preop rx Simplify your surgical journey, improve your surgical outcomes
or preop rx How to have surgery, safer
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SURGICAL RISK FIXED AND MODIFIABLE RISK FACTORS FOR SURGICAL COMPLICATIONS
RISK MITIGATION NUTRITION, PROTEIN, VITAMIN D MRSA & BACTERIAL DECOLONIZATION POSTOP PAIN CONTROL & OPIOIDS DELIRIUM PREVENTION
PREHAB EXERCISES KNEE, LUNG, HEAD
TIMELINE (days before surgery) -7 DAYS, -5 DAYS, -2 DAYS BEFORE SURGERY & THE NIGHT BEFORE SURGERY
LISTS QUESTIONS FOR SURGEON HOUSEHOLD READINESS & SUPPLIES ADVANCE DIRECTIVES & HCPOA FORMS OVERNIGHT AT THE HOSPITAL CHECKLIST
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SURGICAL RISK R E D U C E S U R G I C A L C O M P L I C A T I O N S
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There are FIXED & MODIFIABLE RISK FACTORS for surgical complications
FIXED RISK FACTORS Fixed RISK FACTORS include sex, age & genetics.
MODIFIABLE RISK FACTORS Modifiable RISK FACTORS include smoking, blood sugar, nutrition, bacterial colonization, poor physical conditioning, obesity, sleep apnea and frailty
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SURGICAL RISK MITIGATION R E D U C E S U R G I C A L C O M P L I C A T I O N S
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SURGICAL RISK MITIGATION: you can impact your surgical outcome 1. Nutrition, protein and Vitamin D 2. Bacterial decolonization & MRSA 3. Joint Prehab 4. Lung Prehab 5. Head Prehab 6. Opioid use, storage and disposal 7. Delirium prevention
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Presurgical NUTRITION is more than eating lots of fruits and vegetables! Bones are ~40% protein. It takes a lot of protein to heal well!
How much protein do you need per day before and after surgery? You weigh 70 kg, so you need
105-140 grams of protein per day And that my friend, is a lot of protein!
Good sources of high quality PROTEIN GRAMS PROTEIN
12 6.5 12 9 8 20 18 70 24 40 36 49 2.6 2.4
1 egg 3 strips turkey bacon 1/2 cup almonds 1/2 cup walnuts 1/2 cup hummus 10 oz high protein drink 6 oz Fage yogurt 8 oz chicken breast 6 oz pinto beans 6 oz shrimp 6 oz tuna 1 cup broccoli 1 cup green beans
Examples of commercial high protein products (in case you want to supplement)
Vitamin D is a known immunomodulator Get your Vitamin D Level Checked! Supplement if necessary
Goal: at least 30 ng/ml
*Immunonutrients may improve surgical wound healing
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Arginine Glutamine Omega- 3 fatty acids Nucleotides
While the data are mixed, immunonutrition supplementation before & after surgery may improve outcomes. Protein drinks w/ immunonutrients added or whey protein, supplemented w/ immunonutrients are options. an example found on Amazon:
MRSA: ask to be tested or treat empirically (prescription required)
5 nights prior to surgery, start using mupirocin twice a day
Wash hands with soap & water Apply a pea sized dose to each nostril Press the sides of the nose together and gently massage the nose Change into freshly laundered PJs and pillowcases each night after mupirocin treatment
Bacterial decolonization
2 nights before surgery and the night before surgery
wash with chlorhexadine or hibiclens Find a detailed explanation in the link below; note they suggest washing the night before and the morning of surgery https://www.youtube.com/watch?v=s2xGNkIt9ZA
Who is at risk for opioid abuse? EVERYONE! Curious? Click on the link below
PHOTO WITH TEXT TITLE
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Opioids Opioids treat moderate to severe pain AND use may lead to dependence, addiction, even death Unintentional poisoning is among the top 10 causes of nonfatal & fatal injury for kids 0–4 years old & leading cause of death in 10–24 yo‘s Protect yourself, your loved ones, pets, & visitors from harm Store opioids in a safe and secure place
Your bathroom, or kitchen cabinet or your night stand are not secure. LOCK AND HIDE ALL OPIOIDS
Lockable Box Large Capacity, Clear Locking Box for Medicines, Premium Material Lockable Storage Bin Organizer Box for Fridge Food/Snacks/Phone/Tablet Jail/Home Safety https://a.co/d/92igS1C
Opioid Disposal When opioids are no longer needed, dispose of properly
Use the link below to find out where you can easily & safely drop off your extra pills
https://apps.deadiversion.usdoj.gov/pubdisp search/pring/ main;jsessionid=s0iC9kcqXpFXAwPVvS7j0eilYY1HS_ 4y4pOPwYe.web2? execution=e1s1
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PREHAB EXERCISES R E D U C E S U R G I C A L C O M P L I C A T I O N S
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Knee Prehab
Please check with your surgeon before starting
Lung Prehab
Incentive spirometer, repeat 10 times, 4 times a day https://m.youtube.com/watch?v=O-Zawtb32o
Blow up a small balloon in 1 breath, hold for >5 seconds repeat 10 times, 4 times a day l
Why bother with Lung Prehab? The better question is, why not? Lung Prehab may: decrease the work of breathing increase alveolar inflation improve oxygenation, ventilation reverse hypoxia
Lung Prehab Tools Will lung prehab prevent pneumonia? It sure won't hurt...
