WELCOME Thank you for choosing Park Ridge Health for your Orthopedic Surgery. Park Ridge Health Orthopedic Surgery works with fellowship-trained orthopedic surgeons with the highest level of training to care for your orthopedic condition/injury. Our team works directly with the nationally recognized health care professionals at Park Ridge Health to provide a positive experience for you and your family.
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LONG SHOALS RD.
ASHEVILLE REGIONAL AIRPORT
P A G
D AR W HO
BLUE RIDGE BONE AND JOINT
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100 Hospital Drive Hendersonville, NC 28792 828.684.8501
PARK RIDGE HEALTH IS CONVENIENTLY LOCATED BETWEEN ASHEVILLE AND HENDERSONVILLE, OFF INTERSTATE 26 AND EASILY ACCESSIBLE FROM EXIT 44 – FLETCHER/MOUNTAIN HOME. TRAVELING SOUTH OR WEST (FROM ASHEVILLE): From Interstate 40, merge onto Interstate 26 and continue east to Exit 44 – Fletcher/Mountain Home. Turn south onto Highway 25 and turn left at the first traffic light onto Naples Road. Proceed approximately one mile. Park Ridge Health will be on your right.
TRAVELING NORTH (FROM HENDERSONVILLE, TRYON OR COLUMBUS): Drive west on Interstate 26 to Exit 44 – Fletcher/Mountain Home. Turn south onto Highway 25 and turn left at the first traffic light onto Naples Road. Proceed approximately one mile. Park Ridge Health will be on your right.
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WHAT TO EXPECT
THE DAY OF SURGERY
Do not eat or drink after midnight. Take your medications as instructed at your pre-operative appointment. If you are a diabetic, be sure you understand how to adjust these medications. • • •
You will check in through the main entrance two to three hours prior to your surgery. You will receive your arrival time at your pre-operative appointment. Please let your team know if there are any special communication needs during this pre-operative appointment. You and your family will be taken to the pre-operative holding area. The nurse will do an initial assessment, perform any needed blood tests and start an IV. You will meet with your anesthesiologist and surgeon prior to surgery.
During your surgery, your family and friends will relax in the surgical waiting area. They can walk around, go outside for fresh air or get a bite to eat in the cafeteria. The operating room team will attempt to keep them updated with the progress of your surgery, so ask them to provide a cell phone number. Your surgeon will talk with them after surgery.
SURGERY MEDICAL PROFESSIONALS / ORTHOPEDIC SURGEON • • •
Performs your surgery and directs your care Evaluates you daily during your state Follows your entire recovery process
PHYSICIAN ASSISTANT • • •
May assess your medical status and assist during your stay May assist Orthopedic Surgeon during surgery Answers patient's questions about surgery
NURSING TEAM •
Includes an Orthopedic Nurse Navigator, pre-operative nurses, intra-operative nurses, recovery room nurses and nurses who care for you during your stay
HOSPITALIST/CONSULTING PHYSICIAN • •
Directs your medical care while staying in the hospital Provides specialty medical care
ANESTHESIA OPTIONS •
During your pre-operative appointment, you will meet with an anesthesia team member and review your medical history
ANESTHESIA TEAM •
Includes an Anesthesiologist and a Certified Registered Nurse Anesthetist
IN THE OPERATING ROOM •
You will be surrounded by team members who are trained to care for your needs
PHYSICAL AND OCCUPATIONAL THERAPY • •
Physical Therapist Supervises exercises in the hospital Arranges for your care and recovery needs after you leave the hospital, which may include: home physical therapy, and equipment you may need after discharge Your physical therapist will begin your rehabilitation soon after your surgery, often on the same day. They will work with you on gait (walking), exercises for strength and flexibility of your new joint, mobility activities and education. Occupational Therapy will also assist and train you in activities of daily living, such as bathing, dressing and self-care. You will be seen daily by your therapists, getting you off to a great start in your recovery.
