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

Before, During & After Knee Replacement Surgery

Joint Replacement Surgery: a patient’s guide

AgnesiAn HeAltHCAre is sponsored by tHe CongregAtion of sisters of st. Agnes

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

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

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

after SurgeryPain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Coumadin®/Warfarin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Durable medical EquipmentAgnesian Health Shoppe - Durable Medical Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

ResourcesHome Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Common Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

(SAH Knee Replacement 01/13)

table of contents

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

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

As you will remember, to prepare you for surgery, our team has reviewed your specific joint replacement procedure with you, and our highly-trained associates have provided you with this detailed educational binder . Through our surgical skills, our superior healthcare team and your determination, together we can accomplish a great result for you .

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

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

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

Welcome to agnesian Healthcare!

SAH Knee Replacement | 1

Surgeon

Name of Surgeon: _________________________________________________________________

Office Phone Number: _______________________________________________________________

primary care provider

Name of Primary Care Provider: ________________________________________________________

Office Phone Number: _______________________________________________________________

pharmacy

Name of Pharmacy: ________________________________________________________________

Address: ________________________________________________________________________

Phone Number: ___________________________________________________________________

St. agnes HospitalInformation/Switchboard . . . . . . . . . . . . . . . . . . . . . . . . . (920) 929-2300 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (800) 922-3400

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

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

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

Important phone Numbers


St. Agnes Hospital • (920) 926-4500 • (800) 458-8182Date of Surgery: _____________________________________________ ❑ Right Knee ❑ Left Knee

Unless your provider gives you other instructions, please prepare yourself for your surgery using this checklist .

❑ Make sure to stop the medications as directed by your provider:

______________________________________________________________________________

❑ One week prior to surgery, do not shave your legs or cut/clip your toenails . Make sure to remove all nail polish from toenails .

Day before surgery:❑ Eat a regular meal unless your provider instructs you otherwise .

❑ Stay away from greasy, spicy and/or salty foods to help avoid upset stomach .

❑ We recommend you take a shower or bath on your day of surgery .

❑ Prepare anything you will need to bring with you to the hospital .

___ comb/hairbrush ___ glass case and/or contact case and solutions ___ toothbrush/toothpaste ___ deodorant ___ bring along any prosthetic devices; i .e ., braces, walkers, crutches, etc .❑ Do not have anything to eat or drink including water starting at midnight on:

______________________________________________________________________________

❑ Call the hospital’s Surgical Services department at 926-4500 (800-458-8182, ask for extension 4500) the day before your surgery anytime after 1 p .m . to find out your arrival time . If you do not call the hospital by 6 p .m ., they will call you .

❑ Arrival time according to the hospital: ________________________________________________

Day of surgery:❑ Take the following medications with a sip of water at:

______________________________________________________________________________

❑ Bring to the hospital your Durable Power of Attorney papers for your chart if already have .❑ Brush your teeth but do not swallow any water .❑ Do not wear makeup .❑ Wear comfortable clothing to the hospital .❑ Leave jewelry and all other valuables at home .❑ When coming to the hospital, stop at the Registration department and then go to the Surgical Services department .

patient Information Sheet


Johnson Street

Division Street

Fond du LacRegionalClinicentrance

Park

Ave

nue

Winnebago Drive

Second Street

Vin

cent

St.

Hwy 23

Nat

iona

l A

venu

e

Eve

rett

St.

St. AgnesHospitalentrance

Scott Street

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

Power of Attorney (POA) for Healthcare The Wisconsin statutes recognize two forms of advance directives: the Power of Attorney for Healthcare and the Declaration to Physicians (Living Will) . All hospitals are required by law to make this information available to patients . You may call the case manager at (920) 926-4750 and request that a copy be mailed to you .

A POA for Healthcare is a thoughtful process and should not be rushed . We recommend you complete the POA forms prior to your admission if you wish to have your POA in place for this surgery . Your signature requires two witnesses . Family members are not eligible to witness your signature . The only hospital associates eligible to witness your signature are Spiritual Care Services associates or a social worker, and they may not be readily available the day of your surgery .

Insurance-Related Questions Insurance companies may preauthorize an initial one to two-day hospital stay . During your hospitalization, the insurance company will call the case manager to evaluate your progress . The insurance company will then determine if your stay is to be extended .

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

We recommend that you pre-plan your ride home with a family member or friend . Insurance companies only pay for medically-necessary ambulance transportation . Insurance will not cover wheelchair van transport .

If outpatient services are needed for physical therapy or lab tests, you will need to arrange for the appointment and the transportation . Know before you come into the hospital where you want to go for your therapy and blood work .

