/clinical/,/clinical/pted/,/clinical/pted/hffy/,/clinical/pted/hffy/anesthesiology/,

/clinical/pted/hffy/anesthesiology/7293.hffy

201612354

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UWHC,UWMF,

Clinical Hub,Patient Education,Health and Nutrition Facts For You,Anesthesiology

Blocks for Thoracic Surgery (7293)

Blocks for Thoracic Surgery (7293) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Anesthesiology

7293
















A Patient’s Guide To
Total Hip Replacement Surgery
At The American Center

Before Surgery & After Surgery Unit
(608) 440-6300
1-800-323-8942

Orthopedic Clinic
Monday – Friday, 8:00am – 5:00pm
(608) 263-7540

Nights, Weekends, and Holidays
(608) 262-0486
1-800-323-8942




UW Health at The American Center


Valet parking is a free service. It is open from 6 am to 4 pm.

The Before Surgery and After Surgery Unit is all located to the left of the main
hospital doors.


By law, we need to ask if you would like to complete an advance medical
directive (AMD). This is a Power of Attorney (POA) for Health Care or a
Living Will. This decision is up to you. A POA allows you to name a health care
agent who could speak for you if you were not able to do so. If you choose to
complete an AMD, you must be 18 or older and of sound mind. You have the
choice to complete the form or not.

If you choose to fill one out, complete it and have it signed and witnessed before
coming to surgery. There is not enough time to complete the forms that morning.
The two witnesses cannot be family members or UW Hospital staff. Exceptions are
chaplains, social workers, and volunteers. The person you name as your health care
agent may not be a witness. We suggest you choose a neighbor or friend to witness
you signing the form. If you need help to complete this form or have questions, call
our Patient Relations office at (608) 263-8009.







Welcome to UW Health at The American Center

Knowing what to expect is part of getting ready for surgery. We hope this booklet
helps you.
Getting Ready .................................................................... 3
Psychosocial Aspects of Surgery………………….…… 4
Planning Ahead ................................................................. 4
Day before Surgery ........................................................... 6
Night before Surgery ........................................................ 7
Day of Surgery…………………………………………... 8
Inpatient Unit…………………………………………….10
Blood Clot Prevention……………………………….…..12
Pain Management………………………………………..12
Physical Therapy………………………………………...14
Leaving the Hospital…………………………………….15
Overall Recovery Time………………………………….15
Exercises for Total Joint Replacement………………....16
Phone Numbers ................................................................. 18






















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Getting Ready

Within 30 days before your surgery, you will need to have a pre-surgery work-up
visit. During this time you may have a physical exam and talk with other health
care staff. The complete exam may be done by your primary doctor or ortho
provider. This depends on your health status and insurance plan.

The exam may include:
 Blood work
 ECG (electrocardiogram)
 X-rays
 Other tests

The doctor will also discuss any medicines to stop before surgery. These may
include:
 Aspirin, Excedrin®, Ascriptin®, and Ecotrin®
 Plavix®
 Vitamin and herbal supplements
 Coumadin® or warfarin
 Ibuprofen, Advil®, Motrin®, Nuprin®, Aleve®, naproxen, and naprosyn

If your work-up is done by your primary doctor, please have the doctor’s office
FAX the forms to the Orthopedic Clinic at (608) 662-4545 before your work-up
day. On the day of your work-up visit, bring any x-ray films or other papers that
you received in the Orthopedic Clinic.

Please call Registration as soon as you can to get your paperwork started.
Registration is open 4:30am to 10:00pm. The phone number is (608) 261-1600.








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Smoking Cessation

Some surgeons require you to quit smoking prior to scheduling surgery. Smoking
will impair and delay healing time. You should also avoid second-hand smoke.
Talk with your doctor or nurse if you need help to quit. The Smoking Quit Line
number is 1-800-QUITNOW (784-8669).


Psychosocial Aspects of Surgery

Your surgery may have an impact on you and your loved ones. The impact may be
both mental and physical. Finding out what to expect, what is normal and what is
not, gives you a chance to adjust to the changes caused by surgery. Patients with
strong emotional support tend to recover faster. It is best to talk with someone
about your thoughts and feelings.

Setting goals and having a rehabilitation (rehab) plan before surgery will give you
sense of control. You will be able to measure your progress. Try to focus on
positive thoughts. Remind yourself the goal is to improve your movement and
quality of life. Our staff is here to support you during this time. If you are having
problems coping or need support, please talk with your doctor or nurse.


Planning Ahead

Plan to schedule routine teeth cleaning or dental work ahead of time. In most
cases, it is ok to have dental cleanings done up until 1 week before surgery. Other
dental work should be done 3 to 4 weeks before surgery. You should not have
routine dental cleanings done until 3 months after your joint surgery. If dental work
must be done in cases of infection or a dental emergency, please call the Orthopedic
Clinic.

