Download Your Guide to Joint Replacement

Patient and Family Education
YOUR GUIDE TO JOINT REPLACEMENT
i n t e r m o u:nPreparing
t a i n h e a for
l t h Surgery
care.org
Your Guide to Joint Replacement
What to expect before surgery, in the hospital, and
while recovering at home.
©2016 Intermountain Healthcare. All rights reserved.
1
What’s Inside:
ABOUT THIS GUIDE................................................. 3
Total Joint Replacement Locations.................................4
PREPARING FOR SURGERY....................................... 5
Getting Your Body “Surgery Ready”............................11
Preparing Your Home................................................... 13
Having a Pre-operative Exam...................................... 15
Packing Your Bag.......................................................... 17
HAVING MY SURGERY........................................... 19
Recognizing Your Healthcare Team Members.............24
Understanding Anesthesia...........................................25
Waking Up After Surgery.............................................27
Understanding the Daily Routine................................29
Managing Your Pain......................................................31
Preparing to Go Home..................................................33
GOING HOME........................................................ 35
Knowing When to Call the Doctor...............................38
Being Safe at Home......................................................39
Controlling Constipation and Swelling........................41
Managing Your Pain at Home......................................43
2
Patien
t and F
amily
interm
ountai
Educat
nhealt
ion
hcare.o
rg
About This Guide
Now that you have decided to have joint replacement surgery, we want to help
you learn more about:
•• The best way to prepare for your surgery
Your Gu
ide
to Joint
Replacem
ent
What to
exp
recoverin ect before sur
g at home
gery, in
the hospi
.
tal
, and
•• What to expect while you are in the hospital before, during, and after surgery
•• How to recover as quickly as possible
Research tells us that patients who participate in pre-operative education opportunities (attending a class,
watching a DVD, reviewing printed materials) do better after joint replacement surgery. This guide is
your reference for each phase of your care and helps you keep everything related to your surgery in one
place. Plan to get the most from your guide by:
•• Writing in it. This guide is designed to help you keep track of information, progress, and questions.
•• Sharing it with your health coach (a family member or friend who will help you for a few days
once you go home from the hospital). Help your health coach understand how to best support you
at each phase of your care.
•• Keeping it with you. Bring the guide to appointments and any pre-surgery class you attend. (If you
watch a DVD instead of going to a class, keep the guide handy to refer to.) And, be sure to bring it
with you to the hospital on the day of surgery.
Important dates and contact information
1. My surgeon and contact information:
–– Name:
5. My hospital:
––Location:
––Telephone number:
2. About my surgery:
–– Date of surgery:
––What joint am I having replaced:
3. My health coach (family member or friend):
–– Name:
––Telephone number:
4. My pre-surgery class:
––Date and time:
––Where to park:
––Hospital contact:
––Date and time of my pre-admission screening:
––When I need to arrive at the hospital the day
of surgery:
6. My primary care provider:
–– Name:
––Telephone number:
7. Emergency contact(s):
––Class location:
–– Name:
––Telephone number:
©2016 Intermountain Healthcare. All rights reserved.
3
YOUR GUIDE TO JOINT REPLACEMENT : About this Guide
Total Joint Replacement Locations
Alta View Hospital
Logan Regional Hospital
Sevier Valley Hospital
9660 S 1300 E
Sandy, UT 84094
801-501-2600
500 E 1400 N
Logan,UT 84341
435-716-1000
1000 N Main
Richfield, UT 84701
435-893-4100
American Fork Hospital
McKay-Dee Hospital
170 N 1100 E
American Fork, UT 84003
801-855-3300
4401 Harrison Blvd
Ogden, UT 84403
801-387-2800
TOSH - The Orthopedic
Specialty Hospital
Bear River Valley Hospital
Park City Medical Center
905 N 1000 W
Tremonton, UT 84337
435-207-4500
900 Round Valley Dr
Park City, UT 84060
435-658-7000
Cassia Regional Hospital
Riverton Hospital
1501 Hiland Ave
Burley, ID 83318
208-678-4444
3741 W 12600 S
Riverton, UT, 84065
801-285-4000
Cedar City Hospital
1303 N Main St
Cedar City, UT 84721
435-868-5000
5848 S 300 E
Murray, UT 84107
801-314-4100
Utah Valley Hospital
1034 N 500 W
Provo, UT 84604
801-373-7850
Intermountain Healthcare
Total Joint Replacement Locations
IDAHO
Cassia
Dixie Regional Medical Center
1380 E Medical Center Dr
St. George, UT 84790
435-251-1000
Bear River
Logan
McKay-Dee
Heber Valley Medical Center
UTAH
1485 S Highway 40
Heber City, UT 84032
435-654-2300
LDS
IMC
Park City
TOSH
Riverton
Alta View
Heber Valley
American Fork
Intermountain Medical Center
Intermountain Surgical Center
Utah Valley
5121 Cottonwood St
Murray, UT 84107
801-507-7000
LDS Hospital
Sevier
8th Ave & C St
Salt Lake City, UT 84143
801-408-1100
Cedar City
Dixie
4
©2016 Intermountain Healthcare. All rights reserved.
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•• “Completed” icons with checkboxes for recording your progress as well as checkboxes
that appear next to individual tasks. Focus on those recommendations that apply to you,
checking off each task as you do it. Put a check mark in the “Completed” icon when you
are ready to move to the next step on the time line.
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Preparing for Surgery
–– Getting Your Body “Surgery Ready” — page 7
–– Preparing Your Home — page 9
–– Having a Pre-operative Exam — page 11
–– Packing Your Bag — page 13
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YOUR GUID
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Key steps for your surgery preparation
Record important information for these 7 key steps.
1. Contact my insurance company.
––My insurance company contact:
4. If possible, attend a pre-surgery class (with
your health coach), or watch a DVD provided by
your care provider.
––Date and time of my pre-surgery class:
–– My surgical procedure codes (ask your surgeon):
––My contact for pre-authorization:
––Class location:
5. Gather information for a pre-admission
screening (done either in person or by phone).
––Date and time of my pre-admission screening:
2. Get an exam for medical clearance (statements
from my doctors that I can have surgery).
–– Date of medical clearance:
6. Prepare my home for when I come home from
the hospital (what I plan to do from pages 9–10):
––Other doctors I need to see:
3. Get my body “surgery ready” by (items from
pages 7–8 that I plan to do):
©2016 Intermountain Healthcare. All rights reserved.
7. Speak up! I have questions or concerns about:
5
YOUR GUIDE TO JOINT REPLACEMENT : Preparing for Surgery
PL
ORE
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M
•• Go with you to the pre-surgery class.
RN
•
Prep for discharge: While most
people go home after discharge,
there are times when someone has
health conditions that require specialized
care for a period of time. Review the
•• Care for family members and pets, if needed,
while you are in the hospital (and for a day
or 2 at home).
•• Attend at least 1 physical therapy session
with you while you are in the hospital.
•
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TED
•
M
E
Identify a health coach: A friend
or relative can be your health coach.
A health coach will need to:
CO
What to do in the WEEKS BEFORE surgery
information in Section 5: Having my Surgery
(pages 15–16) to learn more.
•• Take you home from the hospital and stay with
you until you are confident about walking and
doing daily living activities on your own. You
may need their support for a week or two.
Choose the tips in this section’s “Preparing
Your Home” (pages 9–10) that best fit your
situation. Check the “Completed” box when
you are done.
Step 3: Post these important dates on page 1 (items 4
and 5 under “Key steps for your surgery preparation”).
6
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Step 2: Contact your hospital to schedule your:
•• Pre-surgery class (if available) to learn what to
expect before, during, and after your surgery
•• Pre-admission screening visit or phone call
RN
M
However, you should talk to your surgeon about your
discharge options BEFORE you have surgery.
PL
TED
Step 1: Call your insurance company to find out:
•• What is my coverage for post-discharge therapy
(e.g., home health, outpatient therapies) and
number of visits?
•• What is my coverage for options other than being
discharged to go home?
•• What qualifying criteria would I need to meet to
be covered?
•• Are the surgeon and hospital part of my insurance
network and plan?
•• What are my “out-of-pocket” costs?
Your care providers are not authorized to inform
you of your co-pay or other financial responsibilities.
M
Prep for discharge
E
Pre-register: Follow the steps below to pre-register
with BOTH your insurance company and the hospital.
Get “surgery ready”
Get “surgery ready”: Being as
healthy as possible helps your
surgery and recovery go better.
•
Identify a health coach
•
Pre-register
See “Getting Your Body ‘Surgery
Ready’” on pages 7–8 as a guide.
When you have completed any
steps that apply to you, check the
“Completed” box on that page. "My sister flew in
from Iowa to be my
recovery coach.
She went to my
appointments with
me and helped me
do my exercises.”
— Jean S.,
Knee Replacement Patient
©2016 Intermountain Healthcare. All rights reserved.
YOUR GUIDE TO JOINT REPLACEMENT : Preparing for Surgery
Name of Medicine or Supplement
Date to stop taking
DO NOT STOP taking prescribed medicines unless instructed by
your surgeon. If you have rheumatoid arthritis, also talk to your
rheumatologist.
•
CO
Go to class: Plan to attend a free,
Intermountain pre-surgery class with your
health coach (if available in your area) or
watch a DVD provided by your hospital.
Where offered, Intermountain’s free class (or
DVD) gives you detailed information about
your surgery, your hospital stay and discharge,
and your recovery.
PL
TED
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M
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•
Go to class
PL
•
M
Stop some meds
E
•
•• Name the person you want to make
healthcare decisions for you if you can’t
speak for yourself
•• Specify the kind of
care and treatment
you do and do not
want provided in
certain situations
CO
asks you to stop taking and the date you need to stop each one.
Complete an advance directive
Complete an advance directive:
Consider having an advance directive.
This is a document that helps ensure
that the care you receive reflects your
values and wishes in case you cannot
communicate at the time. In it, you can:
•
In the chart below, list medicines or supplements your surgeon
•
•
Get an exam
•
See “Having a Pre-operative
Exam” on pages 11–12 for
a handy place to record
key information. Check the
“Completed” box once this has
been done.
Stop some meds: Talk to your surgeon about medicines
and herbal supplements you will need to quit taking before
surgery (especially those that lead to excessive bleeding).
PL
TED
ORE
Get an exam: To get
“medical clearance” for
your surgery, your surgeon
will want you to have a physical
exam within 30 days of surgery.
You may need to have preadmission tests a week or two
before surgery. This is the time
to share information about
your health history, medicine
use, and language preferences.
M
E
RN
M
LEA
What to do in the WEEKS BEFORE surgery
Visit intermountainhealthcare.org/
JointReplacementClass to find and register for
classes throughout Utah.
Learn more about
advance directives in
Intermountain’s Advance
Care Planning booklet.
“I am so glad I went to the pre-surgery class! Meeting the
physical therapist and some of the nurses, and then seeing
those familiar faces after surgery, was so reassuring.”
—Joan L., Knee Replacement Patient
©2016 Intermountain Healthcare. All rights reserved.
7
YOUR GUIDE TO JOINT REPLACEMENT : Preparing for Surgery
What to do in the DAYS BEFORE surgery
PL
•
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Pack a bag
•
•
CO
•
•
Stop food and drink: DO NOT
eat or drink anything after
11:00 p.m. the night before your
surgery (unless otherwise directed).
After 11:00 pm, be sure to:
PL
TED
…… Last-minute instructions about eating and
medicines, such as:
M
E
…… Where to park:
•
PL
TED
…… Your hospital arrival time:
M
Stop food and drink
E
CO
Talk with a nurse
Talk with a nurse: You will need to talk with
a pre-admitting nurse before your surgery. You
may be instructed to call the nurse, or he or she