Head Prehab " N E RVOUS? W E C ALL THAT N O R M A L ! W E T AKE AWAY Y O U R U N D E RW E A R & P U T YOU UN D E R A C O L D S H E ET IN A ROOM FU L L O F S T R A N GE R S " Cut down on alcohol Take this quick depression screen https://whooleyquestions.ucsf.edu Practice relaxation techniques https://www.nhsinform.scot/healthyliving/mental-wellbeing/stress/ breathing-and-relaxation -exercises-for-stress
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TIMELINE
R E D U C E S U R G I C A L C O M P L I C A T I O N S
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SIMPLIFY YOUR SURGICAL JOURNEY
TOTAL KNEE REPLACEMENT 11/09/2022 W E E K OF OCTO B E R 2 4 T W O WEEKS BE F O R E S U R G E RY P U R CHASE PRO T E I N S U P PLEMENT, I N C E N T I V E S P I R OMETER S T A RT KNEE, LU N G , H E A D P R E HAB
THURSDAY NOVEMBER 3 10 AM JAMIE, PA 1 PM PREOP CLINIC
WEDNESDAY NOVEMBER 2 SEVEN DAYS BEFORE SURGERY START PROTEIN SUPPLEMENTATION. ~ 100 -150 GRAMS 3 TIMES PER DAY UNTIL THE NIGHT BEFORE SURGERY
FRIDAY NOVEMBER 4 FIVE DAYS BEFORE SURGERY START NASAL MUPIROCIN 2 X PER DAY UNTIL MORNING. OF SURGERY FRESH PJS AND PILLOWCASES EVERY NIGHT
MONDAY NOVEMBER 7 CHLORHEXIDINE BODY WASH TONIGHT & TMRW, THE NIGHT BEFORE SURGERY
TUESDAY NOVEMBER 8 DAY BEFORE SURGERY NO EATING AFTER MIDNIGHT
WEDNESDAY NOVEMBER 9 DAY OF SURGERY DON'T EAT, OK TO DRINK "CLEARS" UP UNTIL 2 HOURS BEFORE YOUR SCHEDULED TIME OF HOSPITAL ARRIVAL
OLIVIA WILSON
W O R KBOOK
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QUESTIONS, TO DO & LISTS R E D U C E S U R G I C A L C O M P L I C A T I O N S
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"QUESTIONS TO ASK" list SOME QUESTIONS TO ASK YOUR SURGEON
IS SURGERY PERFORMED UNDER A SPINAL OR A GENERAL ANESTHETIC?
If general, your anesthesiologist will place a mask in the back of your mouth or a breathing tube WILL YOU HAVE (ONE SHOT) NERVE BLOCKS OR NERVE CATHETERS PLACED IN PREOP? IF NERVE CATHETERS, WILL YOU GO HOME WITH A “LOCAL ANESTHETIC PUMP?" WILL SURGEON USE EXPAREL? WILL SURGEON PERFORM INTRARTICULAR INJECTIONS? IF SO, WITH WHAT DRUGS? DOES SURGEON TYPICALLY “ROUND” ON HIS PATIENTS BEFORE OR AFTER CLINIC OR THE OR?
NYT article on preparing for surgery
Advance Directions & Health Care Power of Attorney
https://www.sosnc.gov/documents/forms/a dvance_healthcare_directives/Brochure.pdf
https://www.sosnc.gov/documents/forms/advance_ healthcare_directives/health_care_power_of_attorney.pdf
IF YOUR ADVANCE DIRECTIVES &/OR HEALTHCARE POWER OF ATTORNEY ARE NOT UP TO DATE, YOU MAY GET THEM WITNESSED AND NOTARIZED AT THE HOSPITAL
Day of Surgery List Do not eat after midnight - your surgery will be cancelled (why? under anesthesia, you may vomit up your stomach contents and this mess goes into your lungs—> pneumonia/ death-yikes!) Wear loose fitting clothes Don't bring valuables with you to the hospital, including credit cards Bring insurance cards & a photo ID Do not wear contact lenses If you wear glasses bring a case to store them in Bring reading materials or music to help pass the time You may not taxi/Uber/Lyft home unless accompanied by an adult You will need an adult (aged 18+) to be immediately available & reachable by phone
Preop Holding (on the Day of Surgery) List Before surgery, you will be in a small, curtained room. Your surgeon will see you prior to going to the OR. Ask your surgeon, resident or PA to place the following “standing orders” Postop pain control, acetaminophen 975 or 1000 mg q 8 hrs round the clock, this is key! Ask for daily Colace or MiraLax (or drink prune juice with meals) Incentive Spirometer at the bedside Sleep medication, if you must use it to get a good night’s sleep
Overnight Hospital List Cell Phone Charger with long cable & earbuds or head phones (noise-canceling headphones are best) Smartphone, tablet and or laptop Reading material Shoes or slippers Sweater or vest: Hospitals are cold! Ask for more blankets if you need them. Underwear, change of clothes for trip home Dry Shampoo: If staying in the hospital for a few days Sleeping Mask, ear plugs, your own pillow or pillowcase Notebook & Pen/Pencils Lotion Chapstick Toothbrush, toothpaste, floss Comb or brush Hand sanitizer Antimicrobial wipes Non-Perishable Snacks
You will be given a menu every day to choose your meals and snacks. Maintain a High Protein Diet and include these daily menu items:
Include a high protein drink Ensure/Boost) with every meal Include high protein jello with every meal or for snacks Include daily prune juice to keep your bowels regular