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Joint Replacement Surgery:  A Patient’s Guide       Before, During & After     Hip Replacement Surgery
Table of ContentsWelcomeWelcome  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  . ...
Welcome to Agnesian HealthCare!Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replaceme...
Important Phone NumbersSurgeonName of Surgeon:__________________________________________________________________Office Pho...
Patient Information SheetRipon Medical Center Surgical Services • (920) 748-9136Date of Surgery:__________________________...
Case ManagersA case manager is a nurse or social worker. Case managers are available to assist you with:Power of Attorney ...
Medicare BenefitsHealthcare benefits change constantly; therefore, it is important for you to review your insurance benefi...
Insurance BenefitsIf you have private or a Medicare-replacement insurance:Read the written information you have at home ab...
Planning For Your Hospital StayPrior to Your Surgery DateDo not shave your legs or cut/clip your toenails for one week pri...
Planning For Your Hospital StayWhile in the Hospital•	 As a patient of Ripon Medical Center, we are pleased to offer you a...
AnesthesiaWhat to Expect From AnesthesiaYour anesthesiologist should discuss two main aspects of care with you: the anesth...
AnesthesiaStudies that have looked at the overall outcome of spinal and general anesthesia for hip surgery have not founda...
AnesthesiaPain Control Following SurgeryYour anesthesiologist will discuss pain control options after surgery with you dur...
Frequently-Asked QuestionsQ:	How long will I be in the hospital following my total joint replacement?A:	 Typically followi...
Home Safety AssessmentThe majority of falls that occur happen at home. The good news is that most falls can be prevented t...
Home Safety AssessmentKitchenDo you use a wide-based, sturdy step to reach into high cabinets? .  .  .  .  .  .  .  .  .  ...
Hip Care Guidelines - Day of SurgeryWe are pleased to welcome you to Ripon Medical Center and the Surgical/Orthopedics uni...
Hip Care Guidelines - Day of SurgeryMedicationsYou will have medications to keep you comfortable after surgery and to prev...
Hip Care Guidelines - Day OneToday’s Itinerary•	   Your vital signs will be checked every four hours.•	   IV fluids contin...
Hip Care Guidelines - Day OneLet’s Get Moving!Your therapist will talk to you about hip precautions (what to do to prevent...
Hip Care Guidelines - Day TwoToday’s Itinerary•	   Your vital signs will be checked every eight hours and as needed.•	   T...
Hip Care Guidelines - Day Two	Today’s Goals	 ❑ Pain controlled	                          ❑ No blood clots	 ❑ No pneumonia	...
Hip Care Guidelines - Day ThreeToday’s Itinerary•	 Today may be the day you are discharged home or to another facility.•	 ...
Exercises / Hip PrecautionsQuadriceps SetTighten muscles on top of thighs by pushingknees down into surface. Hold 5 second...
Exercises / Hip PrecautionsBiceps CurlWith right arm straight, thumb forward,holding _______ pound weight, bend elbow.Retu...
Exercises / Hip PrecautionsAnkle PumpsWith left leg relaxed, gently flex and extend ankle.Move through full range of motio...
Exercises / Hip PrecautionsGluteal SetsTighten buttock muscles.Repeat 10-20 times per set.Do 2-3 sets per session.Do 2-3 s...
Exercises / Hip PrecautionsHip Abduction - ResistedWith tubing around right leg, other sidetoward anchor, extend leg out f...
Exercises / Hip PrecautionsAfter total hip replacement:    1) Following proper laying position                 2) Follow p...
Pain ManagementThe associates at the Agnesian Center for Bone & Joint Health are concerned about managing your painafter s...
Pain ManagementPain Scale and FacesAgnesian HealthCare professionals will be able to give you more specific information on...
Coumadin (Warfarin) Information  ®What is warfarin?Warfarin (generic name) or Coumadin® (brand name) is an oral medication...
Coumadin (Warfarin) Information  ®How often do I need blood work performed?In general, when you first start warfarin, you ...
Coumadin (Warfarin) Information   ®What if I miss a dose?It is very important to take your warfarin at the same time each ...
Coumadin (Warfarin) Information                 ®Why do I need to pay attention to my diet?Many foods you eat contain vita...
Medical Equipment for HomeFollowing Hip Surgery•	 Raised toilet seat or a commode chair•	 Long-handled reacher•	 Long-hand...
Medical Equipment for HomeBathroom•	 Install a raised toilet seat.•	 Use a tub transfer bench with a handheld shower   (in...
Durable Medical Equipment327 Winnebago Drive, Fond du Lac, WI 54935(920) 926-5277 • (800) 732-1313Store Hours: weekdays fr...
Agnesian HealthCare Home CareWhen to Consider Home Care•	   Recurrent hospitalizations•	   Medication monitoring (new and ...
Common TerminologyEquipmentIntravenous (IV) CatheterThis catheter allows for fluids and medications to be delivered throug...
Common TerminologyPeoplePhysical Therapy (PT)Physical therapy associates will assist you in regaining mobility and functio...
Questions_________________________________________________________________________________________________________________...
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A Patient's Guide to Hip Replacement Surgery: Ripon Medical Center

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Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replacement surgery. We
hope our mission of providing compassionate care that brings hope, health and wellness to all we serve is
evident in the care you receive. We trust that our associates and your surgeon provided you with the educational
opportunity to prepare yourself adequately for your joint replacement surgery.

