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Your hospital journey

Your Hospital Journey

Pre-assessment Clinic - nurse

The Pre-assessment Nurse will ask you about your general health, medical history, previous anaesthetics and if there were any problems. Please bring this book and all your current medications in their original packaging with you.

It is important that you are assessed prior to your operation to minimise the risks associated with your surgery. Most people will have their first assessment for their fitness for surgery with the Pre-assessment Nurse in a specialist pre-assessment clinic. This clinic typically takes place soon after you have seen the Specialist (Surgeon) in the clinic. It may even occur the same day.

A record will be made of any family history of anaesthetic problems, medicines, pills, inhalers or alternative medications that you use allergies, smoking, alcohol and whether you have any loose, capped or crowned teeth. You may have investigations such as blood tests, a heart trace (ECG), urine tests and X-rays. This helps your anaesthetist consider any medical problems which may either affect the risks to yourself or the likelihood of complications from the anaesthetic or surgery.

The Pre-assessment Nurse will give you time to ask questions about any possible problems and give advice and education on your hospital stay and activities following your surgery.

The National Joint Register

The New Zealand Orthopaedic Association has a National Joint Register which records all the technical data on all joint replacement surgery performed in New Zealand. This provides independent data on the performance of these joints over the

years. The data will be used in future audits of joint replacement outcomes and will identify factors which will provide the best long term surgical results for all New Zealanders.

You are asked for your consent to allow your name, address, date of birth, National Health Index number along with the technical data on your joint surgery to be forwarded to the registry.

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Pre-assessment Clinic - anaesthetist (if required)

The anaesthetist will see you before your operation to discuss your health, the types of anaesthetic and pain relief that can be used and their risks and benefits. Consent for your anaesthetic will also be sought at this time.
Nothing will happen to you until you understand and agree with what has been planned for you. You have the right to refuse if you do not want the treatment suggested or if you want more information or more time to decide.

Pre Assessment Clinic

Types of Anaesthetics:

General anaesthesia

Produces a state of controlled unconsciousness during which you feel nothing. You will receive anaesthetic drugs, strong pain relieving drugs, oxygen to breathe and sometimes a drug to relax your muscles. You will need a breathing tube in your throat once you are unconscious, and will be put on a breathing machine (ventilator) during your operation. When the operation is finished the anaesthetic is stopped and you regain consciousness.

Advantages

You will be unconscious during your operation.

Risks

Common side-effects (<1 in 100) include headache, sore throat, feeling sick or vomiting, dizziness, bladder problems, damage to the lips or tongue, temporary confusion or memory loss, aches and pains and bruising/soreness.

Uncommon side-effects (<1 in 1000) include chest infection, muscle pains, damage to teeth, becoming conscious during your operation, slow breathing and existing medical conditions getting worse.

Rare side effects (less than 1 in 10,000+) include damage to the eyes, serious drug allergy, nerve damage, equipment failure, heart attack, stroke or death.

Spinal anaesthesia

A measured dose of local anaesthetic is injected into the area of the back that contains spinal fluid using a very small needle. The injection is generally well tolerated and will make you go numb from the waist down. This means you will feel no pain, though you will remain conscious. A screen will shield the operation so you will not see the operation unless you want to. Your anaesthetist is always near you and you can speak to them whenever you want to.

If you prefer, you can also have drugs that make you feel sleepy and relaxed (sedation). This will mean you will not be aware of what is happening during surgery though you may hear the noises of what is going on around you.

Advantages

This generally provides better pain relief, and as such you do not need so much strong pain relieving medicine in the first 24 hours after the operation.

There is some evidence that less bleeding may occur during surgery which would reduce your risk of needing a blood transfusion or developing blood clots.

You remain in full control of your breathing. Your breathing should be better in the first few hours after the operation, so you have a lower chance of developing a chest infection. You should have less sickness and drowsiness after the operation and may be able to eat, drink and walk sooner.

Risks

Common side-effects (less than 1 in 100) include headache, dizziness, bladder problems, aches and pains and bruising/ soreness.

Uncommon side-effects (less than 1 in 1000) include itching and existing medical conditions getting worse.

Rare side effects (less than 1 in 10,000+) include serious drug allergy, nerve damage, equipment failure, heart attack, stroke or death.

