8/13/2015Total Knee Replacement - Patient Guidebook (copyright 2007)1

04/21/23 Total Knee Replacement - Patient Guidebook (copyright 2007) 1

04/21/23 Total Knee Replacement - Patient Guidebook 2

NORTHSIDE MEDICAL CENTERTOTAL KNEE ARTHROPLASTY PREHAB PROGRAM

The Total Knee Arthroplasty Prehab Program is designed to acquaint you with Northside Medical Center and the clinical progression planned as you prepare for your Total Knee Arthroplasty.

Northside Medical Center (formerly Hughston Hospital) was the nation’s first hospital designed specifically to treat patients with musculoskeletal injuries or disorders. Today, our 100-bed, private room hospital is nationally recognized for delivering outstanding clinical quality and the highest levels of customer service. Fully accredited by The Joint Commission (TJC), we provide excellent comprehensive care and rehabilitation services through a highly specialized team of professionals using the latest technology and research to care for people of every age and ability and every level of musculoskeletal injury or disorder.

Even more important than the latest technology may be the fact that our commitment to quality care has remained our top priority throughout the years. The hospital consistently ranks among the top one percent in customer service and satisfaction and we go the extra mile to ensure your stay with us is as pleasant and comfortable as possible.

Our employees and physicians work together to provide a comprehensive continuum of orthopedic services for you. Located in North Columbus, the beautifully landscaped setting of the hospital is therapeutic to patients and their families.

We at Northside Medical Center believe if you are well informed and play an active role in your healthcare, we can provide you with a progressive stay that is of the highest quality, comfort and satisfaction possible.

As a part of the Columbus Regional Health System, we are committed to patient satisfaction. Our mission is: To Promote The Health and Healing of Our Patients and Our Vision is: To become internationally recognized for our clinical outcomes and world famous service.

You can be assured that your care is developed and provided by a professional and highly competent team dedicated to your recovery. We expect you to be encouraged by the staff you will meet and those involved in your care.

With your help, we can potentially have you independent and on your way home within 2-3 days.

We hope this information packet will assist you in your preparation for admission and throughout your hospitalization. If there is anything we can do during your stay to increase your comfort and satisfaction, or if there is anything we can do to make this program better…please tell us!

We consider it a privilege to serve you.


Directions to the Hospital and Local Hotels and Lodging 4

Important Hospital Phone Numbers 6

General Information 7

Preadmission Testing 10

Patient Access 11

Pharmacy Services 12

Patient Medication Safety 17

Surgery 18

Intensive Care Unit 21

Patient Care Services 22

Cardiopulmonary Services/Radiology and Lab Services 26

Fall Prevention Guidelines 28

Preventing Blood Clots 29

Rehabilitative Services/Physical/Occupational and Speech Therapy 31

Discharge Planning 33

Case Manager Patient Resource Form for Discharge Planning 34

After Your Discharge 35

Preventing Falls at Home 36

What to Bring to the Hospital 37

What Not to Bring to the Hospital 38

Frequently Asked Questions 39

Pre-op Knee Exercises 46

TABLE OF CONTENTS


Northside Medical Center100 Frist CourtColumbus, GA 31908706-494-2100www.northsidemedicalcenter.com

From Albany, GeorgiaTake Hwy 520 to US 280 through Richland and Cusseta to Ft. Benning. Take I-185 north at the Atlanta/LaGrange exit. Exit onto the Airport Thruway (exit 8) and turn left (west). Turn right at the fourth light onto Veterans Parkway. Drive 1 mile, the hospital campus is on the right. Enter at the traffic light onto Frist Court. The hospital is at the end of the long drive.

From Atlanta, GeorgiaTravel south on I-85 to I-185. Continue south on I-185 to Exit 12 which is Williams Road. Turn left on Williams Road and follow it through a flashing light and to the first traffic light. Turn right onto Veterans Parkway(US Hwy 27), and travel south approximately 2 miles. The hospital campus is on the left. Enter at the traffic light onto Frist Court. The hospital is at the end of the long drive.

From Macon, GeorgiaTravel west on U.S. 80 into Columbus. Follow toward Veterans Parkway and I-184 Atlanta. Travel approximately 1 mile to the Veterans Parkway exit, (U.S. Hwy 27). There is a traffic light at the top of the exit ramp; turn left. This is Veterans Parkway. Travel approximately 1.1 miles and you will see the hospital sign on your left. Enter at the traffic light onto Frist Court. The hospital is at the end of the long drive.

From Warner Robins, GeorgiaTravel west on Watson Boulevard (247 Connector). Approximately 6.8 miles from the Galleria Mall in Centerville there is a stop sign. This is where the 274 Connector ends. Turn left on 49 South. Travel approximately 4.6 miles. There will be a Church of Christ on the right. The Lighthouse Church on the left. Turn right on 49 west. Go approximately 5 miles and you come to Highway 96. Turn right on Highway 96 and travel west through Reynolds, Butler, Junction City and Geneva. Highway 96 ends in Geneva and connects with US 80. Take US 80 West (left) approximately 24 miles to Exit 4. Take Exit 4 (which says Veterans Parkway or To Atlanta) and travel approximately 1 mile to the Veterans Parkway exit, (US Hwy 27). There is a traffic light at the top of the exit ramp; turn left. This is Veterans Parkway. Travel approximately 1.1 miles and you will see the campus on your left. Enter at the traffic light by the hospital sign onto Frist Court. The hospital is at the end of the long drive.

DIRECTIONS TO THE HOSPITAL


From Auburn/Opelika, AlabamaTravel east on U.S. 280 to Phenix City. Take US 80 east into Columbus. Take I-185Atlanta/Veterans Parkway exit. Continue straight to the Veterans Parkway-US Hwy 27 exit. There is a traffic light at the end of the exit ramp; turn left. This is Veterans Parkway. Travel approximately 1.1 miles and you will see the hospital sign and campus on your left. Enter at the traffic light onto Frist Court. The hospital is at the end of the long drive.

From Eufaula/Dothan, AlabamaFrom Dothan - Travel north, take Hwy 431 through Eufaula to Hwy 280 in Phenix City. Take Hwy 280 east for 1.2 miles. Turn left on Veterans Parkway US Hwy 27. Proceed north on Veterans Parkway - US Hwy 27 for approximately 6 miles through Columbus. The hospital campus is on the right. Enter at the traffic light by the hospital sign onto Frist Court. The hospital is at the end of the long drive.

From Montgomery, AlabamaTravel east on I-185 to Opelika, exit east onto Hwy 431/280 (Columbus/Phenix City). Take US 80 east into Columbus. Take I-185 Atlanta, Veterans Parkway exit. Continue straight to the Veterans Parkway - US Hwy 27 exit. There is a traffic light at the end of the exit ramp; turn left onto Veterans Parkway. Travel approximately 1.1 miles and you will see the hospital sign and campus on your left. Enter at the traffic light onto Frist Court. The hospital is at the end of the long drive.

General parking is located on the right and left sides of hospital.

Handicap parking is located in several areas around hospital.

Parking is free.

LOCAL HOTELS AND LODGINGIf you have questions about or need assistance with lodging while you are a patient with us, don’t hesitate to ask us. The Operator at the Front Desk and The Patient Advocate, Extension 2010 are available to assist you.

DIRECTIONS TO THE HOSPITAL – Page 2


If you have any questions before/during/or after your hospital stay, please call:MAIN NUMBER (706) 494 - 21002nd FLOOR NURSING UNIT (706) 494-2290 (in house ext. 2290)

CARDIOPULMONARY SERVICES (706) 494-6090 In house ext. 2288

DISCHARGE PLANNING (706) 494-6005 Carolee LutherIn house ext. 6005

LABORATORY SERVICES (706) 494-2131 Edna LeftwichIn house ext. 2131

FOOD / NUTRITION SERVICES (706) 494-2182 Belinda BarronIn house ext. 2182

OUTPATIENT DEPARTMENT (706) 494-6048 Erin PearceIn house ext. 6048

PATIENT ACCESS/ADMISSIONS (706) 494-2115In house ext. 2115

PATIENT EXPERIENCE/ (706) 494 – 2010 Martha BonnerPATIENT ADVOCATE In house ext. 2010

PHARMACY (707) 494-2429 Nancy ChaffeeIn house ext. 2429

PREADMISSION TESTING (706) 494-2441 Erin PearceIn house ext. 2441

RADIOLOGY SERVICES (706) 494-2135 In house ext. 2135

REHABILITATION SERVICES (706) 494-2165 Kendra Sermarini

REHAB NURSING FLOOR (706) 494-2395 Patti GraulichIn house ext. 2395

SURGICAL SERVICES (706) 494-2190 Diane MorrisIn house ext. 2190

INFECTION CONTROL (706) 494-6093 In house ext. 6093

NORTHSIDE MEDICAL CENTER PHONE NUMBERS


THE PATIENT EXPERIENCEThe staff of Northside Medical Center are committed to the delivery of quality patient care. The Patient Advocate in the Patient Experience/Guest Relations Department, is available as a source of information and assistance and can be reached seven (7) days a week to assist you and to represent your concerns.