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

case managers


Home Care (see page 36)Medicare may cover home care at 100 percent if you meet the following criteria:• Thehomecareneededisskilledinnature.Thismeansyourequireanurseand/orphysicaltherapist.

• Youmustbehomebound.Thismeansthatleavingthehomerequiresaconsiderableandtaxingeffortorleaving the home is medically contraindicated .

Outpatient Therapy Benefits • Medicareprovidesbenefitsforoutpatientservicesbasedonskilledcareneedsatthetimetheserviceis

provided . This may be covered at 80 percent of the charge .

Durable Medical Equipment (see page 35) • Youmayhavetopayaportionorallofthecostdependingonyourinsurancebenefitsforawalker,crutches

or cane .

• Ifyouwereissuedacaneoranyotherequipmentwithinthelastonetofiveyears,yourinsurancecarrier may not cover the cost again .

• Itemsnotcoveredincluderaisedtoiletseats,grabbars,showertransferbenchorchair,reacher, long-handled sponge, sock aid and shoehorn .

If you have private or a Medicare-replacement insurance:

Read the written information you have at home about your insurance coverage . Call the number on the back of your insurance card if you have any questions . In general, insurance companies follow the same criteria as Medicare to determine eligibility for outpatient therapy, home care, acute or subacute rehabilitation services . Let the insurance representative know that you will be having surgery . Keep in mind that the person answering your questions is a service representative who will speak in general terms and will not know all the details about your surgery .

There may be a difference between having the benefit and qualifying for the benefit . Qualifying for the insurance benefit is not a surgeon or primary care provider’s decision . Your insurance company will determine your qualification for benefits based on their standards and policies .

Medicare Benefits


Questions you may want to ask about your benefits.Write down the name of the person you are talking with: _______________________________________

Do I have outpatient physical therapy benefits? ❑ Yes ❑ No

If yes, what are they? _______________________________________________________________

Is there a preferred provider? _________________________________________________________

Do I have home health benefits for in-home therapy or nursing? ❑ Yes ❑ No



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



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


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

If yes, who are the preferred providers? __________________________________________________

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

Insurance Benefits


prior to your Surgery DateDo not shave your legs or cut/clip your toenails for one week prior to your surgery date .

Anti-inflammatory medications (over-the-counter or prescription) that you are currently taking for your joint pain may be requested by your surgeon to stop prior to surgery, so make sure your surgeon has an up-to-date list of your medications . If your surgeon does request you to stop these medications, inquire what you can take in place of them for your joint discomfort .

What to Bring to the Hospital • Ifyoubringyourownpillow,pleasemakesureyourpillowcaseisbrightlycoloredorpatterned,sothatit

won’t be mistaken with the hospital linens .

• Bringloose-fitting,comfortableclothessuchaspajamas,lightweightrobe,sweatpants,shortsandT-shirtsfor therapy . Bring at least two sets of clothing with you .

• Bringcomfortable,low-heeledshoesthathaveanenclosedheelandtoe,suchaswalkingortennisshoes.No open heel/toe shoes or slippers . Non-skid or rubber-soled shoes are preferred .

• Bringpersonalhygienetoiletriesandincontinenceproducts.Youmayalsowanttoincludelipbalm.

• Bringawalkerand/orcrutches,ifyouhavethem.Yourphysicaltherapistwillcheckthemforaproper, safe fit .

• Bringanyspecialequipmentthatyouhaveathome,suchaswristsplints,orthopedicshoes,longhandlereacher, sock aid, shoehorn, etc .

• Bringabook,magazineorhobbyitemtohelpyourelax.

• Bringalistofyourmedications(bothprescribedandover-the-counter)withanychangesifanyfromthetime you attended the education class .

• Donotbringmedicationsfromhomeunlesstoldtodoso(ItisOKtobringyoureyedropsandinhalers).

• Donotbringanyjewelry,checkbook,creditcardsormorethan$5cashwithyoutothehospital.

When to Stop Eating and Drinking• Donoteatordrinkanythingaftermidnightthenightbeforeyoursurgeryunlessotherwiseinstructed.

This includes gum, hard candy, water, soda, coffee, tea, beer, wine or other alcoholic beverages, etc .

• Brushyourteeth,makingsurenottoswallowanywaterortoothpaste.

• Takeyourmedicationsasinstructedwithasmallsipofwater.

planning for your Hospital Stay


While in the Hospital• AsapatientofSt.AgnesHospital,wearepleasedtoofferyouaninnovativediningprogram,whichallows

you to select meals from an expansive menu designed to make you feel as though you were at home or at a favorite restaurant .

