What to Expect in the Hospital

Surgery

Patients are admitted to the hospital the same day as their surgery. Pull your car to the main entrance where free valet parking is available. Upon entering you will be greeted by a member of our concierge desk and escorted to the surgical area by one of our volunteers.

When you arrive in the same-day surgery area, the receptionist will educate you and your companion(s) on what to expect. You will be asked to be seated and your nurse will call your name when it is time for your preparation to begin. At this point, your guests will be asked to remain in the waiting area until the surgical staff has completed some personal and time-sensitive tasks. You will be asked to change into a gown. Your medical history and medications will be reviewed. An IV will be started and blood may be drawn. Your guests will then join you.

You will see your surgeon and the surgical staff prior to surgery. They will verify the surgical site and sign the operative limb. They will answer any questions that you or your guests may have.

The anesthesia staff will also meet with you to discuss your options for anesthesia and to review a brief medical history, medications and allergies. If you have had any problems with anesthesia in the past, please inform the provider at this time.

You may feel that several of our staff are asking the same questions. This is because we want to provide you with the safest experience. Please remember, this is a great time to ask any questions or voice any concerns.

Your guest(s) will be escorted to the waiting room and you will be given a sedative and be taken into the surgical suite. When the operation is over, the surgeon will meet with your guests and give them a progress report.

After surgery, you will be taken to the Post Anesthesia Care Unit (PACU) for recovery until your sedation wears off. Many people feel cold when they wake up, so warm blankets are available if you need them. Monitors will measure your blood pressure, heart rate and breathing. Nursing will medicate you as needed. While you are in the recovery area, a sample of your blood may be drawn to check your blood count, and an X-ray will be taken to check your new joint. You will remain in the recovery room for about 2-3 hours. Due to privacy regulations, visitors are not permitted in this location.

Once you are stable, your visitors will join you as you are taken by bed to the surgery unit where you will stay the night. Nursing staff will orient you to the room, complete an assessment including pain and nausea, and your medical history will be reviewed. A clear liquid tray will be delivered shortly after your arrival, unless contraindicated. Please communicate any questions, concerns, or increases in pain or nausea to your nursing staff.

Pain

Your physicians and nurses are committed to developing a pain management plan to maximize pain control, which will help you meet your therapy goals. It is important to take pain medication prior to therapy sessions. Pain is typically controlled with oral pain medication, with additional IV pain medication as needed. Your pain medication will not be scheduled; it will be ordered “as needed,” which means that you need to request your medication. To remain as comfortable as possible, it is important to request pain medication before your pain level gets too high. Please use your call light to let the nursing staff know when you need pain medication. Staff will also regularly check on you to see if you need anything and ask you how your pain is, this is usually in numeric value of 0 being no pain and 10 being severe pain. Everyone feels and responds to pain differently, so let your nurse know if your pain medicine is not working so that changes can be made. Some of these medications may cause sleepiness and possibly nausea. There is medication available to help with nausea.

Other techniques can also help you manage your pain after surgery:

Activity: It is important to start moving soon after surgery. Moving helps your breathing and digestion and will helpyou heal faster. It may hurt to move; however, being active will help lessen pain. On the day of surgery, your nurse or therapist will help you sit up and get out of bed. You will start walking and exercising when the therapy team works with you. Please note, you are expected to spend several daytime hours out of bed and in a chair.
Distraction: By focusing your attention on something other than your pain, you can relax and stop thinking about it. Playing cards or games, visiting with friends and family, watching television, reading, and listening to music are some of the ways you can distract yourself.
Elevation: While elevating your leg, be sure not to place a pillow directly under the knee. This can inhibit blood flow and increase the risk of a blood clot forming. Instead, place a pillow under your ankle.
Comfort: Get as comfortable as possible while you are in bed. Ask your nurse for more pillows or blankets if you need them. Make sure your room temperature is not too hot or too cold. Other things that may improve your comfort include having your family rub your back, applying a cool cloth to your face or hands and keeping light and sound to a minimum.
Ice/Cold Therapy: The use of ice can relieve pain, swelling, inflammation, and spasm. Your nurse will provide methods for icing while you are here.

