Hip Fracture - Aurora Health Careyour hands. • Clean your hands often. Use soap and water for at least 15 seconds, or use an alcohol-based hand rub. Do this before eating, after

Hip Fracture

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Table of Contents

Welcome ………………………………………………………………………………………………………………… 2 Your Personal Health Care Team …………………………………………………………………………….. 2 Surgical Overview Understanding Hip Fractures……………………………………………………………………………………. 4 Hip Fracture Surgery: Types …………………………………………………………………………………….. 5 Preparing for your Surgery Partners in Safety ……………………………………………………………………………………………………. 6 Deep Vein Thrombosis (DVT) Prevention ………………………………………………………………… 7 Compression Stockings (T.E.D.S) …………………………………………………………………………….. 8 Pressure Ulcer Prevention – Working Together to Keep Your Skin Healthy ……………… 9 Controlling Your Pain ………………………………………………………………………………………………. 10 Advance Directives …………………………………………………………………………………………………. 12 After Surgery Nutrition Tips for the Surgical Patient …………………………………………………………………….. 14 Opioid Induced Constipation …………………………………………………………………………………… 16 Discharge Options After Surgery ……………………………………………………………………………… 17 Returning to Work …………………………………………………………………………………………………… 18 Therapy and Exercises Weight Bearing Instructions ……………………………………………………………………………………. 19 Exercise Program Following Hip Fracture Surgery – Phase 1 ……………………………………. 20 Adaptive Equipment – Dressing ………………………………………………………………………………. 22 Toilet Transfer Following Hip or Knee Surgery …………………………………………………………. 23 Wheeled Walker Instructions ………………………………………………………………………………….. 24 Bed Transfer ……………………………………………………………………………………………………………. 28 Car Transfer …………………………………………………………………………………………………………….. 30 Discharge Information What to Expect at Home after a Hip Fracture ………………………………………………………….. 31 Reducing Your Risk of Osteoporosis ………………………………………………………………………… 32 Fall Prevention in the Home ……………………………………………………………………………………. 34 Important Facts About Quitting Smoking ………………………………………………………………… 36 Miscellaneous Glossary …………………………………………………………………………………………………………………… 37 Notes ………………………………………………………………………………………………………………………. 40

Welcome A sudden fall or accident causing a hip fracture can be a life changing event. Most people will need surgery to repair the fracture. The type of surgery you need will depend on the location and severity of the fracture. You may have pins, screws, or rods holding the fractured bones in place while you heal or you may need to have some or all of your hip joint replaced. This book will provide you with information about your hip fracture, the type of surgery you may need, what to expect during your hospital stay and the knowledge and skills to make your recovery the best it can be. Our staff of highly trained professionals will work with you and your family to provide you with better health care than you can get anywhere else.

Your Personal Health Care Team The success for achieving your outcomes after partial knee replacement surgery requires a team effort. This team includes, but is not limited to, the health care professionals listed below. Please use the brief descriptions as a guide.

• Care Partner: A family member or friend who will help you with your recovery.

• Orthopedic Surgeon: Your orthopedic surgeon will perform the surgery. Your surgeon will work together with your personal health care team to ensure you are healing and recovering.

• Medical Doctor: Your primary medical doctor or a doctor chosen by your surgeon who may help manage

your care.

• Anesthesiology Team: Your anesthesiology team will be responsible for giving you anesthesia and monitoring you during surgery. The team and your surgeon work together to manage your pain.

• Nurse: Your nurse will partner with you to manage your pain, coordinate your care and provide education to prepare you for discharge.

• Physical Therapist: Your physical therapist will help you improve mobility and strength after surgery. The therapist will see you daily for exercise, walking and practicing skills needed for everyday activities.

• Occupational Therapist: Your occupational therapist will help you to safely regain your independence

with activities of daily living, such as bathing, dressing and cooking. The therapist will recommend any needed equipment.

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• Discharge Planning Team: A member of the team will assist you with your discharge needs, help you establish a discharge plan, make referrals to a skilled nursing facility (sub-acute rehabilitation facility), provide community resource information and/or make referrals to home care agencies.

• Other members of your Personal Health Care Team may include:

o Respiratory Therapist o Chaplain o Pharmacist o Dietician/Nutritionist o And the most important member of your team – you

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Understanding Hip Fractures The hip is the largest weight-bearing joint in the body. It’s also a common place for a fracture after a fall—especially in older people. Hip fractures are even more likely in people with osteoporosis (a disease that leads to weakened bones).

A Healthy Hip

The hip is a ball-and-socket joint where the femur (thighbone) joins the pelvis. When the hip is healthy, you can walk, turn, and move without pain. The head or “ball” of the femur (thighbone) fits into a socket in the pelvis. The ball and socket are each covered with smooth cartilage. This allows the ball to glide easily in the socket. Blood vessels supply oxygen and nutrients to keep the hip joint healthy.

A Fractured Hip

The hip can fracture in many places. Most often, the fracture occurs in the upper part of the femur. You can also have more than one type of fracture at a time.

• A transcervical fracture is a break across the neck of the femur. This type of fracture can interrupt blood flow to the joint.

• An intertrochanteric fracture is a break down through the top of the femur.

• A subtrochanteric fracture is a break across the shaft of the femur.

© 2000-2013 Krames StayWell, 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions. Krames Version 6.1 2013 K85945 AHC (12/2013)

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Hip Fracture Surgery: Types

The type of surgery you have often depends on where the hip is fractured. In some cases, an internal fixation is used. These are pins, screws, or a rod placed into the fractured bone to hold it in place. In other cases, part or all of the hip is replaced. This is done when there is a lack of blood supply to the head of the femur.

Metal pins are often used to repair fractures along the neck of the femur. The pins are inserted through the bone to keep it stable while it heals.

A metal compression screw may be used to repair a fracture down through the femur. As the bone heals, the screw gets tighter. This allows the edges of the bone to grow together.

A metal rod or nail may be used if the fracture is along the shaft of the femur. The rod is inserted into the bone shaft. A screw keeps the bone edges together as they heal.

Hip Replacement

Artificial parts may be used to replace part or all of the hip joint. For a total hip replacement, a new stem and ball are placed in the femur. These fit into a new cup secured in the pelvis. For a partial hip replacement, only the stem and ball are replaced.

© 2000-2013 Krames StayWell, 780 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions. Krames Version 6.1 2013 K85945 AHC (12/2013)

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Partners in Safety Help us keep your hospital stay safe and error-free

Our goal is to give you the finest care possible. You can help by being an active member of your health care team. Please feel free to ask questions or share comments about your care.

To help with taking your medicines safely in the hospital • Tell your doctors, nurses and pharmacist what

medicines you take. This includes over-the-counter medicines (such as aspirin or nasal spray) and dietary supplements (such as vitamins and herbs).

• Tell your doctors, nurses and pharmacist about any allergies you have had to medicines or products such as latex or iodine.

• Be sure to ask questions: – If a medicine is new – If it looks different to you – If the timing does not seem right

• When you leave the hospital, we will give you a personal list of your medicines. Always bring this list to your doctor visits and pharmacy.

To help prevent getting an infection • Ask all health care workers who have direct contact

with you if they have washed their hands. • Cover your mouth and nose with tissue when you

sneeze or cough. Throw away the tissue and wash your hands.

• Clean your hands often. Use soap and water for at least 15 seconds, or use an alcohol-based hand rub. Do this before eating, after going to the bathroom, after coughing or sneezing, and after touching dirty clothing, bedding or dressings.

• Remind your family and visitors to clean their hands. If they are sick, they should not visit you in the hospital.

The information presented is intended for general information and educational purposes. It is not intended to replace the advice of your health care provider. Contact your health care provider if you believe

To help your surgery or procedure go as planned • Talk with your surgeon. Make sure you agree with

and know exactly what will be done. • Your doctor may use a special pen to mark

the part of your body to be operated on. Tell your doctor if you think the marking is in the wrong place.

