Bring this guide with you to the hospital on the day of your surgery

Transcription

1 Day f surgery: Expected discharge hme: Surgen: Phne number: Bring this guide with yu t the hspital n the day f yur surgery (17-10)

2 2

3 Intrductin This infrmatin guide will help yu understand what is invlved in knee arthrplasty (knee replacement). We hpe the infrmatin in this bklet will help yu prepare fr yur surgery Abut Hôpital Mntfrt Hôpital Mntfrt is a Francphne academic health care institutin that prvides quality care in bth fficial languages and wrks with its partners t imprve the health f cmmunities. Mntfrt strives fr excellence and wants t be a hspital f chice fr its persnalized patient care, its wrkplace, teaching and research. Our daily actins are guided by the values f cmpassin, cmmitment, excellence and respect. WARNING This guide des nt replace the advice f yur care prvider. Please cnsult yur care prvider t assess if the infrmatin presented in this guide applies t yur situatin. The cntent f this guide was prepared by Vancuver Castal Health and adapted by Hôpital Mntfrt. 3

4 Yur Health Care: Be Invlved! Be invlved in yur health care. Speak up if yu have questins r cncerns abut yur care. Tell a member f yur health care team abut yur past illnesses and yur current health cnditin. Tell yur health team if yu have any fd r medicatin allergies. Make sure yu knw what t d when yu leave the hspital. Yur Interprfessinal Plan f Care Yur hspital admissin fr yur knee replacement will fllw an interprfessinal plan f care mre cmmnly called a "Clinical Pathway". This is yur versin f the Clinical Pathway. It is an interactive dcument. Please take ntes if necessary when the nurse is discussing with yu. It has been prepared s that yu, yur family, and the members f the healthcare team knw yur plan f care. It gives yu an idea f the tests, treatments and diet yu will require during yur hspital stay as well as the educatin and planning necessary fr discharge Once yu and/r yur family have read the infrmatin in this bklet, please feel free t ask any member f the healthcare team any questins. 4

5 Table f cntent 1. Knee arthrplasty Anatmy f the knee Cmmn knee prblems Types f arthrplasty Length f hspital stay Preparing fr surgery Hôpital Mntfrt s Pre-Operative Educatin Sessin Yur appintment at the Pre-Admissin Clinic Preventin f surgical site infectin Nutritin Weight Management Pre-perative exercises Preparing yur hme List f accessries t btain befre surgery Other things t d befre yur surgery The surgery Checklist f things t bring t the hspital At hme the day befre surgery The day f the surgery At the Pre-p Unit n the day f surgery During the surgery In the recvery rm after the surgery In the patient care unit after the surgery After surgery General instructins after yur surgery Ankle and deep breathing exercises Pain cntrl Pain cntrl at hme Cnstipatin and urinary eliminatin Anticagulants Wund Care Sexuality after knee arthrplasty Dental wrk and medical prcedures Transprtatin Driving Air travel

6 5. Cmplicatins Infectin Swelling Bld clts Anemia (lw bld cunt) Pst-perative delirium Skin cmplicatins Jint lsening Exercices and daily activities Physitherapy Psitin f the leg in bed Walking Stairs Getting in and ut f bed Sitting Getting dressed Bathrm safety Car transfer Returning t wrk Fllw-up with yur surgen When t see an emergency dctr?...32 Ttal knee replacement: yur hspital stay...33 Partial knee replacement: yur hspital stay

7 1. Knee arthrplasty 1.1 Anatmy f the knee The knee is a jint between the femur (thigh bne) and the tibia (shinbne). It is a jint that enables bending and straightening f the leg. 1.2 Cmmn knee prblems All frms f arthritis can damage the cartilaginus pad f the knee. As the cartilage deterirates, the bnes gradually becme bare and rub against each ther, causing pain, stiffness, swelling and smetimes creaking. In cases f arthrsis, wear and tear destrys the cartilage, whereas in rheumatid plyarthritis, it is the damage t the synvial membrane that leads t the deteriratin f cartilage. 1.3 Types f arthrplasty Ttal knee arthrplasty Ttal knee arthrplasty cnsists f replacing the damaged jint with an artificial prsthesis. The surgen first makes an incisin in the skin t access the bnes, then mves the muscles and ligaments f the jint ut f the way. The damaged bnes are then trimmed t accmmdate the artificial prsthesis. The ends f the femur and tibia are cvered with metal cmpnents separated by a piece f plastic. If the patella is damaged, it can be resurfaced with a plastic buttn. The muscles and ligaments are then repaired. The incisin in the skin is clsed with sutures r metal staples that hld the skin in place during healing. This peratin takes abut tw hurs. Tday, fr many patients, knee arthrplasty prvides greater jint mbility and pain relief. Patients can als walk mre easily fr up t 25 years after the surgery. 7

8 Artificial knee prsthesis Unilateral (partial) knee arthrplasty If yu have bne lesins n nly ne side f the knee, yur surgen may perfrm a partial knee arthrplasty. As in the case f a ttal arthrplasty, the surgen trims the damaged part f the bnes t accmmdate the prsthesis. Many peple wh underg this prcedure recver faster than thse wh underg a ttal knee arthrplasty. Often, they can g hme the day after the prcedure. Unilateral knee prsthesis 8

9 1.4 Length f hspital stay Yur hspital stay will be brief. The healthcare team will help stabilize yur cnditin and make sure that yu are able t perfrm yur daily activities befre yu are discharged. Befre the surgery, it is imprtant t arrange fr yur transprtatin hme after yu are discharged frm the hspital. Discharges are scheduled befre 10 a.m. If yur recvery is quick, yu may be discharged earlier than planned. Make sure that smene is available t pick yu up in that event. Ttal knee arthrplasty 3 days r less. Pssible discharge n day 2. Example: If yur surgery takes place n Mnday (day 0) and if yu spend 3 nights in the hspital, yu will prbably be discharged Thursday mrning (day 3). Mnday: Tuesday: Day f surgery Day 1 pst-surgery Wednesday: Day 2 pst-surgery, pssible discharge Thursday: Day 3, planned return hme Partial knee arthrplasty One night r less Example: If yur surgery is n a Mnday (day 0) and yu spend three nights in the hspital, yu will prbably be discharged n Tuesday mrning (day 1). hme Mnday: Tuesday: Day f surgery Day 1 pst-surgery, planned return 9

10 2. Preparing fr surgery 2.1 Hôpital Mntfrt s Pre-Operative Educatin Sessin Hôpital Mntfrt ffers a Pre-Operative Educatin Sessin t infrm and prepare patients and their caregivers befre surgery. It is mandatry and usually cnsists f a 1-hur grup sessin. After yur visit t the arthrplasty clinic, an appintment will be made during the fllwing mnth fr a Pre-Operative Educatin Sessin. We encurage yu t bring alng a friend r relative fr additinal supprt, if needed. The physitherapist will explain the surgery, what t expect during yur hspital stay, exercises fr yu t d t prepare fr the surgery and ther things yu must d t prepare fr the surgery and yur discharge frm hspital. Yu will be given a questinnaire abut yur situatin at hme. Yu must bring the cmpleted questinnaire with yu when yu g t yur pre-perative appintment at the Pre-Admissin Unit s that the infrmatin can be validated with the physitherapist. 2.2 Yur appintment at the Pre-Admissin Clinic Yu will have an appintment at the Pre-Admissin Clinic 6 t 8 weeks befre yur scheduled surgery date t help yu prepare fr yur surgery. Please bring the fllwing items t yur appintment: yur health card; a recent list f yur current medicatin frm yur pharmacy (even natural prducts and ver-the-cunter medicatins); if yu are taking anticagulants r aspirin, make sure t infrm the surgen and mentin it t the nurse at the Pre-Admissin Clinic; all infrmatin regarding yur health insurance plan; the name and cntact infrmatin f the persn yu have designated t be respnsible fr all decisins cncerning yu (if yu chse nt t sign the pwer f attrney fr persnal care frm); this infrmatin guide. Hôpital Mntfrt s admitting department will call yu at hme t schedule an appintment. My appintment at the Pre-Admissin Clinic is n: If yu have any questins, please call Hôpital Mntfrt at , ext

