A Patient's Guide to Knee Replacement Surgery: St. Agnes Hospital

Agnesian HealthCare is Sponsored by the
Congregation of Sisters of St. Agnes

Joint Replacement Surgery:
A Patient’s Guide
Before, During & After
Knee Replacement Surgery

Table of Contents

Welcome
Welcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Important Phone Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Joint Replacement Patient Information Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Case Managers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Before Surgery
Planning For Your Hospital Stay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
What to Expect From Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Pain Control Following Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Frequently-Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Home Safety Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Surgery
Knee Care Guidelines - Day of Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Knee Care Guidelines - Day One . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Knee Care Guidelines - Day Two . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Knee Care Guidelines - Day Three . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

After Surgery
Pain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Coumadin®/Warfarin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Durable Medical Equipment
Agnesian Health Shoppe - Durable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Resources
Home Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Common Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

(SAH Knee Replacement 01/13)

Welcome to Agnesian HealthCare!

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.

The Agnesian Center for Bone & Joint Health has been designed to give outstanding care of patients in need
of joint replacements. We have assembled a special team of healthcare professionals that take great pride
in ensuring that you receive the best quality care available. You can have extra confidence knowing that the
Agnesian Center for Bone & Joint Health serves several hundred joint patients each year; our professionals
have extensive experience.

As you will remember, to prepare you for surgery, our team has reviewed your specific joint replacement
procedure 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 accomplish
a great result for you.

Again, thank you for choosing the Agnesian Center for Bone & Joint Health; we are certain that you will find
your care to be extraordinary. During your hospitalization, please inform our associates if we can do anything
for you to help you have an excellent care experience.

You may receive a phone call survey after you are discharged from the hospital. Please give your feedback so
we know how we did in providing your care, along with any opportunities for improvement.

Thank you again and we wish you the best in your recovery!

SAH Knee Replacement | 1

Important Phone Numbers

Surgeon
Name of Surgeon:__________________________________________________________________

Office Phone Number:________________________________________________________________

Primary Care Provider
Name of Primary Care Provider:_________________________________________________________

Office Phone Number:________________________________________________________________

Pharmacy
Name of Pharmacy:_________________________________________________________________

Address:_________________________________________________________________________

Phone Number:____________________________________________________________________

St. Agnes Hospital
Information/Switchboard . . . . . . . . . . . . . . . . . . . . . . . . . (920) 929-2300
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (800) 922-3400

6 South Surgical Inpatient Unit . . . . . . . . . . . . . . . . . . . . (920) 926-5160

Anticoagulation Management Services . . . . . . . . . . . . . . (920) 926-4580

Case Managers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (920) 926-4750


Patient Information Sheet

St. Agnes Hospital • (920) 926-4500 • (800) 458-8182
Date of Surgery:______________________________________________ ❑ Right Knee ❑ Left Knee
Unless 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:
______________________________________________________________________________
❑ One week prior to surgery, do not shave your legs or cut/clip your toenails.
Make sure to remove all nail polish from toenails. ve
Dri
eb ago

Day before surgery: Scott Street Winn

Park Avenue
❑ Eat a regular meal unless your provider instructs you otherwise.
❑ Stay away from greasy, spicy and/or salty foods to help avoid upset stomach.
Hwy 23
❑ We recommend you take a shower or bath on your day of surgery. Johnson Street
Fond du Lac
❑ Prepare anything you will need to bring with you to the hospital. Regional St. Agnes
Clinic Hospital
___ comb/hairbrush Division Street
entrance entrance

___ glass case and/or contact case and solutions

ue
National Aven
___ toothbrush/toothpaste

Vincent St.
Everett St.
Second Street

___ 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:
______________________________________________________________________________
❑ Call the hospital’s Surgical Services department at 926-4500 (800-458-8182, ask for extension 4500) the
day before your surgery anytime after 1 p.m. to find out your arrival time. If you do not call the hospital
by 6 p.m., they will call you.
❑ 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 makeup.
❑ Wear comfortable clothing to the hospital.
❑ Leave jewelry and all other valuables at home.
❑ When coming to the hospital, stop at the Registration department and then go to the Surgical Services
department.