To prevent falling • Get up slowly from the bed or chair to prevent

dizziness. • Use your call light when you need help and wait for

assistance. • Keep personal items within your reach. • Ask for help walking if you need it. • Wear non-skid slippers when out of bed. • When recommended, use help devices such as a

walker, cane or wheelchair. • Keep the pathway to your bathroom free

of obstacles. Other steps you can take • Ask a family member or friend to be your “second

set of eyes and ears” in helping you understand your care.

• Family members should watch for “precaution” signs on door and follow recommendations (such as wear mask or gloves).

• Call for help if the alarm is beeping from your IV (intravenous) pump or other machine in your room.

• Use side rails and handrails to help you move safely while in bed, bathroom and hallways.

Remember It is always OK to ask questions: • If you do not understand your medicines

or treatment • If something is new or confusing • If something does not seem right

you have a health problem. AuroraHealthCare.org

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The information presented is intended for general information and educational purposes. It is not intended to replace the advice of your health care provider. Contact your health care provider if you believe you have a health problem.

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Deep Vein Thrombosis (DVT) Prevention What is DVT? Deep vein thrombosis (DVT) occurs when blood clots form in a vein (blood vessel) far below the skin. It happens most often in the leg, but can also be in the arm. Blood clots can cause swelling, pain, tenderness and redness and may lead to leg ulcers. Blood clots are dangerous because a piece can break off (“embolism”) and travel in the blood stream to the lungs (“pulmonary embolism”). This can be life threatening. Who gets DVT? People who get DVT are those who have one or more “risk factors.” Here are the things that increase a person’s risk of getting DVT: • History of DVT • Personal or family history of clotting • Recent serious surgery • Serious injury or broken bones • Cancer or cancer treatment • Increasing age • Pregnancy or within the first month after delivery • Taking hormones such as birth control or female

estrogen replacement • Smoking if you have a history of clotting problems

or take birth control pills • Obesity • Chronic heart, lung or kidney conditions • Stroke (recent) • Central intravenous (IV) catheters • Bed rest more than 2 to 3 days • Inactivity such as sitting in a car or airplane

for a long time Blood clots can occur without symptoms Be sure to tell your doctors if you have any of the risk factors listed above.

What can you do to prevent DVT? • Discuss your risk factors with your doctor. • Do not smoke. • Walk as much as possible because exercise keeps

your blood moving and prevents clots. • Try not to sit or stand for long periods. Move and

raise your legs when sitting or in bed. • Do not cross your ankles for long periods. • Avoid bumping or injuring your legs. • Avoid tight clothing, especially around the knee. If you have risk factors: • Check your arms and legs and watch for signs of

swelling or poor circulation (blood flow). • Your doctor may order blood thinners

(“anticoagulants”) to prevent clots from forming. Follow all instructions for medicine and laboratory testing if needed.

• Your doctor may order compression stockings for your legs. These stockings improve blood flow, limit leg swelling and are used to prevent blood clots and long-term vein damage. Be sure the stockings fit well and keep them pulled up without wrinkles. Wear them as much as possible for as long as your doctor tells you.

• Deep massage and heating pads may be harmful if used when blood clots are present. Ask your doctor about these treatments before use.

Call your doctor if you have DVT symptoms: • New or increased swelling, pain, tenderness, warmth

or redness in one of your arms or legs • Fever Seek medical care right away if you have: • Chest pain • Shortness of breath • Rapid heart beat • Cough (especially if blood is noticed) If you call your doctor or seek medical care, report DVT risk factors and previous history of blood clots.



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Compression Stockings (T.E.D.S.) Compression stockings improve blood flow, reduce swelling, and prevent injury to the walls of your veins. They are often used to lower the chance of blood clots forming in your legs (deep vein thrombosis – DVT). The chance of blood clots forming is much higher during or soon after hospital discharge because your muscles are less active. Patients who have had a blood clot are encouraged to wear their compression stockings to limit leg swelling and permanent vein damage in the lower leg.

To apply Your legs must be measured to ensure that your stockings fit well. The stockings must be put on according to the steps below to prevent serious complications. Do not gather the stocking together into a “donut” since that will make it less able to stretch. Follow these basic steps: 1. Insert one hand into the stocking as far as the heel pocket. 2. Grasp the center of the stocking inside out to the heel area. 3. Carefully place the stocking over your foot and heel. Be sure your heel is centered in the heel pocket.

4. Pull the stocking up and fit it around your ankle and calf, working up to final position. Smooth out any wrinkles between the tip of stocking and your ankle. Check your stockings often and pull them back up as needed. 5. Be sure to wear your stockings as directed. During your hospital stay you will have your stockings on day and night. Your nurse may

remove them to examine or wash your legs . When you go home, ask your doctor if you may take them off at bedtime. If you take them off, put them on again before getting out of bed when your legs are the least swollen.

Precautions Do not turn down the top of the stockings for any reason. If your stockings cause pain, cramping or skin discoloration, remove them and call your doctor. You may need to be re-measured for new, better-fitting stockings. Skin and stocking care Remove your stockings at least once a day. Wash your legs and feet and look for any reddened areas or sores. If they don’t go away, report them to your doctor. Do not use ointments, oils, or lanolin on your feet or legs unless directed by your doctor. Launder your stockings every three (3) days. They can be machine washed using a mild soap. Do not use harsh detergents and bleaches. Tumble dry on a low temperature for 15 minutes or air dry.

Pressure Ulcer Prevention

Working Together to Keep Your Skin Healthy Our goal is to help you maintain healthy skin • Activity and a good diet promote healthy skin. • If you lie or sit in one position too long you

may injure your skin. This could lead to a pressure ulcer (or bedsore).

• A pressure ulcer is an injury to the skin and the tissue under the skin. A pressure ulcer may be painful and may take a long time to heal. We want to work together to prevent this from happening to you.

Factors that increase the risk for a pressure ulcer: • Decreased activity • Poor diet • Incontinence • Poor circulation • Age – if you are age 70 or older • Underweight

Where do pressure ulcers develop? Pressure ulcers usually occur over bony areas of the body, such as the hips, buttocks and heels. See figure below.

What can we do together to prevent a pressure ulcer? • Change your position often. Tell your nurse or

caregiver if you need help. • When in bed, turn or change position every

1 to 2 hours. • When sitting in a chair, shift your weight at

least every hour. • Use a pillow to lift your heels off the bed. • Keep skin dry. Tell your nurse or caregiver if your

skin or bed is wet. • Tell your nurse or caregiver if something is hurting

your skin. • Do not slide your skin across the sheets.

Lift and move your arms and legs. • Eat a healthy diet. • Do not massage over bones. • You may need or may have a special mattress on

your bed or chair (or both). • Your nurse can work with you to make a turning

schedule. A picture of a clock may be used to help you remember to change your position regularly.

We encourage patients and families to be involved in their health care. We encourage your help to keep your skin healthy.

The information presented is intended for general information and educational purposes. It is not intended to replace the advice of your health care provider. Contact your health care provider if you believe you have a health problem. AuroraHealthCare.org

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Controlling Your Pain Our goal for treating pain A certain amount of pain may be expected for many patients, such as those recovering from surgery. Today, pain is no longer something you “just have to put up with.” With medicines and other therapies, it’s possible to prevent, relieve and sometimes get rid of pain altogether. Our goal is to do everything we can to work with you to control your pain and keep you comfortable.

Good pain control can help you: • Eat, sleep and move better. • Get well faster. With less pain, you can walk more,

do your breathing and physical exercises better, and regain your strength more quickly. You may even leave the hospital sooner.