Plan ahead and prepare your home before surgery.

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Getting your home ready

To prevent falls at home, watch out for:
 Loose throw rugs or carpets
 Pets that may run in your path
 Water spills
 Bare slippery floors
 Long cords across the floor, such as phone or fan cords
 Ice on steps and porches

If you live alone, you should plan for someone to stay with you for a few days.

You may want to make plans for help with:
 Meals
 Child and pet care
 Household chores
 Yard work

Physical Therapy (PT)

ξ Be sure to practice the exercises in the back of this pamphlet once a day
before your hip surgery.

ξ If recommended you need to schedule your follow up PT appointments
before your surgery. These appointment slots fill fast.

Length of Stay

Most patients are able to go home after one night in the hospital. Please make
arrangements for a ride home and for someone to stay with you at home. Before
your surgery, a member of the Coordinated Care team will speak with you about
discharge plans and care needs. Please check with your insurance company on
coverage for medical equipment and/or outpatient therapy services. If you need
assistance with this, your Coordinated Care team member can assist you with
obtaining information and facilitating the discharge plan you have created with your
surgeon.


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Medicines

If you are going home you need to plan ahead and decide where you would like to
get your new medicines. They will not be placed on your hospital bill. If your
insurance covers prescription drugs from the UWHC Pharmacy, we can fill them
here. Keep in mind that you will need money to pay any co-payments at this
time. You may also get your medicines at your local pharmacy.

Day before Surgery

A nurse will call you the day before surgery to review your instructions.
You will be told when and where to check in. If your surgery is on a
Monday, the nurse will call you the Friday before. If you have
questions about how to prepare for surgery, please be sure to ask the
nurse when they call.

Before this call, please review details the clinic or anesthesia staff gave you
during your clinic visit. If you do not hear from us by 3:00 pm, please call
(608) 263-7540. Tell us where you will be staying the night before surgery.

If you have a cold, fever, or illness before surgery, call the Orthopedic Clinic. After
hours or on weekends, ask for the doctor on call for the Orthopedic Clinic.


















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Night before Surgery

1. Do not drink alcohol after 8 pm on the night before surgery. If mixed with
anesthesia, it can cause problems.

2. Do not eat solid food after midnight. This includes gum and candy.

3. Do not use tobacco after midnight.

4. Do not drink milk or juice with pulp, after midnight.

5. Stop drinking clear liquids four hours before your surgery time.
Clear liquids include:
 Water
 Apple juice or white grape juice
 Black coffee
 Clear protein water





6. We will tell you during your clinic visit whether you should take any of your
pills the morning of surgery. Take them with a small sip of water.

7. If you have diabetes, you will be given details about your insulin or oral
pills at your clinic visit.

8. Refer to Health Facts for You #7938 Getting Your Skin Ready for Surgery with
Hibiclens® Chlorhexidine gluconate (CHG) Soap-Adult for skin prep
instructions.

9. Try your best to have a restful night before surgery. If you are coming from
out of town, you may want to stay in Madison. Guest Services can provide
you with a list of nearby hotels at a discount rate. Please call (608) 440-6242.

10. Do not wear make-up. Please remove nail polish from at least one finger.








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11. The morning of surgery, brush your teeth and rinse, but do not swallow.

12. Please remove and leave all jewelry, body piercings, and rings at home. Do
not bring large sums of money and credit cards with you. Please bring money
for co-payment for any medicines you want filled at the hospital.

13. Bring along inhalers, CPAP, eye glasses, eye drops, hearing aids, dentures,
prostheses, and other special equipment that you will need. Be sure these
items are labeled and in a case. Please do not bring bottles of pills with you
the morning of surgery unless you have been told to do so. You will be asked
to leave your glasses, dentures, and hearing aids with your family before you
go to surgery.

14. Please bring non-skid slippers or slip-on shoes and a few personal items. You
may want to bring loose fitting clothes or pajamas. You may want to bring a
book or something to do. TVs are in each room. Bring your cell phone if you
wish to make long distance calls.

15. You may bring in your laptop or smartphone. All of the rooms have free
wireless internet access. Put these items away when leaving your room. The
hospital is not responsible for lost or stolen items. Please leave your
belongings in the trunk of your car the day you check in (except CPAP
and inhalers). Once your room is ready, your family can bring your things to
you.

Day of Surgery

The Before Surgery & After Surgery Unit is open 5:30 am to 9:00 pm. Please
check in at your scheduled time.