Physical and Occupational Therapy

You will have physical therapy sessions and occupational therapy while you are in the hospital. The first session will be either the day of surgery or the morning after. Your whiteboard will notify you as to when your therapy sessions are scheduled.

Be sure to eat your breakfast and take your pain medication at least 30 minutes prior to your therapy session. Following surgery, active participation with therapy is an important part of your recovery. Your therapist will make recommendations for your ongoing therapy, in collaboration with your surgeon, after you leave the hospital. At discharge, you will be provided with an individualized written home exercise program, medical equipment recommendations and icing instructions. Regularly moving your new joint and formal therapy are an important part of your recovery. Ideally, it is recommended you have at least one family/friend stay with you for the first one to two weeks to be available for you as needed. For those that may require additional therapy, such as home care or skilled care through a nursing facility it is recommended you are prepared with 2-3 choices for a skilled nursing facility to assist in providing a smooth transition from the hospital.

Diet

We realize you will have had nothing to eat since midnight the night before, however, it is important for your digestive system to “wake up” after anesthesia. Your first meal after surgery will be clear liquids. Usually, patients tolerate a clear liquid meal following surgery and then resume eating solid food at the next meal, providing you do not experience any postoperative nausea or vomiting. While staying with us, you will be using our room service system, which allows you to order from a menu between 6:30 a.m. and 6:00 p.m. Meals arrive within one hour, or at the requested time.

Home Medications

Your home medications will be verified with you at different times to ensure accuracy. Your surgical staff will order the medica- tions that are necessary and safe for you to take during your hospital stay. Your nurse will give them to you at pre-established times. If these times do not coincide with the times you take your medications at home, feel free to discuss this with your nurse. Please do not take any medications unless your nurse gives them to you.

Blood Clot Prevention

Having a joint replaced puts you at risk for developing a blood clot. There are several ways you and your nurse will help minimize these risks:

You will be encouraged to get up and walk around every day, including the day of surgery. This promotes blood flow.
Your nurse will remind you to do ankle pumps at least 10 times every hour while you are awake. This promotes the return of your blood from your legs back up toward your heart.
Arterial/Venous Impulse (AVI) boots will be on your feet or Sequential Compression Device (SCD) leggings will be applied to your calves. These help the blood circulate well in your legs and throughout your body. These should be on while in bed and in the chair.
Your surgeon will be prescribing a blood-thinning medicine for you while you are in the hospital. This medicine will be continued after you go home.

Pneumonia Prevention

Surgeries can increase the risk of developing pneumonia. Your lungs consist of many air sacs that get larger when you breathe. When awake, we periodically take a deep breath and blow off extra fluid from these tiny air sacs. When you are sleeping, you do not take deep breaths, causing fluid and mucous to build up in the air sacs. If allowed to collect, pneumonia can develop and slow down your recovery.

After surgery, make a conscious effort to deep breathe and cough.
Your nurse will bring you an incentive spirometer and instruct you on its use. This device helps you visualize your deep breaths.
Use the incentive spirometer at least 10 times every hour while you are awake. This device will help us assess the amount of air you are using with each breath. Continue to use it when you go home.
Elevate the head of your bed.
If you meet CDC guidelines, your nurse will offer you a pneumonia vaccine. If you accept, it will be given before you leave the hospital. Talk to your nurse to see if you qualify for this vaccine, as there are certain age and medical requirements.
During the flu season, we will offer you the influenza vaccination.

Operative Incision and Dressing

It is common to have some seepage from the incision during the first week. A waterproof dressing will be applied to the surgical site. This dressing may get changed again before you discharge.

Antibiotics

After your surgery, you will be given two to three doses of intravenous antibiotics to help prevent infection. This is the recommended practice throughout the country for total hip and total knee replacement surgery.

Blood transfusion

On a rare occasion, you may require a blood transfusion if your blood count drops below an acceptable range. All our blood products are screened, tested and considered safe. If needed, your consent or refusal will be verified prior to any blood product being given.