• Improve your results after surgery. Patients whose pain is well controlled seem to do better after surgery and avoid problems like pneumonia and blood clots.

Working together to control pain It is important to set goals for pain control with your health care team (doctors, nurses and other caregivers). Being “comfortable” means that your pain control lets you rest. But, it also means you are able to do the activities needed to recover and maintain your quality of life. Your caregivers will be asking you to set goals for pain control at rest and with activity. If your pain goals change, talk with your caregivers. Describing your pain Tell your caregivers that you have pain, even if they don’t ask. Your doctor or nurse will ask you to describe how bad your pain is on a scale of 0 (no pain at all) to 10 (the worst possible pain). They may use other pain scales that use words or pictures (faces). Tell them where and when it hurts and if anything brings on the pain.

Source: FPS-R, Bieri, et al. (1990)

0 2 4 6 8 10

0 = No pain 10 = Very much pain

The following words can be used to describe your pain: Aching Burning Comes/Goes Constant Cramping Discomfort Dull

Heavy Incisional Pressing Pricking Pulling Radiating Sharp

Shooting Stabbing Tender/sore Tightness Throbbing

You also will be asked about what makes the pain worse and what makes it better. We will let you sleep during the night between your care activities, unless you ask us to wake you. Call your nurse if you wake up and are in pain. The more your caregivers know about your pain, the better they can treat it.

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Controlling Your Pain, Page 2 Developing your pain control plan Your caregivers will work with you to set your pain control goals and to develop a plan to keep you comfortable and active – designed just for you. You often will be asked to “rate” your pain to help us know if your medicine and other treatments are working. We want to treat your pain before it becomes too strong and out of control.

Using pain medications We want you to understand the medicines you are taking for pain, why you need these medicines, and what possible side effects you could have. Pain medicine can be given in many forms. Your doctor may prescribe a pill, liquid or injection (shot) for you. Pain medicine also can be given through a tube in your vein (IV). Some people are able to use patient- controlled analgesia (PCA), a special pump that allows the person to give themselves medicine when they hurt. The most common side effects of pain medicine are upset stomach, nausea, constipation, dizziness, sleepiness, confusion, itching or problems with urination.

Ask for pain medicine at least 30 minutes before any activities that cause discomfort or pain (repositioning, getting up, walking and bathing, and before breathing treatments, wound care or physical therapy). This allows the pain medicine to begin working before the activity starts and will improve your pain control. The more comfortable you are during these activities, the more they will help you.

Medications called “opioids” often are used for people who have more severe pain. Your health care team will give you instructions to prevent and treat constipation, a condition that may occur while taking these medicines. When opioid medication is taken for several weeks, the body gets used to the medication effect, a normal condition known as “tolerance.” Tolerance means that “withdrawal symptoms” like sweating, anxiety, irritability, nausea or diarrhea, may occur if the opioid is stopped suddenly. Tolerance symptoms are normal and not the same as being “addicted.” It just means that when opioids are no longer needed, the dose must be decreased gradually.

Using non-medication pain treatments To reduce pain and help you to relax, the following non-drug pain treatments also can be used: • Position your body for comfort; reposition often • Hot or cold packs • Music • Relaxation techniques • Massage Example: Jaw relaxation is an exercise that can be completed in just a few minutes: 1. Let your lower jaw drop slightly as if you are

starting a yawn. 2. Rest your tongue on the roof of your mouth. Soften

your lips. 3. Breathe slowly and rhythmically while breathing in

and breathing out, and then rest. 4. Repeat the pattern breathing in and breathing out,

and resting while continuing to relax your jaw. Feel the tension leaving your body.

Managing pain at home Your health care team will work with you to plan your pain control, and help you to continue your recovery and healing at home. • Before you leave the hospital, make sure you

understand the medications you will be taking at home, why you need these medications and possible side effects.

• Make a written schedule, take your medications and do treatments as instructed.

• Give your medication time to work. Oral medicines can take 20 minutes or more to work before you start to feel better.

• Medications work better when you relax. • If your pain is not being relieved, getting worse or

has changed, call your health care provider. • Take your medications with food to avoid an upset

stomach, unless told not to do so. • Never drink alcoholic beverages while taking pain

medications. • Pace yourself. Get up and move around. Plan rest

periods to keep from feeling fatigued or overtired. • Keep your pain medications safe and out of reach of

children/teens.


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Advance Directives Letting Others Know Your Health Care Wishes

The Main Points ...

An Advance Directive • Is a legal form • Speaks for you when you are not able to

express your wishes • Ensures your wishes are carried out • Can be made free of cost • Can be changed or canceled any time

The Power of Attorney for Health Care • Is the type of form we recommend • Is the most detailed kind of Advance

Directive • Allows you to appoint someone to speak

for you when you are not able to do so • Allows you to make many choices about

future care • Examples are the Five Wishes® or Aurora Health

Care’s Power of Attorney for Health Care Document

Need help or have questions? • Ask your doctor or nurse for more

information • Visit our website at:

www.Aurora.org/ACP • Call Aurora Health Care at 888-863-5502

for a free packet of information You have the right to choose what kind of care you want. At Aurora Health Care, we will listen to and follow your wishes. But what if you became unable to decide for yourself? Who would speak for you? Would they know what you want and don’t want? Please think about taking steps now to make sure your wishes are known.

Write down your wishes in an Advance Directive One way to make your wishes known is to write them down in an Advance Directive. This is a legal form that tells your choices about the health care you would or would not want if you became unable to decide for yourself. An Advance Directive helps you and your family An Advance Directive speaks for you when you are unable to do so. It serves as a guide for your health care team. It also relieves your family of trying to guess what you would want. Plan now for the future If you are age 18 or older, please think about having an Advance Directive. It’s a good idea to fill one out while your health is good and you can think clearly about your choices. Talk about your wishes with your loved ones and health care provider. You will also want to review your Advance Directive as changes occur in your health or life. Without an Advance Directive, others decide for you If you cannot speak for yourself and have no Advance Directive, your health care provider will ask your family or close friends to help decide on your care. If they are unsure or do not agree about your care, they may ask the court to appoint a guardian who will decide for you. This guardian may not be the person you would have chosen.

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Advance Directives, Page 2 Two kinds of Advance Directives

1. Power of Attorney for Health Care (e.g., the Five Wishes® or Aurora Health Care’s Power of Attorney document) This is a form in which you appoint another person as your “health care agent.” Your agent is your legal decision-maker. He or she will work with your health care provider to make sure your wishes are carried out, if you are not able to do so.

This form goes into effect only when two doctors, or a doctor and a psychologist, agree in writing that you are no longer able to understand your health care choices or express your wishes.

The Power of Attorney for Health Care is more detailed than a Living Will. More choices can be made about future care, such as whether or not you would want to: • Be placed on life support machines • Go to a long-term care home • Receive nutrients or fluids through a tube in

your vein, nose or stomach • Stop, any measures keeping you alive

2. Living Will This form describes what type of care you would want – or not want – to prolong your life. It would be used if you had a terminal illness or were in a persistent vegetative state. (Two doctors must agree to this in writing.)

The Living Will does not give anyone else the right to make health care decisions on your behalf. In some cases, if no one has been named to speak for the patient, the courts become involved in these decisions.

Choosing between Power of Attorney for Health Care and Living Will You do not need both. We recommend the Power of Attorney for Health Care because it names your health care agent who can speak for you. It also allows you to express more of your values and wishes. If you do have both forms, the Power of Attorney for Health Care would be the one that goes into effect for you. You can change or cancel an Advance Directive Advance Directives can be changed or canceled at any time. You can make changes by writing a new form. You can cancel by destroying the form. Be sure to tell your health care provider in either case. Keep the form in a safe place Keep your Power of Attorney or Living Will in a safe place. Let your family or others close to you know where they can find it if needed. If you travel, take a copy with you. Also, ask your doctor or nurse for a wallet card to carry with you at all times. Give a copy to: • Your health care provider (you’ll want to

discuss the form and make sure he or she agrees to honor your wishes) • Your health care agent(s) named in your Power of Attorney for Health Care • Your family or others close to you • Your lawyer if you have one • The clinic or hospital where you go for care

(for your medical record) An Advance Directive is free An Advance Directive can be made free of cost. You can get help and needed forms by calling your health care provider or by calling Aurora Health Care at 888-863-5502. A lawyer can also help you, but this is not required.