• Ifoneofyourguestswishestohavearoomservicemeal,theycancalltheroomservicelineat4673to placetheirorder.Thereisa$7chargepermealwhichincludesanentrée,twosideorders,abeverageanddessert/fruit . The guest must have exact change upon delivery of the guest tray . No checks or credit cards will be accepted .

Suggestions to Make Your Return Home an Easier One• Ensurehallwaysandroomsarefreeofclutterandtrippinghazards.

• Organizeyourlivingareastoavoidexcessivelifting,bendingorreaching.

• Storeheavyandfrequently-usedobjectsatorabovewaistlevel(counterheight).Considermovingitems in the lower parts of the fridge/freezer to a higher shelf .

• Considerpreparingabedroomareaonthemainlivinglevelforshort-termuseuponyourreturnhome.

• Setupafirmchairwitharmrests.

• Arrangeforextrahelpwithhouseholdtasksifneeded.

• Keepanicepackinyourfreezerforpossiblejointswellingaftersurgery.Abagoffrozenpeaswillalsowork.

planning for your Hospital Stay


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

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

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

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

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

anesthesia


Some of the many possible advantages of spinal anesthesia...

1) More rapid recovery of mental function .

2) No need for insertion of breathing tubes .

3) Lower risk of nausea or vomiting .

4) Less pain immediately after surgery .

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

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

Unfortunately, not all patients are candidates for spinal anesthesia . We do not offer this technique to patients who are at risk for internal bleeding issues or to patients with infection in the area where the needle is inserted, or certain other medical conditions . We try to offer a realistic explanation of the different anesthetic techniques, their risks and benefits . When offered, spinal anesthesia is the most popular choice for joint replacement surgery at St . Agnes Hospital . Assuming there is not a compelling reason to choose one anesthetic over another, we usually allow the patient to choose between general or spinal .

anesthesia


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

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

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

pain control Following Surgery


Frequently-Asked Questions


Q: How long will I be in the hospital following my total joint replacement?A: Typically following a total joint replacement, you will have a three to four day stay in the acute care hospital .

During your acute care stay, you will meet with a case manager who will assist you with your discharge plans . Based on your recovery status, rehabilitation associates and your provider will provide you with discharge recommendations .

Q: How much pain will I have after the surgery?A: Your comfort is very important to our associates . In order for our associates to better serve your needs, we

will be asking you to “rate” your pain . The scale will be from 0 to 10, with 0 being no pain and 10 being the worst pain possible . This rating will give associates an idea of how you feel and how to treat your discomfort .

Q: How can I succeed after total joint replacement while in the hospital?A: During the first few days following surgery, you must rely on hospital associates to assist you with many

things . However, during this time, you can assist with your recovery in the following ways:

• Drink plenty of fluids. • Perform ankle pumps and deep breathing exercises frequently while awake. • Actively participate in your rehabilitation program.

Q: How long until I can return to my normal activities following surgery?A: Typically, when you are discharged from your acute care stay, you will be independent with basic activities

of daily living such as dressing and bathing . Within six months, you will be able to resume most of your pre-surgical activities based upon your provider’s recommendation . Your provider or therapist can answer specific questions concerning your activities .

Q: Will I need special equipment at home following surgery?A: During your acute care stay our rehabilitation associates will assess your equipment needs and make

recommendations . Your case manager will coordinate obtaining the appropriate equipment through an agency .

Home Safety assessment


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

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

general Household areas Are light switches easily accessible upon entering a room? . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Do you have throw rugs in your home? (remove them) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Are hallways free from clutter? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Are raised door thresholds clearly marked? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Are electrical cords and telephone cords away from hallways? . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Do you have a portable phone with emergency numbers easily at hand? . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Do you have furniture with good back and arm support that you can get in and out of easily? . . . ❑ Yes ❑ No

StairwaysAre stair treads in good condition? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Is there a sturdy handrail on both sides of the stairs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Are the stairs brightly lit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

BedroomIs there a lighted pathway from the bedroom to the bathroom? . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Is there a clear pathway from the bedroom to the bathroom? . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Do you keep a charged flashlight near your bed for emergencies? . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

BathroomDo you have safety rails or grab bars by toilet and shower/tub? . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Do you have skid resistant strips or a rubber mat both in and in front of the bathtub? . . . . . . ❑ Yes ❑ No

Do you have an adjustable shower chair? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Home Safety assessment


KitchenDo you use a wide-based, sturdy step to reach into high cabinets? . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Are spills immediately wiped up? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Do you avoid using a high gloss floor wax? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Do you store frequently used items at waist level and less frequently used items in higher cabinets? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Is your laundry located on first floor? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Will you have assistance with laundry? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Will you have assistance with meal preparation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Could you prepare microwave meals in advance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ Yes ❑ No

Knee Care Guidelines - Day of Surgery


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

today’s Itinerary:• YouwillhaveanIV.

