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Personal items you will need in hospital

It will be helpful if you have some things brought in from home while you are in hospital. 

These include:

  • Night clothes, easy to wear day clothes, shoes or slippers, toiletries
  • Something to read
  • Walkers, strollers or walking sticks that you use at home
  • You may 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).
  • 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.
  • Mobile phones may be used on the ward, but please be considerate of other patients.

Prompts for family/whānau

  1. Children/ family or Pets in the home - someone will need to make arrangements for their care while you are in hospital.

  2. Have family advise any services such as Meals on Wheels not to come in.

  3. Mats on the floor can be dangerous - you will need to remove those.

  4. A backpack or bum bag is great for carrying mobile phone, water, pills etc while on crutches

  5. Consider the option of a personal alarm if home alone.

Preparing for your operation

Once you have arrived at the Emergency Department, and before being transferred to the ward, you will have an x-ray to confirm that a fracture has occurred.

If you are transferred from the Emergency Department to the Orthopaedic ward before your surgery, you will have a full medical assessment to determine your general health and fitness for surgery. During this assessment, you will be asked about your general health, which medications you take, as well as your living arrangements.

You will be given pain medication to keep you comfortable. You will also need to have a urinary catheter put in and a drip inserted into your arm.

You will be scheduled to have an operation as soon as possible; however this may be delayed if you are not well enough.

Your skin will be marked by the surgeon to indicate which leg is being operated on. Your leg will also be washed with a pre-operative solution. You will be put in a theatre gown and fitted with special stockings to help prevent blood clots developing in your legs.

You will not be allowed to eat for 6 hours before your surgery; however, you will be allowed to drink clear fluids up to 2 hours before your surgery. You may be given a carbohydrate drink the morning of your surgery which is given to help reduce your hunger and thirst. At the time of surgery, you will be taken down to the operating theatre on your bed by a staff member.

Tests:

You may need to undergo some tests as part of your medical assessment to determine your general health and fitness for surgery. Some of these tests may include a chest X-ray, and ECG (a tracing of your heart), blood tests and a urine test.

01 Tests

Consent:

Before you have the operation to repair your fractured hip, one of the surgeons will explain the procedure to you and your family/whānau. They will also outline possible risks and complications. You will get the opportunity to ask any questions. You will also meet the anaesthetist to discuss the type of anaesthetic you will be having.

In some cases a family member may be asked to provide the consent on your behalf. This will only be if you are unable to provide a signature or if you have an Enduring Power of Attorney (EPOA) in place.

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In the operating theatre

In the operating room, an anaesthetist and the anaesthetic team, several nurses, the surgeon and their surgical teams will be present. Once in the operating room you will receive an anaesthetic as previously discussed with you by your anaesthetist.

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.

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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.

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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 injections.

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.

After your operation

02 After OperationImmediately after your operation you will be transferred to the recovery room. Nursing staff will look after you and monitor you closely to ensure you are safe and comfortable.

You may have:

  • An intravenous (IV) drip in your arm - this is used to give you fluids, antibiotics and painkillers.
  • A facial mask or nasal prongs to give you oxygen.
  • A pain pump (patient controlled analgesia) so you can control your pain by pushing a button that will give you a prescribed amount of pain relief.
  • A urinary catheter in place.
  • A few sips of water if you feel able.

On return to the ward you will continue to be monitored closely by the nursing staff. You will be encouraged to eat and drink as soon as you are able.

You will also be encouraged to start moving your leg in bed. The goal is to get you up and stepping around to a chair next to your bed within 24 hours after your operation. This is to map your recovery and help prevent complications.

If you have other injuries or you are currently unwell, your recovery may differ slightly. 

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Pain relief

03 Pain ReliefGood pain control helps you recover more quickly after your operation. It is important to tell the doctors or nurses if you are in pain. Do not wait to be asked and do not feel afraid of being a nuisance. If your pain is well controlled, post-operative complications are reduced, you sleep better and it helps your body heal more quickly.

Pain relief is important and some people need more pain relief medication than others. An assessment scale is used to measure your pain regularly. The nurses will ask you to rate your pain at rest and on movement. They may use a number scale of 0 - 10, 0 meaning no pain and 10 being severe pain. It is important that you are honest about your pain so that you can receive the correct treatment for you.

Occasionally, despite regular painkillers, you may experience stronger pain. This may occur during physiotherapy exercises or walking. You will have additional painkillers prescribed to help relieve this pain. Please ask your nurse for these. It is important that you are comfortable enough to be able to participate in physiotherapy to help your recovery.

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The first day after your operation 

We encourage you to be as independent as possible after your surgery. You will receive help with tasks such as washing, dressing and walking to the toilet, but the aim is to wean off this help as soon as it is safe to do so. 

On the first day you can expect the following to happen:

  • You will be seen by a doctor from the Orthopaedic Team.
  • Your pain pump (patient controlled analgesia) may be stopped.
  • You will receive regular oral medication to lessen your pain, nausea and help prevent constipation.
  • Your oxygen will be stopped if you no longer require it.
  • Your wound drain (if you have one) will be removed.
  • A simple blood test will be taken to check you are not anaemic (have low red blood cells or haemoglobin) after your operation.
  • Your IV fluids will stop if you are able to drink.
  • Your IV cannula will be removed once you have been given a final dose of antibiotics.
  • You may receive a small daily injection to help reduce the risk of developing a blood clot.
  • You may have foot pumps attached to your feet whilst in bed.
  • Nursing staff will assist you with washing and dressing as required.
  • You will be encouraged to sit out of bed for meals.
  • Your physiotherapist or their assistant will visit you at least once a day to help you with your exercises and help you to walk.
  • ACC forms will be completed by staff
  • You may receive a visit from a social worker.

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The second and following days after your operation you can expect the following to happen:

  • 03 Day 2

    Your urinary catheter will be removed.
  • You will be seen by a doctor from the Orthopaedic Team.
  • You will continue to receive regular oral medication
  • Your pain pump (patient controlled analgesia), if not stopped yesterday, may now be removed.
  • You will be encouraged to wash, dress and toilet yourself as independently as possible.
  • You will need to dress in your own clothes.
  • You will sit out of bed for all your meals.
  • Your physiotherapist or their assistant will visit you at least once a day to help with your exercises and supervise your walking.
  • You may receive a visit from a social worker to assess any social needs for your discharge.
  • Your occupational therapist may assess your ability to manage essential everyday tasks. This may include transfers on and off a bed, chair and toilet. They will also ensure that you can wash and dress yourself.
  • Your occupational therapist may also issue you with any equipment you may need at home.
  • You may be transferred to a rehabiliation area. This may be in the same ward or in a different ward.

The physiotherapists will work with you and your nurse to make sure that you have had pain-relief before you participate in physiotherapy. It is really important that you do not have too much pain as this can slow down your recovery. 

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05 Looking After Yourself

Looking after yourself

Eating well will help build up your strength and help your bones to heal. Your family are welcome to bring in any food that you may want in addition to the food you will be served at the hospital.

It is also important to keep up your intake of fruit and vegetables to help with good bowel habits. On some occasions pain relief medication can make you constipated, if this happens it is important to let your nurse know.

Last updated: October 3, 2017