The information presented is intended for general information and educational purposes. It is not intended to replace the advice of your health care provider. Contact your health care provider if you believe you have a health problem. AuroraHealthCare.org

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Nutrition Tips for the Surgical Patient This guide has been prepared for your use by registered dietitians. If you have questions or concerns, please call the nearest Aurora facility to contact a dietitian.

A well-balanced diet: • Gives your body the energy it needs before

and after surgery • Helps fight infection • Promotes healing The amount of food you need depends on your age, gender, activity level and physical condition. Limit your intake of foods high in fat and sugar. They should not replace nutrient-rich foods.

What foods do you need? If you are on a special diet, keep following it unless your doctor tells you to follow another plan. The food guide below will help you choose foods that supply the nutrients you need – protein, carbohydrate, fat, vitamins, minerals and water. A low intake of nutrients delays healing. If you are not able to eat the recommended foods, you may need a vitamin and mineral supplement.

Food groups Recommended servings

Examples of one (1) serving

Grains Good sources of complex carbohydrates, B-vitamins, iron, some minerals and fiber

5 to 10 servings daily • 1 slice of bread • 1/2 cup cereal, rice, potato, pasta or

most starchy foods

Vegetables Good sources of vitamins, minerals and fiber

3 to 5 servings daily • 1 cup raw vegetables • 1/2 cup cooked vegetables or

vegetable juice Fruits Good sources of vitamins, minerals and fiber

2 to 4 servings daily • 1 medium apple, orange, pear • 1/2 banana • 1 cup raw fruit • 1/2 cup cooked fruit or juice

Dairy Products Good sources of protein, calcium, and Vitamins A and D

3 servings daily • 1 cup low-fat milk or yogurt • 11/2 ounces natural low-fat cheese • 2 ounces low fat processed cheese

Meat and Non-Meat Alternatives Good sources of protein, B-vitamins, iron, zinc and other minerals (non-meat examples include peanut butter and nuts)

5 to 7 ounces daily 1 ounce = • 1 ounce cooked lean meat, poultry, fish • 1/4 cup cooked dried peas or beans • 1 egg • 1 tablespoon peanut butter • 1/2 ounce nuts

Fluids Important for the body’s cells

At least 8 cups daily • Water, milk, juice, other fluids • Limit alcohol and fluids that have

caffeine



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Nutrition Tips for the Surgical Patient, Page 2

Protein Protein is needed for healing after a surgery. It is the building block for cells and tissues. A diet low in protein may slow wound healing. Good food sources are meats, dairy products, eggs and legumes. If you need to follow a low-cholesterol, low-fat diet, choose lower-fat items in these groups.

Vitamins and minerals Vitamins and minerals are also needed for healing. Antioxidants may decrease the risk of infection. Fruits and vegetables are the best sources of antioxidants. Try to eat 5 to 9 servings a day from these food groups.

Good sources of antioxidants • Apricots • Asparagus • Broccoli • Brussels sprouts • Canned pumpkin • Cantaloupe • Carrots • Collard greens • Corn • Grapefruit • Green bell peppers • Mangoes • Oranges and orange juice • Papaya • Red peppers • Spinach • Strawberries • Sweet potatoes • Tangerines • Tomatoes and tomato juice • Tropical fruit juice (papaya or mango) • Vitamin-C fortified fruit drinks

Preventing constipation Constipation can be caused by many things, including medication, inactivity and changes in diet. Here are some tips you may find helpful: • While you are in the hospital, you may receive

“Fiber Basics” to help resolve constipation (one to two tablespoons daily as needed). This is a puree of dates, raisins, prunes and prune juice.

• Drink plenty of fluids – at least 8 cups daily. This may help to keep the stool soft.

• Include juices, especially prune juice and apple juice, to help loosen stools.

• Drink a hot beverage about a half hour before your usual time for a bowel movement. Hot liquids often help to start bowel activity.

• Eat high-fiber foods, such as: – Whole-grain bread, cereals and pasta – Fresh fruits and dried fruits, such as prunes,

raisins and dates – Fresh vegetables – Dried beans and peas – Whole-grain products, such as barley, oats or

brown rice • If raw fruits and vegetables are hard to chew,

try grating them into a salad or gelatin, or blenderize them.

• Eat the skin on fruits, vegetables and potatoes, unless you have trouble chewing or swallowing.

• Try high-fiber snack foods, such as oatmeal cookies, fig cookies and date or raisin bars. (Granola, popcorn or nuts may be used if you have no chewing or swallowing problems.)

• Add 1 to 2 tablespoons of unprocessed wheat bran to foods, such as cereal, casseroles and homemade bread.

• Activity, such as walking, can also help start bowel activity. Follow your doctor’s advice for activity.

• If you continue to have problems, you may need a stool softener or laxative.

If you have questions or concerns about your diet or nutrition while you are a patient in the hospital, please ask for a dietitian visit.


AuroraHealthCare.org X23183bc (10/2016) ©AHC

Treatment of Opioid-Induced Constipation Constipation is one of the most common side effects of opioid pain medications. Signs of constipation can include: • Less frequent bowel movements • Hard stools • Difficulty or straining to eliminate • Nausea, bloating, abdominal cramping or pain What can you do about constipation? Constipation often brings hard, dry stools. This is why we recommend using both a stool softener (docusate sodium) and a laxative (senna). The stool softener moistens the fecal matter so it is softer. The laxative promotes movement within the intestinal tract (bowel). There are many forms of docusate and senna available. You can buy both without a prescription. Choose the generic tablets; this will work just as well as the name brand and can save you money. How should you take these medicines? • Take them daily, at bedtime. • If you find you need to increase the dose, you can

space tablets throughout the day – morning, noon, dinnertime, and bedtime – in order to avoid abdominal cramping.

• The recommended starting dose of docusate sodium or Colace® is one 100 mg capsule every day at bedtime. This can be increased to six capsules (or 600 mg) a day at most, if needed. Taken by itself, docusate may take one to three days to work.

• The recommended starting dose of senna or Senokot® is two 8.6 mg tablets every day at bedtime. This can be increased to eight tablets (about 70 mg) a day at most, if needed. Taken by itself, senna may take 6-12 hours to work. Do not be alarmed if senna changes the color of your urine to yellow-brown or pinkish-red.

Can I get both medicines in one tablet? Yes, there are combination products available. Senokot-S® tablets contain both docusate sodium 50 mg and senna 8.6 mg. The recommended dose of Senokot-S® is two tablets taken together every day at bedtime. Again, this can be increased to eight tablets per day at most, if needed. Remember that generic products are available. Ask your pharmacist to help you select the product that’s best for you. What else can I do for constipation? • Drink plenty of fluids – at least eight glasses of

water a day. Try to avoid caffeine and alcohol as these can have a dehydrating effect.

• Eat foods high in fiber (increase amounts slowly to avoid stomach cramping). Examples are: o Whole-grain bread, cereals, barley, oats,

brown rice and pasta o Fresh fruits and dried fruits, such as prunes,

raisins and dates o Fresh vegetables, or dried beans and peas

• Include juices, especially prune juice and apple juice, to help loosen stools.

• Drink a hot beverage about a half hour before your usual time for a bowel movement. Hot liquids often help to start bowel activity.