• Youwillhaveacoolingdevicetoyourkneeasdirected.

• Thepulsesinyourfeetwillbechecked.

• Wewillremindyoutodoanklepumpseveryonetotwohours.

• Takefrequent“catnaps”andlimitvisitors.

• Youwillrepositioninbedfrequentlytopreventdamagetoskin.

• Yourbloodpressure,pulse,respirations,temperatureandoxygenlevels(vitalsigns)willbecheckedfrequently .

• Wewillremindyoutouseyourincentivespirometer(breathingmachine)everyhourwhileyouareawake (if you are watching television, you can do one breath with the incentive spirometer during each commercial or approximately 10 per hour .

• AContinuousPassiveMotion(CPM)deviceforbendingandstraighteningyourkneewillbeappliedandusedthree times daily for two hours at a minimum .

• Ifyoureturnfromsurgeryinthemorning,thephysicaltherapistmaygetyououtofbedtoday.Ifnot,yournurse will have you sit at the side of the bed today .

Hourly Rounding• Nursingassociates will check on you every one to two hours to make sure that you are comfortable and that

your needs are met .• Youcanarrangewithyournurseifyouchooseto“notbedisturbed”toallowforrestandsleep.

today’s goals ❑ Pain controlled ❑ Nausea controlled ❑ No pneumonia

❑ No blood clots ❑ Get some rest!



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

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

medicationsYou will have medications to keep you comfortable after surgery and to prevent complications . Many of these are taken by mouth so controlling nausea is important . You have provided a list of your home medications and if not contraindicated, these will be ordered to begin this evening or tomorrow .

If you were told to bring your medications from home, please provide these to your nurse . They will be reviewed by a pharmacist for identification and then kept in a secure bin assigned to you . The nurse will provide these as ordered .

Food for thoughtYou have been without food or drink since midnight and had surgery… so be good to your stomach . Slow and steady wins the race for getting back to normal meals .

Start with ice chips, followed by a few sips of water . If all is well, Jell-O, clear soups and juices are good choices . These are available on your unit 24/7 . Once you are able to pass gas, you can try portions of solid food .

Remember, you have an IV so you can do without food or drink if your stomach is just not feeling quite right . If you experience nausea, let your nurse know .

The menu in your room will tell you how to order your meals from dietary . We also have regular and diet soda, juice, soup, cold cereals, saltines, graham crackers, milk, ice cream and popsicles on the unit if you want a snack .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Don’t Take a “Trip” to the Bathroom! You may have a catheter in your bladder to drain urine. If not, ask for assistance with a bed pan, urinal or to get up to a bedside commode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dress code• Patientgownforcomfort;saveyourpersonalcomfortableclothingfortheupcomingdays.

• Nasalprongstoprovideoxygen.

• Elasticstockings(TEDhose)and/orsequentialcompressiondevices(SCDs)toaidcirculationandpreventblood clots .

• Adressingoveryoursurgicalsite(thenursemayneedtoaddtoyourdressingifthereisdrainageonthesurgeon’s dressing) .

Sneak Peak at Tomorrow • Blooddrawforlabworkataveryearlyhour.That’swhycatnapsaresoimportant. • Occupationalandphysicaltherapybegins,usuallyonceinthemorningandonceintheafternoon. • Upinthechairforatleasttwomeals. • CPMdeviceforbendingandstraighteningyourkneeusuallyappliedforatleasttwohours,three

times a day .



Knee Care Guidelines - Day One


today’s Itinerary• Yourvitalsignswillbecheckedeveryfourhours.

• IVfluidscontinuedifneeded.

• IVantibioticsdiscontinued.

• Ifyounolongerrequireoxygen,itwillbediscontinued.

• Continuetocoughanddeepbreatheeveryhour.


• Doanklepumpseveryonetotwohourswhileawake.

• Upinchairthreetimes.

• Restbetweenactivityandlimitvisitors.

• Repositioninbedtopreventdamagetoskin.

• Hipprecautionsasordered;hipabductionpillowmaybeusedwhileinbed.

• Ifadrainand/orbladdercatheterisinplace,itwillbediscontinuedtoday.

