Joint Replacement C E N T E R

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NORTHSIDE MEDICAL CENTER TOTAL HIPARTHROPLASTY PREHAB PROGRAM

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

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

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

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

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

As part of the Columbus Regional Health System, we are committed to patient satisfaction. Our mission is:

To Promote The Health and Healing of Our Patients

and Our Vision is:

To become internationally recognized for our clinical outcomes and world famous service.

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

With your help, we can potentially have you independent and on your way home within 2-3 days. We hope this information packet will assist you in your preparation for admission and throughout your hospitalization. If there is anything we can do during your stay to increase your comfort and satisfaction, or if there is anything we can do to make this program better…please tell us!

We consider it a privilege to serve you.

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TABLE OF CONTENTS

Directions to the Hospital and Local Hotels and Lodging Important Hospital Phone Numbers General Information Patient Access Preadmissions Testing Pharmacy Services Patient Medication Safety Surgery Intensive Care Unit Patient Care Services Radiology and Lab Services Fall Prevention Guidelines Preventing Blood Clots Rehabilitative Services Discharge Planning Case Manager Patient Resource Form for Discharge Planning After Your Discharge Preventing Falls at Home What to Bring to the Hospital What Not to Bring to the Hospital Frequently Asked Questions Pre-op Hip Exercises 1/28/2015 Total Hip Rep l acement Patient Guidebook 4 6 7 11 10 12 17 18 37 38 39 48 19 21 27 28 29 31 33 34 35 36 3

DIRECTIONS TO THE HOSPITAL

Northside Medical Center Hospital 100 Frist Court Columbus, GA 31908 706-494-2100

From Albany, Georgia

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

From Atlanta, Georgia

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

From Macon, Georgia

Travel west on U.S. 80 into Columbus. Follow exit toward Veterans Parkway and I-185 Atlanta. Travel approximately 1 mile to the Veterans Parkway exit, (U.S. Hwy 27). There is a traffic light at the top of the exit ramp; turn left. This is Veterans Parkway. Travel approximately 1.1 miles and you will see the campus on your left. Enter at the traffic light onto Frist Court. The hospital is at the end of the long drive.

From Warner Robins, Georgia

Travel west on Watson Boulevard (247 Connector). Approximately 6.8 miles from the Galleria Mall in Centerville there is a stop sign. This is where the 274 Connector ends. Turn left on 49 South.

Travel approximately 4.6 miles. There will be a Church of Christ on the right and The Lighthouse Church on the left. Turn right on 49 west. Go approximately 5 miles and you come to Highway 96.

Turn right on Highway 96 and travel west through Reynolds, Butler, Junction City and Geneva.

Highway 96 ends in Geneva and connects with US 80. Take US 80 West (left) approximately 24 miles to Exit 4. Take Exit 4. (which says Veterans Parkway or To Atlanta). Travel approximately 1 mile to the Veterans Parkway exit, (US Hwy 27). There is a traffic light at the top of the exit ramp; turn left. This is Veterans Parkway. Travel approximately 1.1 miles and you will see the campus on your left. Enter at the traffic light onto Frist Court. The hospital is at the end of the long drive.

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DIRECTIONS TO THE HOSPITAL – Page 2

From Auburn/Opelika, Alabama

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

From Eufaula/Dothan, Alabama

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

From Montgomery, Alabama

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

General parking is located on the right and left sides of hospital. Handicap parking is located in several areas around hospital.

Parking is free.

LOCAL HOTELS AND LODGING

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

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NORTHSIDE MEDICAL CENTER PHONE NUMBERS

If you have any questions before/during/or after your hospital stay, please call: MAIN NUMBER 2 nd FLOOR NURSING UNIT 706 – 494 - 2100 (706) 494 - 2290