Case Managers

A case manager is a nurse or social worker. Case managers are available to assist you with:

Power of Attorney (POA) for Healthcare
The Wisconsin statutes recognize two forms of advance directives: the Power of Attorney for Healthcare and the
Declaration to Physicians (Living Will). All hospitals are required by law to make this information available to
patients. You may call the case manager at (920) 926-4750 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 POA
forms prior to your admission if you wish to have your POA in place for this surgery. Your signature requires two
witnesses. Family members are not eligible to witness your signature. The only hospital associates eligible to
witness your signature are Spiritual Care Services associates or a social worker, and they may not be readily
available the day of your surgery.

Insurance-Related Questions
Insurance 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 then
determine if your stay is to be extended.

Discharge Planning
Discharge planning includes setting up home care, equipment or arranging for inpatient rehabilitation or a
subacute (skilled nursing home) stay.

We recommend that you pre-plan your ride home with a family member or friend. Insurance companies only
pay 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 appointment
and the transportation. Know before you come into the hospital where you want to go for your therapy and blood
work.

After you are admitted to the hospital, your case manager may stop in and ask if you have any questions or
discharge concerns. You or your family may request to see the case manager at any time.


Medicare Benefits

Home Care (see page 36)
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 35)
• 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.

If 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 back
of your insurance card if you have any questions. In general, insurance companies follow the same criteria as
Medicare 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 answering
your questions is a service representative who will speak in general terms and will not know all the details
about your surgery.
There may be a difference between having the benefit and qualifying for the benefit. Qualifying for the insurance
benefit is not a surgeon or primary care provider’s decision. Your insurance company will determine your
qualification for benefits based on their standards and policies.


Insurance Benefits

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 ❑ No

If yes, what are they?________________________________________________________________

Is there a preferred provider?__________________________________________________________
Do I have home health benefits for in-home therapy or nursing? ❑ Yes ❑ No


Do I have durable medical equipment benefits (walker, crutches)? ❑ Yes ❑ No


Do I have acute inpatient rehabilitation benefits? ❑ Yes ❑ No

Do I have skilled nursing facility benefits? ❑ Yes ❑ No

If yes, who are the preferred providers?___________________________________________________

Is there a deductible or co-pay for any of these services?_______________________________________


Planning for Your Hospital Stay

Prior to Your Surgery Date
Do 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 pain
may be requested by your surgeon to stop prior to surgery, so make sure your surgeon has an up-to-date list of
your medications. If your surgeon does request you to stop these medications, inquire what you can take in place
of 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.
• 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).
• 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.


Planning for Your Hospital Stay

While in the Hospital
• As a patient of St. Agnes Hospital, 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 4673 to
place their order. There is a $7 charge per meal 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.


Anesthesia

What to Expect From Anesthesia
Your anesthesiologist will discuss two main aspects of care with you: the anesthesia provided during the
surgical procedure and the plan for pain control after surgery. There are several options your anesthesiologist
may discuss with you. This information is being distributed to you ahead of time to help guide discussion about
your care on the morning of surgery and to dispel common misconceptions about certain types of anesthesia
you may be offered.

Anesthesia for Your Surgery
There are two main choices for surgical anesthesia: general and regional. During general anesthesia, you are
unconscious and have no awareness or other sensations. There are many types of general anesthetic drugs.
Some are gases inhaled through a breathing mask or tube, and others are medications injected into a vein.
After you are asleep, a breathing tube may be inserted into the windpipe to maintain proper breathing and
administer anesthetic gases. During a general anesthetic, you are carefully monitored and treated by your
anesthesiologist. The amount of anesthesia is calculated and constantly adjusted. At the conclusion of surgery,
your anesthesiologist will reverse the process and you will regain awareness in the recovery room.

During a regional anesthetic, your anesthesiologist makes an injection near a cluster of nerves to numb the
area of your body that requires surgery. There are many kinds of regional anesthesia, but the most commonly
used regional technique for knee surgery at our hospital is spinal anesthesia. A spinal anesthetic is performed
by injecting local anesthetic (sometimes combined with other medicines) through a needle in your lower back
directly into the fluid surrounding your spinal cord producing numbness from about your belly button and down.
This is most often done in the operating room with a patient in a sitting position or lying on his/her side.