After you arrive, you will be taken to a room to get ready for surgery. Your family
member(s) will be given a pager and shown to a waiting area. A nurse will ask you
questions about your health and help you get ready. A member of the anesthesia
team will meet with you and answer questions. You will have an intravenous (IV)
placed in a vein of your hand or arm. It is used to give fluids and medicine. You
may be given medicine to help you relax. Before you leave for the operating room
(OR), we will page your family so you can meet with them.




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A Note to Families

The amount of time your loved one spends in the OR depends on the type of
surgery. You can wait in the Surgery Waiting Area. If you have family that will
be calling, please have them call (608) 440-6400. You may want to bring along a
book or something to do since the time may seem to pass slowly. There are coffee,
tea, reading materials, computers and a TV in this waiting area from 7:30 am until
6:30 pm weekdays. If you wish to leave the waiting area, please pick up a pager at
the volunteer desk. The nurses will keep you informed during surgery. After
surgery, the surgeon will talk with you.

In the Operating Room (OR)

Once you are in the OR, your nurse will answer questions and
make sure you are comfortable. The staff wears masks, gowns,
and hats. They will help you move onto a narrow, firm bed. The
nurse will place a safety belt, like a seat belt, across your legs.
They will place ECG (electrocardiogram) patches on your chest,
a blood pressure cuff on your arm, and a plastic clip on your
finger to check your heart rate and oxygen level. The
anesthesiologist will ask you to breathe oxygen through a soft
plastic mask and medicine will be given through your IV.

In the After Surgery Unit

After your surgery, you will be taken to the After Surgery
Unit where staff will watch you as you begin to wake up.
They will check your vital signs and pain level. Family and
friends are not allowed in After Surgery Unit. After 1-2
hours, we’ll bring you to the orthopedic unit.










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Inpatient Unit

Your nurse will keep checking on you after you arrive on the orthopedic unit. We
will check your:

ξ Strength and sensation
ξ Dressing
ξ Pain level
ξ Urine output and bladder volume. We will use a bladder scan machine to
check your bladder volume. It works like an ultrasound machine to check the
amount of urine in your bladder.

The tubes, drains, and equipment you may see include:
ξ Face mask or tube under your nose to give you oxygen
ξ Plastic clip on your finger to check your heart rate and oxygen level
ξ Drain in your wound
ξ Catheter to drain urine from your bladder
ξ IV pump for fluids and medicines
ξ Leg wraps that inflate and deflate and elastic stockings to improve blood
flow in your legs

Eating after Surgery

Slowly moving from liquids to solids may prevent nausea. You may not be able to
eat right after surgery. At first, you may get only ice chips. As your body allows,
your diet will progress from clear liquids (juice and broth) to full liquids (milk or
ice cream) to normal foods.











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Coughing and Deep Breathing

The nurse will ask you to breathe deeply, cough, and use a breathing tool called an
incentive spirometer. Deep breathing helps prevent pneumonia.

To cough and deep breathe

1. Breathe in deeply and slowly through your nose. Hold it for a few
seconds.

2. Exhale slowly through the mouth.

3. Repeat twice more.

4. Breathe in again; hold it, and then cough.

To use the incentive spirometer

1. Exhale and place your lips tightly around the mouthpiece.

2. Take a deep breath. Slowly raise the Flow Rate Guide
between the arrows.

3. Hold it. Continue to inhale, keeping the guide as high as
you can for as long as you can, or as directed by your
nurse or respiratory therapist.

4. Remove the mouthpiece and breathe out as usual.

5. Slowly, repeat 10 times each hour while you are awake.






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Blood Clot Prevention

People who have hip surgery are at a higher risk of getting blood clots. To decrease
the risk of a blood clot, you will take medicine, likely aspirin or warfarin, to thin the
blood. You may need to take it for 2-4 weeks or more. Your doctor will decide
how long. Blood draws may be needed to check how well the blood thinner is
working. This depends on the blood thinner your doctor orders.


Pain Management

Many people worry about how much pain they will have after surgery. Although it
varies with each patient, you should expect some degree of pain. We will work
with you to make sure you have the best pain control possible. There are a number
of options your doctor may choose for pain control. Your doctor will discuss pain
control options with you before surgery.

No matter what your doctor orders right after surgery, the goal is to use pain pills as
soon as you can. Pain pills give you longer lasting relief and better quality pain
control than the other options.

Some patients find pain relief from methods other than medicine. These include:
 Ice therapy
 Deep breathing exercises
 Distraction
 Repositioning










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It is very hard to safely do away with all of your pain. Pain medicine can make you
very sleepy and may affect your breathing. We want to keep you safe and make
you as comfortable as we can. To help make this happen, we want to teach you
about what to expect and how to set realistic goals for pain control. Your nurses
will always be working with you to find the best way to manage your pain.