• If raw fruits and vegetables are hard to chew, try grating them into a salad or gelatin, or blenderize them.

• Eat the skin on fruits, vegetables and potatoes, unless you have trouble chewing or swallowing.

• Try high-fiber snack foods, such as oatmeal cookies, fig cookies and date or raisin bars. (Granola, popcorn or nuts may be used if you have no chewing or swallowing problems.)

• Add 1 to 2 tablespoons of unprocessed wheat bran to cereal, casseroles or homemade bread.

• Exercise if you are able, even if it is only walking around the house. Any movement helps to stimulate the bowel movement.

If problems with constipation continue even with the above suggestions, be sure to contact your health care provider for stronger prescription medicine.



X16399bc (Rev. 08/13) ©AHC

Discharge Options After Surgery

Most patients do go home after recovering in the hospital. Starting the day after surgery, our team (your doctor, nurse, therapist and social worker) will talk with you about your discharge needs. If you are not able to return home, other options are available and listed below. If you have questions, you may call the hospital Social Service department. Your insurance company or Medicare will determine your coverage.

You should be able to return home if you: • Are able to get in and out of bed by yourself. • Are able to get on and off the toilet by yourself. • Are able to walk safely 30 to 50 feet, following

weight-bearing restrictions. • Are able to use stairs (if needed). • Are able to safely perform your home exercise

program. You should be able to go home and return for Outpatient Therapy if you: • Are able to do all of the above, but still need

rehabilitation services (physical therapy, occupational therapy, or speech therapy).

• Are able to transfer in and out of a car or van. • Have someone who can drive you to and from

therapy. You may need Home Care if you: • Are able to do all of the above, but still need help

to enter or leave home. • Need a nurse for skills such as wound care. • Need continued rehabilitation services. • Are temporarily homebound except for going to

doctor appointments.

You may need a Subacute Rehabilitation or Skilled Nursing Facility if you: • Need 24-hour care. • Are able to tolerate at least 1 hour a day of

therapies. • Are medically stable. • Need help with bathing, dressing and transfers. You may need Acute Rehabilitation (a hospital-based program) if you: • Have ongoing medical needs that require

management by a doctor in the hospital. • Need 24-hour care. • Can tolerate and would benefit from 3 hours a day

of at least 2 different therapies. • Need help with bathing, dressing and transfers. You may need unskilled services (private pay, hourly, not covered by insurance) such as: • Mobile meals • Homemaker, companion service • Lifeline

Returning to Work – Hip Fracture If you or your family member is still working, check with your employer’s Human Resources department about short- and/or long-term disability and Family Medical Leave prior to surgery. Returning to work will vary depending on the type of work that you do and what limitations you may have following your surgery. Talk with your orthopedic surgeon about concerns related to returning to work and keep the lines of communication open between you and your employer. If your job does appear to be affected by your time off from surgery, you need to understand your rights. The Americans with Disabilities Act bans discrimination by both public and private employers against qualified workers who have disabilities or history of disabilities. For more information, contact the Equal Employment Opportunities Commission at 800-669-4000.


AuroraHealthCare.org xpe014bc(1/2014)

Weightbearing Instructions

Your doctor has decided how much weight you can bear on your involved leg. Please follow the checked () instructions below. Remember that the harder you push down with your hands (on your crutches or walker) the less weight you will bear on the involved leg.

Non-weightbearing (NWB) • Do not put any weight on the involved leg. • Keep that foot off the ground when walking.

Toe Touch weightbearing (TTWB) • Very little weight (less than 20 pounds) can be put on the leg. • The entire foot of the involved leg is allowed to touch the floor.

Partial weightbearing (PWB) • _____ pounds can be put on the involved leg. • The entire foot of the involved leg is allowed to touch the floor. • You can check how many pounds you are putting on the leg by using a bathroom scale.

Weightbearing as tolerated (WBAT) • You may bear as much weight on the involved leg as comfortable. • If you feel any pain, you’ll know you are putting too much weight on the leg.

Continue to use your walker or crutches until your doctor or therapist tells you that you don’t need them. If you have questions or these instructions are not clear to you, please be sure to call your doctor or therapist.

X16592bc (Rev. 12/2013) ©AHC Hip Fracture

Exercise Program following Hip Fracture Surgery – Phase 1

1. Breathing Exercises Exercise can be done while sitting or lying down. Action: Place your hands directly below the “V” formation of your ribs. Take a slow deep breath in through your nose. Keep your neck and shoulders relaxed. You should feel your stomach push out against your hand. Exhale slowly through your mouth with pursed lips, you should feel your belly move inward as you exhale.

Do repetitions times per day.

2. Ankle Pumps Exercise can be done while sitting or lying down. Action: Pull foot up and then point foot down as far as possible.


3. Quad Sets Action: While lying down, tighten the muscles on the top of the thigh and hold for 5 seconds. Relax and repeat.


4. Gluteal Sets Exercise can be done while lying down or standing. Action: Squeeze buttocks together and hold for 5 seconds. Relax and repeat.


5. Heel Slides Action: While lying down, slowly bend knee, sliding heel up towards buttock. Do not lift heel from surface. Slowly return to the starting position. (May need assist from another person for this exercise.)


Continued



X16592 bc(Rev. 12/2013) ©AHC Hip Fracture

Hip Fracture Exercise Program - Phase I, Page 2 6. Terminal Knee Extension

Action: Lie down. Place rolled towel under knee. Slowly lift foot up by straightening the knee as far as possible. Hold for 5 seconds, then return to starting position.


7. Supine Hip Abduction

Action: Lie down. Keep knees straight and toes pointed up to the ceiling. Slide involved leg out as far as possible and return to the starting position. (May need the assist of another person for this exercise.)


8. Bent Knee Fall Out

Action: Lie down. Keep the non-surgical leg straight and position the surgical leg with foot on floor and knee bent. Put hands on pelvis to monitor motion. Gently let the bent knee fall out to the side. Do not force additional movement. The back and pelvis should not move. Return to starting position.


9. Knee Extension

Action: While sitting, slowly lift foot as you straighten knee. Hold knee straight for 5 seconds, then slowly return to starting position.


10. Sitting Push-Ups

Sit near the front of a chair that has armrests. Place hands on the armrests and bend forward from the hips. Push with your arms and lift the weight of your body halfway to a standing position. Your feet should stay on the floor. Don’t let your spine round forward. Keep chest lifted up to prevent breaking hip precautions. Hold for a count of 3. Slowly lower body back to the starting position using the arms.




X24519 bc(3/2014) ©AHC Adaptive Equipment/ADL/Arthritis

Adaptive Equipment – Dressing You may find that everyday tasks, such as dressing, are difficult and require some thought and preparation. By planning ahead and being prepared, you may find these tasks more manageable. The following suggestions and tips may be helpful.

Dressing 1. Gather all necessary articles of clothing and equipment and place next to where you will be dressing. 2. Sit on the edge of the bed or in a chair. 3. Start by dressing your legs using a sock aide for socks or anti-embolism stockings (if prescribed by

your doctor).

4. Use a long reacher or dressing stick to put on pants and

undergarments. 5. Hold clothing down by your feet and thread your feet

into them. 6. Pull the clothes up with the stick or reacher until you can

reach the waistband with your hand. 7. Stand with walker for support, if necessary, and pull

over hips. 8. To undress, use the reacher or dressing stick to push garments down.

Put on shoes using a long-handled shoehorn. Elastic shoelaces are available to make slip on shoes out of tie shoes.

To take off shoes, use a dressing stick, reacher or long-handled shoehorn to push off.



X24520bc(Rev. 4/2014) ©AHC Transfers/Total Hip Replacement/Total Knee Replacement

Toilet Transfer Following Hip or Knee Surgery

After your surgery, you may find it difficult to complete daily tasks such as toileting. The following suggestions and tips may be helpful to you.