You generally will not feel much discomfort with placement of the spinal medication. There is a slight, brief
discomfort associated with the placement of some medication to numb the skin first. After that, a patient may
feel pressure. Once the medication is injected, it works quickly, usually taking full effect within five minutes
(you may begin to feel warmth, tingling and numbness almost immediately).

One of the most common misconceptions about spinal anesthesia relates to safety. You can rest assured that
if offered to you, spinal anesthesia is a safe choice for joint replacement surgery. Some patients are concerned
about serious side effects, such as paralysis, and also about troubling but less dangerous side effects, such
as headache. There seems to be a common perception that these complications occur often. In fact, spinal
anesthesia has a long track record of safety, with a rate of serious complications (low!) about equal to the rate
of major problems with general anesthesia (also low!).


Anesthesia

Some of the many possible advantages of spinal anesthesia...
1) More rapid recovery of mental function.
2) No need for insertion of breathing tubes.
3) Lower risk of nausea or vomiting.
4) Less pain immediately after surgery.

Serious complications like paralysis, bleeding and infection after spinal anesthesia are very rare. The number
of patients who develop a headache is also quite low – in expert hands, fewer than one percent of patients
develop a headache from the spinal. Although a “spinal headache” is troublesome, it is not life-threatening,
and treatment is available during your hospital stay.

Many patients think that choosing a spinal means they have to be awake during the surgical procedure. Most
patients, in fact, choose to be sedated during the procedure (in addition to the spinal anesthetic). Most patients
who choose a spinal with sedation have no discomfort or memories from their time in the operating room.
However, if you want to remain completely awake and receive no sedation, that is also an option.

Unfortunately, not all patients are candidates for spinal anesthesia. We do not offer this technique to patients
who are at risk for internal bleeding issues or to patients with infection in the area where the needle is inserted,
or certain other medical conditions. 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 St. Agnes Hospital. Assuming there is not a compelling reason to choose one anesthetic over another,
we usually allow the patient to choose between general or spinal.


Pain Control Following Surgery

Options For Pain Control After Surgery
At St. Agnes Hospital we take a multi-modal approach to pain relief for joint replacement surgery. Your
anesthesiologist can also help keep your pain at tolerable levels during your stay in the hospital after surgery.
All patients are candidates for narcotic pain medications given through the IV or by mouth, and most patients
also receive non-steroidal anti-inflammatory drugs such as acetaminophen or ketorolac, or other pain altering
medications. Instead of IV or oral narcotics, some patients may be candidates for narcotic pain medication
given in the spine, if this is the anesthetic choice you make. Adding a narcotic, such as morphine, to the spinal
can give significant pain relief for up to 24 hours after injection. Not all patients offered a spinal are good
candidates for spinal morphine. We do not offer this to patients with obstructive sleep apnea or some other
medical conditions. Your anesthesiologist can discuss whether spinal morphine is a good idea for you on the
day of surgery.

Most patients will be offered a type of regional anesthesia, called a femoral nerve block, to help with
postoperative pain. The femoral nerve is most easily blocked as it crosses your groin, and your anesthesiologist
may use an ultrasound machine to locate the nerve. A small electric current is given through the needle causing
brief contractions of some leg muscles. Placement of this block is generally simple and involves minimal
discomfort. Your anesthesiologist may choose to do a single injection or to leave a catheter in place to give
medicine continuously for a set period of time. The block may be done before or after surgery, and if necessary,
it is possible to repeat the block after the first one has worn off.

Summary
There are two types of surgical anesthesia offered for knee replacement and several options for pain control
afterward. The most common combination used at St. Agnes Hospital is spinal anesthesia with or without
morphine, along with a femoral nerve block. Together, you and your anesthesiologist will decide what is best
for you.


Frequently-Asked Questions

Q: 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.


