The document is a comprehensive guide for patients undergoing knee replacement surgery at Agnesian Healthcare, detailing pre-operative preparations, important contacts, and post-operative care. It includes checklists for surgery day, pain management strategies, and information on durable medical equipment as well as insurance coverage for related services. The guide emphasizes the hospital's commitment to compassionate care and offers resources to ensure a smooth recovery process.

1. 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

2. 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
Equipment for Your Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Bathroom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Agnesian Health Shoppe - Durable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Resources
Home Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Common Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
(WMH Knee Replacement 01/13)

3. 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.
A survey will be mailed to you after you are discharged from the hospital. Please complete the form and return it
to us so that 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!
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4. 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:____________________________________________________________________
Waupun Memorial Hospital
Information/Switchboard . . . . . . . . . . . . . . . . . . . . . . . . (920) 324-5581
Inpatient Physical Rehabilitation . . . . . . . . . . . . . . . . . . . (920) 324-6544
Inpatient Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (920) 324-6520
Day Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (920) 324-6511
Anticoagulation Management Service . . . . . . . . . . . . . . . (920) 324-8444
Case Managers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (920) 324-8410
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5. Patient Information Sheet
Waupun Memorial Hospital Surgical Services • (920) 324-6511
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:
______________________________________________________________________________
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 /1
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❑ Prepare anything you will need to bring with you to the hospital.
___ robe and slippers
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___ comb/hairbrush Waupun
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___ glass case and/or contact case and solutions Hospital
___ 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:
______________________________________________________________________________
❑ You will be called the day before your surgery to find out your arrival time.
❑ Arrival time according to the hospital:_________________________________________________
Day of surgery:
❑ Take the following medications with a sip of water at:
______________________________________________________________________________
❑ Bring your Durable Power of Attorney for HealthCare papers to the hospital.
❑ 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, go to the Surgical Services department.
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6. 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) 324-8410 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.
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7. Medicare Benefits
Healthcare 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
will work 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 Waupun Memorial Hospital 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 you are unable to leave your home except for doctor appointments.
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.
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8. Insurance Benefits
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.
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
If yes, what are they?________________________________________________________________
Is there a preferred provider?__________________________________________________________
Do I have durable medical equipment benefits (walker, crutches)? ❑ Yes ❑ No
If yes, what are they?________________________________________________________________
Is there a preferred provider?__________________________________________________________
Do I have acute inpatient rehabilitation benefits? ❑ Yes ❑ No
If yes, what are they?________________________________________________________________
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?_______________________________________
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9. Planning for Your Hospital Stay
Prior to Your Surgery Date
Your surgeon may request you to stop taking your anti-inflammatory medications (over-the-counter or
prescription) that you are currently taking for your joint pain 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 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.
• Bring medications from home unless told not 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.
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10. Planning for Your Hospital Stay
While in the Hospital
• As a patient of Waupun Memorial 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 6509 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.
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11. Anesthesia
What to Expect From Anesthesia
Your surgeon or anesthesiologist provider should discuss two main aspects of care with you: the anesthesia
provided during the surgical procedure and the plan for pain control afterwards. There are several options
your anesthesia care provider may discuss with you. This information is being distributed to you ahead of time
to help facilitate discussion about your care on the morning of surgery and to dispel what seem to be some
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. While most people are familiar with
general anesthesia, regional anesthesia is less familiar to you but widely used for joint replacement surgeries
also. General anesthesia numbs your entire body, for the entire time of surgery, you will be “put under” - a
state of controlled unconsciousness. The anesthesiologist will use a variety of medications to accomplish
different functions, such as stopping pain, relaxing the body’s muscles, etc. The most common type of regional