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Transcript of "A Patient's Guide to Hip Replacement Surgery: Ripon Medical Center"

  1. 1. Joint Replacement Surgery: A Patient’s Guide Before, During & After Hip Replacement Surgery
  2. 2. Table of ContentsWelcomeWelcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Important Phone Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Joint Replacement Patient Information Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Case Managers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Before SurgeryPlanning For Your Hospital Stay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7What to Expect From Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Pain Control Following Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Frequently-Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Home Safety Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13SurgeryDaily Hip Care Guidelines - Day of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Daily Hip Care Guidelines - Day One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Daily Hip Care Guidelines - Day Two . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Daily Hip Care Guidelines - Day Three . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Exercises/Hip Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22After SurgeryPain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Coumadin®/Warfarin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Durable Medical EquipmentEquipment for Your Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Bathroom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Agnesian Health Shoppe - Durable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 ResourcesHome Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Common Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38RMC (01/13)
  3. 3. Welcome to Agnesian HealthCare!Thank you for choosing the Agnesian Center for Bone & Joint Health for your joint replacement surgery. Wehope our mission of providing compassionate care that brings hope, health and wellness to all we serve isevident in the care you receive. We trust that our associates and your surgeon provided you with the educationalopportunity to prepare yourself adequately for your joint replacement surgery.The Agnesian Center for Bone & Joint Health has been designed to give outstanding care of patients in needof joint replacements. We have assembled a special team of healthcare professionals that take great pridein ensuring that you receive the best quality care available. You can have extra confidence knowing that theAgnesian Center for Bone & Joint Health serves several hundred joint patients each year; our professionals haveextensive experience.As you will remember, to prepare you for surgery, our team has reviewed your specific joint replacementprocedure with you, and our highly-trained associates have provided you with this detailed educational binder.Through our surgical skills, our superior healthcare team and your determination, together we can accomplisha great result for you.Again, thank you for choosing the Agnesian Center for Bone & Joint Health; we are certain that you will findyour care to be extraordinary. During your hospitalization, please inform our associates if we can do anythingfor you to help you have an excellent care experience.Thank you again and we wish you the best in your recovery! 1
  4. 4. Important Phone NumbersSurgeonName of Surgeon:__________________________________________________________________Office Phone Number:________________________________________________________________Primary Care ProviderName of Primary Care Provider:_________________________________________________________Office Phone Number:________________________________________________________________PharmacyName of Pharmacy:_________________________________________________________________Address:_________________________________________________________________________Phone Number:____________________________________________________________________Ripon Medical CenterInformation/Switchboard . . . . . . . . . . . . . . . . . . . . . . . . . (920) 748-3101Inpatient Physical Rehabilitation . . . . . . . . . . . . . . . . . . . (920) 748-9138Surgical Inpatient Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . (920) 748-9120Anticoagulation Management Services . . . . . . . . . . . . . . (920) 748-0532Case Managers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (920) 748-9134 2
  5. 5. Patient Information SheetRipon Medical Center Surgical Services • (920) 748-9136Date of Surgery:________________________________________________ ❑ Right Hip ❑ Left HipUnless your provider gives you other instructions, please prepare yourself for your surgery using this checklist.❑ Make sure to stop the medications as directed by your provider:______________________________________________________________________________Day before surgery:❑ Eat a regular meal unless your provider instructs you otherwise.❑ Stay away from greasy, spicy and/or salty foods to help avoid upset stomach.❑ Remove all nail polish on your toes.❑ Prepare anything you will need to bring with you to the hospital. ___ robe and slippers ___ comb/hairbrush ___ glass case and/or contact case and solutions ___ toothbrush/toothpaste ___ deodorant ___ bring along any prosthetic devices; i.e., braces, walkers, crutches, etc.❑ Do not have anything to eat or drink including water starting at midnight on:______________________________________________________________________________❑ The hospital’s Surgical Services department will call you the day before your surgery with your arrival time.❑ Arrival time according to the hospital:_________________________________________________Day of surgery:❑ Take the following medications with a sip of water at:______________________________________________________________________________❑ Bring to the hospital your Durable Power of Attorney papers for your chart if already have.❑ Brush your teeth but do not swallow any water.❑ Do not wear make-up or toenail polish.❑ Wear comfortable clothing to the hospital.❑ Leave jewelry and all other valuables at home.❑ When coming to the hospital, go directly to the Surgical Services department unless otherwise advised. 3
  6. 6. Case ManagersA case manager is a nurse or social worker. Case managers are available to assist you with:Power of Attorney (POA) for HealthcareThe Wisconsin statutes recognize two forms of advance directives: the Power of Attorney for Healthcare and theDeclaration to Physicians (Living Will). All hospitals are required by law to make this information available topatients. You may call the case manager at (920) 748-9134 and request that a copy be mailed to you.A POA for Healthcare is a thoughtful process and should not be rushed. We recommend you complete the POAforms prior to your admission if you wish to have your POA in place for this surgery. Your signature requires twowitnesses. Family members are not eligible to witness your signature. The only hospital associates eligible towitness your signature are Spiritual Care Services associates or a social worker, and they may not be readilyavailable the day of your surgery.Insurance-Related QuestionsInsurance companies may preauthorize an initial one to two-day hospital stay. During your hospitalization,the insurance company will call the case manager to evaluate your progress. The insurance company will thendetermine if your stay is to be extended.Discharge PlanningDischarge planning includes setting up home care, equipment or arranging for inpatient rehabilitation or asubacute (skilled nursing home) stay.We recommend that you pre-plan your ride home with a family member or friend. Insurance companies onlypay for medically-necessary ambulance transportation. Insurance will not cover wheelchair van transport.If outpatient services are needed for physical therapy or lab tests, you will need to arrange for the appointmentand the transportation. Know before you come into the hospital where you want to go for your therapy and bloodwork.After you are admitted to the hospital, your case manager may stop in and ask if you have any questions ordischarge concerns. You or your family may request to see the case manager at any time. 4