Home Safety Assessment

The majority of falls that occur happen at home. The good news is that most falls can be prevented through
environmental changes and safety precautions. To decrease your risk of falling after your total joint surgery,
we recommend that you ask your spouse, family member or a neighbor to go through your home and answer
the following questions.

If you answer “No” to any of the questions, it is recommended that you change the environment to allow for
better safety. While correcting these common concerns will decrease your risk of a fall, it is also recommended
that you have a safety network of friends, family or neighbors to provide a daily check-in, either by phone or in
person, should you fall and be unable to solicit help independently.

General Household Areas
Are light switches easily accessible upon entering a room? . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Do you have throw rugs in your home? (remove them) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Are hallways free from clutter? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Are raised door thresholds clearly marked? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Are electrical cords and telephone cords away from hallways? . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Do you have a portable phone with emergency numbers easily at hand? . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Do you have furniture with good back and arm support that you can get in and out of easily? . . . ❑ Yes ❑ No

Stairways
Are stair treads in good condition? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Is there a sturdy handrail on both sides of the stairs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Are the stairs brightly lit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Bedroom
Is there a lighted pathway from the bedroom to the bathroom? . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Is there a clear pathway from the bedroom to the bathroom? . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Do you keep a charged flashlight near your bed for emergencies? . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Bathroom
Do you have safety rails or grab bars by toilet and shower/tub? . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Do you have skid resistant strips or a rubber mat both in and in front of the bathtub? . . . . . . ❑ Yes ❑ No
Do you have an adjustable shower chair? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No


Home Safety Assessment

Kitchen
Do you use a wide-based, sturdy step to reach into high cabinets? . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Are spills immediately wiped up? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Do you avoid using a high gloss floor wax? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Do you store frequently used items at waist level and less frequently used items in
higher cabinets? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Is your laundry located on first floor? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Will you have assistance with laundry? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Will you have assistance with meal preparation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No
Could you prepare microwave meals in advance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No


Knee Care Guidelines - Day of Surgery

We are pleased to welcome you to St. Agnes Hospital and the 6 South inpatient unit. We look forward to
providing you the best care possible in an environment that encourages you to actively participate in the
rehabilitation process.

Today’s Itinerary:
• You will have an IV.
• You will have a cooling device to your knee as directed.
• 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.
• 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 use your incentive spirometer (breathing machine) every hour while you are awake
(if you are watching television, you can do one breath with the incentive spirometer during each commercial
or approximately 10 per hour.
• A Continuous Passive Motion (CPM) device for bending and straightening your knee will be applied and used
three times daily for two hours at a minimum.
• 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.

Hourly Rounding
• Nursing associates will check on you every one to two hours to make sure that you are comfortable and that
your needs are met.
• You can arrange with your nurse if you choose to “not be disturbed” to allow for rest and sleep.

Today’s Goals
❑ Pain controlled ❑ Nausea controlled ❑ No pneumonia
❑ No blood clots ❑ Get some rest!



Pain Management
We take pain management seriously and want you to be comfortable. You will be asked to rate your pain using a
0 to 10 pain scale. Zero means no pain and 10 means the worst pain you can imagine. Your nursing associates
will be checking you frequently and will be asking you about your level of pain. Remember to let your nurse know
when your pain is starting to increase.

There are several options for pain management after total joint surgery and these will be ordered by your
surgeon or anesthesiologist. Pain management can be complex so please feel free to ask questions of your
nurse or provider.

Medications
You will have medications to keep you comfortable after surgery and to prevent complications. Many of these
are taken by mouth so controlling nausea is important. You have provided a list of your home medications and
if not contraindicated, 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 reviewed
by a pharmacist for identification and then kept in a secure bin assigned to you. The nurse will provide these
as ordered.

Food for Thought
You have been without food or drink since midnight and had surgery… so be good to your stomach. Slow and
steady 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 good
choices. 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.
• Occupational and physical therapy begins, usually once in the morning and once in the afternoon.
• Up in the chair for at least two meals.
• CPM device for bending and straightening your knee usually applied for at least two hours, three
times a day.


Knee Care Guidelines - Day One

Today’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.
• 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.