• Writedownquestionsforyourphysician,nurseandtherapistasyouthinkofthem.

training table for Rehabilitation• Yourappetitemaybelessthannormalforthefirstcoupleofweeks.

• Yourdietwillbeadvancedwhenyouareabletopassgas.

• Choosefoodhighiniron,protein,fiberandcalcium.

• Drinkplentyofwater.AtleastthreefullAgnesianHealthCarewaterbottles,whichisgiventoyouuponadmission .

• Limitfatandsweets.

today’s goals ❑ Pain controlled ❑ Up in chair two to three times

❑ No blood clots ❑ Walking exercise

❑ No pneumonia ❑ Initial plan for discharge

Fashion Statement• It’stimetogetoutyourownclothesandsaygoodbyetothepatientgown!

• Yourtherapistwillhelpwithanychallengeswhilegettingbathedanddressed.

Knee Care Guidelines - Day One


It’s time to get moving!You will get out of bed in the morning with assistance from therapy associates . Using a walker, you may take some steps in your room or in the hallway . You will learn about getting in and out of bed and transferring to a chair . You will begin your exercise program .

The CPM machine will be applied for at least two hours, three times a day, increasing bending as tolerated .

Therapy associates will see you in the afternoon to continue working with you on bending and straightening your leg and walking . You may go to the gym to continue your exercises .

Keeping ahead of the painNursing associates will ask you to rate your pain from 0 (none) to 10 (worst imaginable) . Let your nurse or therapist know when your pain is starting to increase .

Try additional means to reduce your pain: music, massage, repositioning, reading, television, meditation, prayer, room darkening, etc .

You will be able to take part in therapy most effectively when your pain is controlled . With medication and other pain relieving measures (repositioning, etc .), the goal is for you to have a pain level of four or less . Pain medication is more effective when pain levels are maintained at lower levels .

Homesick?Associates from our Care Management department will visit you to plan for your discharge and identify any equipment you will need .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sometimes what you’ve lost needs to be replaced! Some blood loss is expected with surgery. We check your blood count daily to determine if you need a blood transfusion. If you do, you may notice how much better you feel when your blood count increases after the transfusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

We Say “NO” to Blood Clots!You will continue to wear the TED hose and/or SCDs to aid circulation .

Your nurse will provide you with the medication to prevent blood clots, as ordered by your provider .

Continue to do your ankle pumps every one to two hours and participate in your exercises . Getting up and moving decreases your risk of getting a blood clot .

Knee Care Guidelines - Day two


today’s Itinerary• Yourvitalsignswillbecheckedeveryeighthoursandasneeded.


• Youwillcontinuetouseyourincentivespirometer.

• Continuecoolingdevicetoknee.

• Alternaterestandactivity.

• Upinchairtwotothreetimesdaily.

• Repositionfrequentlyinbed.

• TEDhoseon(offfor30minutesinthemorningandeveningforbathingandskininspection).

• IVfluidsmaybediscontinuedifdrinkingadequateamountsoffluids.

• SCDsonwheninbed.

• Hourlyroundingcontinuesasdiscussed.

It’s time to get to the gym• Youwillgotothetherapygymtoday.

• Youwillcontinuetoworkontheexercisesyoudidyesterdaywithprogressionastolerated.

Back in Your Room• TheCPMsettingswillbeincreasedtoyourtolerance.

• Youwillcontinuetodoyouranklepumpseveryonetotwohours.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

pain, pain go away! While the pain will probably not disappear completely, your pain medication taken by mouth should keep it at a level of four or less. Communicate pain concerns with your nurse or therapist.

try some additional means of reducing pain. If you tried something yesterday and it didn’t help, try it again today or try something different. try music, massage, repositioning, reading, television, meditation, prayer, room darkening, etc.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Knee Care Guidelines - Day two


today’s goals ❑ Pain controlled ❑ No blood clots

❑ No pneumonia ❑ Up in chair two to three times

❑ Walk safely with assistive device ❑ Continue all exercises

❑ Progress with transfers ❑ CPM settings increased

❑ Discharge plan completed

❑ Progress toward independence with straight leg raises

There’s No Place Like Home• Yourreturnhomeisanimportantpartofgettingthebestresultsfromyoursurgery.Daybydayathome,

you will return to your usual routines and increase activity naturally . While in the hospital, your provider, nurses and therapists observe your progress and look for signs that you will be safe at home . Occasionally, a patient may need an additional day in the hospital or perhaps some time in another facility before returning home . Our resource management associates will assist in your transition home or to another facility .

• Ifyouneedadditionalinstructiononassistivedevices,atherapistwillworkwithyou.