  7. 7. Medicare BenefitsHealthcare benefits change constantly; therefore, it is important for you to review your insurance benefits and/or any alternative plans for payment before you come to the hospital. The medical and rehabilitation team willwork with you to decide which options are most appropriate for you.Medicare A and B provides benefits for the following services:Rehabilitation• Inpatient rehabilitation at Ripon Medical Center may be covered. However, patients must meet certain criteria for admission.• Subacute (skilled nursing home): If you think that your recovery may progress more slowly, you may want to consider skilled nursing facilities before you come into the hospital. Medicare may provide coverage for a short period of time. Criteria for admission, discharge and payment are based on the need for skilled care as described by Medicare.Home Care (see page 37)Medicare may cover home care at 100 percent if you meet the following criteria:• The home care needed is skilled in nature. This means you require a nurse and/or physical therapist.• You must be homebound. This means that leaving the home requires a considerable and taxing effort or leaving the home is medically contraindicated.Outpatient Therapy Benefits• Medicare provides benefits for outpatient services based on skilled care needs at the time the service is provided. This may be covered at 80 percent of the charge.Durable Medical Equipment (see page 36)• You may have to pay a portion or all of the cost depending on your insurance benefits for a walker, crutches or cane.• If you were issued a cane or any other equipment within the last one to five years, your insurance carrier may not cover the cost again.• Items not covered include raised toilet seats, grab bars, shower transfer bench or chair, reacher, long-handled sponge, sock aid and shoehorn. 5
  8. 8. Insurance BenefitsIf you have private or a Medicare-replacement insurance:Read the written information you have at home about your insurance coverage. Call the number on the backof your insurance card if you have any questions. In general, insurance companies follow the same criteria asMedicare to determine eligibility for outpatient therapy, home care, acute or subacute rehabilitation services.Let the insurance representative know that you will be having surgery. Keep in mind that the person answeringyour questions is a service representative who will speak in general terms and will not know all the detailsabout your surgery.There may be a difference between having the benefit and qualifying for the benefit. Qualifying for the insurancebenefit is not a surgeon or primary care provider’s decision. Your insurance company will determine yourqualification for benefits based on their standards and policies.Questions you may want to ask about your benefits.Write down the name of the person you are talking with:________________________________________Do I have outpatient physical therapy benefits? ❑ Yes ❑ NoIf yes, what are they?________________________________________________________________Is there a preferred provider?__________________________________________________________Do I have home health benefits for in-home therapy or nursing? ❑ Yes ❑ NoIf yes, what are they?________________________________________________________________Is there a preferred provider?__________________________________________________________Do I have durable medical equipment benefits (walker, crutches)? ❑ Yes ❑ NoIf yes, what are they?________________________________________________________________Is there a preferred provider?__________________________________________________________Do I have acute inpatient rehabilitation benefits? ❑ Yes ❑ NoIf yes, what are they?________________________________________________________________Do I have skilled nursing facility benefits? ❑ Yes ❑ NoIf yes, who are the preferred providers?___________________________________________________Is there a deductible or co-pay for any of these services?_______________________________________ 6
  9. 9. Planning For Your Hospital StayPrior to Your Surgery DateDo not shave your legs or cut/clip your toenails for one week prior to your surgery date.Anti-inflammatory medications (over-the-counter or prescription) that you are currently taking for your joint painmay be requested by your surgeon to stop prior to surgery, so make sure your surgeon has an up-to-date list ofyour medications. If your surgeon does request you to stop these medications, inquire what you can take in placeof them for your joint discomfort.What to Bring to the Hospital• If you bring your own pillow, please make sure your pillowcase is brightly colored or patterned, so that it won’t be mistaken with the hospital linens.• Bring loose-fitting, comfortable clothes such as pajamas, lightweight robe, sweatpants, shorts and T-shirts for therapy. Bring at least two sets of clothing with you.• Bring comfortable, low-heeled shoes that have an enclosed heel and toe, such as walking or tennis shoes. No open heel/toe shoes or slippers. Non-skid or rubber-soled shoes are preferred.• Bring personal hygiene toiletries and incontinence products. You may also want to include lip balm.• Bring a walker and/or crutches, if you have them. Your physical therapist will check them for a proper, safe fit. You may also want to bring a long-handled reacher and shoehorn.• Bring any special equipment that you have at home, such as wrist splints, orthopedic shoes, long handle reacher, sock aid, shoehorn, etc.• Bring a book, magazine or hobby item to help you relax.• Bring a list of your medications (both prescribed and over-the-counter) with any changes if any from the time you attended the education class.• Do not bring medications from home unless told to do so (It is OK to bring your eye drops and inhalers). Check with your provider regarding which medications to take on the day of your surgery.• Do not bring any jewelry, checkbook, credit cards or more than $5 cash with you to the hospital.When to Stop Eating and Drinking• Do not eat or drink anything after midnight the night before your surgery unless otherwise instructed. This includes gum, hard candy, water, soda, coffee, tea, beer, wine or other alcoholic beverages, etc.• Brush your teeth, making sure not to swallow any water or toothpaste.• Take your medications as instructed with a small sip of water. 7
  10. 10. Planning For Your Hospital StayWhile in the Hospital• As a patient of Ripon Medical Center, we are pleased to offer you an innovative dining program, which allows you to select meals from an expansive menu designed to make you feel as though you were at home or at a favorite restaurant.• If one of your guests wishes to have a room service meal, they can call the room service line at 1328 to place their order. There is a $5 charge for lunch and $7 for dinner which includes an entrée, two side orders, a beverage and dessert/fruit. The guest must have exact change upon delivery of the guest tray. No checks or credit cards will be accepted.Suggestions to Make Your Return Home an Easier One• Ensure hallways and rooms are free of clutter and tripping hazards.• Organize your living areas to avoid excessive lifting, bending or reaching.• Store heavy and frequently-used objects at or above waist level (counter height). Consider moving items in the lower parts of the fridge/freezer to a higher shelf.• Consider preparing a bedroom area on the main living level for short-term use upon your return home.• Set up a firm chair with armrests.• Arrange for extra help with household tasks if needed.• Keep an ice pack in your freezer for possible joint swelling after surgery. A bag of frozen peas will also work. 8
  11. 11. AnesthesiaWhat to Expect From AnesthesiaYour anesthesiologist should discuss two main aspects of care with you: the anesthesia provided duringthe surgical procedure and the plan for pain control afterwards. There are several options your anesthesiacare provider may discuss with you. This information is being distributed to you ahead of time to helpfacilitate discussion about your care on the morning of surgery and to dispel what seem to be some commonmisconceptions about certain types of anesthesia you may be offered.Anesthesia for Your SurgeryThere are two main choices for surgical anesthesia: general and regional. While most people are familiar withgeneral anesthesia, regional anesthesia is less familiar to you but widely used for joint replacement surgeriesalso. General anesthesia numbs your entire body, for the entire time of surgery, you will be “put under” - astate of controlled unconsciousness. The anesthesiologist will use a variety of medications to accomplishdifferent functions, such as stopping pain, relaxing the body’s muscles, etc. The most common type of regionalanesthesia offered for the procedure itself is spinal anesthesia, but your provider may discuss epidural or othertypes of regional anesthesia as well.A spinal anesthetic is performed by injecting local anesthetic (although sometimes this is combined with othermedicines as well) through a needle in your lower back directly into the fluid surrounding your spinal cordproducing numbness in the nerves from about the level of your waist and down. This is most often done in theoperating room with a patient in a sitting position or lying on his/her side.You will generally not feel much discomfort with placement of the spinal medication. There is a slight, briefdiscomfort associated with the placement of some medication to numb the skin first. After that, a patientmay feel pressure. If any sharp pain is experienced, it is important to let your anesthesia care provider know.Sometimes, a patient may feel a brief electric shock or “funny-bone” sensation when the spinal is performed.This is normal as long as it goes away in a few seconds. Please tell your anesthesiologist if you get this feeling.Once the medication is injected, it works quickly, usually taking full effect within five minutes (you may beginto feel warmth, tingling and numbness almost immediately).One of the most common misconceptions about spinal anesthesia relates to safety. You can rest assuredthat spinal anesthesia is a safe choice for joint replacement surgery. Many patients when offered this typeof anesthesia are concerned about serious side effects, such as paralysis, and also about troubling but lessdangerous side effects, such as headache. There seems to be a common, although false, perception that thesecomplications occur often. In fact, spinal anesthesia has a long track record of safety, with a rate of seriouscomplications (low!) about equal to the rate of major concerns with general anesthesia (also low!). 9
