Knee Replacement Pre-Op Class at JFK Medical Center


(upbeat synthesizer music) – Welcome to JFK. It’s our pleasure to take care of you when you come here for after your surgery. I’m gonna talk to you a
little bit about nursing and what to expect while you’re here at your stay at JFK. First of all I’d like to
talk about medications. Before your surgery, you’re gonna meet with
your medical doctor. I want to review all your
medications with your doctor to find out which medications he would like for you to stay on, which medications you may
need to stop prior surgery. Some of those medications
could be like Coumadin, blood thinners, and your
doctor will tell you when you need to stop those
medications at that time. It’s very, very important to have a list of your medications with you at all times with the names of those medications, your dosages, and the frequency that you take those medications. Always have that with you. You may be asked for that
list the morning of surgery, and then also when you come up
to the floor post-operatively your nurse is also gonna
ask to see that list, and it’s just gonna be easier for you because from being under anesthesia you may be a little groggy, just to be able to give
that list to the nurse, and that way you can
continue the medications that need to be continued
post-operatively. Leave all your medications at home. That’s why we want you to have the list. You don’t need to bring
any of your medications that you take at home here
with you at the hospital. Pharmacy will set you up and
get your medications started that you need to be on that
your doctor has agreed upon. And any medications that
our pharmacy doesn’t carry or they may be special medications, you will be notified of those medications that you may need to have
brought in to the facility. Pain management. Pain management is very,
very important to us. We need to hear your voice. You’re gonna have to be your advocate as to what tolerance of discomfort you’re able to handle here. First of all, after surgery, there’s gonna be several
choices of pain medication. Some may be injections, where it’s gonna go into your IV, and some may be oral medications. After surgery, yes, you are
gonna have some discomfort. That’s to be expected. But our job is to help
keep that discomfort as low as possible so you’re able to do your physical therapy, do your occupational therapy, and that’s what your nurse is here for, and we’ll be using what’s
called a pain scale that’s zero to 10, zero being absolutely no pain, 10 being that the pain is off the charts and you just don’t want to move. What’s important with the pain scale is that’s our communication
tool that you’re going to use with your nurse so we can evaluate what type of pain medication you may need. A big thing here is you need to ask for your pain medication. You don’t want to allow your pain to get to a five, six, or seven, because it’s harder for us
to pull that pain back in and get you at a more comfortable level. So when you started to ache a little bit, let’s say a two or a three, you’re going to call your
nurse and let her know that you are in pain. The pain medications are as needed, so you must ask for them. They are not scheduled medications. Again, with the injections, that would be if you did
allow your pain to get to be, let’s say, six, seven, eight. We would use an injection into your IV in order to bring your pain back down. If you’re a two or a three, then we would use the oral
medications at that time to keep you at a nice comfortable level so you can proceed with
your physical therapy and occupational therapy. Your nursing care after surgery. You are going to have a registered nurse, a patient care assistant,
what’s called a PCA. And you will have, we have a board in the room
that’s called a whiteboard. This is your communication tool for you communicating to the nurse and to other staff members on the unit. It’s very, very important to
keep in touch with your nurse. We have what’s called Spectralinks. They’re little phones that we each carry. Your PCA will have one. Your nurse will have one, the charge nurse, and et cetera. That’s a phone number that
you will call from your phone. You will directly get
your nurse or that PCA. The whiteboard will be
updated every shift, and as things change with your status, weight-bearing status, or your diet, that board will be updated
so you can see specifically in front of you, okay, who’s my nurse right now? Who’s my PCA? What kind of diet am I on? What kind of status as
weight-bearing status do I have at this point? All the things are on the
whiteboard in your room. If you can’t get a hold of
the staff via Spectralink, we also have call lights. There’s two on either side of the bed and you also have a handheld call light. So we have four different ways that you’re able to get
a hold of a staff member if you need assistance. Daily diary. We have little diaries that
will be at your bedside after you come up from post-op. You will not be receiving
this preoperatively. It’s a little diary that you can keep and you can write what
doctor came to see you, what specialty, if it