anesthesia offered for the procedure itself is spinal anesthesia, but your provider may discuss epidural or other
types of regional anesthesia as well.
Combined General/Regional Anesthesia
Combined general/regional anesthesia is often used for major joint surgery. It usually involves placement of a
nerve block with or without a nerve block catheter that is carefully placed prior to surgery. Once you enter the
surgery room you will be put to sleep until the end of your surgery. One advantage to combined general/regional
anesthesia is the opportunity to block surgical pain before you wake up and continue that pain control through
the use of a continuous infusion of nerve blocking medicine for up to three days after surgery.
“Q Pump”
Many of these infusions that continue for several days involve the use of a “Q Pump.” This is a softball sized
automatic pump that will be with you in a small black carry bag. Anesthesia will order an amount of medication
to be infused at a constant rate. The rate can be adjusted by your nurse or by pharmacy if your anesthesia
provider orders a change in the infusion rate. Most “Q Pumps” are stopped on the third day after surgery and
the nerve catheter is removed at that time. Oral pain tablets are used after the nerve block stops if a patient
still has some pain.
A spinal anesthetic is performed by injecting local anesthetic (although sometimes this is combined with other
medicines as well) through a needle in your lower back directly into the fluid surrounding your spinal cord
producing numbness in the nerves from about the level of your waist 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 will generally not feel much discomfort with placement of the spinal medication. 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).
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12. Anesthesia
One of the most common misconceptions about spinal anesthesia relates to safety. You can rest assured
that spinal anesthesia is a safe choice for joint replacement surgery. Many patients when offered this type
of anesthesia 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, although false, 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!).
Studies that have looked at the overall outcome of spinal and general anesthesia for hip surgery have not found
a completely convincing advantage of one over the other, and therefore both types of anesthesia are commonly
used.
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.
5) The ability to add powerful pain control agents with the spinal medication to help provide up to 24 hours
of significant pain relief.
6) Decreased incidence of blood clots.
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 have
a headache. Although a “spinal headache” is troublesome, it is not life-threatening, and if such a side effect
should 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 falsely
believe that choosing a spinal means they have to be awake during the surgical procedure. While choosing
a spinal anesthetic affords you the opportunity to remain awake during the procedure if you so desire, most
patients are offered sedation in addition. The majority of patients undergoing total joint replacement under
spinal anesthesia at our hospital receive sedation prior to the placement of the spinal and during surgery.
Nearly all who do so have no discomfort or memories from the procedure.
Unfortunately, not all patients are candidates for spinal anesthesia. We do not offer this technique to patients
who are at risk for internal bleeding concerns or to patients with infection in the area where the needle is
inserted. 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 the
patient to make a choice.
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13. Pain Control Following Surgery
Options For Pain Control After Surgery
At our hospital we take a multi-modal approach to pain relief for joint replacement surgery. Your surgeon and
anesthesiologist can help not only with keeping you pain free during surgery, but also with keeping your pain
at tolerable levels during your stay in the hospital after surgery. We usually offer one of two choices of regional
anesthesia for pain control after surgery. These include, but are not limited to, epidural morphine or a femoral
nerve catheter.
At our hospital, we use two types of morphine. One is called DepoDur®. This is an extended release formulation
injected into a patient’s epidural space that works continuously for about 48 hours after surgery. Placement of
the epidural DepoDur® is similar to placement of the spinal as described previously. Epidural injections carry
similar risks to spinal anesthesia and share their remarkable safety record. The second type of morphine is
given with the spinal block and is called Astramorph or Duramorph.
Most often, the DepoDur® injection will take place in your pre-op room (where we get you ready for surgery) prior
to your operation. Just as with spinal anesthesia, not all patients can safely receive DepoDur®. We do not offer
this technique to patients who are at risk for internal bleeding problems, patients with infection in the area
where the needle is inserted, patients with obstructive sleep apnea, patients with certain kinds of breathing
problems or patients with some other medical conditions as well. Your anesthesiologist can discuss with you
whether or not you are a candidate for DepoDur® on the day of your surgery.
Some patients may be offered a femoral nerve catheter to help control pain after major knee surgery. This
is a catheter placed through the skin next to your femoral nerve in your groin. Pain medication is then
given continuously through this catheter after surgery. Placement is generally simple and involves minimal
discomfort. IV sedation is used prior to these blocks.
Summary
There are many types of anesthesia offered for joint replacement surgery. The most common combination used
at our hospital is spinal anesthesia and epidural DepoDur®. Together, you and your anesthesiologist will come
up with a plan that is best for you.
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14. 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.
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15. 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
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16. 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
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17. Knee Care Guidelines - Day of Surgery