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MEDICAL PROFESSIONALS AFTER SURGERY
You will go to the post-anesthesia care unit, or recovery room, where a new team of nurses will monitor you and provide pain medication, as you wake up from the anesthesia. Please be sure to tell the nurse, if you have any pain or nausea. Most patients will go up to the medical/surgical floor (third floor) about 45 minutes after surgery. However, depending on the type of anesthesia, and how you react to it, some may require a longer stay. Your family will be notified when you are going upstairs. Your surgeon will talk with them after the surgery.
• • •
Instructs you on use of oxygen after surgery Assists with breathing exercises that help prevent fever after surgery Assists with CPAP machine, if you have sleep apnea
YOUR STAY ON THE MEDICAL/SURGICAL UNIT
After your release from the recovery room, you will be taken to the medical/surgical unit. In most cases, we hope to get you walking the day of surgery. Family and friends are encouraged to visit; however, they must be aware of your recovery needs after surgery. You will need plenty of rest and quiet time. All guest rooms are private, with accommodations for one adult visitor to stay overnight.
You will start with a liquid diet following surgery. If tolerated without nausea or vomiting, you will progress to a regular diet. If you have any special requests (for example, vegetarian or vegan), we will do our best to accommodate those requests. Each patient will receive one free meal tray for a family member or friend during your stay. Additional guest trays may be purchased for family and friends through the dietary service for a nominal fee.
Your physician will determine your activity orders after surgery. Please remember to bring comfortable clothes. While most people are assessed as capable of bearing their full weight on the surgical extremity, some individuals will be partial or no weight-bearing. If you arrive on the unit before late afternoon, a physical therapy team member will evaluate you and help you stand at your bedside. If you come up later in the day, you will stay in bed until the next morning. You will be allowed to stand on your own as your strength and endurance progress. Until then, your nursing team can help with mobility and positioning at any time. Just Press Your Call Button for Help!
You will have pain medication ordered by your physicians after your procedure. This will include both narcotic and non-narcotic medications. You need to communicate your pain levels with the nursing staff and they will provide medication. Cryotherapy (icing) is also important post-operatively and should be performed frequently through the day.
Your medication will be ordered by your physician and administered to you by your health care team. Only in very rare situations will you be permitted to take your medication from home. Please contact your nurse if you have any questions.
CARE MANAGERS/DISCHARGE PLANNERS
• • •
Arrange your care and recovery after discharge May arrange your stay at a skilled nursing facility Arrange health care and equipment you may need after discharge
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WHAT ARE THE RISKS INVOLVED IN JOINT REPLACEMENT It is important that you understand both the benefits and the risks of joint replacement surgery. The ultimate goal is to eliminate the pain associated with your arthritic joint. Most people recover smoothly after surgery. However, complications are possible. These occurrences are rare and vary based on a patient’s medical and physical conditions. Your surgeon has discussed the risks with you in an earlier clinical visit. A brief list of potential complications includes, but is not limited to:
BLOOD CLOTS These occur when blood flow is slowed due to immobility after surgery. How do we prevent them? • • • • •
Early mobilization: our goal is to get you walking the day of surgery Wearing compression devices. You will receive these after surgery Blood thinning medications (aspirin, Lovenox, Xarelto, Coumadin) Ankle pump exercises Helping you get out of bed several times a day
INFECTION With joint replacement surgery, infection may occur at the incision (a superficial infection) or in the space around your joint prosthesis (a deep infection). You will receive antibiotics at the time of your surgery to help prevent infection. Drainage from the wound a week or more after surgery may be a sign of infection. Call your doctor’s office for a wound check if this occurs.
DENTAL INJURY Teeth may become chipped, loosened or dislodged during your surgery. Please let your anesthesiologist know of any potential dental issues.
Please discuss questions or concerns with your surgeon.
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REACTIONS TO ANESTHESIA OR PAIN MEDICATIONS Please let your anesthesiologist know of any previous problems or reactions to anesthesia or medications.
OTHER COMPLICATIONS COULD INCLUDE: • Nerve injury • Blood vessel injury • Low post-operative blood count • Fracture • Joint dislocation • Leg length discongruency • Death (extremely rare)
CONSENT You will be asked to sign a consent form prior to surgery, permitting your surgeon to perform the required surgical procedure. Please feel free to ask questions.