If you have questions or concerns, compliments or complaints, feel free to contact your Patient Advocate: inside the Hospital – Extension 2010, outside of the Hospital – (706) 494-2010. Your calls will be addressed in a prompt and confidential manner.

Your Patient Advocate is also available to provide assistance on a number of subjects such as ethical issues and patient rights, or contacting a minister to visit you .

If your call is answered by a voicemail message, please leave your name and number and your call will be returned promptly. We consider it a privilege to serve you.

ADVANCE DIRECTIVES - THE DECISION IS YOURSAt Northside Medical Center, we recognize the importance of your participation in all aspects of your care. Executing an Advance Directive, is one method you may choose to express your healthcare choices. Advance Directives are documents written in advance of serious illness which state your choices about medical treatment or name someone to make those choices for you if you are unable to do so.

The Patient Self Determination Act (effective December 1, 1991) mandates that all health care institutions provide adult patients with written information about their rights to make decisions concerning their medical care. Northside Medical Center’s Patient Bill of Rights, Patient Responsibilities and a Georgia Advance Directive Healthcare form are included in this Patient Care packet for your convenience and information. This in no way indicates that this facility requires or requests you to execute an Advance Directive. The execution and possession of an Advance Directive is a completely personal choice. The decision is yours.

If you have questions or concerns about Advance Directives or are interested in additional information, please contact our Patient Advocate, 706-494-2010.

GENERAL INFORMATION


At Northside Medical Center, we are committed to serving you with compassion, care, skill and respect. Our policy is to respect the individuality and dignity of all patients, and to honor, in accordance with law, an adult patient’s right to make informed decisions regarding treatment to include participation in end of life decisions. This includes an adult patient’s right to consent to, refuse, or alter treatment plans and the right to formulated advance directives which will govern, if you become incapacitated.

• You will not be denied access to treatment or accommodations that are medically indicated on the basis of race, sex, age, creed, national origin. You will not be denied treatment needed to stabilize an emergency medical condition, regardless of your ability to pay or the source of payment for such care.•You have the right to privacy regarding information necessary for medical care and regarding the privacy of your body.• You have the right to expect all communications and records pertaining to your care to be treated as confidential and you have the right to access your medical record in accordance with state law.• You have the right to request privacy status while in the hospital. Under such circumstances, no information about your presence in the hospital will be provided to anyone.• You have the right to the proper and safe use of restraints when they are required in acute medical, surgical and behavioral management interventions.• You have the right to the appropriate assessment, management of and education regarding your pain.• You have the right to freedom from abuse, neglect, exploitation or harassment.• You have the right to care in a safe setting.• You have the right to know the name of and talk with the physician and other caregivers responsible for your care and to receive information necessary to understand your medical problem and planned treatment.• You have the right to have a family member or representative of your choice and your own physician notified promptly of your admission to the hospital.• You have the right to receive visitors that you designate, including but not limited to a spouse, a domestic partner, another family member or a friend and you have the right to withdraw your consent at any time. Visitation will not be restricted based on race, color, national origin, religion, sex, gender identity, sexual orientation or disability. At times the hospital may restrict or limit visitation for clinical reasons, including but not limited to: during periods of infections outbreaks; if necessary due to the patient’s condition; visitors with colds, sore throats, signs of infection or any communicable disease; number of visitors if excessive and causing disruption of patient care. The hospital accommodates the patient’s rights to religious and other spiritual services. The hospital respects the patient’s cultural and personal values, beliefs and preferences.• You have the right to examine and receive an explanation of your bill.• You have the right to give or withhold informed consent to the hospital for the production or use of recordings, films, or other images of yourself for purposes other than your care.

PATIENT RIGHTS AND RESPONSIBILITIES


• You have the right to reasonable attention to complaints and grievances when communicated to any member of the health care team.• You have the freedom to voice such concerns without fear of reprisal or compromise of care. If you would prefer to report your concern outside the area you are receiving care, you may contact our Administrative Office, Northside Medical Center, 100 Frist Court, Columbus, Georgia 31909, (706) 494-2101, or our Patient Advocate/Guest Relations Coordinator, (706) 494-2010. The hospital will make every effort to provide a written response to a grievance in (7) days. If the grievance cannot be resolved in (7) days, you will be informed of the plan of action to include an anticipated date of the written response.• In addition to or instead of this process, you may also address concerns to the Georgia Medical Care Foundation, 1455 Lincoln Parkway, Suite 800, Atlanta, Georgia 30436, 1- (404)- 982-0411.• You have the right to contact The Georgia Department of Community Health, Healthcare Facility Regulatory Division, 2 Peachtree Street, N.W., Suite 31-415, Atlanta, Georgia 30303, 1-(404)-657-5782 or via fax 1-(404)-657-5731 to file a grievance or complaint.• You have the right to contact and we encourage you to contact our hospital administration, (706)-494-2101, if you have any unresolved patient safety or quality of care concerns. However, if the concerns remain unresolved we encourage patients to contact the Joint Commission on Accreditation. The concern should be submitted in writing to the Division of Accreditation Operations, Office of Quality Monitoring, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181, or faxed to 1-(630)-792-5636, or e-mailed to [email protected]• You have the right to participate in the consideration of biomedical ethical issues that arise during your care. Any health care team member will refer your request of this nature to the appropriate party. YOUR RESPONSIBILITIES:• You have the responsibility to provide, to the best of your knowledge, accurate and complete information about your present complaints, past illnesses, hospitalizations, medications, and other matters relating to your health.• You have the responsibility to ask questions when you do not understand what you have been told about your health care and what you are expected to do.• You have the responsibility for following the treatment plan developed with the practitioner. If you refuse treatment or fail to follow the practitioner’s instructions, you are responsible for the outcomes and you may be discharged from the hospital.• The patient, family and visitors are responsible for following the hospital’s rules and regulations.• The patient, family and visitors are expected to be considerate of other patients and hospital personnel by not making unnecessary noise, smoking or causing distractions. Patients, families and visitors are responsible for respecting the privacy and property of other persons and that of the hospital and its employees.

PATIENT RIGHTS AND RESPONSIBILITES (CON’T)


Preadmission Testing is a vital part of ensuring that you are thoroughly prepared for your admission to Northside Medical Center Hospital.

Medical and diagnostic testing prior to your admission allows your physician to plan correctly for your care. The Preadmission Testing Department is open from 9:00AM until 5:00PM Monday - Friday. If laboratory tests, x-rays, EKG’s, diagnostic tests or physician clearance have been conducted in the last thirty days, please bring copies of these results with you. This may prevent the same tests from being performed again.

You will find that you are informed and educated at every point of service. During Pre-Admission Testing the following will be addressed:• Diagnostic tests ordered prior to your admission• Your preoperative and postoperative surgical care• Your diet prior to and following your procedure• Your current medications and any allergies • Skin integrity (condition) at the surgical site may be inspected• Clothing and personal items to bring with you to the hospital• Your anesthesia plan and any questions you may have regarding your meeting with the Anesthesiologist• Consult with Internal Medicine Physician if necessary

We hope you will find the pre-admission process informative and thorough in your preparation for your surgical procedure. It is essential that you take advantage of Pre-Admission Testing to avoid delays or cancellation of your procedure.

Bring current medications or list of medications you are taking.

If you have any questions, please do not hesitate to call the Preadmission Testing Department at (706) 494-2441.

PREADMISSION TESTING AND INFORMATION


PRIOR TO ADMISSIONThe Patient Access Department obtains as much informationas possible from your physician’s office and will verify yourinsurance and eligible benefits. Your insurance benefitinformation and estimated charges for your hospitalizationwill enable us to calculate the approximate patientresponsibility. After the compilation of this informationwe will be able to discuss your insurance benefits andany required deposit prior to your procedure.