11 The appintment at the Pre-Admissin Clinic usually lasts 3 t 4 hurs. If pssible, ask a relative r friend t accmpany yu. If yu need an interpreter, have a relative cme with yu. During yur appintment at the Pre-Admissin Clinic, yu may have diagnstic examinatins (xrays) r labratry examinatins (bld tests) depending n yur surgen s recmmendatins. T prperly prepare fr yur surgery, yu will have meetings with several members f yur healthcare team: The pharmacy technician will meet yu t take nte f the medicatins yu are taking at hme. Fr this meeting, bring an up-t-date list f yur medicatins. The nurse will meet yu t cmplete yur health assessment and specific questinnaires n yur lifestyle and health needs. She r he will review the infrmatin guide and yur care pathway with yu. Next, t ensure persnalized fllw-up after yur Pre-Operative Educatin Sessin, the physitherapist will review the questinnaire abut yur situatin at hme, answer yur questins abut the exercise prgram and infrm yu in regards t the physitherapy yu will d after yur discharge frm hspital r any ther questins yu may have regarding yur discharge. Yu might meet ther healthcare prfessinals during yur appintment, including: an anesthesilgist (if yu have questins abut anesthetics, yu will be able t ask them at this time); an internist (e.g., cardilgist, respirlgist, etc.); a scial wrker; a prfessinal dietitian. 2.3 Preventin f surgical site infectin Hw t prepare yur skin befre surgery Tw days befre yur surgery 1. Take a shwer and wash yur entire bdy, including yur hair and scalp with regular shamp; 2. Carefully rinse yur bdy; 3. Use a clean twel t dry yur bdy; 4. D nt use ltins, pwders r creams after yur shwer. The day befre yur surgery 1. Repeat steps 1 t 4 2. Freshly washed sheets and clean pillwslips must be used after this shwer. The mrning f yur surgery 1. D nt take a shwer r bath and d nt wash yur hair; 2. Dress warmly with freshly washed clthes; 3. D nt use ltins, pwders, creams, hair prducts, makeup r dedrant after washing. 11

12 D nt shave n the 2 days prir t the surgery, including yur legs and armpits. Men may shave their face. If yu have questins after having read these instructins, please call , extensin 4311 t speak with a nurse in the Pre-Admissin Clinic. Pre-perative screening fr Staphylcccus Aureus (SA) Why screen fr SA? Fr several years, there has been a dramatic increase in the number f antibitic-resistant bacteria (micrbes). The mst cmmn resistant micrbe in hspitals is staphylcccus aureus. Generally, these micrbes d nt cause any health prblems. Hwever, they can smetimes cause infectin if they penetrate the skin r the incisin. N treatment is necessary unless the patient has an infectin. If an infectin develps, it may be harder t treat because the chice f antibitics is limited. Hw t screen fr SA? The labratry technician will insert the tip f a cttn swab 1-2 cm int each f yur nstrils and rtate it 2 r 3 times against yur mucus membranes. If yur test is negative, n fllw-up is necessary. If yur test is psitive, yu will receive a call frm yur treating physician. Yu will be given a prescriptin with instructins t fllw fr bacterial declnizatin befre yur scheduled surgery date. After yur appintment at the Pre-Admissin Clinic, yu will knw: what type f surgery yu are having; what yu need t d at hme t prepare fr yur surgery; that yu must nt smke r drink alchl at least 24 hurs befre the surgery; what yu need t d the mrning f yur surgery and where t g; when t stp drinking and eating befre yur surgery; what medicatins yu need t take the mrning f yur surgery and which nes yu need t stp taking befre yur surgery; hw t prepare yur skin befre yur surgery t prevent infectin; the type f care yu will need after yur surgery. Nte: Please cntact yur surgen s ffice as sn as pssible if yu have a fever, flu, cld r sre thrat r if yu need t cancel r pstpne yur surgery. 12

13 2.4 Nutritin Gd nutritin will help with recvery after yur surgery and reduce the risk f infectin. Here are sme imprtant nutrients yu will need befre and after yur surgery. Prteins Prtein prmtes healing after surgery. Yu will need mre prtein than usual; therefre, eat at least 3 prtins f each f these fd grups everyday. Meat and substitutes 1 prtin cntains : Milk and substitutes 1 prtin cntains : 85 grams (3 unces) f meat, 225 ml (1 cup) f milk r sy pultry r fish beverage 2 eggs 55 grams (2 unces) f cheese 170 grams (3/4 cup) f legumes 175 ml (3/4 cup) f ygurt 170 grams (3/4 cup) f tfu 2 tablespns peanut butter Multivitamins Multivitamins are nt necessary if yu have a healthy and varied diet. It is preferable t btain yur nutrients frm a healthy diet than frm supplements, when pssible. If yu have a histry f anemia, talk t yur physician, pharmacist r dietitian abut pssible supplements. Calcium and vitamin D It is imprtant t take calcium and vitamin D t ensure strng bnes. Adults shuld cnsume 2 t 3 prtins f milk r calcium and vitamin D frtified fd everyday. It is recmmended that peple 50 years and lder take a vitamin D supplement f at least 400 UI. Ask yur physician, pharmacist r dietitian t recmmend the right supplements fr yu. Fiber and water Prir t an arthrplasty, it is imprtant t have regular sft stls at least every 3 days. Yu may need t add emllients r laxatives if yu g 2 days withut stls, since cnstipatin can lead t cmplicatins. Therefre, it is imprtant t eat fds high in fibre befre and after the surgery, such as whle grains, bran, fruits, vegetables, beans and lentils. Eat them thrughut the day and drink at least 1,5L (8 cups) f liquid a day (juice, milk, tea, cffee), half f which shuld be water. Fr mre infrmatin n nutritin, cnsult Canada s Fd Guide. 13

14 2.5 Weight Management If yu are verweight r underweight, yu may have a mre difficult pst-perative recvery. If yu are verweight, it wuld be gd t try t lse a mderate amunt f weight in rder t reduce yur knee pain and enable yu t accmplish mre activities. Keep in mind that every ½ kg (1 pund) yu carry places apprximately 2 additinal kg (3 t 6 punds) n yur knees. If yu are trying t lse weight befre yur surgery, d nt exceed ½ kg per week. Avid fad diets that culd deprive yu f nutrients and slw dwn yur recvery. ½ EXCESS KG (1 LB) = AROUND 2 ADDITIONAL KGS (3 TO 6 LBS) n yur knees If yu are underweight, it may be harder fr yu t heal after surgery. Therefre, it is imprtant fr yu t eat well in the weeks leading up t the surgery. If yu are wrried abut being ver- r underweight befre the surgery, talk t a prfessinal dietitian. Fr infrmatin n nutritin r certain nutrients, visit the Dietitians f Canada website at r if yu live in Ontari, yu can call Eat Right Ontari at Pre-perative exercises Ding exercises befre yur surgery will make fr a faster and easier recvery. Als, getting t knw a new exercise prgram adapted t yur knee is easier befre the surgery than after, given the incisin and pain related t the surgery. Chse activities that d nt stress yur jints, such as: exercises in a pl, like swimming r walking in water; cycling; ple walking; light stretching and strengthening exercises; exercises recmmended by the physitherapist during yur Pre-Operative Educatin Sessin; balance exercises (useful fr preventing falls). These activities will allw yu t strengthen yur muscles, imprve yur endurance and help yu keep yur jint mving. They will als help yu build up yur cnfidence and prepare yu fr the exercises yu will have t d after the surgery. Remember, after surgery yu will have t d daily exercises fr several mnths as part f yur rehabilitatin. 14

