Free Nursing Care Plans

welcome to the toronto western hospital. in this video you will learn how to preparefor your joint replacement surgery, the importance of participating in therapy and how to carefor yourself during recovery, including controlling pain and recognizing complications. joint replacement surgery - referred to asarthroplasty - is a surgery to relieve pain and restore range of motion by reconstructinga joint. to help you understand hip replacement surgery,the hip joint, which is the largest in the body, is a ball and socket joint. normally a layer of cartilage combined withjoint fluid allows the hip bone to move smoothly

and painlessly. in other cases, the surfaces of the hip jointbecome uneven from wear and tear and friction stops the joint from moving properly. this makes certain hip movements such as bending,straightening, lifting, or twisting at the hip, painful or even impossible to do. during this surgery an incision will be madealong your hip and the damaged hip bone (the femoral head) will be removed. then a new hip prosthesis (an artificial attachment)will be sized to fit and inserted. total joint replacement surgery is a significantevent you need to prepare for.â 

the majority of patients are ready to go homewithin 3 days after surgery and an important part of planning is preparing meals aheadof time and having a good supply of food or frozen meals ready for your return home. if this is not possible and you worry aboutbeing left alone, you may consider a short stay at a respite centre. at home, for your safety, keep floors andstairs free of objects that can cause you to trip and fall.â  we recommend removing loose rugs and clearingup electrical cords. also, you may want to ask someone to cometo stay with you to help for the first few

days. "after your surgery, you may experience achange in balance and energy. it’s important that you find different waysto continue doing your daily activities safely, while re-gaining your independence. organize your home so that any commonly useditems are at waist level, within safe reach. it is also important to lower objects fromhigh cupboards, and raise objects from lower cupboards to be within your reach. ""you can use a raised chair or high stool while in the kitchen to avoid standing fora long time.

your healthcare team will tell you about equipmentthat you can rent or buy and we will show more equipment throughout this video. ""points to remember before your surgery - prepare your meals ahead of time- check your home for safety hazards - arrange for help at home for the first fewdays after surgery - rent or buy equipment to help you walk anduse the washroom safely ""you will need to pack some items for your stay in the hospital. bring a comfortable pair of shoes that area half to 1 size larger than your usual size

as your leg and foot will get swollen. you may want to bring earplugs since the hospitalcan get quite noisy at times. we also suggest an eye mask since a nursewill be checking on you through the night and will need to turn the lights on. "on the day of your surgery, take the elevators located in the fell pavilion and go to thesecond floor. when you exit the elevator you will see thepre-operative care unit. "the waiting area is located in this areafor your family or friends. once the surgery is over, a surgeon will speakwith your family and let them know how you

are doing. if no one is waiting in the hospital, youcan ask the surgeon to call your family member. alternatively, they can call the unit to findout how you are doing. let them know the hospital needs to respectyour confidentiality and can only give limited information. the contact number for the unit can be foundin the surgery binder you received during your pre-admission visit." "points to remember on the day of your surgery:- bring a larger size pair of shoes - bring earplugs and an eye mask- arrive at the pre-operative care unit

""after surgery, you will be moved to an inpatient unit for the rest of your stay in the hospital. if at any time you need assistance, pleaseuse the call bell and let the ward clerk know. the ward clerk will get the right person tohelp you. personal care assistants or pca’s will assistwith your personal needs, such as a request for supplies and assistance going to the washroom. nurses will assist your recovery needs suchas monitoring your vital signs, giving medication, changing dressings, and handling any emergencysituations. "once you are on the inpatient unit please

let your nurse know your special diet requirementsor food allergies. you will experience pain after surgery. to help you learn to control your pain duringyour recovery, a member of the acute pain service team will visit you on the unit. we encourage you to use your pain medicationon a regular basis to prevent pain and to keep on top of your pain. you can expect mild pain when you are in bedand moderate pain with exercise and physiotherapy. you will first be started on pain pills. this medication will be given to you by yournurse.

"if your pain is not well managed with pills,you will be started on a patient controlled analgesia pump or pca. the pump is operated by a button that youcan push up to every 5 minutes and you will receive a dose of medication through yourintravenous line. you should have good pain control at all times. we will assess your pain using a pain scaleof 0-10, 0 is no pain at all and 10 is the worst pain you can imagine. "you should also use ice packs regularly, as this will help to reduce pain and swelling.

after your surgery, two people will assistyou to use the washroom. "unless you are not able to get up from thebed due to dizziness or low blood pressure, then a nurse will assist you in using a bedpanor urinal. if you are unable to empty your bladder onyour own, a catheter will be inserted and left in for 24 hours. ""constipation is a common problem caused by the pain medication you will be given duringyour stay. it is very important not to be already constipatedwhen you come to the hospital. you will be started on a laxative and stoolsoftener twice a day after your surgery.

we will also give you prune juice daily. it’s very important that you have a bowelmovement before going home. "you will have blood tests done every morning for the first three days after surgery. this will tell us how your body is adaptingafter the expected blood loss. "a day after your surgery, you will starton a blood thinner to help prevent blood clots. this medication will be given in the formof an injection in the fat of your belly. it is a tiny needle with a preloaded syringe. the nurse will give it the first day and thenteach you to give it to yourself.

at home you’ll be expected to continue givingyourself these injections. you will need to take it for 21 days for ahip replacement and 10 days for a knee replacement ""points to remember after your surgery: - take your pain medication regularly to keepon top of your pain. - use ice packs often- it’s important to have a bowel movement both before and after surgery- you will start on blood thinner injections "after your surgery, a physiotherapy team will begin working with you. these are therapists who will help with yourmobility so you can re-adjust to daily activities.

they will prepare you for your discharge homeand will teach you a series of exercises that you need to do while in hospital and thencontinue once you go home. for the first exercise, point your toes up. tighten your thigh muscle by pushing the backof your knee down towards the bed. hold for 5 seconds. repeat 10 times. for the second exercise, place a roll underyour knee and point your toes up. lift your foot and straighten your knee. for the third exercise, squeeze your buttockmuscles together and hold for 5 seconds.

avoid holding your breath. for the fourth exercise, slide your leg outsideways while keeping your knee and foot facing upwards. using a 'lasso' at the foot will make thisexercise easier. for the fifth exercise, slide your heel upthe bed and bend your hip and knee. again, using a lasso at your foot will makeit easier to bend your hip. it is important that you do these exercises3 times a day and repeat each exercise 10 times. this will help you gain strength and improvemovement.