In order to receive full benefits, most insurance companies require pre-certification prior to your admission. Please check with your physician’s office to ensure that a pre-certification number has been furnished to the hospital, should it be required. Many insurers now require that the surgical patients be admitted the same day as their surgery. Your physician’s office will provide you with information regarding admission date and time for arrival. If your stay is longer than anticipated, our Utilization Review Department will obtain recertification.

Hospital bills and insurance claims can be quite confusing and sometimes stressful. Our management of your financial account from admission until your account is paid in full is designed to reduce your stress. We are committed to servicing your account and making this process as simple as possible.

Please bring your insurance cards and a picture ID with you.And REMEMBER…..DO NOT eat or drink after midnight the night prior to your surgery.

DAY OF ADMISSIONPlease report to the hospital at the designated time. You will be instructed on the correct hospital entrance for admission to the hospital. If you have visited our Pre-admission Testing area, additional paperwork may not be required. When the admission process is complete, you will be escorted to the appropriate location. Please be aware that many insurance carrier’s require a separate billing account should you be admitted to our Rehabilitation Center. For this reason and for your convenience our staff may ask you to sign a duplicate set of forms upon admission.

Patient Account Services will finalize your insurance claim and submit your billing on behalf of Northside Medical Center to your insurance carrier. This billing represents only the hospital charges. Please be aware that you will have separate billings from your surgeon, radiologist, anesthesiologist and pathologist.

Should you have any questions, please do not hesitate to call. You may contact the Patient Access Office by calling (706) 494-2115.

PATIENT ACCESS DEPARTMENT


PRIOR TO YOUR ADMISSIONIt is necessary for you to discuss all of your medications with your primary or orthopedicphysician prior to your admission to the hospital. Aspirin, aspirin products, blood thinners andall anti-inflammatory medications may be discontinued two (2) weeks prior to your surgery or

as directed by your physician. In rare cases, your physician may prescribe these products, however, you should not take them unless specifically instructed to do so by your doctor.

Please bring a list of your medications with you to the hospital. On the list please state: the medication name, strength, how many for each dose and how often you take each medicine. Please be sure that your physician knows about any medication allergies that you have.

OTHER MEDICATIONSIf you are taking other medications that you have purchased in a health food store, grocery store, drugstore or through mail order please include these on your list. Some examples of other medications are: supplements, herbals and herbal teas. You will not receivethese medications while you are in the hospital unless specifically ordered by your physician. Many of these medications can interact or interfere with the medications that you may begiven during your stay. HOME MEDICATIONSWe discourage the use of home medications. Many patients storetheir medications in the kitchen or bathroom. Storage in these areascan cause the medication to degrade and become less effective. Medications are affected by moisture and heat. Storage of medications in our pharmacy is appropriate according to the guidelines from themanufacturers. We know where the medication originates and how itis stored.

DURING YOUR HOSPITAL STAYYour physician will prescribe various medications throughout yourhospital stay. At any given time during your medication therapy,if you have concerns or questions, you may request a consultation with the pharmacist.

• With the exception of over-the-counter anti-inflammatory drugs, you will be given the routine prescription medications that you already take at home unless your physician orders otherwise.

• You may be placed on Coumadin, Lovenox or Xarelto which are blood thinners. Coumadin requires monitoring of the blood. If indicated, your blood will be drawn

PHARMACY SERVICES


your blood will be drawn every morning and the results called in to your physician to determine how much Coumadin you will need to receive that day.

• Pain medication will be provided so that you will have adequate pain relief but will not be too drowsy to participate in your therapy sessions.

• During your day while you are in the hospital you will be asked to describe your pain using a scale from 1 – 10 called a pain intensity scale.

MEDICATION STORAGEYour medications are stored in a locked cabinet in your room. A Pharmacy Technician

may visit you during your stay in order to place medications in the locked medication cabinet in your room.

The technician will ask you about your medications and whether there are any problems with your medication therapy. If you have questions or problems, you will be referred to a Pharmacist for follow up.

PRN MEDICATIONSPRN medications mean that the patient may request now. You will have medication ordered that you must request to receive. Do not wait to ask for pain medication when you are hurting. The longer you wait, the longer it takes for the medication to work and we want you as comfortable as possible.

PHARMACY CONSULTATIONSYou may request a consultation with the Pharmacist through the Nursing staff. Consultations

are important. They help us in the Pharmacy to know exactly how you are progressing on your medication regimen.

The staff wants to know immediately if you have any adverse drug reactions or if your medication is not agreeing with you.

The Pharmacy Department checks your medications from your medication profile every day to assure that everything is appropriate for your therapy.

We are here to help you have a positive and safe medication experience.

PHARMACY SERVICES - Page 2





Patient safety is very important to us. To assure that you receive the right medication, the right dose, at the right time, in the right amount, we have implemented a patient safety process called “bar coding” and “scanning” of medications. Through this process we use an electronic medication administration record that indicates every medication ordered for you. All medications you are given are scanned against your hospital wristband. This assures the accuracy of the medications and adds another safeguard to your medication therapy. It helps to preventerrors in medication management.

PATIENT MEDICATION SAFETY


YOUR PREPARATION FOR SURGERYAll patients are prepared for surgery in our Outpatient Surgery Department. This is whereyou will wait until it is time to go into the operating room and where any necessary pre-oppreparations will be completed. One or two family members may stay with you during thistime. We have a larger waiting area if you have more visitors.

While you are in your outpatient room:A nurse will be assigned to you and do a physical assessment whichincludes vital signs, weight and other health questions. You will change into a hospital gown and all clothing, jewelry, and denturesmust be removed prior to going to surgery. In this area, we use a warming system called BAIR PAWS that connects to the hospital gown. If needed a prep will be done by either the nurse or theclinical technician. Your operative site will be scrubbed by the nurse using the Chlorhexidine Gluconate wipes. A finger stick blood sugar will be performedthe morning of surgery to screen for diabetes. Please do not have pedicures or manicuresdone in preparation for surgery because the polish will need to be removed prior to surgery.You will be asked many times during your pre-operative period to verify your name and dateof birth and also what you are having surgery on. This process is for Your Safety.

An Anesthesiologist will ask you questions concerning:• allergies • if you have had anything by mouth after midnight• loose teeth or dentures • your home medications• previous anesthesia experiences• previous anesthesia problems you or your family members may have encountered

The procedure site is marked by a licensed independent practitioner or other provider who isprivileged or permitted by the hospital to perform the intended surgical procedure. Thisindividual will be involved directly in the procedure and will be present at the time theprocedure is performed.

An IV needle will be inserted into your hand or arm. Fluids will be attached so that you canreceive medication to relax you for your surgery and have a means for delivering othermedication you will receive during your procedure.

A Registered Nurse from the Operating Room will visit you in your outpatient room. Thenurse will review your hospital chart and may ask you most of the same questions that you

SURGERY


have previously answered; again, this process is for your safety, we want to be as thorough aspossible in your care. This is also an opportunity for you to ask any last minute questions prior toyour transfer into the Operating Room where your surgery will be performed.

THE OPERATING ROOM (O.R.)When you arrive in the Operating Room, the surgical team will perform a “time-out” and ask youto affirm your identity and operative site. You will be assisted to the operating room table. TheAnesthesiologist and Nurse Anesthetist will work together to attach your EKG leads, bloodpressure cuff, and pulse oximeter finger probe. If you are having general anesthesia, you will beasked to breathe normally through an oxygen mask placed upon your face. If this is uncomfortable, we will hold the mask away from your face. The medication to put you tosleep is administered through your IV fluids. You will drift pleasantly off to sleep with the staff at your bedside. Once you fall asleep, a tube is placed in your throat to assist your breathingduring the surgery. It is not uncommon to have a sore throat upon awakening. If you are havingspinal anesthesia, your nurse will assist you to a sitting position and your privacy will bemaintained while the spinal anesthesia is administered. A Foley catheter may be inserted intoyour bladder once you are asleep to keep your bladder empty during the surgery.

LENGTH OF SURGERYThe average total knee replacement takes 2 hours in the operating room followed by at least 1hour in the Post Anesthesia Care Unit/PACU.

ACTUAL PROSTHESISThere are four (4) basic parts to the total knee prosthesis: the femoral (thigh) component and the

tibial (lower leg) component which are made of cobalt chrome or titanium and the tibial insert and patella are made of high density polyethylene that keeps the metal surfaces from touching and is the bearing surface.

FAMILY WAITINGWe will let your family members know where to wait while

you are in surgery. (Family Waiting Room or your assigned room.) They will be contacted when your procedure is completed.