may call you. This call will address:
LEA
•
Use the checklist “Packing Your Bag”
(on pages 13–14) as a guide.
DO NOT shave your legs or hip (surgical area).
Start skin prep
ORE
DO NOT not use lotion, cream, or powder.
M
Pack a bag: You will only need a
small suitcase of personal items.
RN
•
M
E
Start skin prep: To lower your risk of
infection after surgery, you will need
to use a special soap and scrubbers or
wipes when you shower before surgery.
Check your surgeon’s instructions in
Section 2: From My Surgeon.
CO
The afternoon before your surgery,
someone from the hospital will call to
tell you the time you should arrive.
If they don’t call by late afternoon,
call them at:________________ .
…… Use only enough water to swallow
any medicines you have to take
…… Not swallow when you rinse your
mouth while brushing your teeth
…… Answers to any of your other questions:
NOTE: If you eat or drink anything
after this time, your surgery may have
to be rescheduled.
Tell the nurse if you prefer to communicate in a
language other than English or have a chronic
condition, such as diabetes, requiring special care.
8
©2016 Intermountain Healthcare. All rights reserved.
YOUR GUIDE TO JOINT REPLACEMENT : Preparing for Surgery
•
CO
•
Arrive on time: It is very
important that you arrive
at the time instructed in the
pre-surgery phone call, as the
hospital staff will be ready for
you at that time.
•
Remember:
Bring a book to read or
something else to do in case
there is a waiting period
between surgery preparation
phases.
…… DO NOT shave the area where you
will have surgery.
CO
•
PL
TED
Leave personal items in
the car:
M
E
CO
PL
TED
•
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Leave personal items in the car
E
Take ONLY meds as directed:
Your doctor will advise what
medicines you can take the morning
of surgery. If you need a bit of water
to swallow any pills, drink ONLY the
sip necessary to do so.
Arrive on time
•
Shower Take ONLY meds as directed
•
…… DO NOT USE lotion, cream, or powder.
Remember: DO NOT bring your
medicines to the hospital with you
(unless instructed differently).
PL
•
TED
Shower: Make sure to shower
the morning of surgery, following
the instructions your doctor gave you.
Use the soap (or other cleanser) and
scrubbers provided.
M
TED
PL
E
M
E
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What to do the MORNING OF surgery
DO NOT BRING your bag, walker,
and crutches in with you. Your
health coach can bring these
and other personal items in from
the car once you get to a room
following surgery.
DO BRING in your ID, insurance
card, reading material, and
glasses or contacts case — just
what you will need before you
actually go into surgery.
Remember to park your car
where instructed during the
pre-surgery phone call.
©2016 Intermountain Healthcare. All rights reserved.
9
YOUR GUIDE TO JOINT REPLACEMENT : Preparing for Surgery
What are your concerns about your surgery?
Write down any concerns you want to discuss with your healthcare providers.
What are your goals for your surgery?
Write down a goal you want to reach after you recover from surgery.
For example, you might want to be able to:
•• Play with your grandchildren by next summer
•• Golf by this spring
•• Travel on an Alaskan cruise by July
My goal (reason) for having surgery is to be able to:
10
by:
(date).
©2016 Intermountain Healthcare. All rights reserved.
PL
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Getting Your Body “Surgery Ready”
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YOUR GUIDE TO JOINT REPLACEMENT : Preparing for Surgery
•
Being in the best health possible lowers your risk of complications during and after surgery.
Check the tips below that make sense for you.
…… If you smoke, QUIT! You need to quit smoking
for at least 4 weeks before surgery and 6 weeks
after. Those who quit heal better.
…… If you need any medical or dental
procedures, ask your doctor how far in
advance you should schedule these.
…… Get control of any other health conditions
you have. Managing your blood pressure, blood
sugar, and other conditions is essential to a
successful surgery. If your have diabetes, making
sure that your hemoglobin A1c is less than 7.0
will help your wound heal faster.
–– Medical procedures: Any procedure through
the skin (such as a biopsy, Moh’s surgery for
skin cancer, or colonoscopy) can introduce
bacteria into your body. This puts you at
higher risk for an infection that could impact
your new joint.
…… DO NOT USE alcohol or illegal drugs. Both
can seriously impact how you react to anesthesia
and medications. If your surgeon prescribes
Coumadin (to prevent blood clots), you will also
need to avoid alcohol and illegal drugs for a few
weeks after surgery.
–– Dental procedures: Just like medical
procedures, dental cleaning and having root
canals, a tooth pulled, or a crown exposes you
to risky bacteria.
…… Do daily strengthening exercises for your
lower body (see page 8) to give your muscles a
head start on your recovery. Try walking, water
aerobics, or swimming for about 30 minutes a
day, 5 days a week.
…… If you are overweight, try to lose a few
pounds. For every pound you lose, you take
pressure off of your joints, which will make it
easier to get around after surgery. Plus, eating
healthy food (more fruit, vegetables, and whole
grains plus less fat, sugar, and red meat) will
also help speed your recovery. …… Talk to your doctor BEFORE getting a
steroid injection into the joint to be replaced.
This also increases your chance of an infection
in the joint.
…… If you take any narcotic pain relievers,
try to cut back. Decrease your use of these
medicines as much as possible, so your care
team can effectively control your pain after
surgery. If your body is tolerant of high doses
of pain medicine, your pain may be more
difficult to control.
”My doctor told me that doing regular exercise could make it easier
for me to come out of anesthesia after surgery. Plus, if I lost a
few pounds, she said that my incision would heal faster.
That was all I needed to hear to join a water aerobics class.“
— Phyllis, Knee Replacement Patient
©2016 Intermountain Healthcare. All rights reserved.
Continued... 11
YOUR GUIDE TO JOINT REPLACEMENT : Preparing for Surgery
Strengthening and balance exercises for getting “surgery ready”
General strengthening exercises include biking, swimming, walking, and water aerobics.
Aim to exercise 150 minutes a week (or 30 minutes a day, 5 days a week) to optimize your
health before surgery.
Studies have shown that your level of function
before surgery impacts how well you do after
surgery. Ask your surgeon about specific exercises
you can do to help you prepare for the type of
joint replacement surgery you will have. Even if
your surgery is only a week away, starting exercises
now can help give you a head start on your postsurgery rehabilitation and recovery.
In addition, Intermountain offers a free customized
home exercise program (HEP). Ask your doctor
for more information.
Record strengthening and balancing exercises your
doctor recommends in the box below.
"When my doctor scheduled my knee surgery,
I started swimming laps at my neighborhood
pool every morning. It made such a difference
in just a couple of weeks, and I think it really
helped me recover faster after surgery.”
— Bill, Knee Replacement Patient
My plan for strengthening my body before surgery:
To get surgery ready, I will do some strengthening exercises 30 minutes a day, 5 days a week
(CHECK WHAT YOU ARE COMFORTABLE DOING):
…… Biking
…… Swimming
…… Walking
…… Water aerobics (low impact)
My surgeon also recommends doing these specific strengthening and balance exercises:
12
©2016 Intermountain Healthcare. All rights reserved.
YOUR GUIDE TO JOINT REPLACEMENT : Preparing for Surgery
When you come home after surgery, you will need to be extra careful to prevent
falls and injuries while you recover. There are a lots of small changes you can make at
home now to make your recovery as safe and speedy as possible.
TED
CO
PL
•
M
E
Preparing Your Home
•
Check the tips below that make sense for you.
Set up your recovery space
Improve lighting
…… Leave space around furniture for using a walker,
cane, or crutches.
…… Use night lights, and add lamps if necessary.
…… Place a sturdy chair with arms near a table.
Manage pets
…… Ensure that chair seats are high enough to get in
and out of easily. Add cushions if necessary.
…… Make a plan to keep your pets from tripping
you once you come home. For example, you
could keep pets in a different area of the house
or put a bell on each pet’s collar to alert you
when they are near.
Arrange for assistive equipment
…… DO NOT expect people to lift or move you; don’t
risk a loved one suffering an injury. Use assistive
equipment!
…… Plan on needing a front-wheeled walker or
crutches (at minimum). You may also want a
raised toilet seat or toilet safety frame.
Reduce tripping hazards
…… Remove throw rugs or small objects on the floor.
…… Tack down or tape carpet edges.
…… Remove clutter.
…… Clear pathways of furniture and electrical cords.
…… Make sure your stairs and hallways are well lit.
…… Consider boarding your pets or having them
stay with a friend or family member when you
first come home.
Prepare your kitchen and bathroom
…… Stock up on supplies and groceries. Prepare
frozen meals ahead of time to warm up while
you are recovering.
…… Store commonly used items on lower shelves or
on counter tops in your kitchen and bathroom.
…… Place items where you can reach them without
bending below your waist, reaching, or lifting.
…… DO NOT USE step stools.
Learn MORE tips for making your bathroom safe on the next page.
I will get help from these people to complete the items I checked on this and the next page:
Other things I need to do to prepare my home and who can help:
My goal is to complete all the items I checked above and on the next page by.
(date)
©2016 Intermountain Healthcare. All rights reserved.
Continued...
13
YOUR GUIDE TO JOINT REPLACEMENT : Preparing for Surgery
Tips for a safe bathroom after surgery
Check the items in the illustration below that make sense for your situation.
r Use an elevated toilet seat or toilet safety frame
to raise the height of your toilet and steady
yourself when standing up from the toilet.
r Install a hand-held shower hose and
single-lever water mixing faucet for
better temperature control.
r Install grab bars
r Keep a
long‑handled
sponge handy
to wash hardto‑reach areas.
for support
as you get in
and out of the
tub or shower.
(See “Grab Bar
Guidelines” below.)
r Prevent slips and
falls by using
ONLY non‑slip
bath mats on
the floor and
in your tub and
shower.
r
Sit on a bath bench or shower chair while you bathe. A shower chair can also be used for dressing
and grooming at the sink.
Other safety considerations include keeping your hot water heater set at no more than 120 degrees, putting
daily-use items within reach, and not using bath oils in the tub or shower.
— If you decide to
install grab bars for general safety, follow
these guidelines:
Grab Bar Guidelines
Tub enclosure grab bar
• 24
inches long
angle
• 45-degree
•• Consider a professional installation for
wall-mounted grab bars.
•• Use grab bar(s) that are 1 ¼ to 1 ½ inches
in diameter.
•• Choose a bar with a textured surface to
make it easier to grip.
14
Shower-head
wall grab bar
(at least
12 inches long)
©2016 Intermountain Healthcare. All rights reserved.
YOUR GUIDE TO JOINT REPLACEMENT : Preparing for Surgery
TED
CO
PL
•
M
E
Having a Pre-operative Exam
•
Review the items below that apply to you. Then, complete the pre-surgery
health record on the next page.
Your doctors need to know
The better your healthcare providers understand
your current condition, the better they can reduce
the risk of surgical complications. The information
below explains why your care providers need to
learn as much as possible about your medical
history and medicines.
•• Infections. A current or past infection on
any part of your body can lead to surgical
complications. Problems, such as active dental
infections, urinary tract infections, and prostate
disease, should be diagnosed and treated long
before your surgery.
•• History of heart problems. Discuss these with
your primary care doctor and cardiologist
(if you have one) so that your care team can help
prevent heart-related complications.
•• Other medical conditions. To provide the best
care for you, your care team needs to know if
you have ever had certain conditions or allergic
reactions. These include diabetes, a transplant,
a bleeding disorder, sleep apnea, complications
with anesthesia, latex allergy, or a pacemaker.
•• Current skin condition. Open sores, areas
of infection or irritation, and old incisions
can increase the risk of infection, slow wound
healing, and cause other problems. This is