15 Be sure t strengthen yur arm muscles, as yu will need t rely n yur arms after surgery t use yur walking aids, get int bed, sit dwn and get up. If pssible, start the strengthening exercises at least 3 t 6 weeks befre yur surgery. Example: While yu are sitting, lift yurself up by pushing dwn n the armrests. Perfrm up t 10 repetitins twice a day. Make sure t maintain gd back psture thrughut the exercise, as if a small string were pulling yu upward. If this exercise is painful, yu are just starting t d exercises r yu have health prblems, cnsult yur physician befre starting a new exercise prgram. If yu dn t knw hw t get started, talk t a physitherapist. 2.7 Preparing yur hme It is imprtant t set up yur hme BEFORE yur knee arthrplasty s that yu can mve arund mre easily with a walker r crutches and reduce yur risk f falling. Use this checklist as a guide: Clear hallways and rms. Remve bjects that yu culd trip ver like carpets and ftstls. Lay dwn nn-slip surfaces n stairs and utside entrances. Install handrails in stairways r ensure that existing handrails are prperly secured. Make sure yu have a firm chair with armrests. Make sure lighting is adequate in hallways and ther rms that yu use. Arrange fr help if needed fr husehld tasks (e.g., vacuuming, laundry). Place frequently used husehld items (e.g., pts) at cunter height. Cnsider mving items that are usually in the bttm f yur refrigeratr r freezer t a higher shelf. Items shuld be between knee and shulder level. Purchase healthy fd. There are als fd and meal delivery services available in the cmmunity. Keep an icepack in the freezer that yu can use after the surgery if yur jint is swllen. Yu can als use a bag f frzen peas r crn. Arrange fr additinal help at hme (e.g., relative r friend) t help yu with yur return hme. Fr the bathrm: Place a nn-slip bathtub mat in the bathtub r shwer stall and ne beside it. It is very useful t install grab bars in the bathtub, shwer stall and beside the tilet. Sme grab bars are remvable. 2.8 List f accessries t btain befre surgery Make sure yu btain the walking aids listed belw prir t yur surgery s that yur physitherapist can adjust them t yur height during yur hspitalizatin. 15

16 Tw-wheel walker (5 unidirectinal) required 2 t 3 weeks fr a partial knee arthrplasty 4 t 6 weeks fr a ttal replacement Single straight cane (strngly recmmended if yu have stairs at hme) Lng-handled she hrn and sck puller (ptinal, nly if yu were already having difficulty putting n yur shes befre the surgery) Shwer and/r bath chair (ptinal, but may facilitate standing in the shwer r aviding sitting directly in the bathtub) Orthpedic supply stres and pharmacies sell r rent these items. Sme suppliers ffer mnthly rental, therefre, pick up this equipment a few days befre yur surgery, if pssible. Check t see if yur insurance plan cvers these expenses. If a medical prescriptin is necessary, it wuld be best t discuss this with yur surgen s that yu can get a refund. Yu can als ask yur friends and relatives if they have any equipment yu culd brrw. 2.9 Other things t d befre yur surgery Hôpital Mntfrt s admitting department will call yu between 2 p.m. and 5 p.m. n the wrking day befre yur surgery, t cnfirm the time and place yu need t g n the mrning f yur surgery. Prepare the items yu will bring with yu t the hspital the day f yur surgery (see the list in Sectin 3.1 f this infrmatin guide). Cmplete yur skin preparatin fr surgery as explained by the nurse in the Pre-Admissin Clinic (see Sectin 2.3 f this infrmatin guide) Put yur name n all items that yu are bringing t the hspital (e.g., walker, crutches). Knw when yu will be discharged frm the hspital s that yu can arrange fr yur transprtatin hme. Make arrangements fr smene t be clse by fr the 72 hurs fllwing yur discharge frm hspital. Make sure yu have a thermmeter t take yur temperature as needed at hme after the surgery. 16

17 3. The surgery 3.1 Checklist f things t bring t the hspital Pack yur bag fr the hspital. Bring: this infrmatin guide (imprtant) tiletry items (tthbrush, hair brush etc.) lse fitting clthes t wear hme bring yur walker labelled with yur name cmfrtable, clsed te and heel shes/slippers with nn-slip sles. Yur shes shuld be rmy since yu will have sme swelling in yur feet. if yu wear elastic supprt stckings, bring them with yu eye glasses and reading materials hearing aids yur medicatin, fllwing the instructins given t yu during yur appintment at the Pre-Admissin Clinic if needed, credit card infrmatin fr items such as hspital TV rental Hôpital Mntfrt is nt respnsible fr the breakage, lss r theft f persnal effects. It is imprtant that yu nt keep valuable items and large sums f mney with yu during yur stay. 3.2 At hme the day befre surgery D nt eat anything after midnight. Yu can nly sip water r apple juice, up t 3 hurs befre the surgery, up t a maximum f 250 ml (ne cup). D nt chew gum r eat hard candy. Gum and candy can cause the accumulatin f 1.5L (6 cups) f liquid in the stmach. D nt wear jewellery, cntact lenses, nail plish, makeup, perfume, hair spray r dedrant the day f yur surgery. Take ut any bdy piercings, particularly earrings. These bjects can cause burns if electrical equipment is used in the perating rm. If it is lcated clse t the surgical site, the piercing can cause an infectin. D nt shave yur legs, because if yu cut yurself r irritate yur skin, yur surgery culd be cancelled. Medicatin If yu are diabetic, fllw the instructins the nurse gave t yu during yur appintment at the Pre-Admissin Clinic. It is usually recmmended nt t take ral hypglycemics r insulin befre surgery, unless indicated therwise by yur physician. Take yur usual medicatin with a sip f water befre ging t the hspital, unless the nurse, surgen r anesthesilgist has indicated therwise. 17

18 If yu are asthmatic and yu use an inhaler (pump), use it accrding t yur prescriptin and bring it with yu t the hspital. 3.3 The day f the surgery When yu get t the hspital, please prceed t the Operating Rm receptin, rm 2A105, at the scheduled time. Be sure t bring yur health card and insurance infrmatin. 3.4 At the Pre-p Unit n the day f surgery Be aware that the Pre-p Unit is a large rm where bth male and female patients are admitted befre their surgery. Curtains are drawn between the beds fr patient privacy. Befre the surgery, yu will change int a hspital gwn, and the nurse will start an intravenus line. If the surgen recmmended a catheter, the nurse will insert the catheter befre yu are taken t the perating rm. A prter will bring yu frm the Pre-p Unit t the perating rm. 3.5 During the surgery Befre entering the perating rm, yu will see the surgen, anesthesilgist and perating rm nurse. The anesthesilgist will evaluate yur health cnditin and recmmend the safest anesthetic fr yu. A reginal anesthetic, such as spinal, r a cmbinatin f techniques, is ften used. The spinal anesthetic is like the freezing yu get at the dentist, except it is administered in the back and numbs yu frm yur chest dwn t yur lwer limbs s that yu wn t feel any pain during the prcedure. If yu receive this type f anesthetic, yu wn t be able t mve yur legs fr up t 4 hurs after the surgery. The anesthesilgist will mnitr yur cmfrt thrughut the surgery and will give yu medicatin thrugh yur IV that will make yu feel relaxed and sleepy. Sme patients receive a general anesthetic, which invlves administering medicatin that will put yu t sleep during the surgery. 3.6 In the recvery rm after the surgery After the surgery, yu will be taken t the recvery rm r pst-anesthesia care unit. Yu will stay there fr abut 2 hurs. The nurse will frequently check yur bld pressure, pulse, pain level and incisin site. Yu may be wearing an xygen mask fr a shrt time r nasal xygen may be recmmended vernight. As we check yur cnditin, d nt hesitate t describe what yu are feeling, fr example, nausea, pain, discmfrt, thirst, dry muth, itchiness, inability t urinate. The nurse can take steps t relieve yur symptms. 18