POST ANETHESIA CARE UNIT (PACU)After surgery, you will be transferred to the Post Anesthesia Care Unit in your hospital bed. You may have an immobilizer on your leg and a drain from your surgical site, and IV fluids attached to your hand/arm.

While in the Post Anesthesia Care Unit, your nurse will continue to monitor your vital signsand administer oxygen. You will also be encouraged to take deep breaths to help you stabilize

SURGERY – Page 2


from anesthesia and a warm air heating blanket may be placed over you for comfort. An icebag may be placed on your operative knee. Leg exercises, (e.g. ankle pumps), will be initiatedto aid circulation.

You may receive medication for pain relief and a few ice chips for thirst and/or throatdiscomfort. You may also have follow-up lab work drawn or x-rays taken. You will remain inPACU until you are alert, vital signs are stable and your discomfort is minimized (at least onehour). An anesthesiologist will assess your status and release you to your room.

TRANSFER FROM PACUYou will be transferred to your room on your hospital bed accompanied by a Post AnesthesiaCare Unit Nurse. You will still have your IV fluids and may be attached to oxygen. The nursetaking care of you on the nursing floor will meet you in your room, assess, obtain your vitalsigns and receive a status report from the Post Anesthesia Care Unit nurse. If you have bothknees operated on, Bilateral Knee Arthroplasty, you may spend one night in the Intensive CareUnit if your physician feels that your care warrants. Otherwise, you will return to the nursingfloor.

SURGERY – Page 3


Thoughts of hospitalization and intensive care can bring up feelings of fear and uncertainty formost of us. We at Northside Medical Center’s Intensive Care Unit (ICU) want to makeyour stay in our unit as comfortable as possible.

Northside Medical Center’s Intensive Care Unit, ICU, located on the third floor, isdesigned to treat patients that require specialized intensive care. The open design of the ICUallows patients to be easily monitored at all times from the nursing station. If you are admitted to ICU, we request that personal belongings be limited to toiletry articles. All articles of clothing and valuables should be taken home or returned to your family forsafekeeping. Valuables may be placed in the hospital safe. Flowers are not permitted in theunit.

To promote optimal rest and healing, visiting hours are limited. Your family may wait in theICU Waiting Room in the intervals between visitations. For our families that are visiting fromout of town or state, assistance is available for lodging accommodations. The Patient Advocateis also available to assist you at 494-2010.

INTENSIVE CARE UNIT


You have made a big decision to have a surgical joint replacement. We would like to do allthat we possibly can to assist you in preparing for this procedure. The following will outlinewhat you can expect before and after your surgery. PRE-ADMISSION TESTINGBefore you are admitted to Northside Medical Center for surgery, it is extremelyimportant for you to visit our pre-admission testing department. Pre-admission testing mayinclude pre-op lab work, an EKG and medical consult.

MEALSMeals are served to you in your room. We encourage you to be outof bed for your meals as you become able.

Your family may choose to dine with you while you are in thehospital. Guest trays can be purchased at a reasonable cost and delivered to your room. If you are interested, you may check withthe front desk in the hospital lobby. Guest tray food items are selected by Food and Nutrition Services according to the menu ofthe day. To select specific menu items, the trays must be orderedthe day prior to delivery.

BATHINGIt is our goal that patients complete bathing as independently as possible, within theirknee precautions. The nursing staff will prepare items for your bath. Upon completion of yourdaily bath, you are encouraged to dress in attire that is comfortable, loose fitting and conduciveto your therapy goals identified for the day.

THERAPY ATTIREBaggy clothes that allows access to your knee when needed, and comfortable, non-skid shoes(with a back to cover heel) are optimal to best ensure comfort and safety during rehabilitativeactivities and exercises. Open toe or backless shoes are discouraged.

FAMILY INVOLVEMENTWe encourage family to be involved in your recovery. Family involvement in therapy sessionswill help them see how well you are progressing.

DISCHARGE INFORMATIONYour discharge planning and teaching will continue throughout your hospital and or rehabilitative stay. You will be provided with discharge instructions that will be bothphysician and procedure specific. This will include wound care, suture/staple removal,physical therapy and medication instructions, follow up lab work and appointments.

PATIENT CARE SERVICES


Day of SurgeryAfter your surgery, You will be brought from PACU to your room on the surgical floor. And

your family may be there waiting on you. Your family member is welcome to stay with you while you are in the hospital, and if you need a sleeper chair please ask and we will do our best to provide one for you.

You can expect one or more of the following after surgery depending on your physician’s specific orders for you:

• A bulky dressing on your knee and possibly an immobilizer depending on your physician’s preference

• A hemovac drain to drain excess blood from the surgery site to prevent pooling of blood under the skin

• TED/SCD hose on your lower legs to help with circulation and help to prevent blood clots• IV to provide adequate hydration and for antibiotic therapy• Oxygen by nasal cannula or mask to help keep your oxygen saturation between 90 – 100%• Telemetry and monitoring by ICU if you have a history of heart problems or sleep apnea• A Pulse Oximetry which will be applied to your finger with a monitor at the bedside. This

is to monitor your oxygen saturation level in your blood, if you are receiving pain medications through your IV

• A Foley Catheter – which is a tube placed into your bladder during surgery to monitor your urine output. This is typically removed the next day after surgery

Spinal AnesthesiaIf you received spinal anesthesia for your surgery, you will be numb from the waist down after

surgery. This may last from one to four hours postop. As soon as you start to feel pain you will need to ask for your pain medication.

You will remain on bed rest the day of surgery unless your physician orders for you to get up.

Pain Medications are available in the form of IV medications for severe pain or by mouth for mild to moderate pain. Pain medications are not normally scheduled but are given on a PRN, as needed basis. You may receive pain medication every three to four hours as needed and you will need to ask your nurse for pain medication. You will be asked to rate your pain on a scale of 0 – 10 with 0 meaning no pain and 10 being the worst pain you have experienced. All medications given for pain may cause you to feel sleepy, nauseated or may cause itching. We can give you medications to help with the itching and nausea if needed.

It is important that you get plenty of rest on the day of surgery. Make sure to ask for pain medication to keep your pain under control and at a tolerable level.

You may be able to eat a meal if you are awake, not nauseated, and your nurse feels that you can

PATIENT CARE SERVICES – Page 2


tolerate food on your stomach. You will need to start with ice chips and fluids right after surgery and gradually progress to solid foods.

If you need other medications for nausea or sleep you need to notify your nurse.

You may also have a medical doctor in charge of your medical care while you are in the hospital. This physician will visit you each day and will be in charge of ordering any home medications that you may take. It is very important that we have a complete and accurate list of your home medications including any herbal medications, over the counter drugs, and pain medications.

Each patient room has a Communication Board. On this board the nurse will write the day, his or her name and their direct telephone number, your physician, your nurse tech and their direct phone number, your diet, physical therapy, pain level, discharge plans and goal for the day.

Post Operative Day One:The first day after surgery is a busy day. Your doctor will probably order the nurse to remove one

or more of the following things:• The Hemovac Drain• The Foley Catheter• IV fluids and antibiotics• Pulse oximeter (once no longer taking IV pain medications)• Oxygen (If your oxygen saturation is above 90% without the oxygen)

You will start your Physical Therapy today. The dressing will be changed to your knee. You may sit in the recliner at the beside and take a walk in the hallway with assistance. Most patients will need a walker to walk with. You will also start to bend your knee today with the therapist. You may be ordered a CPM machine to help you with your bending.

Please make sure that you ask for your pain medication (whether it be by mouth or IV) to help keep your pain under control.

Please DO NOT GET OUT OF BED WITHOUT ASSISTANCE from the staff. It is important to use the call light or call your nurse or Clinical Tech directly on their phone.

You will also be started on a blood thinner today based on your physician’s order. This helps to prevent blood clots. You will go home on a blood thinner for approximately two weeks.

If you progress well today, it may be possible that you could go home as early as the next day (Post Operative Day Two .)



Someone from Case Management will come by to discuss your discharge plans with you and will be the person to set up Rehab, Home Health, and Physical Therapy. All of the arrangements will be made for your prior to your discharge.

Post Operative Day Two:This is the day that you could possibly go home if you are meeting all of your therapy goals and

your pain is under control.The following are the goals that you should meet:• Walking at least 100 feet and bending your knee greater than 90 degrees• Pain should be controlled with pain medication by mouth• Medically cleared to go home by the medical doctor• Released by the therapist for discharge• Your incision should be dry without any drainage• You should be eating solid food and tolerating it well without nausea and vomiting• You should be urinating without any difficulty and be having normal bowel movements

It is okay if you do not meet all of these goals today. If you are not meeting these goals , you should be able to do so by the nest day, Post Operative Day Three.