especially true for the skin around the incision
site. Tell your surgeon about skin issues —
wounds, abrasions, skin injuries, and any other
changes — that occur between your last office
visit and the day of surgery.
•• Your medicines. Because some medicines can
cause problems when taken together or slow your
recovery, give your care providers a complete list
of all medicines you take. Include those your
doctor prescribes, those you buy at the drug
store (over-the-counter medicines), and herbal
supplements or vitamins.
Tests you may need to have
Your surgeon will require certain tests before having surgery including those listed below. Check those
that your surgeon orders.
…… CBC (complete blood count) — A blood test used to evaluate your overall health and detect
disorders like anemia, infection, and leukemia. This test measures your red and white blood cells
that carry oxygen and fight infection and the platelets in your blood that help with blood clotting.
…… BMP (basic metabolic panel) — A group of blood tests that provides information such as how well
your kidneys function and your blood sugar levels.
…… PT/INR (prothrombin time/international normalized ratio) — If your doctor prescribes Coumadin,
this blood test measures the time it takes for the liquid portion (plasma) of your blood to clot.
…… ECG (electrocardiogram) — A brief test that helps detect your heart’s electrical activity from
many areas at the same time. This painless test involves having soft, sticky patches called electrodes
attached to the skin of your chest, arms, and legs. A machine records signals picked up by these
patches on graph paper or displays them on a screen.
©2016 Intermountain Healthcare. All rights reserved.
Continued... 15
YOUR GUIDE TO JOINT REPLACEMENT : Preparing for Surgery
My pre-surgery health record
Gather the information below that your hospital staff will need to know before your surgery.
Having this information handy will make the process much smoother. You can also request a list
of your medicines from your primary care doctor.
Check the items below
that apply to you.
…… I am a smoker.
…… I have had the pre-surgical tests my doctor
ordered (such as ECG, labs, x-ray, etc.)
…… I have traveled outside of the country in
the last 21 days.
List every medicine, vitamin,
or supplement you take in
the space provided.
In the “Dose” column, include the number of
“mg” printed on the pill bottle label, and if you
take more than 1 pill or a part of a pill each time.
Prescription
medicines I take
How
often
Dose
Over-the-counter
medicines I take
(including vitamins
and supplements)
How
often
Dose
I currently have the following:
…… Diabetes
…… Obstructive sleep apnea
…… A breathing disorder or a need to use
oxygen at home
…… A pacemaker or defibrillator. If so, record:
––Make and model:
––Date of last check to ensure proper
operation and charged batteries:
…… A heart stent. If so, record:
Type of stent:
Date placed:
…… History of chronic infection such as MRSA,
VRSA, VRE, C-diff, etc.
…… Allergies to medicines or food, materials,
or other. If so, list your allergies below:
––
––
––
––
––
––
…… An advance directive (check all that apply):
16
––Power of attorney
–– POLST (UT)
––Living will
–– POST (ID)
©2016 Intermountain Healthcare. All rights reserved.
YOUR GUIDE TO JOINT REPLACEMENT : Preparing for Surgery
TED
CO
PL
•
M
E
Packing Your Bag
•
Check the items below that you need to pack.
What to bring to the hospital
Be sure to leave all
personal items in the
car when you check in
for surgery. Your health
coach can bring them in
once you arrive in a your
room after surgery.
•• This notebook: Your Guide to Joint Replacement
•• A health coach (or other family member or friend)
who can stay with you until the time of surgery.
•• A small bag of personal items (enough for up to 3
days) with:
…… A pair of flat shoes or slippers with non-skid
soles and a back. You’ll need these during
physical therapy.
…… Loose, light-weight clothing, such as T-shirts
and shorts or sweat pants, that will fit easily over
bulky dressings.
…… Pajamas, a robe, and underwear.
…… Personal care items such as a toothbrush and
deodorant.
…… Your cell phone, e-reader, laptop, or book, if you
choose.
…… Your CPAP, if you use one, and your mask.
(Note that your equipment will be inspected by
the hospital.)
…… A
“rescue inhaler” if you use one.
…… A case for glasses or contacts, hearing aids.
…… Your picture ID and insurance card.
…… A list of all medicines you take including
herbal supplements and over-the-counter
medicines (see page 12).
…… A list of any questions or new concerns
you want to discuss with your surgeon or
anesthesia provider.
…… A copy of your advance directive form (if not
already given to your nurse).
•• If you have your own walker or crutches, leave
them in the car until after surgery when you
arrive at your room.
+
©2016 Intermountain Healthcare. All rights reserved.
Continued... 17
YOUR GUIDE TO JOINT REPLACEMENT : Preparing for Surgery
DON’T BRING to the hospital
…… Valuables (such as large amounts of cash and credit cards)
…… Tight-fitting clothes
…… Jewelry (be sure to remove any body piercings)
…… Personal electric equipment (such as an electric shaver or blow dryer)
…… Medications (unless otherwise directed)
18
©2016 Intermountain Healthcare. All rights reserved.
My Surge
ry
ring the
Make you
r anesthe
Make your
sia decisio
n
anesthesia approach for your
surgery and overall health
•• Perform your joint replacement
Replace
the join
t
Move to
are. All rights
—George,
Total Hip
Repla
reserved.
cement
Patient
•
LEA
3
RN
What I need to do:
…… Provide a COMPLETE list of medicines I take
at home including supplements and over-thecounter medicines
…… Provide COMPLETE information on all health
conditions and my health history
surgery using internationally
recognized best practices of
surgical and medical care
…… Make sure I ask questions and voice my concerns
•• Everything possible to manage
…… Be very honest about my level of pain or nausea
•• Evaluate your condition and your
…… NEVER get out of bed without the help of a
your pain and keep side effects to
a minimum
mobility and prescribe exercises
to help you recover
•• Administer medicines, devices,
and tests to help prevent
blood clots
•• Listen carefully to your concerns
and address them
©2016 Intermountain Healthcare. All rights reserved.
PACU
Move to
PACU: Whe
RN
completed
n your
A
Acute Care , you will be movesurgery is
d to the
will make Unit (or PACU
Post). Your
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Waking
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•
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©2016 Intermo
My Surge
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ORE
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untain Healthc
position
Drape and
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TO JOINT
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Go to Sur
ORE
What my healthcare
providers will do:
Drape and
ORE
op que
sthesia
en You
M
–– Recognizing Your Healthcare Team Members — page 20
–– Understanding Anesthesia — page 21
–– Waking Up After Surgery — page 23
–– Understanding the Daily Routine — page 25
–– Managing Your Pain — page 27
–– Preparing to Go Home — page 29
Start ane
YOUR GUID
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the joint
:
process
outlined Your surgical team
in section
on the
type of
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surgery
guide, depe
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©2016 Intermo
•• “Learn More” icons that let you know that more-detailed
suggestions and checklists appear on other pages including:
Prep for
What Ha
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anesthesi
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•• A helpful timeline of what will take place before, during, and
after your surgery (pages 16–19).
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In this section, you will find...
r team
s
•
Meet you
•
Check in
Meet your
team:
you are
taken to Once
the “pre
op” area
, you will
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visit with
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team such your
as:
• A surg
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be with nurse, who will
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• Your
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(and perh
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Recognizi
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Team Mem Your Healthca
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page 6).
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Having My Surgery
Pre -Surge
Prep for
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• You will
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glasses,
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• An orde
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• A nurs
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• You may
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on
• Your
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surgical
site will
be mark
ed.
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ppens Du
•
ENT : Havin
g
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Check in:
When you
double
arrive at
check to
the hosp
be sure
ital, staff
• You have
that:
will
medical
insurance
clear
pre-autho ance from
your doct
• They
rization
or and
know
for surg
ery
medicine about all your
medical
s you take
condition
• You unde
s and
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wha
and after
your surg t will be done
for pain
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• You know
during
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• Your
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• All your
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in the spac
e provided write
below)
•
YOUR GUID
E TO JOINT
REPL ACEM
before going to surgery AND that I understand
what I am being told in response
after surgery so my healthcare providers can
best manage these
staff member
…… Do my physical therapy exercises just as directed
…… Follow all my doctor’s orders about taking
medicines, having blood tests, and preventing
blood clots to avoid complications
…… Let my healthcare providers know if I have any
concerns about my recovery or care
19
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
What happens during the PRE-SURGERY process
Check in: When you arrive at the hospital, staff will
double check to be sure that:
•• You have medical clearance from your doctor and
insurance pre-authorization for surgery
•• They know about all your medical conditions and
medicines you take
•• You understand what will be done for pain during
and after your surgery
•• You know that you will be getting up and moving
around soon after surgery and going home when
discharged from the hospital
Prep for surgery: When you go to the
pre-surgery area, here’s what to expect:
•• You will change into a hospital gown
and hat and remove your glasses,
contacts, hearing aids, and jewelry.
•• A nurse will start an IV for you to get
fluid and medicines in surgery
•• An orderly or nurse assistant may
shave an area and use a special scrub
•• Your health coach understands his or her role
•• A nurse will check your blood pressure
and heart as well as your lungs and
ability to breath normally
•• All your questions are answered (be sure to write
down any questions in the space provided below)
•• You may be fitted with compression
stockings to prevent swelling.
•• Your surgical site will be marked.
LEA
Make your anesthesia decision: Anesthesia is a
type of medicine that keeps you comfortable during
surgery. There are several types — general, regional,
and peripheral nerve block. The anesthesiologist and your
surgeon will review these with you so that you can decide
together what’s best.
Most patients prefer regional anesthesia as it is easier to
wake up from, has less risk of blood clots, may lower your
chance of infection, and will not make you as groggy or sick.
•
•
Learn more about different
hospital staff roles in
“Recognizing Your Healthcare
Team Members” (see page 20).
•
•• The anesthesia team
(usually an anesthesiologist
or a nurse anesthetist)
RN
ORE
•• Your surgeon (and perhaps
a physician’s assistant)
Prep for surgery
M
ORE
•• A surgical nurse, who will
be with you throughout
the process
20
RN
Make your anesthesia decision
M
Meet your team: Once
you are taken to the “preop” area, you will visit with
different people on your
surgical team such as:
LEA
Meet your team
•
Check in
Learn more on page 21, “Understanding Your Anesthesia.”
My pre-op questions:
©2016 Intermountain Healthcare. All rights reserved.