19 Yu will feel drwsy after the surgery, but as yu start t wake up yu will be asked t breathe deeply and d exercises with yur feet and legs. These exercises will help prevent cmplicatins related t bld clts. If yu suffer frm sleep apnea, yu might be transferred t a special unit where yu will be mre clsely mnitred the first night fllwing yur surgery. Yu can discuss this in greater detail with yur healthcare team if necessary. 3.7 In the patient care unit after the surgery Frm the recvery rm, yu will be taken t the patient care unit where yu will stay until yu are discharged. On yur arrival, yu will be n an IV t keep yu hydrated and t administer medicatins like intravenus antibitics. Yu will als have a large dressing n the area f the knee that was perated. Yur nurse will regularly check yur pain level and administer medicatin as needed. Where pssible, the physitherapist and ccupatinal therapist will crdinate their interventins with yur analgesic schedule. A member f yur healthcare team will help yu get up fr the first time n the day f the surgery, as recmmended by yur surgen, in rder t encurage circulatin. Yu will be infrmed f the weight yu can place n yur new jint. This weight varies depending n the persn. Mst surgens prefer weight bearing accrding t tlerance, where pain is yur guide, in rder t accelerate healing, as well as t nrmalize yur gait pattern right away. Hwever, yu may have restrictins (e.g., partial, very light r n weight) fr the perated leg, which will be explained t yu by yur healthcare team. 19

20 4. After surgery 4.1 General instructins after yur surgery Avid activities requiring cncentratin. Yu will need several hurs befre yu regain yur full cncentratin. Eat a light first meal after the surgery. 4.2 Ankle and deep breathing exercises Ankle exercices Pint yur tes twards yur head, then twards the ft f the bed. Make circles with yur feet at least 5 times. Repeat these exercises 4 t 5 times a day until yu start walking again. Deep breathing exercices Breathe deeply thrugh yur nse a few times and cugh every hur t clear yur lungs. 4.3 Pain cntrl It is very imprtant t cntrl pst-perative pain in rder t maximize yur healing. The healthcare team will use several methds t relieve yur pain including anti-inflammatries and lcal analgesic injectins arund the knee (given in the perating rm); this will help t reduce the sensitivity f the area that was perated. Once yu are back in the patient care unit, yur nurse will shw yu hw t use the pain scale t describe the intensity f yur pain. The number 0 is n pain while 10 is the wrst pain pssible. Pain assessment 20

21 The gal is t keep yur pain at 4 r belw at all times. As a general rule, analgesics are administered in the frm f ral tablets r subcutaneusly by injectin. If yu had a general anesthetic, yu may have a patient-cntrlled analgesia (PCA) pump. This will allw yu t push a buttn t administer a precise dse f analgesic thrugh yur IV. Different medicatins will be administered t cntrl yur pain. The cmbinatin f these medicatins makes it pssible t reduce the side effects that are caused when each medicatin is taken alne, and prvides mre effective pain cntrl. It is imprtant t talk t yur healthcare team t find ut hw and when t take these medicatins t maximize relief f yur pain and symptms. Analgesics can have side effects: nausea, vmiting, drwsiness, itchiness r cnstipatin. If yu feel any f these symptms, talk t yur nurse as sn as pssible. 4.4 Pain cntrl at hme Mst peple have less and less pain ver the next 6 t 12 weeks. If pain is preventing yu frm caring fr yurself, sleeping and/r exercising, talk t yur physitherapist r dctr. If yur pain becmes increasingly wrse r if yu have pain in a new part f yur bdy, seek medical attentin immediately. Here are sme ways t manage yur pain: Take pain medicine as directed. It is nrmal t have sme increased pain r symptms during physical activity r physitherapy sessins. It may be helpful t take a dse f pain medicine 1 r 2 hurs befre engaging in these activities in the first weeks after surgery. It is better t take medicine BEFORE the pain is severe. Ice can reduce pain and inflammatin. It is particularly useful fr peple wh have had knee replacement surgery. Place an ice pack wrapped in a twel n yur jint as directed by yur physitherapist. (maximum 20 minutes/hur) Pace yurself. D nt push yurself. Regular rest is an imprtant part f yur healing prcess. Relax. Use relaxatin techniques such as breathing exercises r prgressive muscle relaxatin (prgressive muscle relaxatin is when yu tighten and relax each part f yur bdy, starting with the tes and wrking up t yur neck). Distract yurself. Listen t music, visit with friends, write letters, watch TV. Think psitively. Yu will becme mre and mre cmfrtable as yu recver frm yur surgery. Ice pack n knee jint 21

22 4.5 Cnstipatin and urinary eliminatin Changes in yur diet, reduced activity and the analgesics used t cntrl yur pain can reduce intestinal functin and cause cnstipatin. Here is hw yu can relieve this in the hspital and at hme: Drink a minimum f 2 L (8.5 cups) f liquid a day. Water is the best chice fr maintaining hydratin. Eat fds high in fibre, such as prunes, bran, beans, lentils, fruits and vegetables. Mve as much as pssible and d yur exercises. The physician may prescribe laxatives and emllients as needed. Yu may have t cntinue t take these at hme. If yu suffer frm cnstipatin at hme, talk t yur family physician r pharmacist. Cnstipatin can smetimes be serius s d nt ignre yur symptms (nausea, abdminal pain, lss f appetite and, in rare cases, vmiting). If untreated, it culd cause intestinal blckage. The inability t urinate is a temprary prblem and cmmn after all types f surgery. If this is the case fr yu, tell yur nurse right away. It may be necessary t temprarily insert a catheter (a tube) t empty yur bladder, evacuate the urine and prevent cmplicatins. 4.6 Anticagulants After a knee arthrplasty, bld clts can frm in rare cases. Here is hw t reduce the risk f bld clts after surgery: Take the anticagulants as prescribed by yur surgen at the same time each day (Xarelt, an injectin f Lvenx, Fragmin r ther); Get up and mve regularly every hur (except at night); Maximize the use f intermittent pneumatic cmpressin cmmnly referred t as a venus pump during yur hspital stay. This air pump inflates and deflates an air-tight bag arund yur leg and prevents bld clt frmatin. The frmat f anticagulants varies. They cme in tablet frm r as an injectable slutin. At the hspital, yu may receive anticagulant injectins that yu will cntinue at hme. Or yu may receive an injectin at the hspital, but an ral anticagulant will be prescribed nce yu are hme. Yur surgen will discuss this with yu in rder t determine the best ptin based n yur needs. 4.7 Wund Care The edges f the wund will be clsed using absrbable stiches, staples r Steri-Strips. The staples are metallic and keep the edges f the wund in place while yur skin heals. They will be remved apprximately 14 days after the surgery in the physician s ffice. If yu have Steri-Strips, d nt tuch them. They will detach and fall ff n their wn. It is imprtant t keep the wund and dressings dry. D nt tuch the incisin and make sure the surrunding skin is very clean. Yu will leave the hspital with a dressing that yu can take ff 7 t 10 days after yur discharge. If the dressing gets wet r dirty, yu can replace it r reinfrce it using dry 22