Surgical infiltration

Local anaesthetic is injected in and around the joint by the surgeon at the time your new joint is going is being replaced. It is typically combined with spinal or general anaesthesia.

Advantages

Provides good pain relief immediately following surgery. Reduces the need for strong painkiller injections like morphine and therefore reduces side effects like nausea and vomiting. It also allows early mobilisation and physiotherapy.

Risks

May not provide adequate pain relief and hence may need to be combined with morphine injection.

Nerve block

This is an injection of local anaesthetic near the nerves which go to your leg. This will numb part of the leg and make it pain-free for several hours after surgery. You may also not be able to move it properly during this time.

Advantages

You won't need such strong pain relieving medication during and after your anaesthetic, and therefore won't feel so sick.

You should be more comfortable for several hours after your operation.

Risks

The numbness and weakness may last up to 16-24 hours, delaying your ability to walk and do your exercises.

Rarely there is risk of damage to the nerves.

Blood products

There is a small risk that you may need to have a blood transfusion. A transfusion of blood or blood products is only given when the benefits outweigh the risks.

You have the right to decide whether you want to have the treatment or not. You can ask as many questions as you need to ensure you are making the right choice.

You will be asked to sign a consent form to show that the benefits, risks and alternatives for your treatment, including transfusion of blood products, have been explained to you. The consent form will confirm that you have been able to ask any questions and you agree to receive the treatment.

If you refuse to have a transfusion when needed, the risks to your health are likely to increase.

Further information about blood transfusions can be found at: www.nzblood.co.nz

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Education Class

Education ClassBefore your operation you will need to attend a pre-operative education class. This will usually be two or three weeks before your surgery. This is a group session run by staff who will be involved in your care. The class is designed to help better inform and prepare you for your upcoming hip or knee replacement surgery. You are encouraged to ask any questions you have, however simple you may feel they are.

Please note you will be loaned home equipment during this class that will need to be carried back to your car. We therefore encourage you to bring a support person with you.

Preparing for your discharge home from hospital

It is important to consider how you will manage your care in your home once you are discharged from hospital. It is essential to start planning now.

Before you come to hospital organise your daily living needs in preparation for your return home.

Please note you should be ready to go home by 11am on the day you are discharged.

Please make plans for your transport home accordingly.

This list will help you prepare for your return home:

  • Arrange for someone to take me to hospital.
  • Arrange for someone to take me home on the day I am discharged.
  • Arrange for someone to stay with me for a few days after discharge (if I live alone).
  • Tell family, friends and/or neighbours about my operation.
  • Organise family/friends who are willing to help with chores/ housework.
  • Cook extra meals and freeze them.
  • Buy extra groceries and/or arrange for someone to do my grocery shopping.
  • If necessary, cancel my home help, Meals on Wheels, or other services that come to my home, while I am in hospital.
  • Organise appropriate seating at my home.
  • Consider buying a long-handled shoehorn and sock-aid. Place commonly used items at waist height to prevent the need to bend.
  • Get a clothes horse for my laundry.
  • Organise a gardener for six weeks if needed. Organise someone to look after my pets.
  • Check my house security, cancel paper delivery and organise for my letterbox to be cleared.
  • Make a list of useful contact numbers.
  • Remove rugs and mats, loose cords and anything that can be a trip hazard.
  • Pack ALL my medications/herbal products/alternative medications and supplements.

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Preparing for your hospital stay

Smoking and your lungs

We strongly advise that you try to avoid getting chest infections (stay away from people with coughs and colds) and give up smoking at least two weeks before the operation date. Continuing to smoke doubles your risk of complications, compromises healing and can add to the risk of developing confusion after your operation. It can also intensify the effects of your anaesthetic.

If you need help to quit smoking, please contact resources such as your Doctor (GP) or Quitline (0800 778 778) www.quit.org.nz or www.health.govt.nz\tobacco

Bay of Plenty District Health Board has a "No Smoking" policy on- site and throughout hospital grounds. To minimise withdrawals from nicotine, nicotine patches are available for free for the duration of your hospital stay.

Alcohol and drugs (such as Cannabis and P)

We encourage you to minimise your drug/alcohol consumption prior to and after your surgery. Drug/alcohol consumption significantly increases the risk of complications, compromises healing and can add to your risk of developing confusion after your operation. It can affect your anaesthetic and pain relief requirements.