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
What happens when you GO TO SURGERY
Replace the joint: Your surgical team will follow the
process outlined by your surgeon (see joint-specific
materials in section 3 of this notebook). In addition to
the procedure itself, your care team may also:
Start anesthesia: Your
anesthesia team will
give you the type of
anesthesia selected
(and some medicine to
make you sleepy if you
are getting regional
anesthesia or peripheral
nerve block).
•• Insert a drain to remove fluid near your incision.
•• Place soft-pump devices around your feet or legs
to help reduce the risk of blood clots forming in
your legs.
•• Insert a small, flexible tube (called a Foley
catheter) into your bladder to drain urine. Talk to
your doctor about whether or not you will need a
urinary catheter and for how long after surgery.
Be sure to go to the
bathroom right before
this as your surgery may
last a couple of hours.
Move to PACU
•
ORE
Move to PACU: After surgery, you will
be moved to the Post-Acute Care Unit (or
PACU). Your nurses will make sure that you
are stable and awake before you are taken to
your room.
RN
M
Drape and position limbs:
When you go into surgery, the
team may need to position your
limb for surgery and place blue
drapes over your joint to prevent
infection. You will not likely see
anything after this phase.
Replace the joint
LEA
Drape and position limbs
•
Start anesthesia
The entire surgery will likely last 1 to 3 hours.
Your family or coach cannot come into the
PACU, but the surgeon will let them know
how you are doing and when you will be
moved to a room.
You may wake up from surgery and find
some things attached to you such as a Foley
catheter, IV, wound drain, soft pump device,
and oxygen. Learn more about these on
pages 23–24, “Waking Up After Surgery.”
“I really appreciated how carefully the staff explained what
I could and could not do when I woke up. I had no idea how
the spinal anesthesia would affect me!”
—George, Hip Replacement Patient
©2016 Intermountain Healthcare. All rights reserved.
21
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
•
From now on, your care team
will focus on managing pain,
preventing infection and
blood clots, and making it
possible for you to go home
when ready.
•• Monitoring your health
•• Making sure your anesthesia has worn off
•• Having a care provider with you at all times
when you are out of bed
You will find this time to be
very busy. Learn about the
Becoming mobile early prevents blood clots
and ensures that you recover as quickly as
possible.
Learn about pain medicines and how to best
manage your pain after surgery on pages 27–28,
“Managing Your Pain.”
ORE
Your nurse will often ask you to rate your pain
and work with your surgeon to make sure you
are getting the right amount of pain medicine.
Have therapy: While you are in
the hospital, you will have physical
therapy and occupational therapy
to help you:
RN
M
ORE
•
RN
Have therapy
M
Manage pain: You will have pain after a
major surgery of this type and will need
pain medicine. The goal is to help you
manage your pain so that you can tolerate
physical therapy, rest at night, and breathe
normally.
Get up & move
LEA
Manage pain
•
Go to your room
LEA
daily routine you can expect
during your hospital stay on
pages 24–25, “Understanding
the Daily Routine.”
•
•
ORE
Get up & move: You will likely be getting
up and out of bed within 6 hours after you
arrive at your room. However, your care team
will make sure that you can safely get up and
move by:
•
RN
M
Go to your room: Once
you arrive at your room,
your coach or family
members can visit.
LEA
What happens during your POST-SURGERY hospital stay
•• Care for your surgical site as well as
prevent falls
•• Use a walker or crutches to get in
and out of bed, go to the bathroom,
use stairs, sit in a chair, and get in
and out of a car
•• Set personal activity goals for what
you want to be able to do when you
recover
•• Do exercises to meet your activity
goals (see Section 3: Preparing for
Surgery).
•• Transition to outpatient physical
therapy and/or an exercise program
Note: You may want to take pain
medicine at least 30–60 minutes before
therapy even if you are not in pain.
22
©2016 Intermountain Healthcare. All rights reserved.
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
•
•
LEA
•
•
•
Be sure to discuss your coverage for
outpatient physical therapy with your
insurance company.
RN
ORE
ORE
Learn more about these exercises by
reading any materials from your care
team included in section 3 of this
notebook.
Leave the hospital
M
M
LEA
Review instructions
Leave the hospital: When you are
discharged from the hospital, you
will likely go home. Studies show that
your recovery will be smoother if you
are in your own home.
•
Do your exercises
Do your exercises: Whether or
not your doctor wants you to have
outpatient physical therapy, you will
need to continue the exercises you
learned in the hospital to strengthen
muscles and regain mobility.
LEA
Your surgeon and hospital will give you a
personalized list of discharge instructions.
Make sure you get all your questions
answered about going home.
condition requires specialized care unavailable in
your home. Learn about different types of facilities
and typical criteria for admission on page 30.
RN
•
•• Medicines you will be taking
•• Home health and physical therapy visits
•• Bathing, ice, and wound care instructions
•• Activity and weight-bearing precautions
•• Follow-up visits
•• When to call the doctor (see also page 34
in Section 6: Going Home)
Going to a care facility means that your health
Plan for discharge
•
•• Move around on your own and with assistive
equipment (see Section 4: Going Home)
•• Eat and use the bathroom on your own
•• Manage pain with medicines your doctor
prescribes
•• Control swelling using R.I.C.E. (Rest, Ice,
Compression, Elevation)
•• Follow your therapy plan
Review instructions: Your nurse
will review your surgeon’s discharge
instructions with you and your health
coach. These can cover a variety of topics
including:
ORE
able to:
RN
M
When you go home, you will need to be
ORE
Plan for discharge:
RN
M
LEA
What happens when you are ready to LEAVE the Hospital
•• If you are going home, have your
coach drive you home and stay with
you for at least the first 24 hours.
Make sure both you and your coach
know precautions and when you
should call your doctor. Learn more in
Section 3: Preparing for Surgery and
Section 6: Going Home.
•• If your health condition requires you
to be discharged to a care facility,
make sure you know what your
insurance covers, criteria you must
meet to qualify, and which facilities
are in your insurance network
(see page 30 for more information on
care facilities).
©2016 Intermountain Healthcare. All rights reserved.
23
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
Recognizing Your Healthcare Team Members
You will likely meet a number of different care providers during your hospital stay, many of
whom will be wearing hospital “scrubs.”
The color of the scrubs that care providers wear can help you understand their role in your care. Note
that your physical or occupational therapist, care manager, social worker, or others may be wearing “street
clothes.” In fact, your doctor will likely be wearing “street clothes” when visiting after your surgery.
My doctors:
Care
Technician
or Nursing
Assistant
Doctor
Nurse
Light Blue
Navy Blue
My care technicians:
My nurses:
Surgical
Staff
My surgical staff:
Light Green
Light Grey
Other key members of your healthcare team who typically wear “scrubs” include:
•• Imaging specialists who take x-rays or scans
•• Respiratory therapists who help you with breathing exercises
•• Phlebotomists who draw blood or start IVs
Imaging
Specialist
Dark Grey
Phlebotomist
Beige
Dark Green
My imaging
specialists:
24
Respiratory
Therapist
My respiratory
therapists:
My
phlebotomists:
©2016 Intermountain Healthcare. All rights reserved.
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
Understanding Anesthesia
What types of anesthesia are available?
Before surgery, you’ll be given anesthesia, a type of medicine that keeps you comfortable
during surgery.
There are several types of anesthesia. The type that will be best for you depends on the surgery you are
having and your overall health and risk factors. With any type of anesthesia, there may be some side effects
or complications (although rare). Review the information below for each type of anesthesia, and record
any questions you have for your doctor on the next page.
General anesthesia — Used during many
major surgeries, this type of anesthesia
affects your entire body and puts you into
a deep sleep. It’s usually given by injection,
by inhaling, or through an intravenous (IV)
catheter inserted into a vein.
Once you are asleep, the anesthesiologist
will place a breathing tube down your
throat and give you oxygen to assist your
breathing.
Regional anesthesia — This type of
anesthesia is given usually as an injection
(shot) before surgery to prevent feeling in
the lower part of your body. It will wear
off a few hours after surgery.
Regional anesthesia should not affect your
breathing or heart rate, so you will be
able to breathe and swallow on your own.
Because you remain conscious, you will
also be given sedatives to make you sleepy.
General anesthesia risks:
––Throat pain, hoarseness, or injury
to your mouth or teeth from the
breathing tube
––Drowsiness, confusion, or
restlessness as you wake up
––Teeth clenching as you wake up
––Breathing problems or pneumonia
––Nausea or vomiting
––Very rarely, heart problems,
stroke, or other life-threatening
complications
––Awareness issues
Regional anesthesia or nerve block
risks:
––Bleeding or bruising at the
injection site
––Infection
––Numbness or weakness
––Unrelieved pain
––Headache
––Convulsions
Peripheral nerve blocks —These blocks
are a type of local anesthesia used to
help with pain control after surgery. A
local anesthetic is injected around some
of the nerves to the joint being replaced.
A peripheral nerve block can be a onetime injection or an infusion of medicine
that lasts for 1 or 2 days after surgery.
©2016 Intermountain Healthcare. All rights reserved.
Continued...
25
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
What will it feel like when the anesthesia wears off?
When your anesthesia begins to wear off, you
may feel tingling or burning as well as aching.
The feeling in the part of your body that was
numbed will start to return.
Remember: You will have pain following a
major surgery like this. The goal is to be able to
tolerate your pain so you can rest, heal, and do
physical therapy.
You will need to communicate with your care
providers about the level of pain you are feeling.
Your doctor or nurse will frequently ask you to
rate your pain using a pain scale (such as the one
displayed below) that can compare how pain is
affecting you now and throughout your hospital
stay. Be very honest about the level of pain you
feel. This will help your care providers determine
the best way to manage your pain.
For more information about managing pain
after surgery, see “Managing Your Pain” on
pages 27–28.
Wong-Baker FACES Pain Rating Scale
0
No hurt
2
Hurts
little bit
4
Hurts
little more
6
Hurts
even more
8
Hurts
whole lot
10
Hurts worst
© 1983 Wong-Baker FACES ® Foundation, www.WongBakerFACES.org. Used with permission.
Originally published in Whaley & Wong’s Nursing Care of Infants and Children. © Elsevier Inc.
My questions about anesthesia:
No duele
26
Duele un poco
Duele un
poco más
Duele un
mucho
Duele mucho
más
Duele el
máximo
©2016 Intermountain Healthcare. All rights reserved.
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
Waking Up After Surgery
You will wake up in the PACU and then likely move within an hour or so to a hospital room for a
1- to 3-day stay, depending on how complex the surgery is and your general health.
What will likely be attached to me when I wake up?
A “Foley” catheter:
A thin, soft tube
inserted through your
urethra (where urine
comes out) into your
bladder. The catheter
allows you to urinate
(pee) without getting
out of bed during the
first few hours after
surgery. If you have a
catheter, it will likely
be removed within
24 hours after surgery.
If you want it removed
before then, talk
to your healthcare
provider.
An IV: A small tube inserted
into a vein in your arm
or hand that was placed
before surgery to get liquid
medicines and fluids into
your body. Your IV will be
“capped,” leaving the plastic
tubing in the vein, when
you no longer need it. This
makes it easy to access should
you need additional fluid or
medicines while you are in
the hospital.
Dressing: A bandage that the
A wound drain: A small, plastic tube that drains excess fluid that
gathers around your incision. This is temporary and will likely be