23 materials frm the pharmacy (Elasplast, etc.). Nte that it is nrmal fr the wund t be red and fr clear liquid t drain frm it, but make sure there are n signs f infectin (fr mre infrmatin, see Sectin 5 Pst-perative cmplicatins f this guide). Once the wund has healed well, massaging the scar will be a very imprtant aspect f cicatrizatin. Usually, scar tissue frms arund the incisin, which can cause adhesin f the skin and muscle. This phenmenn can hinder maximum knee mvement. Talk t yur physitherapist abut safe techniques fr massaging the scar. Make sure t practise gd hand hygiene befre massaging the scar. Vitamin E cream, withut perfume r skin irritants, can imprve massage efficiency and healing f the wund. 4.8 Sexuality after knee arthrplasty Yu can resume sexual relatins as sn as yu feel cmfrtable, usually 4 t 6 weeks after the surgery. 4.9 Dental wrk and medical prcedures It is imprtant t tell yur healthcare prfessinal that yu have had an arthrplasty befre having dental wrk r underging any ther medical prcedures (particularly invlving the bladder, prstate, lungs r cln). Yu may be put n antibitics t prevent infectin frm mving thrugh yur bldstream t yur new jint. Fr 2 years fllwing yur surgery, preventive infectin treatment is recmmended fr all dental wrk. After 2 years, preventive treatment is recmmended fr all invasive and bldy interventins (extractins, implants). Talk t yur dentist r physician if yu need mre infrmatin Transprtatin T get arund after yur surgery, call n friends r relatives, take a taxi r use adapted transprtatin (ex. Para Transp); a public transprtatin service fr peple wh cannt take a regular bus. Adapted transprtatin will pick yu up and drp yu ff at appintments as needed. Make sure t find ut if this service is ffered in yur municipality Driving Yur ability t drive will be reduced after yur knee arthrplasty. First, talk t yur surgen r physitherapist. When yu will be able t start driving again depends n a number f factrs. Here are the general restrictins: N driving fr a minimum f 6 weeks fllwing a ttal knee arthrplasty and a minimum f 3 weeks fllwing a unilateral knee arthrplasty depending n the perated knee; N driving while yu are still taking narctics (mrphine, hydrmrphne, etc.); N driving until the physitherapist has cnducted a cmplete assessment f jint range f mtin and strength f the perated limb. 23

24 Fr sme surgeries, yu will receive a cpy f the Medical Cnditins Reprt frm sent t the Ministry f Transprtatin f Ontari and signed by yur surgen (if applicable). It will cntain clear instructins n the restrictins yu must respect Air travel Talk t yur surgen if yu must fly shrtly after yur surgery. After surgery, air travel may require special precautins. Be sure t give yurself extra time when flying. Yur new jint may set ff airprt metal detectrs. T avid awkward situatins, infrm the security agents befre passing thrugh detectrs. Usually, yu are nt required t have a letter frm yur physician r phts f yur x-rays. If yu are planning n flying less than 3 mnths after the arthrplasty, be sure t take several breaks t stretch in rder t prevent serius cmplicatins. In the plane, d ankle exercises every hur t prevent bld clt frmatin. If, after yur discharge frm hspital, yu need t fly hme, ask the airline if medical dcuments are required. 24

25 5. Cmplicatins 5.1 Infectin Less than 1% f patients cntract a wund infectin after surgery. Hwever, an infectin elsewhere in the bdy can reach the new jint thrugh the bldstream. Infectin can start in yur jint during surgery, in the hspital r frm bacteria frm anther part f yur bdy. Peple wh cntract an infectin in the jint must ften take antibitics. In rare cases, they must have anther surgery. Preventin is the key t success in aviding infectins r ther prblems related t the incisin. Here is hw t prevent infectin: Wash yur hands ften. Get in shape by fllwing a healthy diet. Take the antibitics yu receive after the surgery. Avid cntact with peple with clds r infectins. Talk t yur physician if yu suspect r see signs f infectin. Here are the signs f infectin t watch fr: Infectin f the incisin Redness extending beynd the cntur f the wund; Unusual clratin r discharge (greenish, yellwish r ful-smelling pus) The wund and surrunding area are increasingly painful r swllen; Fever abve 38 C r 100 F; Stitches falling ff earlier than expected. Urinary infectin Pain when yu urinate; Frequent r urgent need t urinate; Ful-smelling urine; Fever abve 38 C r 100 F. Sre thrat r chest infectin Swllen lymph ndes in the neck, pain when swallwing; Frequent cughing, yellwish r greenish sputum, shrtness f breath; Fever abve 38 C r 100 F. 25

26 5.2 Swelling It is likely that the perated leg will be swllen after the surgery and during yur recvery (fr the first few weeks). It may swell a little mre as yu becme mre active. T reduce swelling: Elevate the perated leg (ideally 20 t 30 cm abve the level f yur heart). Lie dwn n yur back and lift yur legs by placing pillws under the entire length f yur leg; Avid sitting fr lng perids and d the ankle exercises described abve every hur except at night; Be active fr brief perids. Walk a few steps, rest, then start again; Place an icepack r bag f frzen peas r crn wrapped in a twel n yur jint. Maximum 20 minutes an hur. 5.3 Bld clts In rare cases, bld clts can frm after surgery, generally in the deep veins f the legs. These bld clts can detach and lead t serius health risks. This phenmenn is mre cmmn amng peple with heart r bld circulatin prblems, wh are inactive r wh are verweight r have ther health prblems like diabetes. The signs and symptms are: Red and painful calf; Abnrmal swelling f the perated leg. If this is the case, infrm yur family physician r surgen immediately. If yu have the fllwing symptms, call 911 immediately: Shrtness f breath; Sudden chest pains. 5.4 Anemia (lw bld cunt) Yu may lse a cnsiderable amunt f bld depending n the type f surgery yu have. Anemia is characterized by a reduced hemglbin cunt (mlecule that transprts xygen in the bld). The symptms f anemia are: Dizziness r faintness; Nausea r headaches; Great fatigue r weakness; Rapid pulse r shrtness f breath. If yu present symptms f anemia, cnsult yur family physician. Yu may require irn supplements and/r a bld transfusin. 5.5 Pst-perative delirium Smetimes, elderly patients experience a perid f cnfusin r delirium after surgery. They may act r talk strangely. Delirium usually disappears in a few days, but smetimes it can persist fr a 26

27 few weeks. Sme f the cmmn causes f delirium include the side effects f anesthetics and medicatin, lack f sleep, pain, infectin, alchl withdrawal, cnstipatin r lw xygen levels. The healthcare team will try t find and crrect the cause f the delirium. 5.6 Skin cmplicatins A decubitus ulcer (cmmnly referred t as a bedsre r pressure sre) can ccur amng patients wh are in bed fr lng perids. It is pssible t prevent this cmplicatin by using gd skin care techniques, amng thers. A healthy and balanced diet and adequate hydratin als help t maintain healthy skin and prevent pressure wunds. 5.7 Jint lsening Over many years, the bnd between the jint replacement and yur bne may lsen. This can cause pain and make it difficult fr yu t mve yur artificial jint. T reduce the risk f this cmplicatin, avid high-impact physical activities. If yu ntice increased pain in yur artificial jint, talk t yur dctr as sn as pssible. 6. Exercices and daily activities 6.1 Physitherapy Physical activity plays a very imprtant rle in yur recvery. Nt nly des it imprve yur jint functin, but it als helps t clear yur lungs, reduce the risk f bld clts in yur legs, relieve pain and prmte gd intestinal functin. The physitherapist will assist yu during yur hspital stay. He r she will shw yu hw t: use a walker r crutches; d yur daily exercises; g up and dwn stairs safely. The hspitals physitherapist will advise yu n hw t btain physitherapy services nce yu are hme. Depending n yur needs, where yu live and the services available in yur area, yur appintment may be at a physitherapy clinic (private r public) r hspital utpatient department r yu may receive care at hme. This fllw-up generally ccurs between the 5th and 10th day after the surgery t imprve mbilisatin and adapt the exercise prgram. Yur physitherapist will adapt yur exercise prgram accrding t hw yur cnditin has prgressed fr a perid f 4 t 8 weeks n average. Yur physitherapist will give yu exercises t stretch and strengthen yur legs and imprve yur walking and balance. As yu recver, the exercises will get harder. With these exercises, yu will learn hw t use yur new jint and becme mre autnmus. It is imprtant t d them fr at least a year after yur surgery. 27

