 6months post op

Discharge advice

Slide32

It is essential that you bring all medications which you take at home with you on the morning of surgery. Medications must be labelled correctly as shown below

.

Pharmacy

Medication in labelled bag.

Medication in labelled box

.

Medication in labelled bottle.







Slide33

Medication presented like those shown in the photographs below causes confusion and may result in your surgery being cancelled

Pharmacy

Blister packs

X

Pill box

x

Loose or unlabelled cards

X

Slide34

If you are taking any over the counter medications these may not be labelled, but please present these medications in their original packs to the pharmacist on the morning of surgery.

Some medications will need to be stopped a number of days prior to surgery. If this is relevant to you, you will be advised of this in the pre-assessment clinic.

Pharmacy

Slide35

Do not take any medication before coming to hospital on the morning of surgery. A pharmacist will assess which medications should be taken before surgery when you arrive on St Catherine’s ward.

To ensure your medications are presented in the correct format please present the yellow sheet in your folder entitled ‘Bring your medicines into hospital on admission’ to your usual community pharmacy.

Pharmacy

Slide36

Physiotherapy helps restore movement and function when someone is affected by injury, illness or

disability.

Physiotherapy

Slide37

Day of surgery

:

Depending

on the time of day you return to the ward you may be able to get out of bed with your physiotherapist using a zimmer frame

You

will start the bed exercises as practised before surgery (see handout)

Depending

on the time of day you return to the ward you may be able to get out of bed with your physiotherapist using a zimmer frame

You will start the bed exercises as practised before surgery (see handout)

Physiotherapy after surgery

Slide38

Day 1 onwards

:

You

will be seen by the physiotherapist for :Progression

to crutches/ sticks as

able

Completion

of

exercises

Stair

practice as

required

You

will be encouraged to practice your mobility and exercise programme independently or with a nurse as advised by your physiotherapist

Physiotherapy after surgery

Slide39

Less time in hospital

Less risk of hospital acquired infections

Fewer complications and readmissions

Planned earlier rehabilitation Faster recoveryEat better at home

Sleep better at home

Benefits of early

mobilisation

and discharge

Slide40

Hip replacement exercises

Physiotherapy after surgery

Slide41

Knee replacement exercises

Physiotherapy after surgery

Slide42

We will practice steps and stairs before you go home. We can also go through this with a family member or friend if

necessary

Stairs

Slide43

Prior to discharge the following goals will need to be achieved:

Independent and safe on sticks/crutches

Independent and safe on stairs

Independent with exercises

Practise transfers – in/out bed, on/off chairs

Independent

and safe on sticks/crutches

Independent and safe on stairs

Independent with exercises

Practise transfers – in/out bed, on/off chairs

Goals to be achieved

Slide44

You will continue with your exercises and walking after you go home

Physiotherapy is only routinely arranged for patients who have undergone a total knee replacement

Follow up physiotherapy will be arranged on discharge

Will I need therapy after I go home?

Slide45

Occupational Therapists can assess how you will manage their everyday activities of daily living within your home environment such as:

washing and dressing,

getting around indoors and outdoors,

bathing,

preparing and eating meals,

participating in work,

Following your surgery, you will be encouraged by all staff to be as independent as possible with tasks.

If you are having difficulties, an OT can problem solve with you how to overcome these.

Occupational therapy

Slide46

Following a total hip replacement you will be seen on the ward by the OT Assistant for the following

:

Education

on managing daily activities (washing, dressing, toileting etc).

For

those undergoing a Primary Total Hip Replacement, there are no longer hip precautions in place.

The

OT assistant will review you to determine what equipment, if any, you need to complete dressing and toileting independently

.

Occupational Therapy

Shoe horn

Sock aid

Easy Reacher

Raised toilet seat

Slide47

Recommendations

:

Initially

strip wash – you may need a chair to perch on when washing

If

you have a level access shower and you feel able to stand for long enough you can use this

You

can use a shower with step access BUT

Do

you feel you can manage the step? (It will be slippery after your shower

)

Are

you able to stand for duration

?

Can someone assist legs and feet/long handed equipment?

Washing and dressing

Shower Chair

Long-handled sponge

Slide48

Driving:

No

driving for 6 weeks following

surgery

Flying:

Check

with your consultant at 6 week

appointment

Journeys:

Regular

rest breaks to keep the joint

moving.

Sit

in the front passenger seat of the car and push the seat back.

Active

hobbies

Can

be discussed with your therapist

Activities

Slide49

Medical Social Workers can assist with any social or emotional issues that may arise as a result of hospital admission.

Discharge planning is a multi disciplinary assessment.

Supports/Services in the community are needs based and an assessment is required.

Information is available on private home care agencies if required. Please tell a member of staff today if you have any concerns and want to speak to a social worker.

Medical Social Work

Slide50

Meals:

Stock

the freezer, enquire about local meals on wheels, Wiltshire Farm Foods

Shopping: Consider getting shopping delivered or asking for help from family/ friends/ neighbours TEDs for hips: You

will need help to change these 2-3 times a week for up to 6 weeks

Planning for your recovery at home

Slide51

Enjoy your life with your new joint

Billy Joel

Arnold Schwarzenegger

Elizabeth Taylor

Andy Murray

Slide52

Medical Social Workers can assist with any social or emotional issues that may arise as a result of hospital admission.

Discharge planning is a multi disciplinary assessment.

Supports/Services in the community are needs based and an assessment is required.

Information is available on private home care agencies if required. Please tell a member of staff today if you have any concerns and want to speak to a social worker.

Medical Social Work

Slide53

Looking forward to seeing you soon.

Any Questions?

Thank you

Slide54