We are pleased to welcome you to Waupun Memorial Hospital and the Medical/Surgical 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:
• A Foley catheter will be inserted in surgery and usually removed on day two.
• You will be asked to sign a consent for blood.
• You will have an IV with an antibiotic and oral medication.
• You will have a cooling device or ice 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 may be applied, and
then three times daily for two hours at a time.
• If you return from surgery in the morning, the physical therapist may get you out of bed today. If not, your
nurse will be getting you out of bed.
Today’s Goals
❑ Pain controlled ❑ Nausea controlled ❑ No pneumonia
❑ No blood clots ❑ Get some rest!
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18. Knee Care Guidelines - Day of Surgery
Pain Management
We take pain management seriously and want you to have an acceptable level of pain. 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.
Your provider may order you a patient-controlled analgesic (PCA) pump following surgery. This allows you to get
a pre-determined amount of pain medication by pushing a button.
There are several options for pain management after total joint surgery and these will be ordered by your
surgeon or anesthesiologist provider. 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.
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19. ........................................................................................
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).
• Special nasal prongs to assist in patient evaluation of respirations (EtCO2).
Sneak Peak at Tomorrow
• Blood draw for lab work at a very early hour. That’s why cat naps are so important.
• Physical therapy continues, usually once in the morning and once in the afternoon.
• Occupational therapy begins (usually with a session in the morning) to help you get back to
independence with your daily routine.
• Up in the chair for at least two meals.
• CPM device for bending and straightening your knee usually applied for two hours, three
times a day, if ordered by your provider.
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20. Knee Care Guidelines - Day One
Today’s Itinerary
• Your vital signs will be checked every four hours.
• IV fluids continued as needed.
• IV antibiotics discontinued.
• If you no longer require oxygen, it will be discontinued.
• Continue to use your incentive spirometer every hour.
• The pulses in your feet will be checked.
• Continue cooling device or ice to knee.
• Do ankle pumps every one to two hours while awake.
• Up in chair two or three times.
• Rest between activity and limit visitors.
• Reposition in bed to prevent damage to skin.
• If you have a surgical drain, it may be removed today.
• Write down questions for your provider, 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.
• 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
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21. 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 flexion as tolerated.
Therapy associates will see you in the afternoon to continue working with you on bending and straightening
your leg and walking.
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.
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22. Knee Care Guidelines - Day Two
Today’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 use your incentive spirometer.
• Continue cooling device or ice 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 discontinued as ordered.
• SCDs on except when walking.
• Instruction on giving yourself blood thinning injections at home to prevent blood clots, if ordered by your
provider.
• Foley catheter will be removed.
It’s Time to Get to the Gym
• You will continue to work with physical therapy on the exercises you did yesterday with progression as
tolerated.
• You will continue with occupational therapy as needed to be sure you will be independent at home after
discharge.
Back in Your Room
• The CPM settings (if ordered) 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 tolerable. 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. You will continue to do your ankle pumps every one to two hours.
........................................................................................
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23. 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 ❑ 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 an alternate
care unit as appropriate.
• 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.
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 daily. If you had a surgical drain that was removed, drainage may
continue 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
in fat and sugar. Do not smoke. Smoking interferes with the healing process.
........................................................................................
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!
........................................................................................
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24. Knee Care Guidelines - Day Three
Today’s Itinerary
• Today may be the day you are discharged home or to an alternate care unit.
• Continue your activities of the previous days (ankle pumps, cooling device, incentive spirometer, CPM, etc.)
• You will continue all your exercises and have instruction on exercises to do at home.
• 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
• Start gathering your belongings.
• Take purchased assistive device with you, including dressings.
• 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 volunteer or associate will assist you to your car when the
discharge paperwork is complete.
........................................................................................
Thank you for letting us serve you!
We wish you continued success with improved mobility.
........................................................................................
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25. Exercises
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 sets per session.
Do 2-3 sessions per day.
Terminal Knee Extension
With right knee over bolster, straighten knee by tightening
muscles on top of thigh. Keep bottom of knee on bolster.
Repeat 10-20 times per set.
Do 2-3 sets per session.
Do 2-3 sessions per day.
WMH Knee Replacement | 23