removed the day after surgery. The drainage will be bloody. Your care
team will monitor it closely. Typically, the drain will be removed in the
first day or two after surgery depending on the amount of drainage.
The type of drain varies by surgery and surgeon.
nurses and doctors will monitor
and change to ensure that your
incision heals properly without
infection. The surgical dressing
will likely be replaced with
a smaller one. You and your
health coach will learn how to
change this dressing, if needed,
when you go home.
Other items that you may have when you wake up include:
•• Oxygen: You will likely need to be given oxygen
through a tube in your nose for at least a few hours
after your surgery. Nurses will monitor the oxygen
level in your blood. A respiratory therapist or
nurse will show you how to use a
spirometer — a device that helps
you keep your lungs clear and
prevent pneumonia (see “Spirometer
Instructions” on page 24).
©2016 Intermountain Healthcare. All rights reserved.
•• Compression stockings or
sequential compression
device (SCD): Your surgeon
may want you to wear
compression stockings to help reduce swelling
or an SCD to improve your blood flow for a
while after surgery.
Continued...
27
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
What will my care providers be doing when I wake up?
•• Monitoring your vital signs and oxygen
level. Nurses will check these every few hours
during the day and night.
•• Strengthening your
breathing. In addition to
your assigned exercises with
the spirometer (see instruction
box below), your nurse will
remind you often to cough and
breath deep to help prevent
complications (like pneumonia) after surgery.
•• Checking your legs and feet. Your legs
and feet will be checked for color, warmth,
movement, and sensation. When your legs
are not elevated, you will often need to pump
your ankles and wiggle your feet and toes to
improve blood flow. You may have sequential
compression devices (SCDs) on your lower legs
or feet to reduce the chance of blood clots.
•• Caring for your incision. Nurses will check
your bandage regularly and the drain (if you
have one) to remove fluids. You may also have
ice over the dressing to reduce swelling.
•• Bedside reporting. When one nurse goes
home and transfers your care to another nurse,
both nurses will meet at your bedside to
discuss your progress. You can participate in
this conversation and help make the best plan
for your recovery.
•• Helping you do more and more for
yourself. You’ll participate in your own
personal care such as brushing your teeth
and washing (as approved by your doctor).
Doing more for yourself will help you become
independent again. (But remember to be
SAFE. Always have a staff member with
you before you get out of bed.)
Using your spirometer
A spirometer is for exercising your lungs. While you are awake, use your spirometer every hour, doing
5 to 10 deep breaths (see instructions below) each hourly session. Not only will you do this in the
hospital, but you will take the spirometer home to continue strengthening your breathing.
Follow these steps to effectively use your spirometer:
1. Place spirometer on a flat surface or hold in an upright position.
2. Completely exhale (until there is no more air to come out).
3. Put the mouthpiece in your mouth and close your lips tightly
around it.
4. Inhale through your mouth as slowly and deeply as possible
(if this is difficult, suck the air in as you would if breathing
through a straw but more slowly). Your nurse may give you a
nose clip if it is hard to breathe just through your mouth.
5. Watch the indicator on the spirometer to see if you are reaching
your target goal or even higher.
6. Hold in all the air you inhale for at least 3 to 5 seconds,
if possible.
7. Remove the mouthpiece, and exhale normally.
8. Take several normal breaths before trying another deep breath
with the spirometer.
9. Cough after each deep breath.
28
Deep breathing and
coughing is important to
prevent lung problems.
©2016 Intermountain Healthcare. All rights reserved.
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
Understanding the Daily Routine
While you are in the hospital, your goal is to build your strength and independence enough that
you’ll be able to continue your recovery outside of the hospital. Our goal is to help you become
more mobile, prevent complications, and keep you safe.
Your surgeon or physician assistant
will be by to see you every day.
Most surgeons start rounding around 7:00 am.
In addition to coming to see you, they will be
reviewing your clinical notes and physical therapy
progress, going over all pertinent laboratory
information, and coordinating a plan for your
discharge from the hospital.
Hourly rounding
Blood draws
MORNING
You may have your blood drawn each
morning to check your blood clotting
time (if your physician prescribes Coumadin for
you) and also your hematocrit (blood count or
blood level).
Daily care
Your nurses will regularly check your vital signs,
how much fluid you drink, and how much you eat.
They will monitor drainage from your incision,
increased pain and swelling, and how your legs
and toes feel. In addition to your usual medicines,
you will receive other medicines to prevent blood
clots, control pain, and prevent infection. Your care
team will also offer help with dressing, changing
your linens, ordering food, preparing for physical
therapy, and any nighttime care you may need.
©2016 Intermountain Healthcare. All rights reserved.
Building strength also involves getting up and
out of bed as early as 6 hours after you arrive in
your hospital room following surgery. You will get
out of bed to go to the bathroom, to do physical
therapy, and to start moving on your own with
your new joint. However, you must NOT get up
without a staff member with you AT ALL TIMES.
Remember: your care team wants to help you get
out of bed and become more mobile. You are never
“bothering” your care team!
•• DO NOT
–– Get up by yourself.
–– Have family members help you up.
A
FETY
•
Care team members will be checking on you in
your room every hour. Please take advantage of
this time to have them assist you with any needs,
especially when you feel you may need to go to
the bathroom.
Getting out of bed
S
MORNING
•
Physician rounding
•• DO:
–– Call staff at least 15 to 20 minutes before your
urge to “go” is immediate. (See “A trip to the
bathroom at a glance” below.)
–– Expect a staff member to stay in the bathroom
with you. Safety comes before privacy.
A trip to the bathroom at a glance
1. You notify staff and wait for arrival
(5 minutes)
2. Staff removes equipment (5 minutes)
3. Staff gets you up
using walker or
crutches (3 minutes)
4. Staff helps you walk
to bathroom
(3 minutes)
5. Bed to Toilet =
16 Minutes
Continued...
29
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
Communication
There are two, very important ways that you and
the hospital staff will be able to communicate
during your stay:
•• The communication board — This will be
located somewhere in your room where you can
see it and will include the names of those caring
for you and other information depending on the
facility and your needs. Refer to Section 2: About
Your Facility for more information.
•• The call button — The nursing call button at
your bedside is an important communication
tool for you when you need assistance. Don’t
forget: you MUST HAVE a staff member with you
any time you get up.
Physical and
occupational
therapy
MORNING
AFTERNOON
My questions about the daily routine:
Within a day of your surgery, you will likely have a
physical therapist (PT) visit you to evaluate how you
are doing with moving around (if instructed by your
surgeon). Be sure to ask for pain medicine at least 30
to 60 minutes before any physical therapy session.
The therapist will have you sit on the edge of the
bed, move to a chair, walk in your room, or walk
in the hallway. Then, you will likely learn a series of
exercises prescribed for you to help with recovery
both in the hospital and when you go home. If you
will need to use stairs at home, you will also learn
how to safely go up and down stairs. Plan on one
or two daily sessions of physical therapy. Your coach
is encouraged to attend as many physical therapy
sessions as possible.
You may have an occupational therapist (OT) visit
you to help make sure you can complete activities of
daily living (such as dressing and personal hygiene
tasks). The OT will make sure you know how to use
adaptive equipment safely, especially for moving in
and out of cars as well as tubs and showers.
30
©2016 Intermountain Healthcare. All rights reserved.
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
•
IN
•
PA
Managing Your Pain
Why is pain management
important?
Good pain management allows both your mind
and body to focus on healing, and healing faster
can help prevent complications. As you and your
healthcare providers manage your pain, expect that:
•• You’ll feel less stress. Feeling comfortable
reduces the stress that comes with pain, which
means your mind and body can work harder
on healing.
•• You can move around more easily. If you feel
less pain, it’s easier to do the physical therapy and
breathing exercises that will get your strength
back quicker. You may even leave the hospital
sooner.
•• You may have fewer complications after your
procedure. People whose pain is well controlled
seem to do better after procedures, avoiding
problems such as pneumonia or blood clots.
What is my pain management goal?
You will have pain after joint replacement surgery.
The goal is to reduce your pain enough that you can
rest and do the activities that will help you recover.
To best manage pain, your healthcare providers will
consider 3 factors:
1. What recovery activities you need to do —
These include coughing or breathing deeply to
prevent complications, physical therapy exercises,
and self-care activities.
What causes pain after
your surgery?
Many factors can contribute to the pain you
feel. These can include:
•• The surgical cut
•• Muscle spasms or cramps near the site of
the procedure
•• Tubes inserted into the body during your
surgery or that remain after the procedure
•• Muscle pain as a result of the position you
had to lie in during the procedure, or lying
in bed for a long time after the procedure
•• Constipation
2. What level of pain you can manage and
still do needed activities — Everyone’s ability
to tolerate pain is different. You and your
healthcare providers will rate your pain and
identify the level of pain you could manage and
still do your recovery activities.
3. What will help you to be comfortable —
When you’re uncomfortable, your pain can feel
even worse. Being comfortable may include
listening to music, staying warm, sleeping
without interruption, or quickly managing
feelings of nausea.
With these factors identified, your healthcare
providers will help you determine your best level of
pain control. This is your pain management goal.
"I am so glad I was involved in making a pain management plan
with my care providers. I felt like I had more control."
— Denise, Knee Replacement Patient
©2016 Intermountain Healthcare. All rights reserved.
Continued... 31
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
How do I talk about pain to
my nurse?
How can I stay ahead of the pain?
It’s not always easy to describe pain. Your care
providers will likely use some type of a pain rating
scale — a tool to help you describe how much
pain you’re feeling (such as the scale shown below).
The better your providers understand the kind of
pain you’re having, the better they will be able to
treat it. Your nurse needs to know (typical answers
are shown in bold):
•• Where does it hurt?
It hurts in my: shoulder, hip,
knee, etc.
•• When does it hurt?
It comes and goes, or, it hurts
all the time.
•• What does it feel like?
It feels sharp, dull, aching,
throbbing, like pins and needles, etc.
•• What makes it feel worse?
If your pain starts to increase, let your healthcare
providers know. It’s easier to control the pain before
it gets too strong. If you wait until it’s severe, it
may be harder to get under control.
What can I do to handle side
effects of pain medicines?
A major side effect of pain medicines is that they
cause constipation. If you are not having bowel
movements, follow these steps:
•• Take prescribed medicines for constipation.
•• Drink water.
•• Eat more fiber (whole grains, fruits, vegetables).
•• Walk! Be sure to have a staff member with you at
all times.
It feels worse when
I stand, sit, lie down, walk, sleep, eat, read, get
dressed, etc.
•• What makes it feel better?
It feels better when I
stand, sit, lie down, walk, sleep, eat, read, etc.
Wong-Baker FACES Pain Rating Scale
0
No hurt
2
Hurts
little bit
4
Hurts
little more
