Impatient Information - What the Nurse Said

This is the basics of what I was told about THR at the 2 hour Patient Information Session on Joint Replacement (Hips and Knees) last week. There is a ton of info, so I'll break this into several posts. Keep in mind that this is what is done at Canberra Hospital (see the piccie? That's where I'll be!). This may give you some idea of what to expect for your THR, if you're in the same boat as me, but obviously each country, hospital and surgeon has their own way of doing things.

Hubby came along with me. As expected, I was one of the youngest at the info session - 3rd youngest out of about 20 patients. There was a young girl who looked like she might have rheumatoid arthritis, poor thing, and a man in his 30s with a degenerative joint disease. Everyone else was roughly aged 65-85, at a guess. No-one else had CDH, no surprises there!

The Nurse - Hanna

Some days before surgery there will be a Pre-Admission Clinic, where I'll meet with the nurses, anaesthetist and surgical registrar etc. Blood tests, urine tests, ECG, yet more hip x-rays, and other baseline observations will be made. This is my chance to tell them I have PTSD associated with my childhood surgeries, and that I'll need some help when coming in for surgery (knock me out, please!). More on PTSD later (another post).

The general plan is to come in to hospital on the morning of surgery (not the night before, which is what I've always experienced before). Nil by mouth from midnight, of course. Go to Admission, then into the glamorous "Theatre Gear", and into a Holding Bay until it's my turn off the rank.

I'm actually feeling very anxious about this, it is triggering a lot of my PTSD stuff. I will be sobbing with fear the whole time ... it upsets me even just thinking about it. I really wanted to be sedated in my room beforehand, and oblivious when leaving for the operating theatre. I may be able to change this, I'll discuss it at the pre-admission clinic.

After the operation, it's off to the Recovery Unit, and then Ward 11B, which is for joint replacements only, so all the nurses are very experienced. I'll have a urinary catheter in (put in during surgery), a drain in the wound, and a Charnley Pillow between my legs.

I'll have PCA (Patient Controlled Analgesia) with delicious morphine or fentanyl. You press the button, and you get the nice happy drugs! It's not possible to overdose, as it can only deliver one dose in 5 minutes, no matter how feverishly one presses the button!

There will be either a femoral nerve block in, or an epidural. I really would prefer the femoral nerve block, don't want people mucking around with my spine! Still, don't suppose I'll have much, if any, say. Either of these would be in for about 48 hours, and will numb my leg/s, but I'll still be able to move them.

I'll also be attached to an Alaris pump (IV) and have a canula in my arm, to give fluids and prophylactic antibiotics. This, the catheter, and the wound drain will probably be in for about 48 hours.

On return to the ward, the nurses will check my dressing, make sure I can move my toes, and take my "vitals" (blood pressure, pulse, temp etc) every 30 minutes for the first 2 hours, then hourly for a while, then every 4 hours, tapering down over the days. They'll also give me a bed bath to try to help remove some of the almost indelible bright pink antiseptic paint Canberra orthopedic surgeons favour of late!

Hanna advised wearing nighties (for the women!) for the first few days - it's not really possible to wear PJ pants or undies, with all the tubes and stuff. Dignity goes out the window with this sort of surgery, that much is a given!

There will be 'pressure area care', where I get rolled around in the bed (wheeeee!) to avoid pressure sores. Carefully and slowly, one hopes!

Once the pain machines are taken away from me (why?! WHY?!), the Acute Pain Team (great name, hey?) will come around to see me. They make the decisions about pain control, check me daily, and can prescribe whatever I need. One thing Hanna stressed was to KEEP ON TOP OF YOUR PAIN MEDS. Don't let them wear off before asking for more. This ensures you'll be covered when your physio sessions happen (which are on short notice), as well as helping recovery in general.

Some of the oral pain meds on offer are :

• Endone (narcotic)
• MS Contin
• Good old Panadol - which can enhance the effects of narcotics, and is very effective for bone pain
• Meds for nausea, if needed

Another tip about pain relief is that the nurses will give regular meds, but if they're not cutting it, and you're still in pain, you need to ask for the strong stuff. Hanna really emphasised how important it is to let them know.

There is a high risk of Deep Vein Thrombosis (DVT) after joint replacement surgery, so there are several things that will happen :

1. Early mobilisation - ankle & foot exercises right away, and up and walking, even just a little, by the day after surgery
2. Clexane injections (anticoagulant)
3. TED stockings (possibly)

I will be on Clexane for a month after surgery. It's an anticoagulant medicine, which helps avoid DVT, as mentioned. It's given by injection, and we have to learn to inject ourselves at home. We were given a CD with a video on how to do this, plus we'll be shown in the ward. Oh joy.

Here's your Petal piccie. She's reading a card sent to her by a friend in the States. One clever puppy, no?