Please communicate with your Case Manager so that Home Health and /or Physical Therapy can be arranged for you when you go home.

The Physical Therapist/Occupational Therapist may recommend that you have certain equipment at home for use, such as a walker, bedside commode. Most equipment can be provided to you before you leave the hospital.

Day of Discharge:Once your physician has given us a discharge order, the nurse can begin to prepare your discharge

paperwork. Please know that preparing you for discharge is priority to your nurse although it may take time to get everything together for you.

The physician may have given your discharge prescriptions prior to you coming into the hospital. If not, you will be given a prescription for pain control and a prescription for a blood thinner. You will need to take these to your pharmacy to be filled. We cannot call in medications for you nor can we give you any medication to take home with you to have on the ride home. But we certainly can work with you to ensure that you can take something for pain before you leave especially if you have a long ride home.

Once you have received your discharge papers, any home health has been set up and equipment has been taken care of for you, we will escort you to your car by wheelchair. We encourage you to ask your family to bring a vehicle for the ride home that will be most comfortable for you.



ELECTROCARDIOGRAM/EKGYour physician may order an Electrocardiogram/EKG – A tracing of the electrical activity ofthe heart through multiple electrocardiograph leads placed upon your chest to check for anyabnormalities of the heart.

INCENTIVE SPIROMETRYYou will be provided an incentive spirometry device to help clear the lungs of anesthesia gasesfollowing surgery and to maximize your lung capacity. You will be instructed to slowly inhaleas deeply as possible during this breathing exercise. This exercise is extremely important inorder to minimize congestion and possible pneumonia. The exercise should be performedevery two (2) hours while awake.

OXYGEN (O2)Oxygen is frequently administered following surgery to help maintain oxygen levels in thebody. The use of narcotics can also limit your ability to breathe deeply so oxygen may beprovided for this reason as well.

HIGH FLOW NEBULIZER (HFN)If you smoke or have a respiratory condition, your physician may order high flow nebulizerbreathing treatments. These are usually given several times a day and your physician willorder the desired medications to be administered in the treatments.

If you are currently taking breathing treatments at home including inhalers, please tell yourphysician and the pre-admissions nurse. It will be helpful if you will bring with you the nameof the medication(s) you are currently taking and the correct dosage.

SLEEP APNEAIf you have had a sleep study performed and use either a CPAP or BIPAP machine at home,please bring your machine and all of the accessories (mask, tubing, etc) with you to thehospital. Be sure to tell the nurse in Outpatient Surgery that you brought your CPAP or BIPAPmachine with you. Our Bio-med technician will check it to make sure it is safe for use in thehospital.

CARDIOPULMONARY SERVICES


PRE-OPERATIVEA chest and/or knee x-ray may be ordered by your physician and may be done along with otherpre-admission testing procedures.

POST-OPERATIVEX-rays of your knee may be taken following surgery to ensure correct placement and alignment of your new knee joint.

PRIOR TO DISCHARGEYou may have an x-ray of your knee a few days before you are discharged to provideinformation on your progression of healing.

LAB STUDIESBlood will be drawn on a daily basis if indicated.

RADIOLOGY SERVICES

LAB SERVICES


Accidental falls may occur in the hospital. These accidents are as distressing to hospital personnel as they are to the patient. Our healthcare team of nurses, doctors, physical therapists, and assistants are here to assist you in a safe and speedy recovery. Your participation and cooperation with this program will help you to prevent unnecessary injury. Why Falls HappenFalls may occur in the hospital because:• Medications such as tranquilizers, sleeping tablets, pain relievers, blood pressure pills or diuretics may make you dizzy and disoriented.

• Your illness, enemas, laxatives, long periods without food, or tests your physician has ordered may leave you weak and unsteady.

• The hospital may seem foreign and unfamiliar to you, especially when you wake up at night.

• Some falls, such as those associated with illness or therapy, cannot be avoided. However, by following the safety guidelines, you, your family, and friends can help reduce your risk of falling. Safety Guidelines for Preventing Falls• When you need assistance, use your call light by your bed or in the bathroom and wait for help to arrive. • Remain lying or seated while waiting for assistance. Please be patient, your call will be answered as soon as possible. • Ask the nurse for help if you feel dizzy or weak getting out of bed. Remember you are more likely to faint or feel dizzy after sitting or lying for a long time. If you must get up without waiting for help, sit in bed awhile before standing. Then rise carefully and slowly begin to walk. • Walk slowly & carefully when out of bed. Do not support yourself on rolling objects such as IV poles or bedside table. • It is recommended you wear rubber‑soled or crepe‑soled slippers or shoes whenever you walk in the hospital. If' you do not presently have any, check with your nurse. • Always follow your physician's orders and the caregiver's instructions regarding whether you must stay in bed or require assistance to go to the bathroom. A Special Note for Family Members and FriendsBecause hospital staff members cannot remain constantly at a patient’s side, a family member, or sitter may need to stay with a patient. Whenever possible, ask the nursing staff if there are specific times (for example: at sundown, 6‑9 PM) when your presence would be beneficial to the patient's comfort or piece of mind.

FALL PREVENTION GUIDELINES FOR PATIENTS/FAMILY

Deep Vein Thrombosis: Prevent DVT(Deep Vein Thrombosis) or Blood Clots

A blood clot is made of tissue, fribrinogen, platelets a dn white blood cells that collect and from a

clot. DVT is one of the two types of blood clots .Preventing deep vein thrombosis – the

formation of a blood clot in a deep vein -- is vital. The clot, which usually forms in a calf or thigh

muscle, can partly or completely block blood flow and damage valves in blood vessels. If it

breaks free and travels through your blood to major organs, such as your lungs it becomes a

pulmonary embolism. By preventing DVT’s, we can prevent 90% of the pulmonary embolisms

that could form. You will be assessed for blood clots upon admission and during your hospital

stay. If you are at risk, measures will be used to reduce that risk.

DVT Prevention: Healthy Lifestyle and Regular Checkups

To lower your risk and help prevent DVT, take these steps:

• Maintain an active lifestyle and exercise regularly -- daily, if possible.

• Manage your weight with exercise as well as a healthy diet.

• If you smoke, quit. A nicotine patch, gum, spray or support group can make this much easier to do.

• Get your blood pressure checked regularly; take steps to lower it, if necessary.

• Report any family or personal history of blood-clotting problems to your doctor.

• Discuss alternatives to birth control pills or hormone-replacement therapy with your doctor.

• During pregnancy, ask your doctor what you can do to help prevent DVT.

Preventing DVT After Surgery or While Bedridden

If you need surgery, your surgeon will review your medical history to help assess your risk for

deep vein thrombosis and determine whether you need aggressive measures to prevent DVT.

Your DVT risk can increase with becoming immobile and continue for several months following

surgery. However, in some cases, your risk is greatest right after surgery and about 10 days

afterward.

Researchers continue to look at the best ways to prevent DVT after surgery. For example, some

studies show that using regional anesthesia instead of general anesthesia, when possible, can

decrease your DVT risks.


PREVENTING BLOOD CLOTS

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Measures your doctor may prescribe to help prevent DVT:

• Taking blood thinners (anticoagulants) your doctor prescribes before or right after surgery.

• These may include Aspirin, Heparin, or Warfarin (Coumadin), Lovenox and Arixtra. Depending on the medication, these can be given by injection, intravenously (IV), or by mouth.

• Wearing a sleeve-like device on your legs during surgery to compress your legs and keep blood flowing through your veins.

• Wearing elastic compression stockings. These keep blood from pooling in your veins.

• Elevate the foot of your bed.

• Getting up and move as soon as you can after surgery, or after you've been ill.

• Taking pain medicine as prescribed to make it easier to move around.

• Doing leg exercises your doctor or other health care provider prescribes. These may include leg lifts and gentle foot and ankle exercises


PREVENTING BLOOD CLOTS – Page 2


Rehabilitation services include physical, occupational, and speech therapies.

PHYSICAL THERAPYWith every total knee procedure there are post operative precautions.Your therapist will instruct you on your specific precautionsaccording to your physician and type of procedure. You willparticipate in physical therapy daily to improve functionalmobility.