CARDIOPULMONARY SERVICES DISCHARGE PLANNING (706) 494-6090 In house ext. 2288 (706) 494-6005 In house ext. 6005 LABORATORY SERVICES FOOD / NUTRITION SERVICES (706) 494-2131 In house ext. 2131 (706) 494-2182 In house ext. 2182 OUTPATIENT DEPARTMENT PATIENT ACCESS/ADMISSIONS PATIENT ADVOCATE PATIENT EXPERIENCE PHARMACY (706) 494-6048 In house ext. 6048 (706) 494-2115 In house ext. 2115 (706) 494-2010 In house ext. 2010 PREADMISSION TESTING RADIOLOGY SERVICES REHABILITATION SERVICES (707) 494-2151 In house ext. 4370 (706) 494-2441 In house ext. 2441 (706) 494-2135 In house ext. 2135 (706) 494-2165 REHAB NURSING FLOOR SURGICAL SERVICES INFECTION CONTROL (706) 494-2395 In house ext. 2395 (706) 494-2190 In house ext. 2190 (706) 494-6093 In house ext. 6093 1/28/2015 Total Hip Rep l acement Patient Guidebook Edna Leftwich Belinda Barron Erin Pearce Martha Bonner Nancy Chaffee Erin Pearce Kendra Sermarini Patti Graluich Diane Morris 6

GENERAL INFORMATION

THE PATIENT EXPERIENCE

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

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

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

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

ADVANCE DIRECTIVES - THE DECISION IS YOURS

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

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

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

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PATIENT RIGHTS AND RESPONSIBILITIES

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

• You will not be denied access to treatment or accommodations that are medically indicated on the basis of race, sex, age, creed, national origin. You will not be denied treatment needed to stabilize an emergency medical condition, regardless of your ability to pay or the source of payment for such care.

• You have the right to privacy , regarding information necessary for medical care and regarding the privacy of your body.

• You have the right to expect all communications and records pertaining to your care to be treated as confidential and you have the right to access your medical record in accordance with state law.

• You have the right to request privacy status while in the hospital. Under such circumstances, no information about your presence in the hospital will be provided to anyone.

• You have the right to the proper and safe use of restraints when they are required in acute medical, surgical and behavioral management interventions.

• You have the right to the appropriate assessment, management of and education regarding your pain.

• You have the right to freedom from abuse, neglect, exploitation or harassment..

• You have the right to care in a safe setting.

• You have the right to know the name of and talk with the physician and other caregivers responsible for your care and to receive information necessary to understand your medical problem and planned treatment.

• You have the right to have a family member or representative of your choice and your own physician notified promptly of your admission to the hospital.

• You have the right to receive visitors that you designate, including but not limited to a spouse, a domestic partner, another family member or a friend and you have the right to withdraw your consent at any time. Visitation will not be restricted based on race, color, national origin, religion, sex, gender identity, sexual orientation or disability. At times the hospital may restrict or limit visitation for clinical reasons, including but not limited to: During periods of infectious outbreaks; if necessary due to the patient’s condition; visitors with colds, sore throats, signs of infection or any communicable disease; number of visitors if excessive and causing disruption of patient care. The hospital accommodate the patient’s rights to religious and other spiritual services. The hospital respects the patient’s cultural and personal values, beliefs and preferences.

• You have the right to examine and receive an explanation of your bill.

• You have the right to give or withhold informed consent to the hospital for the production or use of recordings, films, or other images of yourself for purposes other than your care.

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PATIENT RIGHTS AND RESPONSIBILITES (CON’T)

• You have the right to reasonable attention to complaints and grievances when communicated to any member of the health care team.

• You have the freedom to voice such concerns without fear of reprisal or compromise of care. If you would prefer to report your concern outside the area you are receiving care, you may contact our Administrative Office, Northside Medical Center, 100 Frist Court, Columbus, Georgia 31909, (706) 494 – 2101, or our Patient Advocate/Guest Relations Coordinator, (706) 494 – 2010. The hospital will make every effort to provide a written response to a grievance in (7) days. If the grievance cannot be resolved in (7) days, you will be informed of the plan of action to include an anticipated date of the written response.

• In addition to or instead of this process, you may also address concerns to the Georgia Medical Care Foundation, 1455 Lincoln Parkway, Suite 800, Atlanta, Georgia 30436, 1 – (404) – 982 – 0411.

• You have the right to contact The Georgia Department of Community Health, Healthcare Facility Regulatory Division, 2 Peachtree Street, N.W., Suite 31 – 415, Atlanta, Georgia 30303, 1 – (404) – 657 – 5782 or via fax 1 – (404) – 657 – 5731 to file a grievance or complaint. • You have the right to contact and we encourage you to contact our hospital administration, (706) 494 – 2101, if you have any unresolved patient safety or quality of care concerns. However, if the concerns remain unresolved we encourage patients to contact The Joint Commission. The concern should be submitted in writing to the Division of Accreditation Operations, Office of Quality Monitoring, The Joint Commission, One renaissance Boulevard, Oakbrook Terrace, IL 60181, or faxed to 1 – (630) 792 – 5636, or e-mailed to complaint @jcaho.org. • You have the right to participate in the consideration of biomedical ethical issues that arise during your care. Any health care team member will refer your request of this nature to the appropriate party.