Toileting 1. Use the equipment recommended by your therapist(s). 2. Back up to the toilet with your walker until you feel the toilet on the back of your legs. 3. Extend your surgical leg out in front of you. 4. Reach back for the grab bar, toilet seat, and/or armrests and lower yourself to the toilet. 5. Bend your hip and knee on your non-operated leg as your are sitting down. 6. When getting off the toilet, extend your surgical leg out in front of you. 7. Push up from the toilet seat or armrests.


AuroraHealthCare.org X47574bc (10/13) Rehab > Amb/Assistive Devices

Continued

How to adjust your walker to the proper height • Stand up straight with your arms resting at

your side. • The walker height should be at wrist level. • There should be a slight bend in your elbows

(on an angle of about 30 degrees) when holding on to the walker.

To stand up Place both hands on the armrests or seat of the surface you are sitting on. Push yourself up with both hands and legs to stand up. Once you are standing, place both hands on the walker securely before you begin to walk. Do not hold on to or pull up on the walker to stand up, as it may tip over. To sit down Back up until your legs touch the surface you are going to sit on. Reach back, one hand at a time, for the armrest or seat of the surface you are going to sit on. Sit down slowly.

Wheeled Walker Instructions


AuroraHealthCare.org X47574bc(10/13) Rehab > Amb/Assistive Devices

To walk Stand up straight, do not hunch over. Once standing, push the walker forward a comfortable distance so that both of your legs can step into the walker frame. Push the walker forward, keeping all four legs of the walker in contact with the floor. Walk into the walker, keeping hips close to the rear legs of the walker. Step forward one foot at a time. Take a natural stride and pace if possible. As you walk, each foot should step past the other. If one leg is weaker than the other, step forward with the weaker leg first. Turning wheeled walker in a large space Roll walker in a wide turn in the easiest direction. Turning wheeled walker in a tight corner Pick up the walker and turn it slightly; place it down on the floor. Take small steps into the walker. Repeat several times to complete the turn. To climb stairs Walkers are not recommended for use on stairs. If a walker is the only device you can use, follow the special instructions given to you by your physical therapist. Use a railing rather than the walker. Lead with the stronger or less painful leg when going up stairs and lead with the weaker or more painful leg going down stairs. If there is no difference, then lead with either leg, taking one step at a time.

Wheeled Walker Instructions, Page 2



Safety tips Do not try to carry anything in your hands when using a walker. Instead, get a basket or bag to attach to the walker and place your items in that. Curb step without a rail – Option 1 To go up curb • Get the walker as close to the curb as possible. • Place the walker up on the curb with all 4 legs

down flat on the curb. • Step up with the strong leg first. • The weak or painful leg comes up last. • If there is no difference, then lead with either leg,

taking one step at a time. To go down curb • Get the walker as close to the edge of the curb

as possible. • Place the walker down to the lower level • Step down with your weak or painful leg first. • Your strong leg comes down last. • If there is no difference, then lead with either leg,

taking one step at a time.




Curb step without a rail – Option 2 Retro/backward method – if you can put only limited or no weight on one leg To go up curb 1. Back up to the curb with the walker until your

heels are touching the curb. 2. Step back with your strong leg up onto the

curb first. 3. Then bring the weak or painful leg up last.

If there is no difference, then lead with either leg.

4. Slowly pull the walker up onto the curb and place all 4 legs down flat.

5. Turn and face forward, turning the walker with you. Carefully start walking.

To go down curb 1. Get the walker as close to the edge of the curb

as possible. 2. Place the walker down to the lower level. 3. Step down with the weak or painful leg first. 4. Then bring the strong leg down last. If there is

no difference, then lead with either leg. 5. Carefully start walking again.


Continued Xpe015bc (Rev. 12/13) ©AHC

Bed Transfer Lying down 1. Sit at edge of bed. Extend surgical leg out in front of you. 2. Support your upper body with your arms. Slightly lean back and lift your surgical leg onto the bed. 3. Lift your non-surgical leg onto the bed. 4. Using your elbows and forearms, lean back and slowly lower upper body down onto the bed.

Bed Transfer, Page 2


Xpe015 bc(Rev. 12/13) ©AHC


Sitting up 1. Prop yourself up on your forearms and move upper body forward. 2. Swing your non-surgical leg off of the bed. 3. Swing your surgical leg off of the bed. Allow your knee

to relax. Do not hold it out stiff.

Car Transfer You may find everyday tasks, such as getting in and out of a car, to be a little harder after your surgery. By planning ahead and being prepared, you may be able to manage these tasks better. The following may be helpful.

Preparation tips for caregivers • Place firm pillow on seat to make it higher. • Use a slick pillow cover or a garbage bag to

make sliding easier. • Park away from curb. • Move seat back and recline. • Stand by to assist.

Getting into car • Back up to car • Tuck head down and place hand on back of

car seat for support while sitting down. • Use only unaffected leg to push up and back

onto seat. • Caregiver assists as needed. • Slowly swivel around. TIP: Wear smooth

clothing to make this easier. • Once sitting place a pillow between knees. • Fasten seat belt and keep back reclined.

The information presented is intended for general information and educational AuroraHealthCare.org purposes. It is not intended to replace the advice of your health care provider. Contact your health care provider if you believe you have a health problem. X24522bc (3/2014) ©AHC Transfers

Special precautions • Keep legs apart. • Avoid twisting affected leg. • Follow hip precautions if

needed.

http://aurorahealthcare.org/


AuroraHealthCare.org xpe088bc (4/2015) ©AHC

What to Expect at Home after a Fractured Hip First week after discharge

• Call your surgeon’s office and schedule your follow up appointment.

• Follow activity precautions and weight bearing restrictions as instructed and use equipment such as a reacher, sock aid, long handled sponge, shoehorn or a raised toilet seat if needed.

• You may need someone to help you with dressing, putting on support hose, showering and fixing meals. Grab bars in your bathroom may be helpful.

• Check your incision/bandages daily (or have someone help you do this). Follow your discharge instructions.

• Keep using ice and elevate your legs to help reduce swelling.

• Do your ankle pumps often and while your

leg is elevated. • Do not sit for more than one hour at a time.

Get up to walk often. • Take pain medicine before exercise sessions

and with increased activity. Follow your surgeon’s instructions for taking pain medicine

• Rest between activities to prevent getting over tired. It is normal to feel more tired during the first month of recovery.

• You will be more comfortable lying on your non-surgical side until your staples are out.

• While lying on your side, keep pillows between your legs.

• Constipation is a common problem. Talk to your nurse or pharmacist about a treatment plan using diet and medicines.

• Do not drive until your surgeon says it is safe for you to do so. You may need help getting in and out of a car or van.

Two to four weeks after surgery • Follow your activity precautions and weight

bearing restrictions until your surgeon says you may stop doing so.

• Pain and swelling will slowly decrease. • Keep using ice and elevate legs to help

reduce the swelling. • Continue your ankle pump exercises often

and while your leg is elevated • Continue your exercise program. • Do not sit for more than one hour at a time.

Get up to walk often. • Continue to use your walker, crutches or cane

until your surgeon or therapist tells you that you don’t need them.

• Your surgeon will tell you when you can begin driving.

Five to eight weeks after surgery • Follow your activity precautions and weight

bearing restrictions until your surgeon says you may stop doing so.

• Continue your exercise program to increase your strength and motion of your hip.

• Gradually increase your walking distance • Continue to use your walker, crutches or cane

until your surgeon or therapist tells you that you don’t need them.

• Check with your surgeon about sexual activity and position precautions.

Six months after surgery • You may have occasional discomfort and

stiffness. • Swelling will gradually go away. • You may have numbness on the outside edge

of your incision. This is normal. • You should be able to resume a normal

walking pattern.