An assessment is completed by a licensed Physical Therapistfor every patient. The initial assessment involves an evaluation ofyour health status, review of your medical record and socialhistory, as well as, observations and tests. You will be involvedin establishing goals and a treatment plan sufficient to yourrecovery and your return to an optimal state of health. Your activeparticipation is the key to a successful outcome. Family membersor significant others are encouraged to be involved when possible.

The following treatment protocols are relatively the same for all patients with exceptionof when your therapy will be initiated. Your care will be guided by your physicianbased upon your specific needs and your personal goals and objectives.

Patient and family education is a service Northside Medical Center is very proud to offer.Please do not hesitate to ask any questions that concern you and your care.

POSTOPERATIVE DAY ONE:• You will be provided education on proper positioning and precautions for your knee and leg.• Your therapist will assist you in changing your surgical dressing and provide education to

you and your family regarding appropriate technique.• You will begin Range of Motion (ROM) activities as determined by your physician.• You will be taught and assisted to perform exercises such as ankle pumps and quad sets.• You will be taught Transfer Training to include movement into and out of bed, chair, and

commode if necessary. You will be assisted in transferring from your bed to a recliner for several hours daily.

• You will be taught Ambulation Training with an assistive device based on the type of surgical procedure and weight bearing status ordered by your physician. Devices utilized include walkers, crutches, and/or canes.

• The amount of weight placed on the extremity will be determined by your physician.• The ambulation goal you are encouraged to achieve is at least 10 to 20 feet, with 100 feet

optimal by Post Op Day 2.• You may be provided with a Continuous Passive Motion (CPM) Machine, depending on

physician preference, to assist in improving/increasing your range of motion.

REHABILITATIVE SERVICES – Physical, Occupational and Speech Therapy


POSTOPERATIVE DAY TWO:• Postoperative day one (1) activities continue.• You will continue to receive patient and family education regarding knee precautions

during all activities.• You will continue out of bed activities.• You will continue with transfer activities to/from an elevated commode and/or bedside

commode.• You will ambulate and weight-bear as determined by your physician utilizing crutches, a

walker or other assisted devices.• The ambulation goal you are encouraged to achieve is 50 to 100 feet.• Occupational Therapist will educate on adaptive equipment, durable medical equipment

(to include shower chair, tub transfer bench, bedside commode and raised toilet seat).• Some patients may go home by Post Op Day Two , according to your progress.

POSTOPERATIVE DAY THREE:• Postoperative day two (2) activities continue.• You will be encouraged to continue independence with bed transfers without utilizing the

overhead trapeze bar.• You will progress with your transfers to/from commode and chair.• You will continue to receive patient and family education regarding your care to include

specific training for your home exercise program.• You will progress in your knee exercises to increase knee bending and strengthening.• You will continue to progress ambulation distance while maintaining weight-bearing

status indicated by your physician.• You will be taught to negotiate stairs.

Post Discharge:• You will continue to use your assistive device until your follow-up appointment with

your physician.• Keep your incision site clean and dry. Do not use peroxide, alcohol or lotion on the

incision.• No mechanical home or gym equipment should be utilized during therapy.

If you have any questions concerning your Physical Therapy, please contact your Physical Therapist at Northside Medical Center-(706) 494-2165. Your therapist will provide you with instructions for your home exercise program and discuss the importance of continuing your exercise program to promote your recovery.

REHABILITATIVE SERVICES – Page 2


Each patient’s discharge planning needs are different and must be tailored to meet yourindividual needs. Collaboration is required in order to accomplish your plan of care when youleave our facility.

The Case Manager receives orders from your physician to facilitate your discharge from thehospital. The health care team initiates this process in part on the first day of your arrival to thehospital. The Case Manager will visit with you on Post Op Day 1 and will review your needs andaddress any further care that has been identified.

Based on your physician’s orders, your options may be Outpatient Services and/or Home Health.Outpatient Services may include follow-up lab tests, suture/staple removal and physical therapythree times a week. Your lab work can be done at a local hospital, clinic, or your medical physician’s office; whichever is most convenient and/or economical. Your physician or physicaltherapist may perform staple removal, if indicated. (Some wound closures will not require stapleor suture removal.) Other services can be provided according to your individual needs.

Currently, we are unaware of any insurers that pay for sitter/aide services. Due to the variousoptions and/or possible limitations of benefits, the earlier we can begin your discharge planning,the better we can meet your needs. To facilitate your plans and meet your needs and wishes, wewould appreciate your assistance in identifying the resources available to you in the communityin which you live. A form is provided in this packet, to assist you in this endeavor.

If you already know that you have specific needs for care following discharge, for instance mealpreparation, housekeeping, the desire for sitters, or a personal care home, you must address theneeds prior to your admission to the hospital. You will need to speak to your family and friendsor private sitters to assist you after discharge. Northside Medical Center does not facilitate theseservices but can provide a list if you need assistance locating someone prior to your surgery.

Some patients may go to an extended care facility, rehabilitation facility, or personal care homefor a short time following discharge due to extenuating circumstances at home or due tocontinuing care needs. Whatever your discharge planning needs, we want to make sure weaddress your needs in every way possible.

We will make referrals and schedule all outpatient appointments prior to you leaving the hospital.The Case Manager will also assist in ordering any medical equipment that you may need otherthan that issued to you during your hospital stay. Items such as a hospital bed, bedside commode,or other items will be ordered for you as your physician deems it is necessary.

We look forward to working with you!

DISCHARGE PLANNING


Please identify the following agencies of your choice from your local community. Please bringthis information with you to the hospital. Your Case Manager will obtain it from you at your firstmeeting.

PATIENT NAME: ______________________________________________________________

PHONE NUMBER: _____________________________________________________________ LOCAL HOSPITAL: ____________________________________________________________

HOME HEALTH AGENCY: _____________________________________________________

PHYSICAL THERAPY AGENCY: ________________________________________________

NURSING HOME: _____________________________________________________________ INPATIENT REHABILITATION CENTER: ________________________________________

____________________________________________________________________________

FAMILY PHYSICIAN: ________________________________________________________

CASE MANAGER PATIENT RESOURCE FORM

FOR DISCHARGE PLANNING


CALL THEDOCTOR IF…

Wound is leaking abnormally. Temperature is over 101°.

Pain increasesdrastically.

Swelling increases.

Calf or thigh is very firm.

Uncontrolled nausea and vomiting.

Chest Pain

Shortness of Breath

CALL THEDOCTOR IF…

Wound is leaking abnormally. Temperature is over 101°.

Pain increasesdrastically.

Swelling increases.

Calf or thigh is very firm.

Uncontrolled nausea and vomiting.

Chest Pain

Shortness of Breath

Family:Offer support and encouragement.• Keep morale high by sharing time with him/her watching movies, playing a board game or practicing on the putting green.• Encourage getting the most out of the exercise classes.• Keep him/her focused on returning to a healthy lifestyle.

On the home field:• Prepare healthy meals• Keep incision clean and dry• To help with swelling, elevate the lower legs/feet on three pillows for 30 minutes, twice a day. The legs should be as straight as possible when lying down• Apply ice to the incision area 20 minutes, twice a day•Make sure that your patient does the exercises included in this patient guidebook. No slacking on this one!• A walker or cane should be used until the patient feels confident to walk without it. Encourage increased activities gradually – go outside and enjoy a walk as tolerated. Eventually expand the activity to include things that have been avoided because of painful joints. Start enjoying life again.

AFTER YOUR DISCHARGE

Each year, thousands of Americans fall at home. Many of them are seriously injured and some

are disabled. Falls are often due to hazards that are easy to overlook, but easy to fix. Because of

your hospitalization, you are at an increased risk for falls. There are many things you

can do to decrease the risk of falls in your home. The following is a checklist you can use to

prepare your home for your return from the hospital.

_____Be sure to use equipment such as your walker, cane, crutches properly.

_____Move furniture for a clear path to walk around the house with your walker.

_____Remove throw rugs or put non-slip backing/double sided tape on the back of

rugs so they will not slip.

_____Remove objects on the floor that may be in your way such as magazines, shoes,

boxes, etc.

_____Adhere electrical cords to the wall or have an electrician put in an extra outlet

so you do not have to walk over or near them.