6
Hurts
even more
8
Hurts
whole lot
10
Hurts worst
© 1983 Wong-Baker FACES ® Foundation, www.WongBakerFACES.org. Used with permission.
Originally published in Whaley & Wong’s Nursing Care of Infants and Children. © Elsevier Inc.
32
No duele
Duele un poco
Duele un
poco más
Duele un
mucho
Duele mucho
más
Duele el©2016 Intermountain Healthcare. All rights reserved.
máximo
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
Preparing to Go Home
The best place for a patient to recover after joint surgery is in their own home. Intermountain
care providers will work with you throughout your surgical experience to ensure that you can
make a successful transition to your home after surgery.
What happens at discharge?
Your care team (surgeon, nurse, care manager,
social worker, etc.) will decide when it is safe for
you to recover at home.
Research tells us that patients have less risk of
infection, are readmitted to the hospital fewer
times, and move better with their
new joint when they recover at
In Section 3: My Joint
home. If you live alone, talk to
Replacement , you will
find specific guidelines
your family and friends about
from your care providers
getting some help for at least a
about your joint
few days after you go home.
If, however, you have health
conditions that require additional
care, you and your care providers
will discuss other options (see
replacement including
precautions and rehab
exercises.
“Where do I go when I am discharged?” on
page 30). These options could include going
to a
skilled nursing facility, an inpatient rehabilitation
facility, or a long-term acute care facility. Together,
you and your provider will decide what’s best for you.
Patients who are considered homebound qualify
for home healthcare following joint replacement
surgery. If you are homebound, you choose a
home health provider based on any insurance
coverage restrictions you might have. Contact
your insurance provider before your surgery to
determine your options.
Discharge from the hospital typically
requires that you:
•• Are medically healthy
•• Have achieved your personal goals
for discharge (see below)
•• Have completed your home health
arrangements, if appropriate
•• Have a committed family member
or health coach to take you home
When all hospital discharge criteria have been met,
your surgeon will discharge you with:
•• A prescription for the medicines you need. Some
medicines may be new to you, so be sure to ask
any questions you have about these.
•• Any orders for home health or outpatient
physical therapy based on the type of joint
replacement you had and your individual needs.
Before you are discharged, your nurse will meet
with you to answer questions and to review
medicine use and other information you need for
your continued recovery at home.
My goals for when I go home:
…… Be able to get in and out of bed, up from
a chair, and on and off the toilet without
assistance
…… Go up and down a flight of stairs safely
…… Safely walk at least 50 to 100 feet on my
own with crutches or a walker
…… Perform my therapy exercises on my own
or with help from my health coach
…… Control pain so that I can complete
exercises and daily activities
…… Eat and drink without difficulty
…… Other:
Your surgeon’s team is available 24/7 — be sure you have a phone number to call if you have questions
or concerns after your surgery. That phone number is:
©2016 Intermountain Healthcare. All rights reserved.
Continued... 33
YOUR GUIDE TO JOINT REPLACEMENT : Having My Surgery
Where do I go when I am discharged?
Because you will likely do better if you recover at home, your care team is committed to helping
you feel confident that you can safely go home after surgery.
Going home: Studies show
that joint replacement surgery
patients who recover at home
get better faster and with fewer
complications. This is why
it is important to identify a
committed health coach long
before your surgery. Your coach
should be able to stay with
you for a few days after you
go home. Talk to your family
and friends about getting the
support you need at home.
Ask about your insurance
It is very important that for any
care option, you contact your
insurance company and ask:
…… Does my health insurance cover
this service or type of facility?
…… For how long?
…… Which facilities are in my
insurance network?
Going to a care facility:
If you have health conditions
that require specialized care, you
and your care team (surgeon,
nurse, case manager, social
worker, etc.) will discuss other
discharge options (including
skilled nursing facility, inpatient
rehab center, or long-term acute
care center). It is very important
that you talk to your surgeon
about these options BEFORE
your surgery. Together,
Your surgeon may recommend that you continue
with outpatient physical therapy once you go
home. If you are unable to leave home to go to
outpatient physical therapy or if you go home with
medicines that require assistance or monitoring,
you may need to have home health services.
Be sure to:
you and your provider will
decide what is the best option for you.
Criteria for going to a care facility upon discharge
from the hospital varies depending on your
insurance (Medicare or private insurance). All
insurance providers will require a discharge
recommendation from your care team. Refer to the
typical insurance criteria for each type of facility
listed in the box below.
•• Check with your insurance provider to see what
physical therapy and home health services they
cover and for how long.
•• Talk to your care team (surgeon, nurse, care
manager, social worker, etc.) about local options.
Medicare and other insurance providers look
carefully at your care needs before paying for these
services. If you choose to go to a care facility and
do not meet insurance criteria, you may have to pay
the entire cost of your stay at the facility.
Typical criteria for discharge to a care facility
Skilled Nursing Facility
Inpatient Rehab Facility
Long-Term Acute-Care Facility
Needing intravenous (IV)
antibiotic therapy
Being physically able to do
3 or more hours of physical
therapy 5 days a week
Needing care for more than 30 days
Needing 2 or more people
Needing 2 or more people to
to help you get in and out
help you get in and out of
of bed and to the bathroom bed and to the bathroom
Needing more than 2 people to help
you get in and out of bed and to the
bathroom
Having other skilled nursing
Having other skilled nursing care
care needs for at least 3 hours needs for at least 6.5 hours a day
a day
34
©2016 Intermountain Healthcare. All rights reserved.
ENT : Havin
ENT
: Goin gg My
HomeSurge
ry
What to
•
Control
•
•
•
•
LE
ation and
swelling
Manage
constipat
•
LE
RN
RN
pain
Follow
your ther
apy plan
M
ORE
your ther
A
RN
ORE
Follow
Your phys
apy plan
ical thera
:
created
pist has
an
likely
(see Secti exercise plan
on
Replacem 3 - My Joint
ent) to
strengthe
retrain
your musc
n and
to using
les
your new as you get used
joint.
By doin
g your
exercises
therapist
just
instructs,
as your
how well
you will
the joint
impr
are heal
works once ove
ed.
you
Contact
your phys
have any
ical thera
concerns
pist if you
at:
M
are. All rights
A
LE
•
A
•
TIP
TION •
CO
NS
A
reserve
reserved.
d.
ENT : Goin
g Home
e
pain
a common
ion: Con
medicine side effect whe stipation is
n you take
and when
you are
pain
Your doct
less activ
or want
e.
to help
s you to
control
… Stoo
constipat take the following
l softener:
ion:
… Laxa
tive:
… Othe
r:
Contact
your doct
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RN
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–– Knowing When to Call the Doctor — page 34
–– Being Safe at Home — page 35
–– Controlling Constipation and Swelling — page 37
–– Managing Your Pain at Home — page 39
LEA
33
suggestions and checklists appear on other pages including:
•
Key steps for your at-home recovery
Record important information for these 6 key recovery steps.
1. Prevent complications. I will be safe by:
4. Do these home therapy exercises as directed:
2. Go for recommended follow-up appointments
with my surgeon or others on:
––Date of appointment:
––Date of appointment:
––Other doctors I need to see:
5. If directed by my surgeon, go to outpatient
physical therapy these days and times:
––Days and times: ––Phone number: ––Physical therapy location:
3. Have my health coach or other caregiver help
me by:
––Transporting me to medical appointments
and physical therapy
6. Speak up! I have questions or concerns about:
––Watching for and removing tripping hazards
––Tracking which pain medicines I take
and when
––Helping me contact the doctor if I have
problems
©2016 Intermountain Healthcare. All rights reserved.
35
YOUR GUIDE TO JOINT REPLACEMENT : Going Home
LEA
•
•
•
ORE
Be Safe: It is important that you protect yourself from falling AND keep your new joint in safe positions while you heal. You will need to use
assistive equipment to prevent falls and help you with tasks while you
are recovering at home.
RN
M
FETY
•
SA
What to focus on when you FIRST go home
Your care team wants you to use:
…… A walker
…… Crutches
…… A single crutch
…… A cane
Other recommended equipment includes:
…… A tool for reaching items or putting on shoes and socks
…… A raised toilet seat
…… A sponge with a handle for the shower or bath
…… Other:
Learn more safety tips on pages 35–36.
Be safe
Watch for blood clots
Watch for blood clots: Surgery can increase your risk
of developing blood clots, which can be dangerous
and require immediate medical care. To prevent this,
my surgeon has prescribed:
Medicine
Dose
For How Long
Symptoms of a blood clot can vary and are not always
clear. Call your doctor if you have:
•• More swelling than normal throughout your leg
•• Pain or tenderness in your calf (the back of your
lower leg) that gets worse when you pull your
foot forward
•• A specific area on your calf that feels warmer to the
touch than the rest of your leg
36
Care for your wound
Care for your wound: Prevent
infection by following these
guidelines:
•• Always wash your hands before
changing a dressing.
•• Follow your doctor’s instructions on
how to clean the area and change
the dressing.
•• Keep the incision dry and clean.
•• Follow your doctor’s instructions for
bathing and showering, especially:
––DO NOT take baths, use a hot
tub, swim, or soak your incision or
dressing.
––(If your doctor approves) Shower
as soon as you can move safely in
the bathroom. If you’re not steady
when standing, get help with your
shower to prevent falls.
©2016 Intermountain Healthcare. All rights reserved.
YOUR GUIDE TO JOINT REPLACEMENT : Going Home
LEA
•
ORE
•
Manage pain: You will have some pain throughout your
recovery at home.
RN
M
PA I N
•
•
What to do in the NEXT FEW WEEKS at home
Your doctor has prescribed the following pain medicine for you
when you go home:
Refer to pages 39–40 to learn more about managing your pain at home. You
will also find a handy medicine tracker on pages 40–42.
Contact your doctor if you do not have a bowel
movement by 7 days after your surgery.
Control swelling: Swelling will occur around your
surgery site, which increases your pain and makes your
joint stiff. To control swelling, you will need to:
…… Apply ice (pack or machine) to your incision
for
minutes times a day.
LEA
•
LEA
•
CO
•
…… Other:
Follow your therapy plan:
Your physical therapist has likely
created an exercise plan
(see Section 3 - My Joint
Replacement) to strengthen and
retrain your muscles as you get used
to using your new joint.
•
…… Laxative:
ORE
…… Stool softener:
RN
M
Your doctor wants you to take the following
to help control constipation:
By doing your exercises just as your
therapist instructs, you will improve
how well the joint works once you
are healed.
Contact your physical therapist if you
have any concerns at:
…… Elevate the leg ABOVE the level of your heart for
minutes times a day.
…… (If prescribed) Wear a compression stocking for
ORE
ON•
Control constipation: Constipation is
a common side effect when you take pain
medicine and when you are less active.
RN
Follow your therapy plan
M
ST I PA
TI
N
Manage pain
•
Control constipation and swelling
weeks.
Learn more tips for controlling constipation and swelling
on pages 37–38.
©2016 Intermountain Healthcare. All rights reserved.
37
YOUR GUIDE TO JOINT REPLACEMENT : Going Home
Knowing When to Call the Doctor
It is important that you and your health coach or other caregivers know what to watch for as
you recover and whom to call if needed.
What should I report to my
surgeon?
What should I report to my
primary care physician?
•• Pain that gets worse or that you can’t control
with prescribed pain medicine
•• Problems with your incision such as:
–– Unusual bleeding or new drainage (your
dressing becomes soaked before it’s time to
change it)
–– Separation of the edges of the incision