X19722bc (Rev. 06/12)

Reducing Your Risk for Osteoporosis What is osteoporosis? Osteoporosis is a silent disease that causes bones to become fragile and prone to fracture. Bone loss usually occurs slowly, over time, without symptoms.

Do I need to worry about osteoporosis? All adults, especially women, should know about their risk for osteoporosis and what they can do to prevent it. Osteoporosis leads to 1.5 million fractures of the hip, spine or wrist each year. More than half of those who survive having a hip-fracture will need long-term care. A smaller number of hip fracture patients do not even survive the first year.

How do I know if I’m at risk? Talk with your health care provider, as each person’s risk will depend on many factors. If it appears you may have osteoporosis, your health care provider can request testing to find out for sure. In general, the risk factors for osteoporosis include:

• Lifestyle – A diet low in calcium, not enough vitamin D, little or no exercise, cigarette smoking and drinking too much alcohol are all risk factors for this disease.

• Gender – Women are more likely to get osteoporosis than men. This is due to women’s lighter, thinner bones and the decrease in the hormone estrogen during and after menopause.

• Age – The longer you live, the more likely you are to get osteoporosis. Although all of us lose bone tissue as we age, the amount and rate of loss varies widely with each person.

• Family history – Adults who have had a broken bone, or have close family members who have had fractures, are at increased risk for osteoporosis.

• Ethnicity – Caucasian and Asian women are at highest risk; African-American and Hispanic women are at less but still significant risk.

• Body size – Low-body weight (under 127 pounds) and a small-boned frame places you at risk.

• Prolonged use of certain medications can lead to bone loss and fractures. This includes steroids to treat conditions such as asthma and arthritis, chemotherapy drugs, certain antacids, proton pump inhibitors and blood thinners.

What can I do to decrease my risk?

• Make sure you’re getting enough calcium. Calcium is important for bone health, for proper function of your heart, muscles and nerves, and for normal blood clotting. Dairy products are a good source of calcium. Other calcium sources include some fruits, vegetable, grains and fish (see next page for more details). The National Osteoporosis Foundation recommends that women over age 50 need at least 1,200 milligrams (mg) of calcium per day, and men over 50 need at least 1,000 mg per day. The typical American diet provides about 600 mg per day. Calcium is best absorbed when taken in 500 to 600 mg amounts.

• Make sure you’re getting enough vitamin D.

Vitamin D plays an important role in calcium absorption and in bone health. The combination of supplemental calcium and vitamin D reduces the risk of fracture of the spine, hip and other sites. Sources of vitamin D include sunlight, foods and supplements. Good food sources include vitamin D-fortified milk and cereals, egg yolks, saltwater fish and liver. The National Osteoporosis Foundation recommends: – 400 to 800 international units (IU) of vitamin D

per day for adults under age 50 – 800 to 1,000 IU of vitamin D per day for adults

age 50 and older Some people may need higher doses of vitamin D – talk with your health care provider about what dose is right for you.

Continued

X19722 bc(Rev. 06/12)

1 cup 189 1 medium 60

1 slice 25

Reducing Your Risk for Osteoporosis, Page 2

• Do regular weight-bearing exercise. Weight-bearing and muscle-strengthening exercises can improve strength and balance, and reduce the risk of falls. Exercise can also promote a modest increase in bone density. Weight-bearing exercises (which force you to work against gravity) include walking, jogging, stair climbing, dancing, jumping rope and high-impact aerobics. Weight lifting improves muscle mass and bone strength.

• Do not smoke. Smoking is bad for your bones, as well as your heart and lungs. Women who smoke have lower levels of estrogen and go through menopause earlier than nonsmokers.

• Avoid overuse of alcohol. More than two to

three drinks a day may be harmful to your bones. People who drink heavily are more prone to bone loss and fracture because of poor nutrition and an increased risk of falling.

Osteoporosis can be prevented. Talk with your health care provider about your risk for osteoporosis and whether you should have a screening test. Take action now to reduce your risk and prevent this disease from happening to you.

The best sources of calcium

Milk and dairy products Amount Calcium (mg) Yogurt, plain (low-fat) 1 cup 416 Milk, non-fat (dry) powder 1⁄3 cup 377 Yogurt, fruit flavored (low-fat) 1 cup 345 Cheese, Ricotta, part non-fat 1⁄2 cup 337 Cheese, Parmesan (hard) 1 ounce 336 Milk, skim 1 cup 302 Milk, 1% and 2% 1 cup 300 Milk, whole 1 cup 291 Buttermilk 1 cup 285 Milk, chocolate (low-fat) 1 cup 284 Cheese, Swiss 1 ounce 272 Cheese, Monterey Jack 1 ounce 212 Cheese, mozzarella (low moisture, part skim) 1 ounce 207 Cheese, cheddar 1 ounce 204 Cheese, Muenster 1 ounce 203 Cheese, colby 1 ounce 194 Cheese, American 1 ounce 174 Ice cream 1⁄2 cup 88 Cottage cheese, creamed 1⁄2 cup 63

Meat & Protein Sardines (canned, with bones) 3 ounces 372 Salmon, pink (canned, with bones) 3 ounces 165 Tofu (processed with calcium) 4 ounces 145 Almonds, shelled 1 ounce 66 Soybeans, cooked 1⁄2 cup 66 Dried beans, cooked (lima, navy, kidney) 1⁄2 cup 35-48 Egg 1 large 27

Fruits and vegetables Amount Calcium (mg) Collards, cooked 1⁄2 cup 168 Turnip greens, cooked 1⁄2 cup 134 Kale, cooked 1⁄2 cup 103 Spinach, cooked 1⁄2 cup 84 Broccoli, cooked 1⁄2 cup 68 Chard, cooked 1⁄2 cup 64 Orange 1 medium 60 Carrot, raw 1 medium 27 Dates, chopped 1 cup 26 Raisins 1 cup 22 Calcium-fortified orange juice (Citrus Hill, Minute Maid) 8 ounces 300 Calcium-fortified cereal (Total) with milk 1 ounce 350

(with 1⁄2 cup milk) Grains Farina, enriched

(instant, cooked) Tortilla, corn Bread, whole wheat

Peanut butter 2 Tablespoons 18 Beef patty, cooked (21% fat) 3 ounces 9



X27812bc (9/2015) ©AHC Home Safety/Falls Prevention, Multiple

Fall Prevention in the Home Falls are a leading cause of injury and death in the home, especially for older adults. Most falls can be avoided by using the following tips:

1. Make your home safe

In the bathroom • Install grab bars in the tub and around the toilet • Use a non-skid shower mat • Use a hand held shower head • Install a raised toilet seat • Use a shower bench to sit while showering and drying • In a sitting position, dry your feet before getting out of

the tub or shower • Sit to shave, apply makeup or fix your hair • Use a urinal or bedside commode if you have problems

with urination or diarrhea that cause you to rush

In the living room • No throw rugs or area rugs • Remove cords and clutter from walkways • Use furniture with firm cushions and arms to help you get up safely • Make walkways wider

In the bedroom • No throw rugs or area rugs • Turn on the light before getting out of bed in the dark • Sit for a minute at the edge of the bed before getting up • Sit while dressing • Use equipment to help with dressing • Make sure bed covers do not drag on the floor

In the kitchen • Put commonly used items in easy to reach places • Slide heavy objects along counter top to avoid carrying • Use a cart to move heavy items • Use kitchen chairs that don’t have wheels • No throw rugs • Use a kitchen timer to avoid unnecessary trips to check food

Stairs • Use handrails; install handrails on both sides if possible • Install light switch at the top and bottom of the staircase • Place bright colored tape at the edge of each step • Install a non-skid surface on each step • Remove all clutter

Continued



X27812bc (9/2015) ©AHC Home Safety/Falls Prevention, Multiple Sclerosis

Fall Prevention in the Home, Page 2

Lighting • Use night lights • Make sure a light switch is at the entry of every room • Use an automatic light timer to avoid walking into a dark house • Try to use glare-free light bulbs

Outdoors and entries • Walkways are free of clutter • Walkways and entrances are well lit and salted during ice/snow • Steps have railings and lighting • Consider motion sensors

2. Take your medication

Be sure to take medications as instructed by your doctor or pharmacist.