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. At least three full Agnesian HealthCare water bottles, which is given to you upon
admission.
• Limit fat and sweets.

Today’s Goals
❑ Pain controlled ❑ Up in chair two to three times
❑ No blood clots ❑ Walking exercise
❑ No pneumonia ❑ Initial plan for discharge

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.


Knee Care Guidelines - Day One

It’s Time to Get Moving!
You will get out of bed in the morning with assistance from therapy associates. Using a walker, you may take
some steps in your room or in the hallway. You will learn about getting in and out of bed and transferring to a
chair. You will begin your exercise program.
The CPM machine will be applied for at least two hours, three times a day, increasing bending as tolerated.
Therapy associates will see you in the afternoon to continue working with you on bending and straightening
your leg and walking. You may go to the gym to continue your exercises.

Keeping Ahead of the Pain
Nursing associates will ask you to rate your pain from 0 (none) to 10 (worst imaginable). Let your nurse or
therapist know when your pain is starting to increase.
Try additional means to reduce your pain: music, massage, repositioning, reading, television, meditation, prayer,
room darkening, etc.
You will be able to take part in therapy most effectively when your pain is controlled. With medication and
other pain relieving measures (repositioning, etc.), the goal is for you to have a pain level of four or less. Pain
medication is more effective when pain levels are maintained at lower levels.

Homesick?
Associates from our Care Management department will visit you to plan for your discharge and identify any
equipment 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 provider.
Continue to do your ankle pumps every one to two hours and participate in your exercises. Getting up and
moving decreases your risk of getting a blood clot.


Knee Care Guidelines - Day Two

Today’s Itinerary
• Your vital signs will be checked every eight hours and as needed.
• You will continue to use your incentive spirometer.
• Continue cooling device to knee.
• Alternate rest and activity.
• Up in chair two to three times daily.
• Reposition frequently in bed.
• TED hose on (off for 30 minutes in the morning and evening for bathing and skin inspection).
• IV fluids may be discontinued if drinking adequate amounts of fluids.
• SCDs on when in bed.
• Hourly rounding continues as discussed.

It’s Time to Get to the Gym
• You will go to the therapy gym today.
• You will continue to work on the exercises you did yesterday with progression as tolerated.

Back in Your Room
• The CPM settings will be increased to your tolerance.
• 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 it at 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 again today or try something different. Try music, massage, repositioning, reading, television,
meditation, prayer, room darkening, etc.
........................................................................................


Knee Care Guidelines - Day Two

Today’s Goals
❑ Pain controlled ❑ No blood clots
❑ No pneumonia ❑ Up in chair two to three times
❑ Walk safely with assistive device ❑ Continue all exercises
❑ Progress with transfers ❑ CPM settings increased
❑ Discharge plan completed
❑ Progress toward independence with straight leg raises

There’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 resource 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.
• You may want to send some of your things home with family or friends to make your discharge day easier
to organize.

How Does My Incision Look?
The edges of your incision have started to come together but some drainage may still be present, especially
with activity. The dressing will be changed as instructed. Redness, swelling and tenderness should be starting
to decrease. Upon discharge, it is not uncommon to have swelling and bruising. This may continue for some
time after you are at home.

To promote healing and rehabilitation, choose foods high in iron, protein, fiber and calcium. Avoid foods high
in fat and sugar.
........................................................................................
All Systems Go?
If you don’t have a bowel movement (BM) today, let your nurse know. Remember to eat foods high
in fiber and drink plenty of liquids, especially water (total of three water bottles of fluid per day).
Walking and exercise also helps a lot!
........................................................................................


Knee Care Guidelines - Day Three

Today’s Itinerary
• Today may be the day you are discharged home or to another facility.
• Continue your activities of the previous days (ankle pumps, cooling device, incentive spirometer, CPM, etc.)
• You will go to the therapy gym 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)
❑ Independent with straight leg raises
❑ Questions answered
❑ Discharge instructions understood

To-Do List for Discharge
• Pack up belongings.
• 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.
........................................................................................


Exercises

Ankle Pumps
With 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.