• Youmaywanttosendsomeofyourthingshomewithfamilyorfriendstomakeyourdischargedayeasier to organize .

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

To promote healing and rehabilitation, choose foods high in iron, protein, fiber and calcium . Avoid foods high in fat and sugar .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

all Systems go? If you don’t have a bowel movement (BM) today, let your nurse know. Remember to eat foods high in fiber and drink plenty of liquids, especially water (total of three water bottles of fluid per day). Walking and exercise also helps a lot! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Knee Care Guidelines - Day three


today’s Itinerary• Todaymaybethedayyouaredischargedhomeortoanotherfacility.

• Continueyouractivitiesofthepreviousdays(anklepumps,coolingdevice,incentivespirometer,CPM,etc.)

• Youwillgotothetherapygymandcontinueallyourexercises.

• Ifyourhomehascertainfeatures,suchasstairways,stepsorlackofhandrails,yourtherapistwillprovideinstruction on staying safe .

today’s goals ❑ Pain controlled

❑ Labs within your normal limits

❑ No blood clots

❑ No pneumonia

❑ Walk safely and independently with assistive device

❑ Able to dress and perform personal activities safely and independently with assistive device(s)

❑ Independent with straight leg raises ❑ Questions answered

❑ Discharge instructions understood

To-Do List for Discharge• Packupbelongings.

• Gooveryourprovider’swrittendischargeinstructionswithyournurse,includingprescriptionsandappointments .

• Putallimportantdischargepapersinthebindersoyouwillhavethemwhenyouarrivehome.

• Letyournurseknowwhenyouarereadyandamemberofthenursingstaffwillassistyoutoyourcarwhenall discharge paperwork is complete .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Thank you for letting us serve you! We wish you continued success with improved mobility. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Exercises


Ankle Pumps

Quadriceps Set

With left leg relaxed, gently flex and extend ankle . Move through full range of motion . Avoid pain .

Repeat 20 times per set .Do 1-2 sets per session .Do 10 sessions per day .

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

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

Exercises


terminal Knee Extension

Straight leg Raise

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


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

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

Heel Slide (Supine)

Exercises


Sitting Knee Flexion

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


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


Exercises


Standing Hip/Knee Flexion

Standing Knee Flexion

With support, lift surgical leg bending hip and knee .


With support, bend surgical knee as far as possible .


Exercises


chair Squat

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


The associates at the Agnesian Center for Bone & Joint Health are concerned about managing your pain after surgery . Pain that is poorly controlled can interfere with sleep, appetite, activity, relationships and your emotional outlook .

Pain is to be expected following joint replacement surgery, but by working with your nurses, therapists and providers we should be able to control the pain enough for you to actively participate in your recovery . Do not let your pain get out of control because as pain becomes more severe it is harder to treat . Ask for assistance from your nurse if you feel your pain level is increasing .

Ways for you to Help us manage your pain• Youcangiveusaratingona0to10painscale.Aratingof10reflectstheworstpainyoucouldever

imagine, a rating of 5 means you feel a moderate amount of pain and a 0 rating reflects no pain .

• Yourtherapistsandnurseswillaskyoutorateyourpainafteractivity,therapyandatrest.

• Whenyouareable,describewhattypeofpainyouarehavingsuchasthrobbing,shooting,aching,burningor pressure . This will assist the medical staff and getting you the right type of pain control .

things to Keep in mind• Itiseasiertotreatpainwhenitismildormoderateratherthanwaitinguntilitissevere.Takeyourpain

medications on a regular schedule to prevent severe pain .

• Itisnearlyimpossibletoeliminateallpainduringthefirstfewdaysafteryoursurgery.However,yourmedical team will work with you to control your pain at a level that allows you to rest and participate in your recovery, including your therapies .

• Painwillgraduallydiminishordecreaseinthedaysafteryoursurgery.Youshouldexpecttohavegooddaysand bad days with regards to your pain and your ability to perform activities .

• Studieshaveshownthatwhenpainmedicationsareusedappropriatelytotreatsurgicalpain,addictionto the medication occurs in only a small number of patients . Please let us know if you have a history of addiction or intolerance to pain medications .

pain management


No Mild Moderate Severe Pain Pain Pain Pain

0 1 2 3 4 5 6 7 8 9 10

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

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

Some of the common side effects from the pain medication include: nausea, sedation, confusion, constipation and itching . Most of these side effects will improve after taking the medication for a period of time . Constipation may be experienced during the time you are taking the medication, but it can be prevented and/or treated after discussion with your healthcare professional . If you experience any of these side effects or any others, tell your healthcare professional right away .