28 Talk t yur physitherapist if yu have questins abut yur exercises r cncerns abut yur prgress. Befre yur discharge, be sure t set up an appintment at a physitherapy clinic. 6.2 Psitin f the leg in bed After the surgery, yu must fllw these precautins fr 3 mnths, unless therwise indicated by yur surgen. By limiting yur activities, yu will help yur jint heal prperly and reduce stiffness. In the fllwing illustratins, the shaded leg indicates the perated leg. D nt place a pillw under the perated knee: Yu can place a pillw lengthwise beneath yur legs: Yu can als sleep n yur side with pillws between yur legs t maintain the alignment f yur leg. 6.3 Walking Yu can expect t use walking aids, such as a walker, crutches r cane, fr 2-3 mnths after surgery. By 4 t 6 weeks after yur surgery, yu shuld be walking with mre cnfidence, have mre strength and be able t walk lnger distances. Regular physitherapy after yur surgery will 28

29 help yu get the mst ut f yur new jint. Physical activity will help yu have a faster recvery and will get yur bld mving. This will als reduce yur risk f develping a bld clt. 6.4 Stairs It is a gd idea t practice the stairs with the hspital physitherapist s that yu are able t manage stairs safely and independently. Ging up the stairs: Use a handrail and crutches r cane Step UP with yur gd (nn-perated) leg first Fllw with yur perated leg and crutch r cane, ne stair at a time. Ging dwn the stairs Use the handrail and yur crutches r cane Place yur crutch r cane n the step belw Step DOWN with yur perated leg first Fllw with yur gd (nn-perated) leg, ne stair at a time. 6.5 Getting in and ut f bed Getting int bed Sit dwn n the side f the bed. It may be easier t start with yur strnger side. Slide yurself nt the bed using yur arms. A plastic bag under yur buttcks can make this easier. A half-side rail fr the bed culd help yu get in and ut f bed mre easily but it isn t mandatry. It has a handle and 2 lng metal bars and is placed between the mattress and the bx spring. Yu can get ne frm a medical supply stre. Lift yur perated leg nt the bed, r use a leg lift (this can simply be the belt frm a rbe r a crutch that yu turn arund and hk yur ft int, t lift yur leg with yur arms). 29

30 Getting ut f bed Slide yur bdy t the edge f the bed Use yur arms t push yurself t a sitting psitin. Slide yur perated leg ff the bed, fllwed by the nn-perated leg. Bring yur bdy t a sitting psitin at the bedside 6.6 Sitting Use a firm chair with armrests. If yu had difficulty sitting befre the surgery, stand beside the chair t check the height f the seat befre yu sit dwn. Back up until yu feel the edge f the chair behind yur knees. Mve the perated leg frward and hld the armrests with yur hands. Slwly lwer yur bdy until yu are sitting. 6.7 Getting dressed Sit n a chair r bed Dress yur perated leg first and undress it last Use adaptive aids like a lng-handled reacher, sck aid and shehrn t reach the ft f yur perated leg and put n scks, pants, shes, etc. if yu had difficulty gretting dressed prir t surgery. 6.8 Bathrm safety Falls can happen anywhere but are mst likely in the bathrm. Here are ways t reduce the risk: D nt rush. Plan t use the tilet ften. Have a bedside cmmde if needed. When bathing, use a bench r chair if needed and use nn-slip bath mat and grab-bars. Make sure the rute frm yur bedrm t the bathrm is well-lit Wear sensible, nn-slip shes r slippers If yu feel dizzy r unsteady, talk t yur family dctr. Using the tilet: Make sure that the tilet seat has secure armrests r that yu can use the cunter t push yurself up. Yu can als install grab bars t help yu stand r sit. D NOT use twels racks r tilet paper hlders t help yu stand r sit dwn. Bathtub: 30

31 Sme surgens will want yu t d spnge-baths until yur staples are remved in rder t avid getting the new incisin wet Use a tub transfer bench with a hand-held shwer (in a bathtub) r shwer chair (in a shwer stall) fr the first few weeks after surgery. D NOT try t sit n the bttm f the tub.if yu are tall, yu may need bench leg extensins. Sit dwn as yu wuld in a chair. Slide back as far as yu can n the seat. Then lift yur legs ver the edge f the tub. Use lng-handled aids t clean yur feet and ther hard-t-reach places. 6.9 Car transfer Talk t yur physitherapist if yu have questins abut car travel. Please practice these instructins befre yu cme t the hspital: Park away frm the sidewalk r curb s yu are nt stepping dwn frm the curb t the car. If yu have a high truck r sprt-utility vehicle, yu may need t park near the curb s that yu d nt have t climb up t the seat. Mve the seat as far back as pssible Back up t the seat until yu feel the back f the seat n yur legs Extend yur perated leg Hld nt the back f the seat and the car t stabilize yurself Lwer yurself t the seat Slide back and lift yur legs int the car A piece f plastic r a large garbage bag ver the seat may help yu t slide in mre easily Yu can als try a device called a Handybar that can assist yu t get in and ut f a regular car. This can be purchased at medical supply stres Returning t wrk Allw yurself time t recver frm surgery and fcus n yur rehabilitatin befre returning t wrk. Sme peple return t sme frm f wrk quickly after surgery but thers need a lnger time t heal and recver. This depends n factrs such as health status and the type f wrk yu d. Talk t a health care prfessinal abut what is right fr yu. Review yur wrkstatin befre surgery s that yu can make the necessary adjustments befre yu return t wrk. 31

32 Wrk envirnment adaptatins Chair: Chse a standard chair fr sitting. Avid chairs with wheels; they can rll away frm yu when yu are getting up. Desk: Psitin yur phne, paperwrk and cmputer clse t yu. Keybard Tray: If yur desk is t lw, use a height-adjustable keybard tray s that yu can sit cmfrtably while typing. Schedule: Plan lts f stretch breaks. Get up and mve arund frequently. Avid sitting in the same psitin fr mre than 45 minutes at a time. Bathrm: Check the lcatin f grab bars. 7. Fllw-up with yur surgen Yu will have a fllw-up appintment with yur surgen abut 2 weeks after yur surgery, fllwing yur return hme, t check the wund, remve stitches/staples and renew prescriptins, if necessary. Yu shuld als make an appintment with yur family physician, nce yu have recvered, fr a general health check-up. Yur perated reprt can be sent t yur family physician as needed. 8. When t see an emergency dctr? Call 911 if yu have: sudden intense pain in the perated leg inability t mve the perated leg sudden chest pain sudden shrtness f breath 32