  12. 12. AnesthesiaStudies that have looked at the overall outcome of spinal and general anesthesia for hip surgery have not founda completely convincing advantage of one over the other, and therefore both types of anesthesia are commonlyused.The many advantages of spinal anesthesia include:1) More rapid recovery of mental function.2) The lack of need for insertion of breathing tubes.3) The lower incidence of nausea or vomiting.4) The prolongation of anesthesia after completion of surgery, which means a longer pain free period.Paralysis after spinal anesthesia is very rare. The number of patients that develop a headache is also quite low- in expert hands and using appropriately sized (small) needles, fewer than one percent of patients should havea headache. Although a “spinal headache” is troublesome, it is not life-threatening, and if such a side effectshould occur, our hospital’s anesthesia care team will help you with treatment of your headache.Another common misconception relates to consciousness during the surgical procedure. Many patients falselybelieve that choosing a spinal means they have to be awake during the surgical procedure. While choosinga spinal anesthetic affords you the opportunity to remain awake during the procedure if you so desire, mostpatients are offered sedation in addition. The majority of patients undergoing total joint replacement underspinal anesthesia at our hospital receive sedation during surgery and nearly all who do so have no discomfortor memories from the procedure.Unfortunately, not all patients are candidates for spinal anesthesia. We do not offer this technique to patientswho are at risk for internal bleeding concerns or to patients with infection in the area where the needle isinserted. We try to offer a realistic explanation of the different anesthetic techniques, their risks and benefits.When offered, spinal anesthesia is the most popular choice for joint replacement surgery at our hospital.Assuming there is not an absolutely compelling reason to choose a particular technique, we usually allow thepatient to make a choice. 10
  13. 13. AnesthesiaPain Control Following SurgeryYour anesthesiologist will discuss pain control options after surgery with you during your pre-operative visit,and again on the day of your surgery.Options For Pain Control After SurgeryAt our hospital we take a multi-modal approach to pain relief for joint replacement surgery. Youranesthesiologist can help not only with keeping you pain free during surgery, but also with keeping your painat tolerable levels during your stay in the hospital after surgery. We usually offer one of two choices of regionalanesthesia for pain control after surgery. These include, but are not limited to, spinal morphine femoral nervecatheter and popliteal nerve block.Patients will be offered a femoral nerve catheter to help control pain after surgery. This is a catheter placedthrough the skin next to your femoral nerve in your groin using ultrasound. Pain medication is then givencontinuously through this catheter after surgery. Placement is generally simple and involves minimaldiscomfort. The femoral nerve catheter will be placed in your pre-op room prior to your operation.SummaryThere are many types of anesthesia offered for joint replacement surgery. The most common combinationused at our hospital is spinal anesthesia and femoral nerve catheter with pain pump. Together, you and youranesthesiologist will come up with a plan that is best for you. 11
  14. 14. Frequently-Asked QuestionsQ: How long will I be in the hospital following my total joint replacement?A: Typically following a total joint replacement, you will have a three to four day stay in the acute care hospital. During your acute care stay, you will meet with a case manager who will assist you with your discharge plans. Based on your recovery status, rehabilitation associates and your provider will provide you with discharge recommendations.Q: How much pain will I have after the surgery?A: Your comfort is very important to our associates. In order for our associates to better serve your needs, we will be asking you to “rate” your pain. The scale will be from 0 to 10, with 0 being no pain and 10 being the worst pain possible. This rating will give associates an idea of how you feel and how to treat your discomfort.Q: How can I succeed after total joint replacement while in the hospital?A: During the first few days following surgery, you must rely on hospital associates to assist you with many things. However, during this time, you can assist with your recovery in the following ways: • Drink plenty of fluids. • Perform ankle pumps and deep breathing exercises frequently while awake. • Actively participate in your rehabilitation program.Q: How long until I can return to my normal activities following surgery?A: Typically, when you are discharged from your acute care stay, you will be independent with basic activities of daily living such as dressing and bathing. Within six months, you will be able to resume most of your pre-surgical activities based upon your provider’s recommendation. Your provider or therapist can answer specific questions concerning your activities.Q: Will I need special equipment at home following surgery?A: During your acute care stay our rehabilitation associates will assess your equipment needs and make recommendations. Your case manager will coordinate obtaining the appropriate equipment through an agency.Q: What positions should I avoid following surgery?A: Specific recommendations are provided to you as part of your educational packet. However, you will need to avoid the following positions: • Crossing your legs. • Bending your hips past 90 degrees. • Turning leg inward. 12
  15. 15. Home Safety AssessmentThe majority of falls that occur happen at home. The good news is that most falls can be prevented throughenvironmental changes and safety precautions. To decrease your risk of falling after your total joint surgery, werecommend that you ask your spouse, family member or a neighbor to go through your home and answer thefollowing questions.If you answer “No” to any of the questions, it is recommended that you change the environment to allow forbetter safety. While correcting these common concerns will decrease your risk of a fall, it is also recommendedthat you have a safety network of friends, family or neighbors to provide a daily check-in, either by phone or inperson, should you fall and be unable to solicit help independently.General Household AreasAre light switches easily accessible upon entering a room? . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoDo you have throw rugs in your home? (remove them) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoAre hallways free from clutter? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoAre raised door thresholds clearly marked? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoAre electrical cords and telephone cords away from hallways? . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoDo you have a portable phone with emergency numbers easily at hand? . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoDo you have furniture with good back and arm support that you can get in and out of easily? . . . ❑ Yes ❑ NoStairwaysAre stair treads in good condition? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoIs there a sturdy handrail on both sides of the stairs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoAre the stairs brightly lit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoBedroomIs there a lighted pathway from the bedroom to the bathroom? . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoIs there a clear pathway from the bedroom to the bathroom? . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoDo you keep a charged flashlight near your bed for emergencies? . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoBathroomDo you have safety rails or grab bars by toilet and shower/tub? . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoDo you have skid resistant strips or a rubber mat both in and in front of the bathtub? . . . . . . ❑ Yes ❑ NoDo you have an adjustable shower chair? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No 13