YOUR RESPONSIBILITIES:

• You have the responsibility to provide, to the best of your knowledge, accurate and complete information about your present complaints, past illnesses, hospitalizations, medications, and other matters relating to your health.

• You have the responsibility to ask questions when you do not understand what you have been told about your health care and what you are expected to do.

• You have the responsibility for following the treatment plan developed with the practitioner.

• If you refuse treatment or fail to follow the practitioner’s instructions, you are responsible for the outcomes and you may be discharged from the hospital.

• The patient, family and visitors are responsible for following the hospital’s rules and regulations.

• The patient, family and visitors are expected to be considerate of other patients and hospital Personnel by not making unnecessary noise, smoking or causing distractions. Patients, families and visitors are responsible for respecting the privacy and property of other persons and that of the hospital and its employees.

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PREADMISSION TESTING AND INFORMATION

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

Medical and diagnostic testing prior to your admission allows your physician to plan correctly for your care. The Preadmission Testing Department is open from 8:00AM until 6:00PM Monday - Friday. If laboratory tests, x-rays, EKG’s, diagnostic tests or physician clearance have been conducted in the last thirty days, please bring copies of these results with you. This may prevent the same tests from being performed again.

You will find that you are informed and educated at every point of service. During Pre Admission Testing the following will be addressed: • Diagnostic tests ordered prior to your admission • Your preoperative and postoperative surgical care • Your diet prior to and following your procedure • Your current medications and any allergies • Skin integrity (condition) at the surgical site may be inspected • Clothing and personal items to bring with you to the hospital • Your anesthesia plan and any questions you may have regarding your meeting with the Anesthesiologist • Consult with Internal Medicine Physician if necessary We hope you will find the pre-admission process informative and thorough in your preparation for your surgical procedure. It is essential that you take advantage of Pre-Admission Testing to avoid delays or cancellation of your procedure.

Bring current medications or list of medications you are currently taking.

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

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PATIENT ACCESS DEPARTMENT

PRIOR TO ADMISSION

The Patient Access Department obtains as much information as possible from your physician’s office and will verify your insurance and eligible benefits. Your insurance benefit information and estimated charges for your hospitalization will enable us to calculate the approximate patient responsibility. After the compilation of this information we will be able to discuss your insurance benefits and any required deposit prior to your procedure.

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

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

Please bring your insurance cards and a picture ID with you,.

And REMEMBER..…DO NOT eat or drink after midnight prior to your surgery.

DAY OFADMISSION

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

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

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

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PHARMACY SERVICES

PRIOR TO YOUR ADMISSION

It is necessary for you to discuss all of your medications with your primary or orthopedic physician prior to your admission to the hospital. Aspirin, aspirin products, blood thinners and all anti inflammatory medications may be discontinued two (2) weeks prior to your surgery as directed by your physician. Please bring a list of your medications with you to the hospital. On the list please state: the medication name, strength, how many for each dose and how often you take each medicine. Please be sure that your physician knows about any medication allergies that you have.

OTHER MEDICATIONS

If you are taking other medications that you have purchased in a health food store, grocery store, drugstore or through mail order please include these on your list. Some examples of other medications are: supplements, herbals and herbal teas. You will not receive these medications while you are in the hospital unless specifically ordered by your physician. Many of these medications can interact or interfere with the medications that you may be given during your stay.

HOME MEDICATIONS

We discourage the use of home medications. Many patients store their medications in the kitchen or bathroom. Storage in these areas can cause the medication to degrade and become less effective. Medications are affected by moisture and heat. Storage of medications in our pharmacy is appropriate according to the guidelines from the manufacturers. We know where the medication originates and how it is stored.

DURING YOUR HOSPITAL STAY

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

• prescription medications that you already take at home unless your physician orders otherwise.

• You may be placed on Coumadin, Lovenox or Xarelto which are blood thinners.