was the medical doctor, if it was the orthopedic doctor, what did they have to say? You also can write in who’s your nurse and also their Spectralink number. If you have a problem seeing the board, please let your nurse or PCA know that so we can write it down for you so you’re able to visibly
see how to get in contact with your nurse or with your PCA. You can make notes. I think it’s very important that when you think of a question that you want to ask your doctor, please just jot it down. That way you have it here
ready for when they walk in. You can say, okay, doctor. I have this question for you. Joint Street Journal. This is gonna come daily. And what it is is it’s just
an information brochure that lets you know kind of
what to expect for the day, what’s gonna be coming
up the following day, and just gives you general information about the type of joint
replacement that you have had. – Hello, I’m a physician and a member of the JFK Hospital
Department of Anesthesiology. Here at JFK Hospital, we endeavor to make your
experience in orthopedic and other surgeries as
pleasant as possible. Our hope is to make this as pleasant an experience as possible for you. We focus primarily on
your comfort and safety. Every patient coming for
surgery at JFK Hospital will meet with an anesthesiologist. The choice of anesthesia
will ultimately made by the anesthesiologist and the patient as well as the surgeon. The choice of anesthesia
is specific to the patient, their past medical history, the surgery they’re having, any specific preferences that the patient and the surgeon may have. There are three types of
anesthesia that you may undergo. One is a general anesthetic. Many patients are familiar
with general anesthesia. General anesthesia is a process whereby we put you under a state of anesthesia, rendering you unable
to feel, hear anything, or remember anything. We also have to breathe for you. Many surgeries are performed
under general anesthesia today. Some patients and
alternatively some surgeons prefer what we call regional anesthetic, where we anesthetize only
a region of your body. This can be accomplished
in a number of ways. If we need a brief anesthetic, several hours or less, we may elect to do a spinal anesthetic. This is a painless injection in your back that will numb you up, usually from about the mid-waist on down. In addition to the spinal anesthesia, you’re provided with intravenous sedation to keep you comfortable and relaxed throughout the process. For surgeries that are longer or for patients who may require pain management after the surgery, we may elect to put in an epidural. A epidural is similar to a spinal, although a catheter is placed
and left in the patient until the patient is comfortable, usually two or three
days after the surgery. In addition to a choice
of general anesthetic or spinal anesthetic, we frequently employ
another type of anesthesia to help patients maintain
a level of comfort after this procedure. Specifically, we do something
called a femoral nerve block. A femoral nerve block
is a nerve injection. We place a small catheter
into the patient’s nerve in the area of their groin. This allows us to help numb up the knee and provide you with a
significant level of comfort after the surgery. It will render you somewhat weak, and the physical therapist will help you with ambulation and physical
therapy after the procedure. It is a relatively simple procedure. It’s performed while
the patient is sedated, but prior to the time the patient goes in the operating room. – After your surgery, you’ll be working with
an occupational therapist here at JFK. The occupational therapist will assist you in relearning how to perform
your activities of daily living like bathing, dressing, grooming after your surgery. That way you’ll be safe to go home. If you’re going to a rehab center, you’ll work with your
occupational therapist at the rehab center. However, if you’re going home from JFK, you’ll be working with an
occupational therapist here. – Physical therapy is an integral part of your recovery at JFK medical center. You’ll be seen by physical
therapy two times a day. Based on your surgeon, physical therapy will be in to see you and start some exercises
for your total knee surgery. You will be taught all your precautions and all safety measures. The most important part
of your total knee surgery is the use of your immobilizer. Because you have the ropivacaine that has gone into your groin and you’re numb from basically the top of your thigh down to your knee, you will not have any control over those muscles in that leg. When you go to stand up
with physical therapy or with anybody, you need to have the immobilizer on. It’s a safety precaution. The only people that can tell you that you do not need
your immobilizer anymore is your surgeon or a physical therapist. So if you’re going to get up, even to go to a bedside
commode or got sit in a chair, we need to have that immobilizer on you. Your CPM. Your doctor will also order a CPM machine. CPM stands for continuous passive motion. The machine does all the work. We call it the WD-40 of the knee because it does keep your knee fluid. This will be on twice a day, usually in the morning, and early in the morning around here is somewhere between five and seven, and then at your second
session of physical therapy it’ll be placed on again. We like to see you at 90