33 33

34 Pre-admissin Assessment Tests Medicatins Nutritin Activity Educatin Discharge planning We will check yur temperature, bld pressure, pulse and xygen level, weight and height. Yu will be asked abut yur general health and medical histry, including alchl intake and smking status. Yu will be seen and be assessed by ther members f the health care team including a physitherapist (PT). Yur dctr may als want yu t be seen by an anaesthetist, a scial wrker and/r a dietitian. T ensure yu are ready fr surgery, we will d bld tests, nasal swabs and may have t repeat a knee x-ray. An x-ray f yur chest may be dne. An electrcardigram may be rdered tday (ECG). Bring yur drugs with yu t the hspital in their riginal package, if pssible. Als bring an up-t-date list f medicatins frm yur pharmacy. Any drugs yu are taking will be reviewed; yu may be advised t stp taking sme. Instructins will be given fr drugs taken n day f surgery. The nurse will infrm yu n when t stp eating r drinking n the night befre yur peratin. Yu have attended the Prehab educatin class prir t this sessin where we have taught yu the exercises that yu will be expected t d prir t yur surgery, during yur hspital stay and pst-discharge. A team member will verify that yu have acquired the recmmended equipment that yu need t get prir t yur surgery. A list was given in Prehab. A member f the team will review the cmpleted questinnaire that yu have received in the Prehab educatin class and assist yu with any questins yu may have fr a safe discharge frm the Hspital. A team member will be reviewing the Knee Replacement bklet and patient pathway with yu. Feel free t ask any questins yu may have. The nurse will ask yu and yur family abut the plans fr when yu are discharged frm the hspital. If yu are unsure and need help planning yur discharge, we can arrange fr yu t meet with a scial wrker. 34

35 Day 0 (day f yur admissin) Assessment Tests Medicatins Nutritin Activity Treatment Educatin Discharge planning We will check yur temperature, bld pressure, pulse and xygen level befre the surgery and frequently thrughut the day. We will als be assessing yur pain levels. We use a scale and will be asking yu t rate yur pain frm 0 (n pain) t 10 (wrst pain). We will be checking the clr, sensatin and mvement in yur perated leg every 4 hurs. We will be lking at yur dressing frequently t make sure it is nt draining t much thrugh the bandages. If yu have a small drain in yur leg, we will be emptying and measuring the drainage. We will be asking yu and recrding hw much yu drink and hw much yu urinate. The dctr may rder sme bld wrk befre and after the surgery. Yu will have an intravenus and be given fluids as the dctr rders. The nurse will give yu yur medicatins as rdered by the dctr. Yu will receive an antibitic t prevent infectin. Yu will be allwed t drink clear fluids (fluids yu can see thrugh, like water) after yur surgery. Yu may be able t drink r eat regular fd as tlerated. The nurse will help yu mve, psitin in bed r get up t use the cmmde as needed. The team will be reminding yu the precautins t take t remain cmfrtable. D nt try t get ut f bed by yurself always have a member f ur team assist yu. We will ask yu t take deep breaths and cugh. This exercise helps clear yur lungs and prevent pneumnia. Yu will be encuraged t use the tilet, cmmde r urinal t empty yur bladder as sn as yu feel the need. Have a nurse assist yu. We will be mnitring the urine vlume in yur bladder using a bladder scan. We will ask yu t pump yur ankles and feet 2 t 3 times per day while yu are awake. This helps prevent bld clts frm develping and keeps yur muscles active. While in bed, yu will be wearing a prtable intermittent pneumatic cmpressin device (IPCD) n yur feet t help with bld circulatin and prevent bld clts frm develping in yur legs (deep venus thrmbsis) r lungs (pulmnary emblism). The nurse will make sure that yu knw hw t d deep breathing and cughing exercises and the ankle pumping exercises. The nurse will talk t yu abut managing yur pain. Yur healthcare team will be referring t the knee replacement bklet yu have received befre yur surgery thrughut yur hspital stay. Feel free t ask any questins yu may have. The nurse will review infrmatin with yu and yur family abut yur hme situatin and yur plans fr discharge. If yu need help planning yur discharge, we can arrange fr yu t meet with a scial wrker. 35

36 Day 1 (day after yur admissin) Assessment Tests Medicatins Nutritin Activity Treatment Educatin Discharge planning We will check yur temperature, bld pressure, pulse and xygen level every fur hurs and then every shift. We will als be assessing yur pain levels frequently t make sure yu are able t d yur exercises. We will be checking the clr, sensatin and mvement in yur perated leg every shift. We will be lking at yur dressing every shift t make sure it is nt draining t much. We will be asking yu and recrding hw much yu drink and hw much yu urinate. We will be assessing yur abdminal sunds and bwel rutine every shift t prevent cnstipatin. The dctr will rder sme bld wrk t verify yur hemglbin levels (mlecule that carries xygen thrughut yur bdy). If yu are drinking well and yur hemglbin is nrmal, we will be remving the intravenus tday. The nurse will give yu yur medicatins as rdered by the dctr. Yu may eat regular fd tday. The team will help yu t transfer frm lying t sitting and frm sitting t standing. The physitherapist will teach yu hw t walk using a walker r sme gait aid. A member f ur team will help yu t bathe, if needed The team will encurage yu t sit up fr meals thrughut the day, as tlerated. The team will encurage yu t d the exercises that the physitherapist has taught yu in the prehab educatin sessin. If yu have a small drain in yur leg (hemvac), we will be remving it tday. Yu will be encuraged t use the tilet, cmmde r urinal t empty yur bladder. We will be mnitring the vlume f urine in yur bladder using a bladder scan if needed. While in bed, yu will still be wearing a prtable intermittent pneumatic cmpressin device (IPCD) n yur feet t help with bld circulatin and prevent bld clts frm develping. If yur hemglbin is lw, yu may need a bld transfusin. Yur dctr wuld talk t yu abut this ptin if needed. The nurse will talk t yu abut managing yur pain and yur nausea. We will make sure that yu knw hw t d yur bed exercises and yur safe transfer techniques. Yur healthcare team will be referring t the knee replacement bklet thrughut yur hspital stay. Feel free t ask any questins yu may have. The nurse will review yur hme situatin and make sure yur plans fr discharge are in place. 36

37 Day 2 Assessment Tests Medicatins Nutritin Rest and activity Treatment Educatin Discharge planning We will check yur temperature, bld pressure, pulse and xygen level every shift. We will als be assessing yur pain levels and checking the clr, sensatin and mvement in yur perated leg every shift. We will be assessing yur abdminal sunds and bwel rutine every shift t prevent cnstipatin. The dctr may rder sme bld wrk. The dctr will rder a knee x-ray t be dne tday. The nurse will give yu yur medicatins as rdered by the dctr. Please ask the nurse if yu have any questins abut yur medicatin. Yu will eat regular fd tday. We recmmend high fiber fd t help prevent cnstipatin. The team will watch yu transfer frm lying t sitting and frm sitting t standing. The physitherapist will help yu walk using a walker r sme gait aid. The physitherapist will help yu practice the stairs if needed at hme. The team will encurage yu t sit up fr meals thrughut the day, as tlerated. We will encurage yu t d the exercises that the physitherapist has taught yu. We will be changing yur dressing tday. While in bed, yu will still be wearing a prtable intermittent pneumatic cmpressin device (IPCD) n yur feet. The nurse will fcus n talking abut nutritin, yur exercises, yur bwel rutine and yur bld thinner medicatin (if needed). Yur healthcare team will be referring t the knee replacement bklet thrughut yur hspital stay. Feel free t ask any questins yu may have. We will make sure yur plans fr discharge are in place and that yu have all the equipment yu need at hme. It is pssible that yu may get yur discharge tday. Yu will be ging hme tmrrw. Please make sure yur transprtatin is arranged. If yu need hme care services, the hspital will refer yu t the champlain cmmunity care access centre (CCAC). 37