–– Blood, pus, or a foul odor coming from the
incision
•• Numbness, tingling, or weakness in your
arms or legs — or where you don’t expect it
•• Itching
•• Fever of 100.5º F. that doesn’t get better after
taking medicine
•• Dizziness, light-headedness, or fainting
•• Redness, swelling, heat, or drainage around the
incision site
•• Skin rash
•• An unexpected ringing, buzzing, or whistling
sound in your ears
•• Blurred vision
•• Persistent headache
•• No bowel movement within 7 days after surgery
•• Nausea when eating and drinking
•• Concerns about regular medicines such as those
you take for high blood pressure, diabetes, or
heart conditions
If you experience any of the above, contact your
surgeon or other care team member at the number
indicated below:
38
•• Symptoms of a urinary tract infection such
as feeling like you need to urinate (pee)
frequently, difficulty or pain when urinating,
blood in the urine, pelvic or back pain, or fever
•• Trouble controlling your blood sugar (if you
have diabetes)
If you experience any of the above, contact your
primary care doctor at the number indicated
below:
GO TO THE EMERGENCY ROOM
OR CALL 911!
If you have:
••Difficulty breathing, shortness of
breath
••Chest pain
••Signs of a blood clot
••Black or bloody stool
••Bloody vomit
©2016 Intermountain Healthcare. All rights reserved.
•
FETY
•
SA
YOUR GUIDE TO JOINT REPLACEMENT : Going Home
Being Safe at Home
Preventing a fall or injury to your new joint is one of the most important things you can do to
recover safely at home.
Review the tips on pages 9–10 of Section 4:
Preparing for Surgery to see if you have made your
home as safe as possible to prevent falls. Then, use
the tips below and on the next page to safely use
assistive equipment during your recovery.
See page 36 for
specific instructions
on using a walker.
Tips for using assistive equipment
You will likely use a walker, crutches, or cane (for
surgeries other than shoulder replacement) until
your therapist says you no longer need them. Tips
for getting around with these include:
•• Start with short, frequent walks.
•• Take steps that are smooth, even, and rhythmical
(not limping).
•• Cut back on walking if you have more swelling
or pain than usual.
•• Follow all precautions for the type of joint you
had replaced. See section 3.
Tips for preventing falls:
•• DO NOT have others help you to stand up or
to walk. You risk falling as well as injuring the
other person.
•• Keep your walker, crutches, slippers, and other
items you need within reach of your bed.
•• Make sure your room and any hallways to the
bathroom and kitchen are well lit and free of
tripping hazards (cords, throw rugs, small pets).
•• Take your time! Don’t hurry to answer the
door or phone or wait too long to head for
the bathroom.
©2016 Intermountain Healthcare. All rights reserved.
Be safe in the bathroom
Consider getting a
raised toilet seat and
toilet safety frame
with side handles.
Most toilets are
lower to the ground
than chairs, and it
may be hard to get
up from the toilet
after either hip or
knee surgery.
39
YOUR GUIDE TO JOINT REPLACEMENT : Going Home
How to use your walker
Follow these safety guidelines to help reduce
potential risks. Refer to the manufacturer website
if you would like further information about
your walker.
•• Push up from your seat to a standing position —
don’t use your walker to pull yourself up.
•• Make sure all four legs of the walker are on the
ground before taking a step.
"Once my physical therapist
showed me how to use
the walker correctly, I was
up and moving whenever
possible. I started out slow
and steady and then soon
developed a good gait that
protected my joint and
helped me keep up my
daily exercise.”
— Bill, Hip Replacement Patient
•• Stand in the middle of the walker.
•• Grasp the grips on each side of the walker with
both hands.
•• Push the walker forward at an arm’s length that
feels comfortable. The back legs of the walker
should be even with your toes.
•• Step forward with your weaker leg into the
middle of the walker. Continue to grasp the
walker grips with both hands.
•• Step forward with your stronger leg. Keep weight
off your weaker leg by supporting some weight
with your arms.
•• Work at keeping a good posture — keep your
elbows bent slightly and don’t lean forward
over the walker.
•• Keep an eye on what’s ahead of you.
•• To turn or change direction, you may need to
lift the walker.
•• Your physical therapist may adjust the walker
to meet your particular needs.
•• Always have at least part of your body inside
the frame of the walker.
•• DO NOT USE your walker on stairs or an
escalator.
About my assistive equipment:
Where to get equipment:
_
What does my insurance provider cover?
_
Other questions or concerns?
40
©2016 Intermountain Healthcare. All rights reserved.
ST I PA
ON•
•
N
TI
CO
YOUR GUIDE TO JOINT REPLACEMENT : Going Home
Controlling Constipation and Swelling
Because you are less active and taking pain medicines after surgery, you will probably have
some trouble with constipation. You will also experience some swelling for a few weeks after
surgery as a normal part of healing. Use the tips below and on the next page to control these
side effects.
Dealing with constipation
Constipation after surgery typically happens
because of taking pain relievers, such as narcotics,
and being less active for some time while you
recover. Symptoms include:
•• Less than 3 bowel movements a week
•• A sudden decrease in bowel movements
•• Having to strain to have a bowel movement
•• Bloating, increased gas
•• Pain in your abdomen or rectum
Usually, post-surgery constipation gets better
without major complications if you control it by:
•• Taking stool softeners (such as Colace)
and laxatives (such as Metamucil) if
recommended by your doctor. Continue
taking these as long as you are taking pain
medicine.
•• Adding fiber to your diet. You can eat more
whole grains, fruits, vegetables, and nuts or take
a fiber supplement. Add fiber slowly to prevent
feeling bloated.
•• Walking. Exercise helps your colon be more
active. Plus, it is important for your recovery!
•• Hard stools
•• A full feeling after a bowel movement
•• Drinking water. It is important to give your
body the fluid it needs to prevent constipation.
•• Avoid foods that can cause constipation.
Dairy products, bananas, white bread or
rice, and processed foods can all make the
problem worse.
If you are following these guidelines and still have
symptoms of constipation after 7 days, contact
your doctor.
"I drank lots of water after I came home from my hip surgery. I
really think it helped both my constipation and swelling."
— Sylvia, Hip Replacement Patient
©2016 Intermountain Healthcare. All rights reserved.
41
YOUR GUIDE TO JOINT REPLACEMENT : Going Home
Controlling swelling
Swelling is best controlled by using the R.I.C.E.
method:
•• Rest. Getting enough rest will help your body
heal and reduce swelling.
•• Ice. Use an ice pack or ice machine (see
recommendations at right). Your therapist will
tell you how long to keep using ice.
•• Compression: Your doctor may recommend
that you wear compression stockings for a few
weeks after you come home from the hospital.
•• Elevate. Keep your leg elevated above the level
of your heart when you sit or lie down.
In addition, doing your post-operative exercises
will help in the long run. You may experience
more swelling right after doing your exercises in
the first week or two after you come home. Be
sure to drink plenty of water — this will also help
with swelling.
Tips for using ice packs and
ice machines
•• There are a variety of ways to apply
cold to manage swelling. Most people
use ice packs made of something
that will mold to the body’s contours
without putting damaging pressure
on the surgical site. These packs can
be filled with a gel, ice cubes, or even
frozen peas, which don’t melt and leak.
Gel packs refreeze in 10 to 20 minutes.
•• Typically, it is a good idea to apply cold
packs for no more than 20 minutes at a
time and then wait 10 minutes before
reapplying.
•• Ice machines are particularly effective
for knee replacement patients because
they come with a pad that wraps
around the knee with iced water
flowing through the pad on a constant
basis. You can buy or rent these
machines from home health equipment
suppliers.
•• Other:
"I am so glad that I invested in an ice machine. It made
controlling swelling in my knee so easy. And, when I
went back to work, I could keep it under my desk.”
— Joe, Knee Replacement Patient
42
©2016 Intermountain Healthcare. All rights reserved.
YOUR GUIDE TO JOINT REPLACEMENT : Going Home
•
IN
•
PA
Managing Your Pain at Home
When you go home, being able to control your pain will help you rest, do daily activities, and
engage in the exercises and therapy needed to make your joint replacement a complete success.
You will still have some pain, especially when doing recommended exercises, but if you manage it, you’ll get
better faster. Here are some strategies for managing pain effectively.
Relieving pain with medicine
Pain medicine safety
You may be sent home with one or more
prescription or non-prescription medicines to
relieve pain, to reduce inflammation, or to help
your muscles relax. These medicines control pain in
different ways.
•• NEVER take more medicine or take it more often
than your healthcare provider tells you to.
You can prevent problems and avoid risk of
addiction to pain medicines by taking them
EXACTLY as your doctor directed. Note: If your
surgery was done on or near the weekend, be
sure to fill your prescriptions before you leave
the hospital and get a phone number where your
doctor can be reached after business hours.
•• NEVER use alcohol or street drugs when taking
narcotic pain medicines. The combination can
kill you.
Relieving pain without medicine
•• Keep medicine in the bottle it came in. The label
has instructions and information you need.
You may be able to take fewer doses of pain
medicine when you use alternative ways to relieve
pain. Ask your doctor about these options:
•• Cold or heat
•• Guided imagery and distraction
•• Physical therapy or exercise
•• Relaxation or meditation
•• Massage
•• Spiritual or emotional counseling
•• Don’t have someone wake you to take pain
medicine or let you take pain medicine if you
can’t stay awake for meals and daily activities.
•• Don’t take your medicines with any other pills
unless your healthcare provider says it’s okay. This
includes over-the-counter medicines, vitamins,
herbs, or supplements.
•• NEVER share pain medicine. Don’t give your pills
to friends or family members, even if the person
is in pain.
•• Lock up medicines. Don’t keep your pain
pills in your medicine cabinet where anyone
can find them. Dispose of leftover pills safely.
Find out more about disposal locations at:
useonlyasdirected.org.
Tips for refilling narcotic pain medicines
Narcotic pain medicine prescriptions CANNOT be called in by your doctor to a pharmacy. To make sure
you don’t run out of pain medicine on the weekend, follow these 4 steps:
1. Count how many pills you take a day to see when you will run out.
2. Contact your doctor’s office at least 48 hours before the date you will need more pills.
3. Pick up your written refill prescription from the doctor in person or tell the doctor’s office who
you will send to pick it up (and have that person bring identification).
4. Take the written refill prescription to your pharmacy to be filled.
©2016 Intermountain Healthcare. All rights reserved.
43
YOUR GUIDE TO JOINT REPLACEMENT : Going Home
Pain medicine tracker
Use the chart below and on the next couple of pages to track how much pain medicine you
take during your recovery. An example has been provided to help you get started. Make
copies of these pages if needed. Remember these precautions when taking pain medicine:
DO:
•• Have someone you trust help you keep track of
how many pain pills you take each day.
•• Tell your doctor if you still have a lot of pain
even after taking your pain medicine.
•• Tell your caregivers to CALL 911 if your
breathing slows down or stops, or if they can’t
wake you.
DO NOT:
•• Take any other medicine while you are taking
pain medicine unless your doctor says it’s okay.
•• Take more medicine than your doctor has
prescribed, even if you still have some pain.
•• Have your caregivers wake you to take pain
medicine or give you pain medicine if you can’t
stay awake to eat or do daily activities.
Example
44
Medicine: Percocet
Dose: 5 mg (1 pill) every
Day, Date
Time taken Soonest next dose Pain level (select the “face”
can be taken
that fits how you feel)
Monday, 3/5/15
2:00 PM
Medicine:
Dose:
Day, Date
Time taken Soonest next dose Pain level (select the “face”
can be taken
that fits how you feel)
8:00 PM
every
6
hours, only as needed
Before
After