Additional Options for Treating Pain• Repositioning

• Coldapplication

• Relaxation/medication/imagery

• Physical/occupationaltherapy

• Massagetherapy

pain management


What is warfarin?Warfarin (generic name) or Coumadin® (brand name) is an oral medication used to prevent clotting in the blood . It is called an anticoagulant, which means to prevent blood clots . Warfarin is often referred to as a “blood thinner” but does not actually make the blood “thinner .” Warfarin works to slow the blood’s ability to make a clot . Blood will still continue to form clots but will take slightly longer while taking warfarin .

Warfarin is a very special medication that requires a blood test to monitor how the medication is working . Based on the result of the blood test, the dose of warfarin may change .

Why do I need warfarin?Sometimes the postsurgical recovery period can have complications . Warfarin is used to decrease the chance of one type of complication . This potential complication is the formation of blood clots in different areas of the body . Following your surgery, you are at an increased risk of forming blood clots for two reasons . First, you will not be as mobile following surgery . Being less active increases your risk of clotting . Second, the process of healing following surgery increases your risk of clotting . Warfarin works to prevent clots from forming in the blood . This reduces your risk of developing a deep vein thrombosis (DVT) - a blood clot in your leg, or a pulmonary embolism (PE) - a blood clot in your lungs .

How long do I need to take warfarin?Following your surgery, warfarin is typically prescribed for four to six weeks .

How do I know it is working? What is an INR?In order to assure you are getting the right dose of warfarin, you will be required to have frequent blood tests .

Warfarin is monitored with a lab test called the INR (International Normalized Ratio) . INR can also be called a protime (PT) . INRs are used to determine the correct dose of warfarin to give . Your INR should be near 1 if you are not taking warfarin . Your INR will rise when the warfarin is working .

1 2 3 4 5

“Normal” INR à à à

not on warfarin

Warfarin cause the INR to rise

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

coumadin® (Warfarin) Information


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

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

What factors may change my INR test results?Besides warfarin dose changes, several factors, such as sickness, diet, other medicines (prescription, over-the-counter, herbal, etc .) or physical activities, may affect your blood test results . Tell your healthcare provider about changes in your health, medicines or lifestyle .

Where do I get my INR checked, and who adjusts the dose?Agnesian HealthCare has an Anticoagulation Management Service Clinic that can check your INR . The clinic, located on the main floor of St . Agnes Hospital, specializes in warfarin management . Your provider may refer you to the clinic where your INR is checked and warfarin dose is adjusted at your 10- to 15-minute appointment . Alternatively, you may have blood drawn at a local lab and your provider will adjust your dose . If you are not able to leave your home, you may be eligible for a home care service to come to your home and draw your blood test .

How should I take warfarin?It is important to take your warfarin once daily at the same time each day . It is best to take warfarin before your evening meal . Take your warfarin exactly as your healthcare provider instructed you to take it . Your dose may change frequently based on your INR . It is common to take full tablets on some days and half tablets on other days . For this reason, a pill box or recording your daily dose on a calendar is highly recommended . If you have questions regarding your dosing, please call your healthcare provider . Do not change your warfarin dose without talking to your healthcare provider .

Warfarin can be taken with or without food .



What if I miss a dose?It is very important to take your warfarin at the same time each day . If you miss your dose, take the missed dose as soon as possible on the same day . DO NOT take a double dose of warfarin the next day to make up for the missed dose unless instructed to do so by your healthcare provider .

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

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

Symptoms of minor bleeding include:• gumbleedingwhilebrushingteeth• occasionalnosebleed• easybruising• bleedingafteraminorcutthatstopswithinafewminutes• menstrualbleedingthatisalittleheavierthannormal

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

Symptoms of major bleeding include:• darkbrownorredurine• bowelmovementscontainingbloodorverydark,tar-likestool• excessivebleedingfromthegumsornose• throwingupcoffee-colored,brightredorred-tingedsecretions• severepain(headacheorstomachache)• dizziness/weakness• bleedingfromacutthatwillnotstop• suddenappearanceofbruisesfornoknownreason• excessivemenstrualbleeding• pain,discomfortorswellinginanyarea,especiallyafteraninjury

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

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



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

Symptoms of an allergic reaction include:• difficultybreathing• swellingofyourthroat,tongueorface• hivesand/orarash• itching

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

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

Are there over-the-counter medications to avoid?While taking warfarin, Tylenol® (acetaminophen) is the only recommended over-the-counter pain medication . The use of aspirin (unless recommend by your healthcare provider), Aleve®, Motrin® (ibuprofen) and Advil® (ibuprofen) should be avoided .