  16. 16. Home Safety AssessmentKitchenDo you use a wide-based, sturdy step to reach into high cabinets? . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoAre spills immediately wiped up? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoDo you avoid using a high gloss floor wax? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoDo you store frequently used items at waist level and less frequently used items inhigher cabinets? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoIs your laundry located on first floor? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoWill you have assistance with laundry? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoWill you have assistance with meal preparation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ NoCould you prepare microwave meals in advance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No 14
  17. 17. Hip Care Guidelines - Day of SurgeryWe are pleased to welcome you to Ripon Medical Center and the Surgical/Orthopedics unit. We look forwardto providing you the best care possible in an environment that encourages you to actively participate in therehabilitation process.Today’s Itinerary:• You will have an IV.• The pulses in your feet will be checked.• We will remind you to do ankle pumps every one to two hours.• Take frequent “cat naps” and limit visitors.• An abductor pillow may be used to keep your legs in a safe position while in bed.• You will reposition in bed frequently to prevent damage to skin.• Your blood pressure, pulse, respirations, temperature and oxygen levels (vital signs) will be checked frequently.• We will remind you to take deep breaths and cough every hour while you are awake (if you are watching television, you can do this during each commercial or approximately 10 per hour).• If you return from surgery in the morning, the physical therapist may get you out of bed today. If not, your nurse will have you sit at the side of the bed today.Pain ManagementWe take pain management seriously and want you to be comfortable. You will be asked to rate your pain using a0 to 10 pain scale. Zero means no pain and 10 means the worst pain you can imagine. Your nursing associateswill be checking you frequently and will be asking you about your level of pain. Remember to let your nurse knowwhen your pain is starting to increase.There are several options for pain management after total joint surgery and these will be ordered by yoursurgeon or anesthesiologist. Pain management can be complex so please feel free to ask questions of your nurseor provider. Today’s Goals ❑ Pain controlled ❑ No pneumonia ❑ Nausea controlled ❑ Carry out hip precautions ❑ No blood clots ❑ Get some rest! 15
  18. 18. Hip Care Guidelines - Day of SurgeryMedicationsYou will have medications to keep you comfortable after surgery and to prevent complications. Many of these aretaken by mouth so controlling nausea is important. You have provided a list of your home medications and if notcontraindicated, these will be ordered to begin this evening or tomorrow.If you were told to bring your medications from home, please provide these to your nurse. They will be reviewedby a pharmacist for identification and then kept in a secure bin assigned to you. The nurse will provide these asordered.Food for ThoughtYou have been without food or drink since midnight and had surgery… so be good to your stomach. Slow andsteady wins the race for getting back to normal meals.Start with ice chips, followed by a few sips of water. If all is well, Jell-O, clear soups and juices are goodchoices. These are available on your unit 24/7. Once you are able to pass gas, you can try portions of solid food.Remember, you have an IV so you can do without food or drink if your stomach is just not feeling quite right.If you experience nausea, let your nurse know.The menu in your room will tell you how to order your meals from dietary. We also have regular and diet soda, juice,soup, cold cereals, saltines, graham crackers, milk, ice cream and popsicles on the unit if you want a snack. ........................................................................................Don’t Take a “Trip” to the Bathroom! You may have a catheter in your bladder to drain urine.If not, ask for assistance with a bed pan, urinal or to get up to a bedside commode. ........................................................................................Dress Code• Patient gown for comfort; save your personal comfortable clothing for the upcoming days.• Nasal prongs to provide oxygen.• Elastic stockings (TED hose) and/or sequential compression devices (SCDs) to aid circulation and prevent blood clots.• A dressing over your surgical site (the nurse may need to add to your dressing if there is drainage on the surgeon’s dressing). Sneak Peak at Tomorrow • Blood draw for lab work at a very early hour. That’s why cat naps are so important. • Physical therapy begins, usually once in the morning and once in the afternoon. • Up in the chair three times. 16
  19. 19. Hip Care Guidelines - Day OneToday’s Itinerary• Your vital signs will be checked every four hours.• IV fluids continued if needed.• IV antibiotics discontinued.• If you no longer require oxygen, it will be discontinued.• Continue to cough and deep breathe every hour.• The pulses in your feet will be checked.• Do ankle pumps every one to two hours while awake.• Up in chair three times.• Rest between activity and limit visitors.• Reposition in bed to prevent damage to skin.• Hip precautions as ordered; hip abduction pillow may be used while in bed.• If a drain and/or bladder catheter is in place, it will be discontinued today.• Write down questions for your physician, nurse and therapist as you think of them.Fashion Statement• It’s time to get out your own clothes and say goodbye to the patient gown!• Your therapist will help with any challenges while getting bathed and dressed.Training Table for Rehabilitation• Your appetite may be less than normal for the first couple of weeks.• Your diet will be advanced when you are able to pass gas.• Choose food high in iron, protein, fiber and calcium.• Drink plenty of water.• Limit fat and sweets. Today’s Goals ❑ Pain controlled ❑ Walking ❑ No blood clots ❑ Up in chair two to three times ❑ No pneumonia ❑ Initial plan for discharge ❑ Exercise 17
  20. 20. Hip Care Guidelines - Day OneLet’s Get Moving!Your therapist will talk to you about hip precautions (what to do to prevent dislocation) and how much weightyou can put on your leg.You will get out of bed in the morning with assistance from therapy associates. Using a walker, you may takesome steps in your room or in the hallway. You will learn about getting in and out of bed and transferring to achair. You will begin your exercise program.Therapy associates will return in the afternoon. Perhaps you will go to the Inpatient Therapy room to continueyour exercises.Keeping Ahead of the PainNursing associates will ask you to rate your pain from 0 (none) to 10 (worst imaginable). Let your nurse ortherapist know when your pain is starting to increase.Try additional means to reduce your pain: music, massage, repositioning, reading, television, meditation, prayer,etc.You will be able to take part in therapy most effectively when your pain is controlled. With medication andother pain relieving measures (repositioning, etc.), the goal is for you to have a pain level of four or less. Painmedication is more effective when pain levels are maintained at lower levels.Associates from our Care Management department will visit you to plan for your discharge and identify anyequipment you will need......................................................................................... Sometimes what you’ve lost needs to be replaced! Some blood loss is expected with surgery. We check your blood count daily to determine if you need a blood transfusion. If you do, you may notice how much better you feel when your blood count increases after the transfusion. ........................................................................We Say “NO” to Blood Clots!You will continue to wear the TED hose and/or SCDs to aid circulation.Your nurse will provide you with the medication to prevent blood clots, as ordered by your physician.Continue to do your ankle pumps every one to two hours and participate in your exercises. Getting up andactivity decreases your risk of getting a blood clot. 18