hours, only as needed
Before



After



Before



After



Before



After



Before



After



Before



After



Before



After


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Before

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
After



©2016 Intermountain Healthcare. All rights reserved.
YOUR GUIDE TO JOINT REPLACEMENT : Going Home
Medicine:
Dose:
Day, Date
Time taken Soonest next dose Pain level (select the “face”
can be taken
that fits how you feel)
every
hours, only as needed
Before



After



Before



After



Before



After



Before



After



Before



After



Before



After



Before



After



Medicine:
Dose:
Day, Date
Time taken Soonest next dose Pain level (select the “face”
can be taken
that fits how you feel)
©2016 Intermountain Healthcare. All rights reserved.
every
hours, only as needed
Before



After



Before



After



Before



After



Before



After



Before



After



Before



After



Before



After



Continued...
45
YOUR GUIDE TO JOINT REPLACEMENT : Going Home
Medicine:
Dose:
Day, Date
Time taken Soonest next dose Pain level (select the “face”
can be taken
that fits how you feel)
every
hours, only as needed
Before



After



Before



After



Before



After



Before



After



Before



After



Before



After



Before



After



Concerns about my pain medicines or my level of pain:
“I am so glad that I followed my doctor’s advice to take my pain
medicine 30 minutes before doing physical therapy exercises. It
took the edge off so that I was able to stick with the program and
recover faster.”
— Eldon, Hip Replacement Patient
46
©2016 Intermountain Healthcare. All rights reserved.
To find this booklet and other patient education, go to:
intermountainhealthcare.org
©2016 Intermountain Healthcare. All rights reserved.
The content presented here is for your information only. It is not a substitute for professional medical
advice, and it should not be used to diagnose or treat a health problem or disease. Please consult your
healthcare provider if you have any questions or concerns. More health information is available at:
intermountainhealthcare.org/health-information/health-library.
Patient and Provider Publications MSK005a – 06/16