Why do I need to pay attention to my diet?Many foods you eat contain vitamin K . Vitamin K can decrease the effectiveness of warfarin . You can continue to eat foods that contain vitamin K, however, you need to eat a consistent amount of these foods . Eating a diet that is not consistent may affect your INR and your warfarin therapy .

Avoid drastic changes in dietary habits . In general, leafy, green vegetables and certain legumes and vegetable oils contain high amounts of vitamin K . Foods that generally contain low amounts of vitamin K include most fruits, cereal grains, dairy products and most meats such as beef, chicken, pork, shrimp and turkey .


this is a partial list of foods that contain higher levels of vitamin K:

Vegetable Serving SizeBroccoli (raw or cooked) . . . . . . . . . . ½ cup

Brussels Sprouts . . . . . . . . . . . . . . . . 5 sprouts

Cabbage (raw) . . . . . . . . . . . . . . . . . 1 ½ cups

Collard greens . . . . . . . . . . . . . . . . . . ½ cup

Cucumber peels . . . . . . . . . . . . . . . . 1 cup

Endive (raw) . . . . . . . . . . . . . . . . . . . 2 cups chopped

Green scallion (raw) . . . . . . . . . . . . . 2/3 cup

Mustard greens . . . . . . . . . . . . . . . . . 1 ½ cups shredded

Spinach (raw leaf) . . . . . . . . . . . . . . . 1 ½ cups

Turnip greens (raw) . . . . . . . . . . . . . . 1 ½ cups chopped

Watercress (raw) . . . . . . . . . . . . . . . . 3 cups chopped

Remember, it is important that you keep your diet consistent .

What about alcohol?Alcohol can also affect how warfarin works in your body . Alcohol combined with warfarin can increase your risk of bleeding . It is best to avoid alcohol while on warfarin . However, having up to one to two drinks in a day may be acceptable .

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



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

Durable medical Equipment Our durable medical equipment (DME) specialist, customer service representative or delivery technician personally teaches every patient how to use their equipment . We provide and maintain only the most modern, attractive, quality equipment . Each item is carefully inspected and regularly serviced . We provide personal, one-on-one service for each individual’s needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

We deliver and install equipment! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Durable medical Equipment Following Knee SurgeryWheelchairs, walkers, crutches Lift chairs

Raised toilet seat or commode chair Long-handled reacher, shoehorn

CPM machines for the knee Sock aids

Handheld shower hose Chair/foam cushions

Grab bars Other aids for daily living

Wheelchair cushions Other bathroom safety products

Compression stockings Specialty mattresses

Wound dressings

Shower chair (shower) or tub transfer bench (bathtub)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

We will gladly help with special orders too. call us today! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Durable medical Equipment


When to consider Home care • Recurrenthospitalizations• Medicationmonitoring(newandcurrent)• Homeoxygenneeds• Conditionsof:CHF,COPD,diabetes,postCVA,cancerandotherchronicillnesses• Post-surgicalcare(orthopedics,cardiac)• Painmanagement/education• Safetyconcerns• Ostomies,tubefeedings,cathetercare• Needforadaptiveequipment/rehabilitationneeds• Symptommanagement/palliativecaremanagement

Services provided • Specialmedicaltreatments(LovenoxB-12injections)• Woundcarewithcertifiedwound/ostomy/continencenurse(woundvactherapy)• Homeinfusionservices(IVtherapy/linecares)• Telehealthmonitoring• Physicaltherapy,occupationaltherapy,speechtherapy,homehealthaides,medicalsocialworker• Medicationboxfills/medicationmanagement• Pediatricclinicalnursespecialist• Chemotherapy• Palliativecare• Diabeticmanagement

coverage • AcceptMedicare/Medicaidassignment• Insurance• Self-pay• CommunityCare

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

agnesian Healthcare Home care


EquipmentIntravenous (IV) CatheterThis catheter allows for fluids and medications to be delivered through your bloodstream .

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

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

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

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

Sequential Compression Device (SCD) These are inflatable plastic sleeves that are wrapped around your leg and may be used to improve blood flow in your legs .

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

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

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

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

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

common terminology


peoplePhysical Therapy (PT)Physical therapy associates will assist you in regaining mobility and function following your surgery .

Occupational Therapy (OT)Occupational therapy associates will assist you in regaining independence with your activities of daily living (ADLs) . Activities of daily living include: dressing, bathing, homemaking tasks and training in the use of adaptive equipment .

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

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

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

pEPulmonary embolism is a blood clot that forms in your lungs .

common terminology


______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Questions


Health & Medicine

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