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

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PHARMACY SERVICES - Page 2

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

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

MEDICATION STORAGE

Your medications are stored in a locked cabinet in your room. A Pharmacy Technician may visit you during your stay in order to place medications in the locked medication cabinet in your room. The technician will ask you about your medications and whether there are any problems with your medication therapy. If there are problems, you will be referred to a Pharmacist for a follow-up visit with you.

PRN MEDICATIONS

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

PHARMACY CONSULTATION

You may request a

consultation

with the Pharmacist through the Nursing Staff. Consultations are important. They help us in the Pharmacy to know exactly how you are progressing on your medication regimen.

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

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

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

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4/27/2020 Total Knee Replacement - Patient Guidebook 14

Total Knee Replace ment Patient 4/27/2020 15

Total Knee Replace ment Patient 4/27/2020 16

PATIENT MEDICATION SAFETY

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

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SURGERY

YOUR PREPARATION FOR SURGERY

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

WHILE YOU ARE IN YOUR OUTPATIENT ROOM:

A Nurse will be assigned to you and do a physical assessment which includes vital signs, weight and other health questions. You will change into a hospital gown and all clothing, jewelry, and dentures must be removed prior to going to surgery. In this area, we use a warming system called BAIR PAWS that connects to the hospital gown. If needed a prep will be done by either the nurse or the clinical technician. Your operative site will be scrubbed by the nurse morning of surgery to screen for diabetes. Please do not have pedicures or manicures done in preparation for surgery because the polish will need to be removed prior to surgery. You will be asked many times during your pre-operative period to verify your name and date of birth and also what you are having surgery on. This process is for Your Safety.

An Anesthesiologist will ask you questions concerning: Allergies If you have had anything by mouth after midnight Loose teeth or dentures Your home medications Previous anesthesia experiences Previous anesthesia problems you or your family members may have encountered Your procedure site will be marked by a licensed independent practitioner or other provider who is privileged or permitted by the hospital to perform the intended surgical procedure.

This individual will be involved directly in the procedure and will be present at the time the procedure is performed.

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

A Registered Nurse from the Operating Room will visit you in your outpatient room. The nurse will review your hospital chart and may ask you most of the same questions that you have previously answered; again, this process is for your safety, we want to be as thorough 1/28/2015 Total Hip Rep l acement Patient Guidebook 18

SURGERY – Page 2

as possible in your care. This is also an opportunity for you to ask any last minute questions prior to your transfer into the Operating Room where your surgery will be performed.

THE OPERATING ROOM (O.R.)

When you arrive in the Operating Room, the surgical team will perform a “time-out” and ask you to affirm your identity and operative site. You will be assisted to the operating room table. The Anesthesiologist and Nurse Anesthetist will work together to attach your EKG leads, blood pressure cuff, and pulse oximeter finger probe. You will be asked to breathe normally through an oxygen mask placed upon your face. If this is uncomfortable, we will hold the mask away from your face. The medication to put you to sleep is administered through your IV fluids. You will drift pleasantly off to sleep with the staff at your bedside. Once you fall asleep, a tube is placed in your throat to assist your breathing during the surgery. It is not uncommon to have a sore throat upon awakening. A Foley catheter may be inserted into your bladder once you are asleep to keep your bladder empty during the surgery.

LENGTH OF SURGERY

The average Total Hip Replacement takes 1 ½ to 2 hours in the operating room followed by at least 1 hour in the Post Anesthesia Care Unit/PACU.

ACTUAL PROSTHESIS

There are four (4) basic parts to the total hip prosthesis: the femoral (thigh) component consisting of the head and the stem; the acetabular component consisting of a metal shell, or cup and liner.

The stem, head and cup are made of cobalt chrome or titanium and the liner of the cup is made of high-density polyethylene that keeps the metal surfaces from touching and is the bearing surface.

FAMILY WAITING

We will let your family members know where to wait while you are in surgery.(Family Waiting Room or your assigned room.) They will be contacted when your procedure is completed.

POST ANETHESIA CARE UNIT (PACU)

After surgery, you will be transferred to the Post Anesthesia Care Unit in your hospital bed. You will have an abduction pillow between your legs; one or two drains from your surgical site and IV fluids attached to your hand/arm. You will have an abduction pillow between your legs; one or two drains from your surgical site and IV fluids attached to your hand/arm.