Reduce sources of infection

Surgery may be cancelled if you have any source of infection such as ulcers, tooth problems, sores or open wounds. We advise you to see your dentist to have your teeth checked prior to having a joint replacement operation. Please visit your GP to have ulcers and other sores checked.

Managing your weight

If you are overweight, recovery can be more difficult as you have more strain on your muscles and joints. It can be hard to lose weight, especially with reduced mobility but exercise and
changes in diet even without weight loss can reduce your chance of complications after surgery. Talk to your GP or other health professional about managing your weight. It is also important to tell them if you have had a recent weight loss.

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Exercise

It is advisable to remain as active as possible leading up to your surgery, to strengthen your muscles and speed up recovery.

What to do if you become unwell

It is important we know if you have any of the following:

  • A cold or cough.
  • Skin infections - such as a sore, graze, pimple or eczema,
  • especially around your operation site.
  • Burning pain or passing urine more often than usual.
  • You are generally unwell - such as diarrhoea, vomiting or
  • high temperature.

Any of these conditions could cause your operation to be postponed. For your safety it is important that we know about them prior to your operation. You will receive a phone call from the Surgical Admission Unit two days before your operation day to check whether you are unwell.

If you do not receive a call and you are unwell please phone the hospital where you are having your operation and ask to speak to someone in the Surgical Admission Unit.

Tauranga 07 579 8000

Whakatane 07 306 0999

What do I bring to hospital?

  • You should leave valuables at home (eg; jewellery, bank or credit cards etc.) The Bay of Plenty District Health Board does NOT take responsibility for stolen items.
  • You may bring something to read.
  • Night clothes, easy to wear day clothes, shoes or slippers, toiletries.
  • Walkers or other aids you may use.
  • You may also bring your own pillow which will make your hospital stay more comfortable. Please make sure your pillowcase is not blue or white (these are hospital colours).
  • Please bring all your current medications in their original packaging.

Please name your personal belongings.

Mobile phones may be used on the ward, but please be considerate of other patients.

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The day before your operation

Your skin - using the body wash

Your SkinTo help prevent a wound infection after your operation, we ask that you use the Chlorhexidine 4% skin wash. The tube is intended for two washes before your operation. We ask that you shower or bath the night before and the day of your surgery. If possible, we would prefer that you shower rather than bath.

When you shower or bath, wet your body all over and then turn the shower off or stand up in the bath. Using half of the tube of Chlorhexidine soap, lather your body and hair with foam and remember to wash skin folds and inside your tummy button.
Be careful to avoid contact with your eyes.

Leave the foam on the skin for at least two minutes and then rinse off and dry your body thoroughly using a clean towel. Get dressed in clean clothes. 

Don't shave, pluck or wax your skin

It is very important that you do not shave or wax anywhere within the vicinity of the operation site before your operation. If it is necessary for hair to be removed, the staff will clip the hair with a specially cleaned surgical clipper on the day of surgery. This is to help reduce the risk of infection.

Eating and drinking

An empty stomach is important for a safe anaesthetic. We suggest you have a generous supper (after dinner snack) the night before you come to hospital. Unless you are a diabetic you will have been given two packs of pre-op drink when you attended the Education Class. Please follow these instructions carefully.

Please do not drink the preop if you are a known diabetic or taking medications for diabetes.

Eating and drinking instructions

You may eat (unless you have been instructed otherwise) up to six hours before your operation.

Up to two hours before the time of your operation you may continue to drink clear fluids (up to 400mls only); this will include your two cartons of pre-op drink which need to be drunk just prior to the two hours before your operation.

Clear fluids are any liquids that you can see through; this includes water and clear fruit juice without pulp and tea or coffee without milk. You should avoid carbonated (fizzy) drinks.

Morning surgery admit Tauranga 7am, Whakatane 7.15am:

  • Drink one pre-op drink at 5.30am
  • Drink the second pre-op drink at 5.45am (finish both by 6.00am.)

Afternoon surgery admit Tauranga 12.30pm, Whakatane 11am:

  • Drink one pre-op drink at 10.30am
  • Drink the second pre-op drink at 10.45am (finish both by 11.00am.)

Pre-op* is a clear carbohydrate (sugar) drink designed to prepare your body for your operation; it is best served chilled, shake well before use.

In the six hours prior to surgery DO NOT chew chewing gum, suck lozenges or lollies.

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Last updated: October 3, 2017