Quadriceps Set
Tighten muscles on top of thighs by pushing
knees down into surface. Hold 5 seconds.

Repeat 10-20 times per set.
Do 2-3 sessions per day.


Exercises

Terminal Knee Extension
With right knee over bolster, straighten knee by tightening
muscles on top of thigh. Keep bottom of knee on bolster.


Straight Leg Raise
Tighten muscles on front of right thigh, then lift leg
_____ inches from surface, keeping leg locked.

Repeat _____ times per set.
Do _____ sets per session.
Do _____ sessions per day.


Exercises

Heel Slide (Supine)
Slide right heel toward buttocks until a gentle
stretch is felt. Hold 2 seconds. Relax.


Sitting Knee Flexion
Gently push surgical leg back with other leg
until a stretch is felt. Hold 5 seconds. Relax.



Exercises

Standing Hip/Knee Flexion
With support, lift surgical leg
bending hip and knee.


Standing Knee Flexion
With support, bend surgical knee
as far as possible.



Exercises

Chair Squat
Keeping feet flat on floor, shoulder width
apart, squat as low as is comfortable.
Use support as necessary.



Pain Management

The associates at the Agnesian Center for Bone & Joint Health are concerned about managing your pain
after surgery. Pain that is poorly controlled can interfere with sleep, appetite, activity, relationships and your
emotional outlook.
Pain is to be expected following joint replacement surgery, but by working with your nurses, therapists and
providers we should be able to control the pain enough for you to actively participate in your recovery. Do not let
your pain get out of control because as pain becomes more severe it is harder to treat. Ask for assistance from
your 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 Pain

Things 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.


Pain Management

Pain Scale and Faces
Agnesian HealthCare professionals will be able to give you more specific information on how to use these scales
and identify an achievable goal for your pain control.

Medications Used to Treat Pain
There are many forms and types of medications used to treat pain. You may be on a combination of pain
medications with some taken orally (by mouth) or through your intravenous (IV) line. Because medications can
work in different ways, taking more than one medication for pain can sometimes provide greater relief while
minimizing side effects.

Some of the common side effects from the pain medication include: nausea, sedation, confusion, constipation
and 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 any others, tell your healthcare professional right away.

Additional Options for Treating Pain
• Repositioning
• Cold application
• Relaxation/medication/imagery
• Physical/occupational therapy
• Massage therapy


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 “blood
thinner” but does not actually make the blood “thinner.” Warfarin works to slow the blood’s ability to make a
clot. 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.
Based on 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 chance
of one type of complication. This potential complication is the formation of blood clots in different areas of
the body. Following your surgery, you are at an increased risk of forming blood clots for two reasons. First, you
will not be as mobile following surgery. Being less active increases your risk of clotting. Second, the process
of healing following surgery increases your risk of clotting. Warfarin works to prevent clots from forming in
the blood. This reduces your risk of developing a deep vein thrombosis (DVT) - a blood clot in your leg, or a
pulmonary 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? What is an INR?
In order to assure you are getting the right dose of warfarin, you will be required to have frequent blood tests.
Warfarin is monitored with a lab test called the INR (International Normalized Ratio). INR can also be called a
protime (PT). INRs are used to determine the correct dose of warfarin to give. Your INR should be near 1 if you
are not taking warfarin. Your INR will rise when the warfarin is working.

1 2 3 4 5
“Normal” INR à à à
not on warfarin
Warfarin cause the INR to rise

It is very important to have your INR tested regularly. Your healthcare provider will tell you when to have your
INR tested. If your INR is too high, you are at increased risk of bleeding complications. If your INR is too low,
you are at increased risk of clotting. The INR is used to determine the appropriate dose of warfarin and prevent
complications. It is very normal to have the dose of warfarin change based on the INR results.



How often do I need my INR performed?
In general, when you first start warfarin, you will need to get your INR checked about one to two times a week
for the first two weeks. As your level begins to stabilize, the INR can be done one to two times a month. The
frequency will vary, depending on the stability of your INR. Your healthcare provider will tell you when to have
your INR checked.