  21. 21. Hip Care Guidelines - Day TwoToday’s Itinerary• Your vital signs will be checked every eight hours and as needed.• The pulses in your feet will be checked.• You will continue to cough and deep breathe.• Alternate rest and activity.• Up in chair three times daily.• Hip precautions as ordered; hip abduction pillow may be used while in bed.• Reposition frequently in bed.• TED hose on (off for 30 minutes in the morning and evening for bathing and skin inspection).• The nurse will change your surgical dressing today.• SCDs will be discontinued today.• Instruction on giving yourself blood thinning injections at home to prevent blood clots, if ordered by your physician.It’s Time to Get to the Gym• You will go to the Inpatient Therapy room.• You will continue to work on the exercises you did yesterday and add some new exercises.Back in Your Room• You will continue to do your ankle pumps every one to two hours.........................................................................................Pain, Pain Go Away!While the pain will probably not disappear completely, your pain medication taken by mouth should keep itat a level of four or less. Communicate pain concerns with your nurse or therapist.Try some additional means of reducing pain. If you tried something yesterday and it didn’t help, try it againtoday or try something different......................................................................................... 19
  22. 22. Hip Care Guidelines - Day Two Today’s Goals ❑ Pain controlled ❑ No blood clots ❑ No pneumonia ❑ Up in chair three times ❑ Walk safely with assistive device ❑ Continue all exercises ❑ Progress with transfers ❑ Discharge plan completedThere’s No Place Like Home• Your return home is an important part of getting the best results from your surgery. Day by day at home, you will return to your usual routines and increase activity naturally. While in the hospital, your provider, nurses and therapists observe your progress and look for signs that you will be safe at home. Occasionally, a patient may need an additional day in the hospital or perhaps some time in another facility before returning home. Our Care Management associates will assist in your transition home or to another facility.• If you need additional instruction on assistive devices, a therapist will work with you.• If you will be giving yourself injections at home to prevent blood clots, your nurse will provide instructions.• You may want to send some of your things home with family or friends to make your discharge day easier to organize.........................................................................................All Systems Go?If you don’t have a bowel movement (BM) today, let your nurse know. Remember to eat foodshigh in fiber and drink plenty of liquids, especially water. Walking and exercise also helps a lot!........................................................................................How Does My Incision Look?The edges of your incision have started to come together but some drainage may still be present, especially withactivity. The dressing may be changed as needed. If you had a surgical drain that was removed, drainage maycontinue until the site has healed. Redness, swelling and tenderness should be starting to decrease.To promote healing and rehabilitation, choose foods high in iron, protein, fiber and calcium. Avoid foods high infat and sugar. Do not smoke. Smoking interferes with the healing process. 20
  23. 23. Hip Care Guidelines - Day ThreeToday’s Itinerary• Today may be the day you are discharged home or to another facility.• Your intravenous catheter will be discontinued today.• Continue your activities of the previous days unless discontinued by your provider (ankle pumps, coughing and deep breathing.)• You will go to the Inpatient Therapy room and continue all your exercises.• If your home has certain features, such as stairways, steps or lack of handrails, your therapist will provide instruction on staying safe. Today’s Goals ❑ Pain controlled ❑ Labs within your normal limits ❑ No blood clots ❑ No pneumonia ❑ Walk safely and independently with assistive device ❑ Able to dress and perform personal activities safely and independently with assistive device(s) ❑ Maintain hip precautions ❑ Questions answered ❑ Discharge instructions understoodTo-Do List for Discharge• Pack up belongings.• Take purchased assistive devices with you, including dressings.• Check the closet, bathroom and drawers for personal items.• Go over your provider’s written discharge instructions with your nurse, including prescriptions and appointments.• Put all important discharge papers in the binder so you will have them when you arrive home.• Let your nurse know when you are ready and a member of the nursing staff will assist you to your car when all discharge paperwork is complete.........................................................................................Thank you for letting us serve you!We wish you continued success with improved mobility......................................................................................... 21
  24. 24. Exercises / Hip PrecautionsQuadriceps SetTighten muscles on top of thighs by pushingknees down into surface. Hold 5 seconds.Repeat 10-20 times per set.Do 2-3 sets per session.Do 2-3 sessions per day.Chair StandWith hands on armrests, push up from chair.Use legs as much as necessary. Return slowly.Repeat _______ times per set.Do _______ sets per session.Do _______ sessions per day. 22
  25. 25. Exercises / Hip PrecautionsBiceps CurlWith right arm straight, thumb forward,holding _______ pound weight, bend elbow.Return slowly.Repeat _______ times per set.Do _______ sets per session.Do _______ sessions per day.Arm Raise in FrontHolding _________ pound weights, raise armstoward ceiling. Keep elbows straight.Repeat ________ times per set.Do ________ sets per session.Do ________ sessions per day. 23
  26. 26. Exercises / Hip PrecautionsAnkle PumpsWith left leg relaxed, gently flex and extend ankle.Move through full range of motion. Avoid pain.Repeat 20 times per set.Do 1-2 sets per session.Do 10 sessions per day.Heel Slide (Supine)Slide right heel toward buttocks until a gentle stretchis felt. Hold 2 seconds. Relax.Repeat 10-20 times per set.Do 2-3 sets per session.Do 2-3 sessions per day. 24
  27. 27. Exercises / Hip PrecautionsGluteal SetsTighten buttock muscles.Repeat 10-20 times per set.Do 2-3 sets per session.Do 2-3 sessions per day.Hip Abduction / AdductionsBring right leg out to side and return.Keep knee straight.Repeat 10-20 times per set.Do 2-3 sets per session.Do 2-3 sessions per day. 25
  28. 28. Exercises / Hip PrecautionsHip Abduction - ResistedWith tubing around right leg, other sidetoward anchor, extend leg out from side.Repeat 10-20 times per set.Do 2-3 sets per session.Do 2-3 sessions per day. 26
  29. 29. Exercises / Hip PrecautionsAfter total hip replacement: 1) Following proper laying position 2) Follow proper sitting position 4) Do not internally rotate3) Do not flex past 90 degrees 5) Do not cross your legs 6 & 7) Follow proper car transferring procedures 27
  30. 30. Pain ManagementThe associates at the Agnesian Center for Bone & Joint Health are concerned about managing your painafter surgery. Pain that is poorly controlled can interfere with sleep, appetite, activity, relationships and youremotional outlook.Pain is to be expected following joint replacement surgery, but by working with your nurses, therapists andproviders we should be able to control the pain enough for you to actively participate in your recovery. Do not letyour pain get out of control because as pain becomes more severe it is harder to treat. Ask for assistance fromyour nurse if you feel your pain level is increasing.Ways for You to Help Us Manage Your Pain• You can give us a rating on a 0 to 10 pain scale. A rating of 10 reflects the worst pain you could ever imagine, a rating of 5 means you feel a moderate amount of pain and a 0 rating reflects no pain.• Your therapists and nurses will ask you to rate your pain after activity, therapy and at rest.• When you are able, describe what type of pain you are having such as throbbing, shooting, aching, burning or pressure. This will assist the medical staff and getting you the right type of pain control. 0 1 2 3 4 5 6 7 8 9 10 No Mild Moderate Severe Pain Pain Pain PainThings to Keep in Mind• It is easier to treat pain when it is mild or moderate rather than waiting until it is severe. Take your pain medications on a regular schedule to prevent severe pain.• It is nearly impossible to eliminate all pain during the first few days after your surgery. However, your medical team will work with you to control your pain at a level that allows you to rest and participate in your recovery, including your therapies.• Pain will gradually diminish or decrease in the days after your surgery. You should expect to have good days and bad days with regards to your pain and your ability to perform activities.• Studies have shown that when pain medications are used appropriately to treat surgical pain, addiction to the medication occurs in only a small number of patients. Please let us know if you have a history of addiction or intolerance to pain medications. 28