26. Exercises
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.
Chair Stand
With 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.
WMH Knee Replacement | 24

27. Exercises
Biceps Curl
With 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 Front
Holding _____ pound weights, raise arms toward
ceiling. Keep elbows straight.
Repeat _____ times per set.
Do _____ sets per session.
Do _____ sessions per day.
WMH Knee Replacement | 25

28. 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.
Heel Slide (Supine)
Slide right heel toward buttocks until a gentle
stretch is felt. Hold 2 seconds. Relax.
Repeat 10-20 times per set.
Do 2-3 sets per session.
Do 2-3 sessions per day.
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29. Exercises
Chair Squat
Keeping feet flat on floor, shoulder width
apart, squat as low as is comfortable.
Use support as necessary.
Repeat 10-20 times per set.
Do 2-3 sets per session.
Do 2-3 sessions per day.
WMH Knee Replacement | 27

30. 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.
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31. 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
WMH Knee Replacement | 29

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 “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?
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 your
blood 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 and
prevent complications. It is very normal to have the dose of warfarin change based on the blood test results.
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 times
a week for the first two weeks. As your level begins to stabilize, the blood test can be done one to two times a
month. The frequency will vary, depending on the stability of your blood test. Your healthcare provider will tell
you when to have your blood checked.
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33. Coumadin (Warfarin) Information ®
If the level is not within goal range, or your dose is changed, you will need to go for blood tests more often. When
a person first starts taking warfarin, the level 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 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 Waupun Memorial Hospital, specializes in warfarin management. Your
provider may refer you to the clinic where your blood is tested and 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 level. 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.
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34. Coumadin (Warfarin) Information ®
What side effects can I expect?
Warfarin is generally well tolerated. Very few patients experience side effects while taking warfarin. The most
common complications that patients experience are issues with bleeding, such as a slight bloody nose, bleeding
from the gums after brushing teeth and increased bruising. These complications are not uncommon and not life
threatening. 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 vagina
Serious, but rare, side effects of warfarin include skin necrosis (death of skin tissue) and “purple toe
syndrome.” 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 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.
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35. 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 blood levels 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
Lettuce (raw/bib/red leaf) . . . . . . . . . 1 ¾ cups shredded
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.
WMH Knee Replacement | 33

36. Medical Equipment for Home
Following 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.
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37. Medical Equipment for Home
Bathroom
• 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.
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38. Durable Medical Equipment
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)
Durable Medical Equipment
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!
........................................................................................
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)
........................................................................................
We will gladly help with special orders too. Call us today!
........................................................................................
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39. 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
• Dementia
• 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)
• Case Management
• Physical therapy, occupational therapy, speech therapy, home health aides, medical social worker
• Medication box fills/medication management
• Pediatric clinical nurse specialist
• Chemotherapy
• Palliative care
Coverage
• Accept Medicare/Medicaid assignment 100 percent
• 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
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40. 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.
Hemovac Drain
This drain collects blood and body fluid and is placed near your operative site.
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 Catheter
This catheter will be placed in your lower back 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.
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41. Common Terminology
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.
EtCO2
This tubing allows us to help assess your respiratory status.
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.
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42. Questions
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