38 Day 3 (until discharge) Assessment Medicatins Nutritin Rest and activity Treatment Educatin Discharge planning We will check yur temperature, bld pressure, pulse and xygen level befre discharge We will als be assessing yur pain level and nausea. We will make sure yu are emptying yur bladder and recrding yur bwel rutine t prevent cnstipatin. We will be checking yur dressing and the clr, sensatin and mvement in yur perated leg. The nurse will prvide yu yur medicatin as needed. Yu will eat regular fd tday. Yu will walk using a walker r sme gait aid with minimal r n assistance as tlerated. Yu will be able t use the bathrm/bathe with minimal r n assistance and resume yur daily activities. The physitherapist will help yu practice the stairs if needed at hme. We will encurage yu t d the exercises that the physitherapist has taught yu. We will be changing yur dressing as needed. We will talk t yu abut pain cntrl at hme. We will als fcus n yur exercises, yur bwel rutine, yur at-hme medicatin (including bld thinners), and yur daily activities. We will be reviewing pst-p cmplicatins with yu and when t seek medical treatment r cnsult yur dctr. Yur healthcare team will be referring t the knee replacement bklet fr yur discharge instructins and fllw-ups. Feel free t ask any questins yu may have. Yu will be ging hme tday. The physitherapist will assist yu t crdinate any utpatient physitherapy appintment that may be required. We will make sure that any ther appintments yu may need are arranged including arrangements t remve the clips yu have n yur incisin. 38

39 39

40 Pre-admissin Assessment Tests Medicatins Nutritin Activity Educatin Discharge planning We will check yur temperature, bld pressure, pulse and xygen level, weight and height. Yu will be asked abut yur general health and medical histry, including alchl intake and smking status. Yu will be seen and be assessed by ther members f the health care team including a physitherapist (PT). Yur dctr may als want yu t be seen by an anaesthetist, a scial wrker and/r a dietitian. T ensure yu are ready fr surgery, we will d bld tests, nasal swabs and a may have t repeat a knee x-ray. An electrcardigram may be rdered tday (ECG). Bring yur medicatin with yu t the hspital in their riginal package, if pssible. Any medicatin yu are taking will be reviewed; yu may be advised t stp taking sme. Instructins will be given fr medicatin taken n day f surgery. The nurse will infrm yu n when t stp eating r drinking n the night befre yur peratin. Yu have attended the Prehab educatin class prir t this sessin where we have taught yu the exercises that yu will be expected t d prir t yur surgery, during yur hspital stay and pst-discharge. A team member will verify that yu have acquired the recmmended equipment that yu need t get prir t yur surgery. A list was given in Prehab. A member f the team will review yur cmpleted questinnaire that yu have received in the Prehab educatin class and assist yu with any questins yu may have fr a safe discharge frm the Hspital. A team member will be reviewing the Knee Replacement bklet and patient pathway with yu. Make sure yu refer t the Partial Knee Replacement sectins f the bklet when apprpriate. Feel free t ask any questins yu may have. The nurse will ask yu and yur family abut the plans fr when yu are discharged frm the hspital. If yu are unsure and need help planning yur discharge, we can arrange fr yu t meet with a scial wrker. 40

41 Day 0 (day f yur admissin) Assessment Tests Medicatins Nutritin Activity Treatment Educatin Discharge planning We will check yur temperature, bld pressure, pulse and xygen level befre the surgery and frequently thrughut the day. We will als be assessing yur pain levels. We use a scale and will be asking yu t rate yur pain frm 0 (n pain) t 10 (wrst pain). We will be checking the clr, sensatin and mvement in yur perated leg every 4 hurs. We will be lking at yur dressing frequently t make sure it is nt draining t much thrugh the bandages. If yu have a small drain in yur leg, we will be emptying and measuring the drainage. We will be asking yu and recrding hw much yu drink and urinate. The dctr may rder sme bld wrk befre and after the surgery. Yu will have an intravenus and will be given fluids as the dctr rders. The nurse will give yu yur medicatins as rdered by the dctr. Yu will receive an antibitic t prevent infectin. Yu will be allwed t drink clear fluids after surgery. Yu may be able t drink r eat regular fd as tlerated. The nurse will help yu mve, psitin in bed r get up t use the cmmde. The team will keep reminding yu abut the psitins yu need t avid. D nt try t get ut f bed by yurself always have a member f ur team assist yu. We will ask yu t take deep breaths and cugh. This exercise helps clear yur lungs and prevent pneumnia. Yu will be encuraged t use the tilet, cmmde r urinal t empty yur bladder as sn as yu feel the need. Make sure a nurse assists yu. We will mnitr the vlume f urine in yur bladder using a bladder scan. We will ask yu t pump yur ankles and feet 2 t 3 times per day while yu are awake. This helps prevent bld clts frm develping and keeps yur muscles active. While in bed, yu will be wearing a prtable intermittent pneumatic cmpressin device (IPCD) n yur feet t help with bld circulatin and prevent bld clts frm develping in yur legs (deep venus thrmbsis) r lungs (pulmnary emblism). The nurse will make sure that yu knw hw t d deep breathing and cughing exercises and the ankle pumping exercises. The nurse will talk t yu abut managing yur pain. The nurse will make sure that yu and yur family understand the psitins yu must avid. Yur healthcare team will be referring t the knee replacement bklet yu have received befre yur surgery thrughut yur hspital stay. Feel free t ask any questins yu may have. The nurse will review infrmatin with yu and yur family abut yur hme situatin and yur plans fr discharge. If yu need help planning yur discharge, we can arrange fr yu t meet with a scial wrker. 41

42 Day 1 (until discharge) Assessment Tests Medicatins Nutritin Activity Treatment Educatin Discharge planning We will check yur temperature, bld pressure, pulse and xygen level every fur hurs and then every shift. We will als be assessing yur pain levels frequently t make sure yu are able t d yur exercises. We will be checking the clr, sensatin and mvement in yur perated leg every shift. We will lk at yur dressing every shift t ensure it is nt draining t much. We will be asking yu and recrding hw much yu drink and urinate. We will be assessing yur abdminal sunds and bwel rutine every shift t prevent cnstipatin. The dctr will rder sme bld wrk t verify yur hemglbin levels (mlecule that carries xygen thrughut yur bdy). The dctr will rder a knee x-ray t be dne tday. If yu are drinking well and yur hemglbin is nrmal, we will be remving the intravenus tday. The nurse will give yu yur medicatins as rdered by the dctr. Yu may eat regular fd tday. The physitherapist will help yu walk using a walker r sme gait aid. The physitherapist will help yu practice the stairs if needed at hme. The team will encurage yu t sit up fr meals thrughut the day, as tlerated. We will encurage yu t d exercises the physitherapist taught yu. If yu have a small drain in yur leg (hemvac), we will be remving it tday. Yu will be encuraged t use the tilet, cmmde r urinal t empty yur bladder. We will be mnitring the vlume f urine in yur bladder using a bladder scan if needed. While in bed, yu will still be wearing a prtable intermittent pneumatic cmpressin device (IPCD) n yur legs t help with bld circulatin and prevent bld clts frm develping. We will talk t yu abut pain cntrl at hme. We will als fcus n yur exercises, yur bwel rutine, yur at-hme medicatin (including bld thinners), and yur daily activities. We will be reviewing pst-p cmplicatins with yu and when t seek medical treatment r cnsult yur dctr. Yur healthcare team will be referring t the knee replacement bklet fr yur discharge instructins and fllw-ups. Feel free t ask any questins yu may have. We will make sure yur plans fr discharge are in place and that yu have all the equipment yu need at hme. Yu will be ging hme tday. The physitherapist will assist yu t crdinate any utpatient physitherapy appintment that may be required. We will make sure that any ther appintments yu may need are arranged including arrangements t remve the clips yu have n yur incisin. 42

43 Persnal ntes 43

44 713 Mntreal Rd Ottawa, Ontari K1K 0T2 Phne: hpital.cm 44