  31. 31. Pain ManagementPain Scale and FacesAgnesian HealthCare professionals will be able to give you more specific information on how to use these scalesand identify an achievable goal for your pain control.Medications Used to Treat PainThere are many forms and types of medications used to treat pain. You may be on a combination of painmedications with some taken orally (by mouth) or through your intravenous (IV) line. Because medications canwork in different ways, taking more than one medication for pain can sometimes provide greater relief whileminimizing side effects.Some of the common side effects from the pain medication include: nausea, sedation, confusion, constipationand itching. Most of these side effects will improve after taking the medication for a period of time.Constipation may be experienced during the time you are taking the medication, but it can be prevented and/or treated after discussion with your healthcare professional. If you experience any of these side effects or anyothers, tell your healthcare professional right away.Additional Options for Treating Pain• Repositioning• Cold application• Relaxation/medication/imagery• Physical/occupational therapy• Massage therapy 29
  32. 32. Coumadin (Warfarin) Information ®What is warfarin?Warfarin (generic name) or Coumadin® (brand name) is an oral medication used to prevent clotting in the blood.It is called an anticoagulant, which means to prevent blood clots. Warfarin is often referred to as a “bloodthinner” but does not actually make the blood “thinner.” Warfarin works to slow the blood’s ability to make aclot. Blood will still continue to form clots but will take slightly longer while taking warfarin.Warfarin is a very special medication that requires a blood test to monitor how the medication is working. Basedon the result of the blood test, the dose of warfarin may change.Why do I need warfarin?Sometimes the postsurgical recovery period can have complications. Warfarin is used to decrease the chanceof one type of complication. This potential complication is the formation of blood clots in different areas ofthe body. Following your surgery, you are at an increased risk of forming blood clots for two reasons. First, youwill not be as mobile following surgery. Being less active increases your risk of clotting. Second, the processof healing following surgery increases your risk of clotting. Warfarin works to prevent clots from forming inthe blood. This reduces your risk of developing a deep vein thrombosis (DVT) - a blood clot in your leg, or apulmonary embolism (PE) - a blood clot in your lungs.How long do I need to take warfarin?Following your surgery, warfarin is typically prescribed for four to six weeks.How do I know it is working?In order to assure you are getting the right dose of warfarin, you will be required to have frequent blood tests.It is very important to have your blood tested regularly. Your healthcare provider will tell you when to have yourblood tested. If your level is too high, you are at increased risk of bleeding complications. If your level is too low,you are at increased risk of clotting. The blood test is used to determine the appropriate dose of warfarin andprevent complications. It is very normal to have the dose of warfarin change based on the blood test results. 30
  33. 33. Coumadin (Warfarin) Information ®How often do I need blood work performed?In general, when you first start warfarin, you will need to get your blood level checked about one to two timesa week for the first two weeks. As your level begins to stabilize, the blood test can be done one to two times amonth. The frequency will vary, depending on the stability of your blood test. Your healthcare provider will tellyou when to have your blood checked.If the level is not within goal range, or your dose is changed, you will need to go for blood tests more often. Whena person first starts taking warfarin, the level tends to fluctuate up and down until the correct dose of warfarinis found that keeps your level within the goal range. It is, therefore, very important to get your level checkedfrequently when your healthcare provider tells you to do so.What factors may change my INR test results?Besides warfarin dose changes, several factors, such as sickness, diet, other medicines (prescription, over-the-counter, herbal, etc.) or physical activities, may affect your blood test results. Tell your healthcare provider aboutchanges in your health, medicines or lifestyle.Where do I get the blood test done, and who adjusts the dose?Agnesian HealthCare has an Anticoagulation Management Service Clinic that can check the blood level.The clinic, located on the third floor of Ripon Medical Center, specializes in warfarin management. Yourphysician may refer you to the clinic where your blood is tested and dose is adjusted at your 10- to 15-minuteappointment. Alternatively, you may have blood drawn at a local lab and your provider will adjust your dose. Ifyou are not able to leave your home, you may be eligible for a home care service to come to your home and drawyour blood test.How should I take warfarin?It is important to take your warfarin once daily at the same time each day. It is best to take warfarin before yourevening meal. Take your warfarin exactly as your healthcare provider instructed you to take it. Your dose maychange frequently based on your level. It is common to take full tablets on some days and half tablets on otherdays. For this reason, a pill box or recording your daily dose on a calendar is highly recommended. If you havequestions regarding your dosing, please call your healthcare provider. Do not change your warfarin dose withouttalking to your healthcare provider.Warfarin can be taken with or without food. 31
  34. 34. Coumadin (Warfarin) Information ®What if I miss a dose?It is very important to take your warfarin at the same time each day. If you miss your dose, take the missed doseas soon as possible on the same day. DO NOT take a double dose of warfarin the next day to make up for themissed dose unless instructed to do so by your healthcare provider.What side effects can I expect?Warfarin is generally well tolerated. Very few patients experience side effects while taking warfarin. The mostcommon complications that patients experience are issues with bleeding, such as a slight bloody nose, bleedingfrom the gums after brushing teeth and increased bruising. These complications are not uncommon and not lifethreatening. To lower the risk of bleeding, your blood level should be kept within the goal range that is right for you.Please contact your healthcare provider right away if you experience signs or symptoms of bleeding, such as:• headache, dizziness or weakness• bleeding from shaving or other cuts that do not stop• persistent nosebleeds• throwing up blood• unusual bruising for unknown reasons• red or dark brown urine• red or black color in your stool• more bleeding than usual when you get your menstrual period or unexpected bleeding from the vaginaSerious, but rare, side effects of warfarin include skin necrosis (death of skin tissue) and “purple toesyndrome.” Talk with your healthcare provider for further information on these side effects.What medications interact with warfarin?Warfarin can interact with many other medications. Your healthcare providers should be aware you areon warfarin. While on warfarin, it is always best to discuss starting or stopping any medication with yourhealthcare provider. This includes over-the-counter and herbal medications in addition to prescriptionmedications.Are there over-the-counter medications to avoid?While taking warfarin, Tylenol® (acetaminophen) is the only recommended over-the-counter pain medication.The use of aspirin (unless recommend by your healthcare provider), Aleve®, Motrin® (ibuprofen) and Advil®(ibuprofen) should be avoided. 32