_____Keep objects off the stairs.

_____Install light switches at the top and bottom of your stairs.

_____Have any loose carpet repaired.

_____Have any loose or broken handrails repaired.

_____In the kitchen, move all frequently used items to low shelves.

_____Put a non-slip rubber mat or self-stick strips to the floor of the tub or shower.

_____Install grab bars inside your tub or shower and next to the toilet.

_____Put a lamp on each side of your bed.

_____Use a night-light so you have a clear path through the house at night.

_____Wear shoes inside and outside the house.

_____Add lighting to dark areas of your house.

_____Have your vision checked at least once a year.

_____Be aware of which medications you take that may cause you to be sleepy or

dizzy.

_____Keep emergency numbers in large print near each phone.

_____Put a phone near the floor in case you fall and can’t get up.

_____There are alarm devices that you can wear in case you fall and can’t get up.

These can be purchased from security companies/medical companies.


PREVENTING FALLS AT HOME


ITEM YES NO COMMENT

Support person to drive you home upondischarge

Driver’s license or picture ID with yourname and address

Completed Advance Directive

Insurance card(s) and any other insuranceforms you may deem necessary

Any and all forms supplied to you by yourphysician such as Consents or PhysicianOrders

Pajamas and/or nightgown, knee length robe

Shorts, T-shirts, loose fitting pants,warm-up suits for comfort duringexercising. Socks, non-skid slippers & apair of closed-toe supportive shoes

CPAP/BIPAP machine & accessories

Extra pillows for supporting yourself in thecar on the way home(personalized)

Basic Toiletries

Any assistive devices that you already have, - walker, crutches, elevated commode

seat, may be brought to the hospital.- Please clearly mark you name on these

items.Otherwise, we will provide them for you.

A list of medications with the name of the medication, the dosage and how often taken.

Autologous / Directed Donor BloodInformation.

All recent lab work results, test results and medical consultation information

WHAT TO BRING TO THE HOSPITAL

Please utilize this worksheet as a checklist to verify important items you will want to bring with you to the hospital.


WHAT NOT TO BRING TO THE HOSPITAL

Please leave valuables, such as jewelry or money, at home. If you find it necessary to bring valuable items with you, we encourage you to allow security to lock them in our safe during your stay. Northside Medical Center will not be responsible for lost items.

REMEMBER: DO NOT EAT OR DRINK AFTER MIDNIGHT THE NIGHT PRIOR TO YOUR SURGERY

We hope this information packet was helpful in your preparation for admission and your hospital stay. If there is anything we can do during your stay to increase your comfort and satisfaction, or if there is anything we can do to make this program better… please tell us. We consider it a privilege to serve you.


People facing joint replacement surgery typically ask the same questions. However if you have questions that are not covered in this section, please ask your surgeon or the joint care team. We are here to help.

What is arthritis and how does it affect my knee? There is a skin like covering over the bones called the periosteum.This covering contains nerve endings. In a healthy joint, there is agelatin like structure, called cartilage, which cushions the area wheretwo bones meet to form the joint. The cartilage actually prevents thetwo bones from coming in direct contact with each other and irritatingthe nerve endings. Over time, the cartilage begins to wear away. With little or nocartilage to serve as a cushion, the ends of the thigh bone (femur) andthe shin bone (tibia) begin to rub on each other. The nerve endingsbecome irritated. The constant rubbing of bone-on-bone is responsiblefor the pain, swelling and stiffness that are associated with an inflamedbone or arthritis.

What is a total knee replacement?The term “total knee replacement” is misleading. The knee is not totally removed and a new knee inserted. Rather, the ends of the femur and tibia are reduced and then capped with an implant device referred to as a prosthesis. The process is similar to having a crown put on your tooth. A plastic spacer is attached to the prosthesis that creates a smooth cushioning effect much like the original cartilage. Relieving the bone-on-bone contact eliminates the pain and allows you to return to an active, healthy lifestyle.

Will my new knee set off security sensors when traveling?The prosthesis used to replace your worn bone endings is made of a metal alloy and may or may not be detected when going through some security devices. You will be mailed a joint I.D. card indicating that you have an artificial joint.

FREQUENTLY ASKED QUESTIONS

BEFORE: Bone rubbing on bone

AFTER: Cap and spacer preventsbone-on- bone contact

04/21/23 Total Knee Replacement - Patient Guidebook) 40

FREQUENTLY ASKED QUESTIONS - Page 2

What is the success rate for total knee replacements?Approximately 90-95% of patients report good to excellent results in terms of pain relief. Most are able to significantly increase activity and mobility and return to the activities they participated in prior to the onset of arthritis pain.

Am I too old for this surgery?Your overall health is more of a determining factor than your age. Prior to the surgery, you will be asked to see your family doctor or one of the Internal Medicine Physicians at Northside Medical Center to assess any health risks. All measures will be taken toPrepare you for a successful surgical outcome.

How long will my new knee last?There are no guarantees on how long your new knee will last. Various factors such as weight, activity type, activity level, etc., can affect the usable life of your new knee prosthesis. Current studies indicate that the average knee prosthesis lasts for 10-20 years. With new materials and procedures, this expectation may change.

Will I need to have my knee replaced again in the future?Some people have a knee replacement that lasts their entire lives; other people need to have the procedure repeated. If the bone does not bond properly to the first replacement, the prosthesis becomes unstable and needs to be replaced. If the plastic spacer that cushions the joint becomes extremely worn, this may also require replacing.

Are there major risks associated with this type of surgery?All surgeries carry a certain amount of risk. However, because of our proactive approach in preventing possible complications, most of our joint patients are just fine and are ready to leave the hospital in a few days.

We take special care to safeguard you from infection following surgery. You will be given antibiotics both before and after the surgery. To further minimize the risk of infection, we have streamlined the surgical procedure to take less time. The less time your wound is open, the less chance of infection.

Following surgery, blood clots can be a problem. To keep clots from forming, you will be given an anticoagulant and shown several exercises. Getting you up and walking soon after surgery is another way to reduce the risk of blood clots.


FREQUENTLY ASKED QUESTIONS – Page 3

How long does knee replacement surgery take?The surgery itself takes about 2 hours. After the surgery you will be monitored closely in aspecial unit called the Post Anesthesia Care Unit (PACU) until the anesthesia wears off (usuallyone hour). Once you are awake and stable, you will return to your room.

Who will be doing the surgery?Your orthopedic surgeon will be performing the surgery. An assistant often helps during the surgery. You may be billed separately for the assistant’s services.

Will I be awake during the surgery?During the surgery, an anesthesiologist will administer an anesthetic that will provide total pain relief. There are several different forms of anesthetic. A general anesthetic will “put you to sleep.” Other forms of anesthetic, such as a spinal, epidural or nerve block, will numb specific areas so that you will not feel any pain. Often these types of anesthetics will be used with another IV medication to help you relax and go into a light sleep like state. You and your anesthesiologist will discuss which method is best for you prior to your surgery. Feel free to discuss any concerns you may have at this time.

What will my scar look like?The scar length may vary depending on multiple factors, but the average length is four to six

inches long, starting above the knee and traveling down the center of the knee. If you have a scar from a previous knee surgery, it may be possible to enter over the old scar depending upon its location. Incisions are closed with sutures or staples. If Steri Strips are over the incision, leave them on until they come off on their own. There may be some numbness around the scar after it is healed. This is perfectly normal and should not cause any concern. The numbness usually disappears over time.

Other than the scar, will my joint be any different? Some people notice a minor clicking sound when they bend their joints. This is the result of the

prosthesis, or artificial parts, coming in contact with each other. It is normal and is no cause for concern.

Kneeling may be a bit uncomfortable during the first year. This normally becomes less noticeable over time.

Will I need a blood transfusion after surgery? There is a possibility that you may need a blood transfusion after surgery. You have the option

of relying on blood from the blood bank or you may donate your own blood prior to the surgery. Your donated blood will be stored for your use only.



Will I be in a lot of pain? Our joint center specializes in joint replacement surgery. Assuch, we have considerable experience in caring for patientsafter surgery and know how to keep our patients comfortable. Pain meds are given as IM injections, IV, or by mouth which can be received every three hours if needed. Ask for your pain meds before the pain gets bad. It is more difficult to get the pain undercontrol if you wait. Feeling pain is to be expected. Most people do not require strong pain medication after the first day and can switch to oral medications. Your pain will be graded on a pain scale of 1-10. Our goal is to make it tolerable for you so you canparticipate in your therapy and daily activities.

How long will I be confined to bed after surgery? Physical Therapy may get you out of bed on day of surgery, depending on your physician and the time of day you return to your room. Early the next morning, you will be up and dressed to start the day’s activity. Usually, patients are up and walking with a walker or crutches in the morning.