If the INR is not within goal range, or your dose is changed, you will need to go for INR checks more often. When
a person first starts taking warfarin, the INR tends to fluctuate up and down until the correct dose of warfarin
is found that keeps your level within the goal range. It is, therefore, very important to get your level checked
frequently 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 about
changes in your health, medicines or lifestyle.

Where do I get my INR checked, and who adjusts the dose?
Agnesian HealthCare has an Anticoagulation Management Service Clinic that can check your INR. The clinic,
located on the main floor of St. Agnes Hospital, specializes in warfarin management. Your provider may refer
you to the clinic where your INR is checked and warfarin dose is adjusted at your 10- to 15-minute appointment.
Alternatively, you may have blood drawn at a local lab and your provider will adjust your dose. If you are not able
to leave your home, you may be eligible for a home care service to come to your home and draw your 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 your
evening meal. Take your warfarin exactly as your healthcare provider instructed you to take it. Your dose may
change frequently based on your INR. It is common to take full tablets on some days and half tablets on other
days. For this reason, a pill box or recording your daily dose on a calendar is highly recommended. If you have
questions regarding your dosing, please call your healthcare provider. Do not change your warfarin dose without
talking to your healthcare provider.

Warfarin can be taken with or without food.



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 dose
as soon as possible on the same day. DO NOT take a double dose of warfarin the next day to make up for the
missed dose unless instructed to do so by your healthcare provider.

What are the side effects of warfarin?
Side effects from warfarin may occur from time to time. If you notice anything abnormal that you believe may be
caused by the medication, please call your provider.

Two types of side effects that sometimes occur are concerns with bleeding and allergic reaction.

Symptoms of minor bleeding include:
• gum bleeding while brushing teeth
• occasional nosebleed
• easy bruising
• bleeding after a minor cut that stops within a few minutes
• menstrual bleeding that is a little heavier than normal

If you have minor bleeding that does not stop, please contact your provider, go to the emergency department or
call 911.

Symptoms of major bleeding include:
• dark brown or red urine
• bowel movements containing blood or very dark, tar-like stool
• excessive bleeding from the gums or nose
• throwing up coffee-colored, bright red or red-tinged secretions
• severe pain (headache or stomachache)
• dizziness/weakness
• bleeding from a cut that will not stop
• sudden appearance of bruises for no known reason
• excessive menstrual bleeding
• pain, discomfort or swelling in any area, especially after an injury

If you have major bleeding, contact your provider, go to the emergency department or call 911 right away. These
are signs that your INR may be high.

The chance of bleeding increases with increasing INR. Keeping your INR within target range will reduce your risk
of bleeding.


In rare cases, warfarin can cause an allergic reaction. Get help right away if you have an allergic reaction.

Symptoms of an allergic reaction include:
• difficulty breathing
• swelling of your throat, tongue or face
• hives and/or a rash
• itching

Warfarin can also cause skin necrosis or gangrene, which can cause dark red or black areas on the skin. This is
a rare complication that may occur during the first several days of warfarin therapy. If either of these conditions
occur, contact your physician, go to the emergency room or call 911 right away.

What medications interact with warfarin?
Warfarin can interact with many other medications. Your healthcare providers should be aware you are
on warfarin. While on warfarin, it is always best to discuss starting or stopping any medication with your
healthcare provider. This includes over-the-counter and herbal medications in addition to prescription
medications.

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.

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 continue
to eat foods that contain vitamin K, however, you need to eat a consistent amount of these foods. Eating a diet
that is not consistent may affect your INR and your warfarin therapy.