before you leave us here, so each time somebody puts it on, it’ll be increased. If you just try to relax and
let the machine do the work, it should not hurt. Your exercises are very important
while you’re here as well, the first one being your ankle pumps. You should always be pumping
your ankles at all times, even when you wake up from
PACU after your surgery. It just gets the fluid and the
blood back up to your heart, and the only way that can
happen is by muscle contraction. So you need to move those ankles. Your next two exercises
are isometric exercises, the first one being your quad set, and that’s where you push your knee down, you hold it for a count of three, and then you relax. The second one being a glut set where you squeeze your
butt muscles together, hold it for a count of three, and relax. The next one is the heel slide. This is where you slide your
heel back and forth on the bed. The important thing you have
to remember about this exercise is you don’t want your knee to
go to one side or the other. You need to keep it straight. The last one is the straight leg raise. This is one of the hardest
exercises for you to do because of the ropivacaine. We blame everything on ropivacaine here. Because you’re not gonna
be able to lift that leg because of the numbness in your thigh, but I do want you to practice
that prior to coming in here because that will
determine whether you need the immobilizer or not. The doctor, your surgeon, and your physical therapist
will ask you continuously if you can do a straight leg raise. With physical therapy
and your participation, we can get you back on the road to recovery as soon as possible. – Hello everyone. My name is Sharon Mesper and I am with JFK Case
Management Services. My job is to facilitate your
discharge from this hospital. What I do per se in this hospital is if you’re coming in for a knee, I make the arrangements. We will either be going home or you will be going to a
skilled nursing facility. We will come in and see you the day, first day post-op, the
day after your surgery. If you are coming with a uni knee, we typically try to get you
discharged the same day. It just depends on how
well you are reacting to the medications. If you are going to rehab, we will send the referrals out the day, first day post-op. First day post-op mean we
will come by and see you first thing in the morning
after physical therapy has done their evaluation of you. We will send you to at
least three facilities. Those facilities are facilities that you have the opportunity to select. If you are going home, we make the arrangements for Home Health. Home Health arrangements are
to made to certain agencies. The agencies are based upon your insurance and also on what your doctor likes. But I often have to let you know that because you are the patient, you have the opportunity to change them. It is up to you. It is your choice. We send the information
out via the computer. We will know before your discharge what the agency will be. We will give you the
name of the information before you’re discharged
from the hospital. If you are going home, you will need equipment. The equipment that you
will need is a CPM motion, a rolling walker, and
a three-in-one commode. If you have any of the equipment, per se the rolling walker
and a three-in-one commode, please let us know so that
we will not duplicate it. If Medicare has given you a rolling walker or a three-in-one commode
within the last five years, you will have to pay for
one if you’ve given it away. If your family member has one at home and you want to use it and
you want to bring it in, please bring it in so physical
therapy can measure you to the right height to make sure that that piece of equipment is adequate. You will also be
discharged on a medication, not a medication, you will also be discharged on a DVT prophylactic medication. It could either be Coumalin or Lovenox. We will make the arrangements
for that medication. The visiting nurses will administer the injections for the Lovenox. If you are on Coumadin, the visiting nurse will come out and check a PT/NIR at least
two to three times a week and forward that
information to your doctor so he can adjust the Coumain accordingly. The rolling walker will
be delivered to your room the day after your surgery. The CPM machine and the
three-in-one commode will be delivered to your
home on the day of discharge. If you would like us to
call in for the Lovenox, you can give us your pharmacy number. We will call it in. As a matter of fact, we prefer to call it in, the reason being not every pharmacy will have that medication on hand. So to ensure that you have it, we will call it in to your
pharmacy and you can pick it up. If you have an HMO, i.e. Humana, what else, Coventry, Vista, Summit, they deliver the medication to your home. Blue Cross, United, you have to go out and pick it up. Health options, all of those other insurance agencies you have to go to your
pharmacy and pick it up. This medication, like I say, is given twice a day for knees normally, and it will be injected by a nurse, or if you select, you can do it yourself. (upbeat synthesizer music)

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