While in the Post Anesthesia Care Unit, your nurse will continue to monitor your vital signs and administer oxygen. You will also be encouraged to take deep breaths to help you stabilize from anesthesia and a warm air heating blanket may be placed over you for comfort. An ice bag may be placed on your operative hip. Leg exercises, (e.g. ankle pumps), will be initiated to aid circulation.

You may receive medication for pain relief and a few ice chips for thirst and/or throat discomfort. 1/28/2015 Total Hip Rep l acement Patient Guidebook 19

SURGERY – PAGE 3

You may also have follow-up lab work drawn or x-ray(s) taken. You will remain in PACU until you are alert, vital signs are stable and your discomfort is minimized (at least one hour). An Anesthesiologist will assess your status and release you to your room.

TRANSFER FROM PACU

You will be transferred to your room on your hospital bed accompanied by a Post Anesthesia Care Unit Nurse. You will still have your IV fluids and may be attached to oxygen. The nurse taking care of you on the nursing floor will meet you in your room, assess, obtain your vital signs and receive a status report from the Post Anesthesia Care Unit Nurse. If you have both hips operated on, Bilateral Hip Arthroplasty, or your physician feels that your care warrants, you will be transferred to the Intensive Care Unit. Otherwise, you will return to the nursing floor.

INTENSIVE CARE UNIT

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

Northside Medical Center’s Intensive Care Unit, ICU, located on the third floor, is designed to treat patients that require specialized intensive care. The open design of the ICU allows patients to be easily monitored at all times from the nursing station.

If you are admitted to ICU, we request that personal belongings be limited to toiletry articles. All articles of clothing and valuables should be taken home or returned to your family for safekeeping. Valuables may be placed in the hospital safe. Flowers are not permitted in the unit.

To promote optimal rest and healing, visiting hours are limited. Your family may wait in the ICU Waiting Room in the intervals between visitations. For our families that are visiting from out of town or state, assistance is available for lodging accommodations. There is a list of local hotels available at the front desk in the lobby or you may also contact the Patient Advocate in the Guest Relations/Patient Experience Office for assistance, 706 - 494 -2010.

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PATIENT CARE SERVICES

You have made a big decision to have a surgical joint replacement. We would like to do all that we possibly can to assist you in preparing for this procedure. The following will outline what you can expect before and after your surgery.

PRE-ADMISSION TESTING

Before you are admitted to Northside Medical Center for surgery, it is extremely important for you to visit our pre-admission testing department. Pre-admission testing may include pre-op lab work, an EKG and medical consult.

MEALS

Meals are served to you in your room. We encourage you to be out of bed for your meals as you become able.

Your family may choose to dine with you while you are in the hospital.

Guest Trays can be purchased at a reasonable cost and delivered to your room.

If you are interested, you may check with the front desk in the hospital lobby. Guest Tray food items are selected by Food and Nutrition Services according to the menu of the day.

To select specific menu items, the trays must be ordered the day prior to delivery.

BATHING

It is our goal that patients complete bathing as independently as possible, within their functional hip limitations. The nursing staff will prepare items for your bath. Upon completion of your daily bath, you are encouraged to dress in attire that is comfortable and conducive to your therapy goals identified for the day.

THERAPYATTIRE

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

FAMILY INVOLVEMENT

We encourage family to be involved in your recovery. Family involvement in therapy sessions will help them see how well you are progressing.

DISCHARGE INFORMATION

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

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PATIENT CARE SERVICES – Page 2

DAY OF SURGERY

When you arrive to your room on the surgical floor, your family may be there waiting on you.

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

• .

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

bulky dressing

to your hip A

Hemovac drain

to drain exess blood from the surgery site to prevent pooling of blood around your hip

IV fluids

to keep you hydrated and to give you antibiotics A

Foley Catheter

– which is a tube placed in your bladder during surgery to monitor your urine output. This is typically removed the next day after surgery.

Oxygen

by nasal cannula or mask to help keep your oxygen saturation between 90 – 100%.

Telemetry

and monitoring by ICU if you have a history of heart problems or sleep apnea

Pulse Oximetry

which will be applied to your finger with a monitor at the bedside.

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

TED hose and SCD hose

– these are worn to help prevent blood clots

SPINAL ANESTHESIA

You may have spinal anesthesia. If you receive this form of anesthesia, you will be numb from the waist down after surgery. This may last from one to four hours post op. As soon as you start to feel pain you will need to ask for pain medication.