A good pain management plan will allow you to exercise to improve your strength.
Good pain control should also allow you to get some rest without feeling too
sleepy. Each person responds in their own way to pain medicine. It often takes a
while to find what works best for you.

For best results

1. Talk with your doctor and nurses about the choices you have.

2. Take (or ask for) pain medicine before exercise or when pain first begins. Pain
pills take 20-30 minutes to work.

3. You will be asked to rate your pain using this scale.

0-10 Number Pain Scale
______________________________________________________
0 1 2 3 4 5 6 7 8 9 10
No Mild Moderate Severe Worst
Pain Pain
Possible

4. Tell us about pain that will not go away. Do not worry about being a “bother.”

5. Let us know if you feel any side effects from the pain medicine. This includes
feeling very sleepy, dizzy, nauseous or lightheaded.









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Constipation

Surgery, narcotic pain medicine, decreased activity level, and a change in your diet
all play a role in getting constipated. After surgery, it is very common to have a
problem with your bowels. Medicines may be ordered to help prevent or treat
constipation.

Physical Therapy (PT)

PT may start as soon as the same day of your surgery. Or it may begin the morning
after surgery. The therapist will come to your room. You will learn how to:
ξ Move comfortably in bed.
ξ Get in and out of bed safely.
ξ Use a walker or crutches to walk and go up and down stairs.
ξ Maintain total hip precautions.

In some cases hip precautions are needed to prevent hip dislocation. If
recommended, you should follow these rules until your surgeon tells you otherwise:

ξ Do not cross the hip replacement leg across the other leg.
ξ Do not bend the artificial hip more than 90 degrees. Your knee should stay
below your belt.
ξ Do not let your hip turn inward (pigeon-toed).

To prevent falls, take caution when getting up too quickly after eating, lying down,
resting, or using the toilet. We want you to call for our help when you want to get
up during your hospital stay.

In the hospital, PT is often scheduled twice a day to improve the strength and
flexibility of your leg. Ask your nurse for pain medicine before your PT. It is also
good to have a family member or friend attend one PT session with you. They can
see how you walk and what exercises you are doing.

You should keep doing your exercises 3 times a day for 3 months. Then, you may
switch to a maintenance program doing the same exercises 3 times a week for at
least a year.


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Occupational Therapy

You may meet with an Occupational Therapist (OT). The OT will help you so that
you are able to shower, dress, and fix meals.

You may need daily help with self-care or use assistive devices to become more
independent. Some devices that others have found helpful include:
ξ A dressing stick
ξ Long-handled sponge
ξ Stocking aid
ξ Elastic shoelaces
ξ Long-handled reachers
ξ Bathroom aids

Leaving the Hospital

There are many things that need to be done on the day of discharge before you
leave. These tasks may take several hours. Your nurse will teach you about your
diet, incision care, showering, driving, activity level, and your follow-up clinic
visit.

The unit pharmacist will review your medicines with you. If you plan to have your
prescriptions filled at the UWHC pharmacy before you leave the hospital, please
bring money for your co-payment. If you are unclear about how to pay for them, a
member of the case management team will help you.

Overall Recovery Time

The recovery time after surgery varies from person to person. Most patients are no
longer using a cane, walker, or crutches after 6-8 weeks. Surgery can cause you to
feel weak and tired. In most cases, common sense will tell you when you are doing
too much. But too little activity can delay the return of your strength. For the best
outcome, you should keep doing the exercises given to you by the PT.






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Phone Numbers


Before Surgery and After Surgery.............................................. (608) 440-6300

Guest Services……………...................................................... (608) 440-6242

Hospital Paging Operator........................................................ (608) 262-0486

Orthopedic Clinic weekdays................................................... (608) 263-7540

After hours or weekends.......................................................... (608) 262-0486

Orthopedic Clinic fax.............................................................. (608) 662-4545

Toll free.................................................................................. 1-844-607-4800

Patient Information (for room number)................................... (608) 440-6400

Patient Relations...................................................................... (608) 263-8009

Pharmacy …………………… ..............……………………. (608) 240-4265

Registration………………………………………………..... (608) 261-1600
To get admit paper work started, speak with a financial
counselor or confirm insurance

Surgical Waiting Area............................................................. (608) 440-6400







Your health care team may have given you this information as part of your care. If so, please use it and call if you have
any questions. If this information was not given to you as part of your care, please check with your doctor. This is not
medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s
health needs are different, you should talk with your doctor or others on your health care team when using this
information. If you have an emergency, please call 911. Copyright © 6/2016. University of Wisconsin Hospitals and
Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7793