  35. 35. Coumadin (Warfarin) Information ®Why do I need to pay attention to my diet?Many foods you eat contain vitamin K. Vitamin K can decrease the effectiveness of warfarin. You can continueto eat foods that contain vitamin K, however, you need to eat a consistent amount of these foods. Eating a dietthat is not consistent may affect your blood levels and your warfarin therapy.Avoid drastic changes in dietary habits. In general, leafy, green vegetables and certain legumes and vegetableoils contain high amounts of vitamin K. Foods that generally contain low amounts of vitamin K include mostfruits, cereal grains, dairy products and most meats such as beef, chicken, pork, shrimp and turkey.This is a partial list of foods that contain higher levels of vitamin K:Vegetable Serving SizeBroccoli (raw or cooked) . . . . . . . . . . . ½ cupBrussels Sprouts . . . . . . . . . . . . . . . . 5 sproutsCabbage (raw) . . . . . . . . . . . . . . . . . . 1 ½ cupsCollard greens . . . . . . . . . . . . . . . . . . ½ cupCucumber peels . . . . . . . . . . . . . . . . . 1 cupEndive (raw) . . . . . . . . . . . . . . . . . . . . 2 cups choppedGreen scallion (raw) . . . . . . . . . . . . . . 2/3 cupLettuce (raw/bib/red leaf) . . . . . . . . . 1 ¾ cups shreddedMustard greens . . . . . . . . . . . . . . . . . 1 ½ cups shreddedSpinach (raw leaf) . . . . . . . . . . . . . . . 1 ½ cupsTurnip greens (raw) . . . . . . . . . . . . . . 1 ½ cups choppedWatercress (raw) . . . . . . . . . . . . . . . . 3 cups choppedRemember, it is important that you keep your diet consistent.What about alcohol?Alcohol can also affect how warfarin works in your body. Alcohol combined with warfarin can increase your riskof bleeding. It is best to avoid alcohol while on warfarin. However, having up to one to two drinks in a day maybe acceptable.We encourage you to contact your healthcare provider if you have any questions. 33
  36. 36. Medical Equipment for HomeFollowing Hip Surgery• Raised toilet seat or a commode chair• Long-handled reacher• Long-handled shoehorn• Sock aid• Non-slip bath mat• Handheld shower hose• Shower chair (shower) or tub transfer bench (bathtub)• Grab bars (for bathtub)Using Durable Medical Equipment Following Hip Surgery• Since you are not able to bend your hip past 90 degrees following hip surgery, all surfaces that you sit on must be two inches above knee height (chairs, beds and toilets). Sit on a raised chair or use a high-density foam cushion to increase surface heights. Take the foam cushion with you to adapt to chairs outside of your home. Use a raised toilet seat.• Use long-handled aids, such as a shoehorn and reacher to help you dress and pick up items.• Sleep with pillows between your legs following surgery. You may need assistance placing the pillows, or choose to use an extra-long pillow.• Set up a firm chair with armrests.• Set up a table beside your chair for frequently- used items since you will not be able to bend forward.• If your bed is too low, add another mattress or place the frame on bed blocks. 34
  37. 37. Medical Equipment for HomeBathroom• Install a raised toilet seat.• Use a tub transfer bench with a handheld shower (in a bathtub) or shower chair (in a shower stall) following surgery. Do not try to sit on the bottom of your tub.• Sit down as you would in a chair. Slide back as far as you can on the seat. Then lift your legs over the edge of the tub. Do not bend your hip past 90 degrees if you have had hip surgery.• Use long-handled aids to clean your feet and other hard-to-reach places.• If you need to, remove glass shower doors on your tub and replace with a shower curtain.• Use a handheld shower hose to help you bathe more easily.• Place a non-slip bath mat inside and outside of the bathtub or shower.• Grab bars in the bathtub or shower stall and by the toilet are very useful. Removable grab bars are available. Do not use towel rack or toilet paper holders to assist you in standing or sitting.• Check with your surgeon to see is he/she wants you to do sponge baths until your staples are removed in order to avoid getting the new incision wet. 35
  38. 38. Durable Medical Equipment327 Winnebago Drive, Fond du Lac, WI 54935(920) 926-5277 • (800) 732-1313Store Hours: weekdays from 8 a.m. to 6 p.m.www.agnesian.com (click on the Agnesian Health Shoppe)Durable Medical EquipmentOur durable medical equipment (DME) specialist, customer service representative or delivery technicianpersonally teaches every patient how to use their equipment. We provide and maintain only the most modern,attractive, quality equipment. Each item is carefully inspected and regularly serviced. We provide personal,one-on-one service for each individual’s needs. ........................................................................................We deliver and install equipment!........................................................................................Durable Medical Equipment Following Hip SurgeryWheelchairs, walkers, crutches Lift chairsRaised toilet seat or commode chair Long-handled reacher, shoehornCPM machines for the knee Sock aidsHandheld shower hose Chair/foam cushionsGrab bars Other aids for daily livingWheelchair cushions Other bathroom safety productsCompression stockings Specialty mattressesWound dressingsShower chair (shower) or tub transfer bench (bathtub)........................................................................................We will gladly help with special orders too. Call us today!........................................................................................ 36
  39. 39. Agnesian HealthCare Home CareWhen to Consider Home Care• Recurrent hospitalizations• Medication monitoring (new and current)• Home oxygen needs• Conditions of: CHF, COPD, diabetes, post CVA, cancer and other chronic illnesses• Post-surgical care (orthopedics, cardiac)• Pain management/education• Safety concerns• Ostomies, tube feedings, catheter care• Need for adaptive equipment/rehabilitation needs• Symptom management/palliative care managementServices Provided• Special medical treatments (Lovenox  B-12 injections)• Wound care with certified wound/ostomy/continence nurse (wound vac therapy)• Home infusion services (IV therapy/line cares)• Telehealth monitoring• Physical therapy, occupational therapy, speech therapy, home health aides, medical social worker• Medication box fills/medication management• Pediatric clinical nurse specialist• Chemotherapy• Palliative care• Diabetic managementCoverage• Accept Medicare/Medicaid assignment• Insurance• Self-pay• Community CareHours of ServiceRegular office hours are 7:30 a.m. to 4:30 p.m. weekdays.Office phone number: (920) 923-7950After 4:30 p.m. an Agnesian HealthCare operator will page the on-call nurse.Nurse available 24 hours a day, seven days a week 37
  40. 40. Common TerminologyEquipmentIntravenous (IV) CatheterThis catheter allows for fluids and medications to be delivered through your bloodstream.Endotracheal TubeThis tube may be placed in your trachea (windpipe) by anesthesiology to keep your airway open during surgery.Foley CatheterThis tube is used to eliminate urine from the bladder. It is used both during surgery and for a short time aftersurgery.Hemovac DrainThis drain collects blood and body fluid and is placed near your operative site.Incentive SpirometerThis breathing exercise device is designed to help you improve your ability to expand your lungs after surgery.Continual Passive Motion (CPM) MachineThis machine may be available for use to exercise your knee while increasing blood circulation, decreasingswelling and increasing range of motion.Sequential Compression Device (SCD)These are inflatable plastic sleeves that are wrapped around your leg and may be used to improve blood flow inyour legs.TEDsThese are elastic stockings that help prevent blood clots from forming in your legs.Pulse OximeterThis clip is attached to one of your fingers to monitor the percentage of oxygen carrying blood in your body.Epidural CatheterThis catheter will be placed in your lower back for pain relief.Femered Nerve CatheterThis catheter is placed by an anesthesiologist in your groin pre-operatively to deliver continuous painmedication.Patient Controlled Analgesic PumpThis is a pump that allows the patient to give themselves pain medication by pressing a button. The pumpdelivers a specific amount of pain medication as ordered by your physician. 38
  41. 41. Common TerminologyPeoplePhysical Therapy (PT)Physical therapy associates will assist you in regaining mobility and function following your surgery.Occupational Therapy (OT)Occupational therapy associates will assist you in regaining independence with your activities of daily living(ADLs). Activities of daily living include: dressing, bathing, homemaking tasks and training in the use ofadaptive equipment.Social Workers/Case ManagersSocial workers/case managers will assist you and your family with discharge planning such as arranging homecare and necessary equipment. They ensure quality, efficiency and most importantly your satisfaction duringyour hospital stay.MiscellaneousInternational Normalized Ratio (INR)This ratio is taken through a blood test to determine the appropriate dose of warfarin to prevent complications.DVTDeep vein thrombosis is a blood clot in your leg.PEPulmonary embolism is a blood clot that forms in your lungs. 39
  42. 42. Questions____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 40

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