How long will I be in the hospital?Joint replacement patients usually stay with us about two to three days. Then they are ready to go home. Before you leave, however, it is important to be comfortable using a walker or crutches, and you must meet certain goals.

Will I need a walker, crutches or cane? People progress at their own rate. Normally, patients use an assistive device such as a walker, crutches or cane for about four to six weeks. Your surgeon will tell you when it is time to retire them.

After leaving the hospital, when do I need to see my surgeonagain?An appointment will be made for you when you are discharged telling you when to see your surgeon.



When can I go home?Most of our patients go home on the second or third dayfollowing surgery. Occasionally, some patients require a short three to five day stay in a sub acute facility, but this is the exception rather than the rule.

Will I need help at home the first week?Although you will be well on your way to recovery whenyou leave the hospital or sub acute facility, it may be necessary to have someone assist you with meals, medication, dressing, etc. If you go directly home from the hospital, the case manager can arrange for a home healthcare nurse to visit you as needed. Be sure to alert the joint care team if you live alone or have special needs.

To make the transition to home easier, be sure to plan ahead. It is a good idea to have thought through options of what you would like after you leave the hospital. Also, prior to coming to the hospital, take care of such things as getting prescriptions filled, changing the beds, doing the laundry, washing the floors, arranging for someone to cut the grass and walk the dog, stocking up with frozen foods, etc. Your job after surgery is to focus on recovering, not household tasks.

Will I need physical therapy when I go home?Your surgeon will order physical therapy after discharge as needed. If you cannot attend outpatient physical therapy, an in-home therapist will be arranged.

The number of physical therapy sessions is based on your individual progress. To a large extent, your progress will be determined by how much effort you put into your exercise routines. You will be given post-op exercise instructions at time of discharge.

Are there any activities that I should avoid initially?Keeping your new joint moving will help your recovery process. However, you should return to your normal activities gradually. In some instances you may have to work your way up to a particular activity. Taking a five mile walk on your first time out, for example, is not realistic. Rather, walk until you begin to get tired. Add distance to each subsequent walk until you have reached your goal.

Avoid extreme positions and high impact activities, such as jogging, singles tennis, basketball, downhill skiing, football, etc. Consult your surgeon prior to participating in any high impact or potentially injury-prone sports.



Why should I exercise before surgery?The better the condition your muscles are in prior to the surgery, the easier and faster your recuperation is expected to be. It isimportant to learn the exercises and be comfortable with themprior to the surgery so that you can continue them once youreturn home. Starting the exercises now will build muscletone and pave the way to a quick recovery.

Read exercise section in this patient guidebook which outlinespre-op exercises. Begin doing the exercises immediately. Yournew joint will be happy that you did.

Are any activities better than others?Exercise is important to the entire body to maintain health. It is especially beneficial for your new joint. Ask your doctor when it is safe for you to incorporate low impact activities, such as dancing, golf, hiking, swimming, bowling, gardening, etc., back into your normal routine.

When can I return to work?The physical demands required for your job, as well as your own progress, will determine when you can return to work. Typically, people plan on taking a one month leave of absence from work. Some people with very sedentary jobs may be able to return sooner. Your surgeon will tell you when you can return to work.

When can I drive?How soon you resume driving depends on several factors.It can be as little as two weeks or as long as six weeks ormore. Much of this largely depends on how committed youare to your exercises and physical rehabilitation.

Another consideration is the mechanics it takes to driveyour car. If you have had a left knee replaced, you maybe able to drive a car with an automatic transmission inas little as four weeks depending upon your own personalprogress. If your surgery was on your right knee or youare driving a manual transmission requiring the use ofboth feet, then you may not be ready to drive for six ormore weeks. It all depends on the condition of your joint and how far you have progressed. Regardless of your progress, you should not consider driving if you are still taking narcotic pain medication. Your surgeon will let you know when it is advisable to drive again.



When can I resume sexual intercourse?After surgery, it takes time to regain your strength as well as your confidence in your new knee. Most people feel able, physically and mentally, to engage in sexual activity about four to six weeks after surgery. Although individuals vary in their healing rate, at the four to six week point the incision, muscles and ligaments are usually sufficiently healed to consider resuming sexual activity. Talk to your surgeon if you have any questions regarding this.

Will my medications affect my ability to engage in sexual intercourse? Some medications can affect performance and/or enjoyment during intercourse. Many narcotic pain relievers and cortisone medications can decrease sexual performance. Other common medication-related side effects are a decreased interest in sex, vaginal dryness, abnormal erections and delayed orgasms.

If you sense that your medication is causing these side effects, try having sex in the morning before taking your first dose or in the evening before your last dose.

DO NOT adjust or stop taking your prescribed medicine without consulting your surgeon. Often, a simple adjustment or change of medication can eliminate unwanted side effects.

What if sex doesn’t go well?Remember, you are still healing. Just like other activities that youare returning to, it may take some time to regain your formerstamina. Realize that these changes to your sex life are temporaryand are needed to protect your new knee joint. Just relax.You’ll be back to your old self in no time.


PRE-OP KNEE EXERCISE CIRCUITSDO A MINIMUM OF TWO CIRCUITS A DAY

See the following pages for descriptions of the exercises below:

Exercise #1 Ankle pumps 20 reps

Exercise #2 Quad Sets – Knee Pushdowns 20 reps Exercise #3 Gluteal Sets – Buttock Squeezes 20 reps Exercise #4 Abduction and Adduction 20 reps Exercise #5 Heel Slides 20 reps

Exercise #6 Short Arc Quads 20 reps

Exercise #7 Long Arc Quads 20 reps

Exercise #8 Armchair Push-ups 20 reps

Exercise #9 Seated Hamstring Stretch 20 reps

Exercise #10 Straight Leg Raises 20 reps


EXERCISE # 1 - ANKLE PUMPS

1. Extend your foot as far as you can with toes pointing forward.

2. Then bring your foot back in the opposite direction towards your leg. You should feel the calf muscles working.

3. Repeat 20 times.


EXERCISE # 2 - QUAD SETS – PUSHDOWNS

1. Lie on your back and using the muscles on top of your thigh, press knee into bed or couch. Hold and release.

2. You should feel the muscles on front of thigh tighten.

3. DO NOT hold your breath.

4. Repeat 20 times.


EXERCISE # 3 - GLUTEAL SETS – BUTTOCK SQUEEZES

1. Squeeze the buttock muscles together. Hold and release.

2. DO NOT hold your breath.

3. Repeat 20 times.


EXERCISE # 4 - HIP ABDUCTION AND ADDUCTION

1. Lie on your back with legs together.

2. Slide right leg out to the side. Keep toes pointed up and knee straight. Return

to starting position.

3. Slide left leg out to the side. Keep toes pointed up and knee straight. Return

to starting position.

4. Repeat 20 times.


EXERCISE # 5 - HEEL SLIDES

1. Lying on couch or bed, slide the heel of your foot towards your buttock.

2. Slide your heel to the original resting position.

3. Repeat 20 times.


EXERCISE # 6 - SHORT ARC QUADS

1. Lie on your back. Place a towel roll under your knee.

2. Lift foot, straightening knee.

3. DO NOT raise your knee off the towel roll.

4. Repeat 20 times.


EXERCISE # 7 - LONG ARC QUADS

1. Sit with your back comfortably against chair with feet on the floor.

2. Straighten your knee so that your leg is parallel to the floor.

3. Hold and release, returning to original position.

4. Repeat 20 times


EXERCISE # 8 - ARMCHAIR PUSH-UPS

1. Develop your arm muscles by sitting in a straight armchair.

2. Place hands on armrests.

3. Straighten arms, raising buttocks up off chair seat. This may take some

practice if your arm muscles are weak. It is important to continue to do

this exercise to build up your muscles. Increased arm strength will

be needed during your recovery period.

4. Repeat 20 times.


EXERCISE # 9 - SEATED HAMSTRING STRETCH

1. Sit on couch or bed with your leg extended straight.

2. Lean forward, keeping your back straight.

3. Stretch until pull is felt in the hamstring muscles.

4. NO bouncing or reaching toward your toes.

5. Hold for 20-30 seconds and release.

6. Repeat 20 times.


EXERCISE # 10 – STRAIGHT LEG RAISE

1. Lie on your back with the nonsurgical knee bent and foot flat.

2. Keep the surgical knee straight and raise it 12 inches.

3. Toes should be pointed up.

4. Hold and release.

5. Repeat 20 times.

Documents

8/13/2015Total Knee Replacement - Patient Guidebook (copyright 2007)1