"there are certain movements you are not allowedto do for 3 months after your hip surgery because it puts too much pressure on the hipand could cause the new hip to dislocate. here are the movements you should try to avoid:1. bending forward, over 90 degrees, when sittingon a chair or standing upright 2. crossing legs at the ankle 3. crossing legs at the knees or hips, (sittingin a chair or lying in bed)" "you will need to change the way you performcertain activities. there is equipment you can use to do the activitiesyou need to do without putting your new hip at risk.

use a reacher so you don't bend too much whilepicking things up or pulling on your pants. ""you can also use a sock aid and a long-handled shoe horn to prevent yourself from bendingtoo much. "your surgery binder has pictures and lists of the equipment you need to get organizedbefore your surgery. you should make arrangements with local medicalsuppliers to purchase or rent the equipment you need. initially, you will start to walk with a highwheeled walker and extra support. as your walking improves, your equipment andsupport needs will change.

you will advance to a 2 wheeled walker andcane when you go home. staff will teach you how to climb stairs afteryour surgery. using the rail and a cane, you will move 1stair at a time. lead with the strong leg on the way up, andlead with the weak leg on the way down. there are a few equipment aids that can beused in the bathroom to keep you safe. this includes a raised toilet seat with arms,a non-slip bath mat, and a hand held shower head. some patients will be comfortable and ableto safely step over the edge of the bathtub, but some patients will require the use ofa tub transfer bench.

we recommend that you use either a tub clampand/or a grab-bar that is professionally installed if you will be stepping over the edge of thetub. do not reach for a towel bar, shower curtainor soap dish to support you as it may increase your risk of falling and not offer you thesupport that you require. you should also avoid sitting on the tub floorfor at least 3 months after surgery. depending on how your home is set up, andon your needs, additional equipment may be recommended to keep you safe and active. if required, an occupational therapist couldprovide a home safety assessment and make suggestions.

please see your surgery binder for detailson how to access occupational therapists’ services. "points to remember:- do your exercises while in hospital and at home- staff will teach you about equipment for walking and safety in the washroom- you will need to rent or purchase equipment at home" the majority of patients are ready to go homewithin 3 days after surgery, once they have achieved all the goals that are required bythe healthcare team. you are ready to go home when you can moveon your own with equipment, be able to go

up and down the stairs, be able to eat andhave a bowel movement. once you have accomplished all these, youwill be told the day before that you are ready to go home the following morning. an incision is the cut made during your surgery. as we prepare you for your discharge home,you will be taught how to care for your incision. do not put any cream on the wound. you will need to get the staples removed 2weeks after your surgery by your family doctor. we will give you a disposable staple removerthat you must take to your doctor. before you leave the hospital we will giveyou a follow up appointment scheduled 6 weeks

after your surgery, with your surgeon. we recommend that while you are home recovering,you write a list of questions for the surgeon, such as when you can drive or fly, returnto work, or any other concerns you have. you will be given a prescription for the exactnumber of blood thinner injections you need when you go home. the pharmacy at toronto western hospital willprepare the exact number you require. please know the blood thinner medication isnot covered by most drug plans. pain medication and stool softeners will alsobe prescribed. please make arrangements to be picked up fromthe hospital.

have your family member or friend bring acushion, and get a wheelchair from the front door of the hospital and bring it up to theunit as it is too far for you to walk to your car. for safe entry into a car, move the car seatback and lower the back of the seat. "points to remember- you will most likely go home within 3 days after your surgery- you will be given dressing changes, a prescription and a notice of your follow up appointment- please ask whoever is picking you up to bring a cushion and get a wheelchair fromthe front lobby ""when you are home, it’s important to recognize

the signs of a blood clot. if the clot begins in your leg you will haveextreme pain and swelling in the back of your calf and perhaps some redness. this can be treated but you must go to thenearest emergency hospital. if the blood clot traveled to your lung, youmay experience shortness of breath, a fast heartbeat and sometimes pain in your mid back. if this happens, this is a medical emergencyand you need to go to the closest emergency hospital for immediate treatment. "it is very important to prevent infection

at the joint replacement site where a germcould enter your bloodstream. to help prevent the risk of infection youwill need to take antibiotics for any medical procedures including dental cleaning, anyoperation and examinations one hour before procedure. "if you develop an infection in any part ofyour body, it must be treated quickly. signs of infection include. 1. fever2. increased discharge and redness at the incisionsite.

if you have an infection please consult yoursurgeon or family doctor. ""when you go home after surgery, please remember to:-use safety equipment as recommended by your healthcare team. -keep your incision clean-finish your blood thinner injections. - if you think you have a blood clot go tothe closest emergency department -take antibiotics to prevent infection-have your family doctor remove your staples 2 weeks after your surgery we hope you found this video helpful.

please watch it as often as you like untilyou feel comfortable before your surgery. if you have any questions please speak toa member of the healthcare team.