Total Joint Replacement Nursing Pre-admission Information

Things to Bring

• Personal toiletries -- toothbrush, toothpaste, lotion, powder, deodorant, comb, brush, etc.
• Robe and non-slip slippers
• Any walkers, canes, supportive back corsets, or pre-fitted braces, or any other personal equipment that is designed for your particular needs
• List of medications (with listing of dose and frequency) that you are currently taking
• Loose fitting clothing for when you are discharged home -- a button-up shirt/blouse may be preferable to a pull-over
• Eye glasses, hearing aids, and dentures -- they are your responsibility
• Living will, durable power of attorney, or health care power of attorney

Do Not Bring

• Large amounts of cash
• Valuables of any kind
• Medications from home
• Cigarettes/pipes/cigars -- Duke is a non-smoking facility
• Alcohol or illegal drugs
• Food that needs refrigeration
• Any items that will need storage, such as large suitcases

Pre-operative Concerns

• Ask your physician about blood donation. Currently most doctors are not recommending that you give blood ahead of time, except for bilateral surgery or revisions, but there may be other reasons why donation may be necessary.
• Ask your doctor about when to stop specific medications if you have not been instructed. This step is usually taken during your pre-operative visit for surgery.
• A few days before surgery, eat light meals so that you will not have constipation issues during procedures.

Visitors

Visitors are welcome, but please limit to two at a time. Children under the age of 12 are discouraged, except under special circumstances. Please check with your nurse.

If you are not being admitted to the Intensive Care Unit after surgery, one person may stay with you overnight for assistance. This visitor will be permitted to sleep in the recliner. Overnight visitation requires a visitor pass after 9 p.m. -- the pass can be obtained from the unit secretary nightly.

Length of Hospital Stay by Procedure

Your doctor or Patient Resource Manager (PRM) will inform you of the approximate length of stay (LOS) for a typical case. Unless your medical condition warrants longer LOS, expect the quoted LOS. Please make preparations with family or friends to pick you up by 11 a.m. check-out time on the day of discharge.

Please ask questions. Although we do our best to give you answers to commonly asked questions, we do not know your specific concerns. Please ask!

Expectations

• You may attend to your own hygiene needs unless you require assistance. Please inform your nurse or nursing assistant if you desire or need help.
• Three meals are served daily by Food Services. If you have special needs, please let your nurse know or discuss this with the dietitian.
• Each bed is equipped with a call system to request help from the nursing assistant or the nurse. It is helpful to indicate which staff member would best suit your needs. Your call light should be answered and request met as soon as possible on a priority basis. There is an emergency call bell located in the bathroom.
• Each patient has a caregiver team assigned to deliver care. Your team may include:
  • Attending physician and a team of physicians that will assist him or her. You can expect to see them during different times of the day
  • Nurses who will coordinate medication administration, taking vital signs every shift, education, physical assessment, and preparing you for tests and interventions
  • A patient resource manager (PRM), who will make sure your insurance company has the information needed to authorize your stay in the hospital, help with any special needs, and assist in discharge planning
  • A physical therapist, occupational therapist, or other therapist who may work with you after surgery

Immediately After Surgery

• The nurses will check on you frequently and assist you to turn.

• The nursing assistant will provide you with a basin of water for washing and will help you with areas you cannot or should not reach. Remember, you must not bend more than 90 degrees forward. Please do as much for yourself as possible.

• You will have an incentive spirometer to use hourly while awake to prevent breathing difficulties. Your nurse will show you how to use the equipment.

• Remember that opioids (narcotics) can cause constipation. Ask for a laxative if the stool softener given to you routinely is not enough.

Blood Clot Prevention

You will start on medication to prevent blood clots. Your surgeon will specify the blood clot medication based on your needs.

One common drug is Lovenox, a medication that is given by a shot through a tiny needle into the fatty tissue on the abdomen. This medication will need to be continued after you leave the hospital. If this is ordered, your nurse will teach you and another person of your choice on how to give this shot. It is simple and easy to learn.

The usual dose of Lovenox is 40 milligrams (mgm), once a day for 10 to 14 days. If you live in a small town, please check with your pharmacy to see if Lovenox is available. If it is not, please ask your local pharmacist to order it so you can obtain it when you get home.

Please Ask Questions

If you have any questions or concerns regarding your care, please let your doctor or nurse know. You may also contact Patient Visitor Relations (919-681-2020).