BLOOD TRANSFUSION Some people will develop a low blood count after surgery. If this occurs, you may require a blood transfusion from the blood bank. The decision is based on both your blood count level and any symptoms you may have, such as getting light headed when you stand up. The risks involved with blood transfusion are extremely low due to the stringent testing performed by the blood bank. These risks include joint infection, HIV, Hepatitis B and C, and HTLV. If you have any religious reasons preventing you from receiving blood transfusions, please let your doctor know ahead of time. It is important that we are aware in advance if anyone will refuse blood transfusions. Donating your own blood before surgery is no longer an option, as it leads to increased need for transfusions.
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QUESTIONS WHAT TESTS ARE REQUIRED BEFORE SURGERY? Everyone is required to undergo pre-admission testing (PAT) before surgery to assess if you are medically fit to undergo surgery. You will meet with an Orthopedic Nurse Navigator to review your medical history and medications. You will also speak with one of our Anesthesiologists to discuss your surgery. Testing will include: • • •
Blood work EKG MRSA nasal colonization screening
In some cases, other tests may be required. Within two weeks of surgery, you will be scheduled to meet with the anesthesiologist on campus and finish up any remaining tests.
WHAT ABOUT MY DAILY MEDICATIONS PRIOR TO SURGERY? At the time of your PAT or health campus visit, you will be told which medication(s) to take and which to hold prior to surgery.
HOW LONG WILL I BE STAYING AT PARK RIDGE HEALTH? The length of stay is dependent on your pre-operative condition, the surgical procedure, your progression through physical therapy and any medical complications. You are our guest, and as such, you will not be discharged until you are medically ready.
WHAT IF I CAN’T GO HOME AFTER SURGERY? While most people go home after surgery, in rare cases, some may require a short stay at a skilled nursing facility.
WILL I HAVE THE OPPORTUNITY TO ASK QUESTIONS? Please feel free to approach any of your health care team when a question arises, not just your surgeon. While the surgeon is the leader of your team, any of our team members will be happy to assist you.
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A POSITIVE APPROACH Preparing mentally for surgery is just as important for you and your support group as it is for your surgeon and the rest of the medical team. Keep in mind that the pain and activity limitations after surgery will be different than what you are experiencing now, and that they will be short-term. Using your new joint by walking and doing the exercises that your doctor orders, is a vital part of the recovery process. Your recovery and exercise plan will be tailored to meet your needs, as each individual recovers differently. Individuals requiring a revision total joint replacement, or replacement of a worn out or damaged prosthesis, often progress at a slower rate than after the first surgery. Your stay at Park Ridge Health will be short, and your recovery will continue at home. It is important for you to commit to your doctor’s instructions and exercise after surgery in order to benefit fully from the joint replacement. If you or your family has questions or concerns after surgery and during recovery, please talk with your team. Remember, the improved lifestyle after recovery is well worth the risk and stress of surgery!
YOUR SUPPORT PERSON’S ROLE IN YOUR RECOVERY Your family and friends are a very important part of your recovery when you go home.
THEY CAN HELP BY: • • • • • • •
Assisting with meal preparation prior to surgery Moving food to cabinets located between the level of your shoulder and waist. Preparing a room with all the needed supplies so you can rest during the day Removing rugs and other clutter for safe walking Running errands, grocery shopping and driving you to follow-up appointments with your doctor Arranging for needed equipment Assisting with children and pets
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START A CHECKLIST
TO PREPARE FOR YOUR VISIT! PREPARE YOUR HOME FOR SURGERY • • • • • •
Remove throw rugs, electrical cords and other small objects that could cause tripping Arrange child care and pet care Raise the height of your chairs with cushions Place commonly used items within reach Stock up on quick meals, such as canned, boxed and frozen foods Keep your phone within reach
If your bedroom is on the second floor, get creative. During your initial recovery, you may only be allowed to use the stairs once a day, and most likely will not feel like making multiple trips up and down. Be prepared to stay on the first level for a couple of weeks and make arrangements for help. You won’t be driving until your doctor or therapist gives you the OK. It will be two to six weeks before you are able to drive, depending on which leg has had the replacement and how long you are taking narcotic pain medication. Arrange for assistance in running errands, getting groceries and traveling to doctor’s appointments.