Avoid drastic changes in dietary habits. In general, leafy, green vegetables and certain legumes and vegetable
oils contain high amounts of vitamin K. Foods that generally contain low amounts of vitamin K include most
fruits, 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 Size
Broccoli (raw or cooked) . . . . . . . . . . . ½ cup
Brussels Sprouts . . . . . . . . . . . . . . . . 5 sprouts
Cabbage (raw) . . . . . . . . . . . . . . . . . . 1 ½ cups
Collard greens . . . . . . . . . . . . . . . . . . ½ cup
Cucumber peels . . . . . . . . . . . . . . . . . 1 cup
Endive (raw) . . . . . . . . . . . . . . . . . . . . 2 cups chopped
Green scallion (raw) . . . . . . . . . . . . . . 2/3 cup
Mustard greens . . . . . . . . . . . . . . . . . 1 ½ cups shredded
Spinach (raw leaf) . . . . . . . . . . . . . . . 1 ½ cups
Turnip greens (raw) . . . . . . . . . . . . . . 1 ½ cups chopped
Watercress (raw) . . . . . . . . . . . . . . . . 3 cups chopped

Remember, 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 risk
of bleeding. It is best to avoid alcohol while on warfarin. However, having up to one to two drinks in a day may
be acceptable.

We encourage you to contact your healthcare provider if you have any questions.



327 Winnebago Drive, Fond du Lac, WI 54935
(920) 926-5277 • (800) 732-1313
Store Hours: weekdays from 8 a.m. to 6 p.m.
www.agnesian.com (click on the Agnesian Health Shoppe)

Our durable medical equipment (DME) specialist, customer service representative or delivery technician
personally 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!
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Durable Medical Equipment Following Knee Surgery
Wheelchairs, walkers, crutches Lift chairs
Raised toilet seat or commode chair Long-handled reacher, shoehorn
CPM machines for the knee Sock aids
Handheld shower hose Chair/foam cushions
Grab bars Other aids for daily living
Wheelchair cushions Other bathroom safety products
Compression stockings Specialty mattresses
Wound dressings
Shower chair (shower) or tub transfer bench (bathtub)

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We will gladly help with special orders too. Call us today!
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Agnesian HealthCare Home Care

When 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 management

Services 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 management

Coverage
• Accept Medicare/Medicaid assignment
• Insurance
• Self-pay
• Community Care

Hours of Service
Regular office hours are 7:30 a.m. to 4:30 p.m. weekdays.
Phone number: (920) 923-7950
After 4:30 p.m. an Agnesian HealthCare operator will page the on-call nurse.
Nurse available 24 hours a day, seven days a week


Common Terminology

Equipment
Intravenous (IV) Catheter
This catheter allows for fluids and medications to be delivered through your bloodstream.

Endotracheal Tube
This tube may be placed in your trachea (windpipe) by anesthesiology to keep your airway open during surgery.

Foley Catheter
This tube is used to eliminate urine from the bladder. It is used both during surgery and for a short time after
surgery.

Incentive Spirometer
This breathing exercise device is designed to help you improve your ability to expand your lungs after surgery.

Continual Passive Motion (CPM) Machine
This machine may be available for use to exercise your knee while increasing blood circulation, decreasing
swelling 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 in
your legs.

TEDs
These are elastic stockings that help prevent blood clots from forming in your legs.

Pulse Oximeter
This clip is attached to one of your fingers to monitor the percentage of oxygen carrying blood in your body.

Epidural Injection
This injection may be placed in your lower back for delivering a one-time injection for pain relief.

Femerol Nerve Catheter
This catheter is placed by an anesthesiologist in your groin pre-operatively to deliver continuous pain
medication, or can be a one-time injection.

Patient Controlled Analgesic Pump
This is a pump that allows the patient to give themselves pain medication by pressing a button. The pump
delivers a specific amount of pain medication as ordered by your provider.


Common Terminology

People
Physical 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 of
adaptive equipment.

Social Workers/Case Managers
Social workers/case managers will assist you and your family with discharge planning such as arranging home
care and necessary equipment. They ensure quality, efficiency and most importantly your satisfaction during
your hospital stay.

Miscellaneous
International Normalized Ratio (INR)
This ratio is taken through a blood test to determine the appropriate dose of warfarin to prevent complications.

DVT
Deep vein thrombosis is a blood clot in your leg.

PE
Pulmonary embolism is a blood clot that forms in your lungs.


Questions

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A Patient's Guide to Knee Replacement Surgery: St. Agnes Hospital

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A Patient's Guide to Knee Replacement Surgery: St. Agnes Hospital