• Keep a current list of all medications with you at all times • Ask your doctor to review the list at every visit • Know the purpose and possible side effects of medications • Some medications can make you dizzy or lose your balance

3. Stay active

Staying active is one of the most important ways to stay strong, keep your balance and lower your chances of falling.

• Lack of exercise can lead to weakness and problems with walking • Use shoes that fit well and have non-slip soles • Use a cane or walker as instructed by a therapist • Be careful of ice and bad weather

4. Other hints

• See your doctor if you fall or feel unsteady when you walk. The doctor may recommend physical therapy to help prevent falls.

• Be sure your clothing fits well and does not cause you to trip • Be sure to wear your glasses • Have your eyes checked regularly • Drinking alcohol may make your balance worse • Increase the number of phones in the house • Keep a cordless phone with you • Do not rush • Never use a chair as a step stool • Clean up spills • Carry small, light loads • Consider a Lifeline® or other emergency alert system



X26396bc (07/12) ©AHC

Important Facts About Quitting Smoking

Why is it worth the effort? Quitting smoking is one of the best things you can do for the sake of your health. Tobacco is the single greatest cause of disease and premature death in our country today. To quit smoking is to: • Greatly lower your risk for lung cancer, heart

attack, stroke • Lower your risk for many other illnesses

and cancers • Increase your energy and improve your circulation • Breathe easier • Protect those around you

Your family will be healthier if you quit smoking. Second-hand smoke is a known cause of lung and other cancers and it can lead to other health problems. Children exposed to second-hand smoke have more ear infections, colds, asthma, pneumonia, and bronchitis than those who are not exposed.

Isn’t quitting just a matter of willpower? No. Nicotine is a very addictive drug. Because smoking is an addiction, quitting is not easy for most smokers. But no one should have to quit without help and support. Today, help is just a phone call or an office visit away.

What if I’ve already tried and failed? Most people make two or three tries or more before they are able to quit smoking for good. Think of your past attempts to quit as good practice for this time. You may not have had the information and support you needed in the past. This time can be different.

What about the weight gain? It’s true that many people gain weight after quitting smoking, but the gain is usually just several pounds. You can plan ahead for a healthy diet and activity that can help you limit any weight gain. The risks to your health from smoking are far greater than the risks from several extra pounds.

What’s the best way to quit? The United States Public Health Service recommends that smokers trying to quit should use one of the approved medications that can help. These medications were approved by the Food and Drug Administration. Some of them can be bought without a prescription. Ask your health care provider or pharmacist about these. Often medications alone are not enough to help a person quit. Studies show that medication and counseling together can increase a person’s chances of quitting for good. One great source of free information is the Wisconsin Tobacco Quit Line. Wisconsin Tobacco Quit Line The Quit Line provides telephone coaching to Wisconsin tobacco users who want to quit. Callers will receive: • Personalized advice on how to quit, information

on medications, and help with choosing a quit date and creating a quit plan.

• Two weeks of free medication (nicotine patch, nicotine gum, or nicotine lozenge)

• Self-help materials and referrals to local programs and services.

• Use of a secure website where tobacco users can interact with others trying to quit, get support, and track results.

The Quit Line is free of charge to Wisconsin residents. Call 800-QUIT NOW.

Glossary Adaptive equipment Special equipment that can be used to assist with performing everyday tasks

like dressing and bathing. ADL Activities of Daily Living Daily activities such as dressing, bathing, preparing meals, etc. Ambulate Walking Anesthesiologist The physician who will give you anesthesia and monitor you during surgery. Anesthetist The specially trained nurse who will give you anesthesia and monitor you

during surgery. Antibembolic stockings Commonly called TED or JOBST stockings. Nylon elastic compression

stockings worn on the legs to improve circulation and help prevent blood clots. Blood transfusion Receiving blood though an IV tube inserted into one of your blood vessels. Care partner A family member or friend who will help you with your recovery. Clear liquids Liquids you can see through, such as water, broth, apple juice, cranberry juice

and white soda. Crutch A device used to assist in walking. Drain A plastic tube attached to a collection unit. The plastic tube is placed near the

operative site during surgery to drain excess fluids. Dressing change Changing the bandage over the incision.

DVT Deep Vein Thrombosis (blood clot)

Occurs when blood clots form in a vein (blood vessel) far below the skin. It happens most often in the leg, but can also be in the arm. Blood clots can cause swelling, pain, tenderness and redness and may lead to leg ulcers. Blood clots are dangerous because a piece can break off (embolism) and travel in the blood stream to the lungs (pulmonary embolism). This can be life threatening.

EKG Electrocardiogram A test used to evaluate the electrical activity of the heart.

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Epidural Catheter inserted into your back to deliver pain medication and anesthetic

medication. Extension To straighten a joint. Flexion To bend a joint. Foot pump A soft device that wraps around the foot and ankle to help promote good

circulation and prevent blood clots. Hemiarthroplasty Replacement of the head and neck of the femur with a new ball and stem. Incentive spirometer A plastic, hand-held device used to help with breathing exercises,

which will help prevent pneumonia. Incision A cut made for surgical purposes.

IV Intravenous Solution that is injected directly into a vein through a soft catheter and tubing. IV capped Placing a cap on the IV, in place of the tubing, to allow it to be used as needed. Knee immobilizer A brace that is wrapped around your leg to prevent knee movement. Nerve block Injection (shot) of numbing medication onto or near a nerve for temporary

control of pain Neurovascular checks Evaluation of your blood flow, movement and feeling. NPO Nothing by mouth; Nothing to eat or drink ORIF Open Reduction internal Fixation Surgery using pins, screws and rods to hold broken bones in place. Osteoporosis A disease that causes bones to become fragile and prone to fracture. The bone

loss occurs slowly over time. OT Occupational Therapist A therapist who assists you with activities of daily living.

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PCA Patient Controlled Analgesia A machine designed to allow you to administer your own intravenous pain medications by pushing a button.

PACU Post-Anesthesia Care Unit The recovery room where you wake up after surgery. PT Physical Therapy/Therapist A therapist who teaches and assists you with ambulation and exercises. Pulse oximetry A device attached to your finger to monitor oxygen levels. RT Respiratory Therapy/Therapist A therapist who instructs and assists you with breathing techniques. SCD Sequential Compression Device

A sleeve of fabric placed on the leg, which is attached to a motor. This motor pumps air into the stocking to help promote good circulation and prevent blood clots.

Staple A U-shaped wire used to fasten skin together. Skilled nursing facility (Sub-acute Rehabilitation)

A facility that provides care for patients who no longer require hospitalization but still need skilled medical care before returning safely home.

Sutures A thread or wire used to stitch body tissues/skin together. Traction Use of a pulling force with weights to relieve pressure on a broken bone.

Trapeze A triangle-shaped device over the hospital bed that assists patients when

moving in bed. Urinary catheter Also known as a Foley Catheter

A flexible tube inserted into the bladder and attached to a collection bag that is used to drain urine from the bladder.

Vital signs The rate and quality of your breathing, heartbeat, temperature and blood

pressure. Walker A device used to help with balance and walking.

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Documents

Hip Fracture - Aurora Health Careyour hands. • Clean your hands often. Use soap and water for at least 15 seconds, or use an alcohol-based hand rub. Do this before eating, after