PREVENT INFECTION There is a risk of infection associated with your joint replacement surgery. You will receive a cloth with special soap and instructions prior to surgery. Do not apply lotions to your surgical site prior to surgery. Use proper handwashing techniques, and be particularly careful after using the bathroom or handling pets. Do not shave the surgical area yourself. That will be performed by the surgical team.
POST-OPERATIVE MEDICAL EQUIPMENT • • • • • •
Raised toilet seat Walker Crutches Long-handled shoe horn Sock aids Reacher
ST. JAMES LOAN CLOSET
(must be a Henderson County resident) 766 North Main Street Hendersonville, NC 28792 828.692.9005 Tuesday & Friday 9:30 a.m. - 4:30 p.m.
NO BOUNDARIES LOAN CLOSET 47 Forga Plaza Loop Waynesville, NC 28786 828.456.7930
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WHAT TO BRING TO THE HOSPITAL • • • • • • • • • • •
A list of all medications Cell phone Eyeglasses or contact lenses with case Robe or gown Loose-fitting shorts/pants and T-shirts Dentures Hearing aids Ambulatory aids Driver’s license and insurance cards Slip-on shoes Comfortable clothes for after surgery—you will not be in a gown
WHAT NOT TO BRING TO THE HOSPITAL • • • •
Jewelry Credit cards Large sums of money Keys
WHAT ELSE SHOULD I KNOW? • • • •
Do not eat or drink after midnight, the night before surgery If you are diabetic, check with your primary care physician about how to adjust your diabetic medication All suites at Park Ridge Health are private rooms with accommodations for one adult family member to spend the night Chaplains are available during your stay at Park Ridge Health
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CONSTIPATION Constipation is common after the procedure. It is often caused by pain medication and/ or the lack of activity after surgery. We will provide medication to alleviate the symptoms and your nurse will monitor you. If the problem persists, especially after returning home, contact your physician.
CATHETER Most patients will have a catheter placed in the bladder during surgery. It will be taken out the morning after the surgery.
BREATHING EXERCISES You will receive an incentive spirometer during your stay, and it is important to use it. This device allows you to do breathing exercises that can help prevent atelectasis or pneumonia. Atelectasis is fluid collecting around the lungs â€“ the most common cause of a fever after surgery -- and deep breathing normally clears this fluid. The team will review instructions on how to use it appropriately. You should use this 10-15 times an hour.
BLOOD WORK The health care team will monitor your blood count in the mornings and make sure your hemoglobin level does not get too low. If it does drop below a certain point, your doctor may order a blood transfusion.
REST It is important to get adequate rest between therapy sessions. You will spend part of the day resting in the bedside chair and in the bed. It is important to sit in the chair for part of day.
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DAY ONE: On day one after surgery, most of your tubes (IV, catheter, oxygen) will be removed so you can do your exercises. Please remember to bring comfortable clothes. Ask for help getting up, as people are often unsteady the first day and sometimes fall. You will get dressed in your own clothes today. Occupational therapists will teach you how to dress. Some people will be discharged within 24 hours of the surgery.
DAY TWO: You will be more steady on your feet and able to get up on your own to go to the bathroom or sit in the chair. Physical therapists will continue to work with you.
DISCHARGE Once your pain is under control, and you can get out of bed safely and ambulate in the hallway with the therapists, you will be discharged to go home. This occurs one to three days after your surgery. The case manager will help you navigate through insurance requirements and options if placement at a skilled nursing facility is required. Some skilled nursing facilities offer transport services, but most patients will provide their own transportation. If your doctor and your physical therapist recommend home physical therapy services, the case manager can assist you in arranging this. Patients going to outpatient physical therapy will schedule their care with the practice where their physician originates or with the physical therapist of their choice.
