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
PREHAB EXERCISES NKEE, 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 include sex, age & genetics.
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
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Presurgical NUTRITION is more than eating more fruits and vegetables! Bones are ~40% protein. It takes a lot of protein to heal well! How much protein do you need per day?
1.5-2 grams protein/ kg / day 70 kg --> 105-140 grams per day And that my friend, is a lot of protein!
Good sources of high quality PROTEIN
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Commercial Product Examples (in case you want to supplement)
Vitamin D is a known immunomodulator Get your Vitamin D Level Checked! Supplement if necessary
Immunonutrients May Improve Healing Arginine Glutamine Omega- 3 fatty acids Nucleotides The data regarding improving surgical outcomes with the use of immunonutrients are mixed - they may help as such, there are no “recommended doses” at this time. Reasonable to include via supplemented protein formulations or if yo are using whey protein, include via pill
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 and even death Unintentional poisoning is among the top 10 causes of nonfatal and fatal injury for kids 0–4 years old and is the leading cause of fatal injury in 10–24 years old Protect yourself, your loved ones, pets, & visitors from harm Store opioids in a safe and secure place YOUR BATHROOM OR KITCHEN CABINET OR NIGHT STAND ARE NOT SAFE PLACES - LOCK AND HIDE ALL OPIOIDS
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/pubdispsearch/spri ng/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 or PA before starting
Lung Prehab 1. Incentive spirometer, repeat 10 times, 4 times a day https://m.youtube.com/ watch?v=-O-Zawtb32o 1. Blow up a small balloon in 1 breath, hold for >5 seconds, repeat 10 times, 4 times a day
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 work? It sure won't hurt...
Head Prehab "NERVOUS? WE CALL THAT NORMAL! WE TAKE AWAY YOUR UNDERWEAR AND PUT YOU UNDER A SHEET/BLANKET IN A ROOM FULL OF STRANGERS"
Cut down on alcohol Take this quick depression screen https://whooleyquestions.ucsf.edu Practice relaxation techniques https://www.nhsinform.scot/healt hy-living/mentalwellbeing/stress/breathing-andrelaxation-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, LISTS, FAQ 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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Some questions for your SURGEON assuming you’ve already chosen your surgeon
Is surgery performed under a spinal or a general anesthetic or both. If general, your anesthesiologist uses an ETT (breathing tube) or laryngeal mask 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 the surgeon perform intrarticular injections? if so, where and with what drugs? Will surgeon use Exparel? Does surgeon typically “Round” on his I
patients before or after Clinic or Surgery?
Advance Directions & Health Care Power of Attorney https://www.sosnc.gov/docum ents/forms/advance_healthcar e_directives/Brochure.pdf
https://www.sosnc.gov/documents/fo rms/advance_healthcare_directives/h ealth_care_power_of_attorney.pdf
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/ deathyikes!) 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 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 Prevent constipation, daily Colace or MiraLax or prune juice with meals Nutritional Supplement Drink (high protein), 1 bottle with each meal 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 phones. Noisecanceling 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 Dry Shampoo: If you’re staying in the hospital for a few days Non-Perishable Snacks: Sleeping Mask and ear plugs Notebook & Pen/Pencils Lotion Chapstick Toothbrush, toothpaste, floss Comb or brush Hand sanitizer Antimicrobial wipes