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FACTS ABOUT PAIN MANAGEMENT THE KEY TO A RAPID RECOVERY
While you will experience pain, we want to keep it manageable. In doing so, we will try to avoid the common side effects of pain medication, which include nausea/vomiting, constipation and sleepiness.
HOW WILL MY PAIN BE CONTROLLED? • • • • • • • •
Moderate pain is to be expected after surgery You will receive medication injected into the joint during the surgery You will receive IV pain medication in the post-anesthesia care unit You will receive both IV and oral pain medication when you arrive on the medical/surgery unit Some pain medication is long-acting and given before you ask Other pain medication will be short-acting and you will need to ask the nurse for it It is important to stay ahead of the pain and treat it before it reaches a high level The goal is to adequately control your pain as soon as possible with oral pain medication
IMPORTANT POINTS • • • • •
You will not be totally pain free – Let us know as soon as you hurt or feel uncomfortable Usually when you are at a 3 out of 10 on the pain scale, it is a good time to ask for pain medicine Pain medication should be taken regularly after surgery to stay ahead of the pain It is harder to control your pain if you were taking narcotic pain medication prior to surgery Tell us if the pain medication is not working, and we may be able to adjust it
• • •
You will meet with your doctor one to four weeks after surgery You will receive a prescription for pain medications You will be instructed in wound care. If you have an Aquacel dressing, follow your surgeon’s instructions. The Aquacel dressing is usually left on for a week and then removed as directed. You may begin showering one to two weeks after surgery, but do not take a bath or get in a pool of water until your surgeon says you can You will receive a phone number where you can contact your surgeon, or the doctor on call 24 hours a day
PHYSICAL THERAPY • • •
You will be referred to Physical Therapy to continue the rehab started while in the hospital Your therapy program is one of the most critical components of your recovery from joint replacement surgery, and is key to helping you achieve your best long-term outcome Therapists are specially trained to assist you in your recovery with specific activities, exercises and instruction
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FAMILY AND FRIENDS WELCOME TO PARK RIDGE HEALTH Family and friends are an integral part of the healing process, before, during and after the surgery. You are important members of the caregiving team and will spend the most time with your loved one during his or her recovery.
DURING THE SURGERY:
• You may stay in the waiting area located on the first floor • If you want to walk around or get a bite to eat, please be sure the Surgery Center Desk team has your cell phone number • The health care team will keep you updated on the progress of the surgery
FEATURES FOR YOUR CONVENIENCE:
• Wireless Internet service is available throughout Park Ridge Health
CAFETERIA HOURS OF OPERATION: Breakfast is served from Lunch is served from Dinner is served from
6 – 10 a.m. 11 a.m. – 2 p.m. 4 – 6 p.m.
WEEKEND HOURS: Breakfast is served from Saturday lunch is served from Sunday brunch is served from Dinner is served from
7 – 10 a.m. 11 a.m. – 2 p.m. 11 a.m. – 2 p.m. 4 – 6 p.m.
VISITING THE PARK RIDGE CAFÉ: Located on the ground floor of Park Ridge Health, the Park Ridge Café is arranged buffet style, with items sold according to weight. Drinks, snacks and desserts are also available to accompany your meal The Park Ridge Café accepts cash, Visa, Mastercard, Discover Card and American Express A vending machine area is also available near the elevators on the ground floor
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AFTER JOINT REPLACEMENT POST-OPERATIVE & RECOVERY INSTRUCTIONS WILL INCLUDE INFORMATION ON: • • • •
Medication Care of your Wound Signs of Infection Activity - Walking - Sitting - Using Stairs - Sports - Sexual Activity Managing Swelling Driving
You will receive the date and time of your follow-up appointment prior to leaving. Please call your physician’s office if you have any questions or concerns.
If you do not receive your surgeon’s post-operative and recovery instructions, please ask your nurse for this information before you leave the hospital.
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Published on Mar 9, 2018