You will remain on bed rest the day of surgery, unless your physician has orders for you to be up in the chair (if the spinal has worn off). Getting plenty of rest is important today.

Pain Medications

are available in the form of IV for severe pain or by mouth for mild to moderate pain. Pain medications are not normally scheduled but are given on a PRN, as needed basis. You may receive pain medications every three to four hours as needed and

will need to ask your nurse for pain medication.

You will be asked to rate your pain on a scale of 0 – 10 with 0 meaning no pain and 10 being the worst pain you have experienced. Pain medications may cause you to feel sleepy, nauseated or may cause itching. We can give you medications to help with the itching and nausea if needed.

You may be able to eat a meal if you are awake, not nauseated, and your nurse feels that you can tolerate food on your stomach. You will need to start with ice chips and fluids right after surgery and gradually progress to solid foods.

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LAB SERVICES

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PATIENT CARE SERVICES – Page 3

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

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

Each patient room has a the day.

Communication Board.

On this board the nurse will write the day, his/her name, their direct telephone number, your physician, your nurse tech and their direct phone number, your diet, physical therapy, pain level, discharge plans and goal for •

Post Operative Day One:

• • .

• The first day after surgery you will have some of your drains and tubes removed.

The hemovac will be removed and the dressing may be changed The IV fluids will be removed but the catheter may be left in place in case it is needed for any other medications given through the IV The Foley Catheter in your bladder will be removed once you have gotten up with Physical Therapy Oxygen (if your oxygen saturation is above 90% without the oxygen) The Physical Therapist will get you up out of bed today. You may feel dizzy the first time but this is normal. The Therapist may place you in the recliner at your bedside. You will use a walker as an assistive device to help you as you get up.

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

• • • • •

The following are the goals you should meet:

Walk 50 feet with Physical Therapy Get in and out of bed with minimal assistance Keep pain under control Be able to tolerate regular food Be able to walk to the bathroom with assistance and urinate without difficulty Please

DO NOT GET OUT OF BED WITHOUT ASSISTANCE

from the staff. It is important to use the call light or call your nurse or tech directly to assist you.

You will start on a blood thinner today based on your physician’s order. This helps to prevent blood clots. You will also go home on a blood thinner .

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LAB SERVICES

Total Hip Rep l acement Patient Guidebook 23

PATIENT CARE SERVICES – Page 4

Someone from

Case Management

will come by to discuss your discharge plans with you.

It is helpful to have an idea of your discharge plan prior to having surgery. You can decide on home health or a Rehab Facility. The main therapy for a Total Hip Replacement is walking. Physical Therapy will go over your limitations with you and reinforce them during your stay. Occupational therapy will work with you on getting dressed and your activities of daily living.

Post Operative Day Two:

On Post Operative Day Two, you should be feeling a little better.

• • .

• • • • •

The following are the goals you should meet:

Walking 100 feet or more with Physical Therapy. You will be using your walker.

Navigate, go up and down stairs Taking pain pills for pain control Made a decision on discharge plans No drainage from the incision Urinating without difficulty Tolerating regular food without nausea and vomiting Once you have been released by Physical Therapy, Your Surgeon, and the Medical Doctor, you may go home.

Physical Therapy and Occupational Therapy will continue to emphasize your “Do’s and Don’ts”. Please ask questions and ask for clarification if you do not understand something.

You will continue to receive your blood thinner today and when you go home.

If you have questions about your discharge plans, your Case Manager will be glad to answer them for you.

You may be able to go home today or on the third day after your surgery.

Day of Discharge:

Once your physician has given us a discharge order, the nurse can begin to prepare your paperwork. Please be patient with the nurse as it takes time to get everything together for you.

The physician may have given you your discharge prescriptions prior to you coming into the hospital. If not, he/she will write a prescription for pain control and a prescription for a blood thinner. You will need to take these to your pharmacy to be filled. We cannot call in medications for you nor can we give you any medication to take home with you to have on the ride home. But we certainly can work with you to ensure that you can take something 1/28/2015 Total Hip Rep l acement Patient Guidebook 24

LAB SERVICES

.

PATIENT CARE SERVICES – Page 5

for pain before you leave especially if you have a long ride home.

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

LAB SERVICES

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CARDIOPULMONARY SERVICES

ELECTROCARDIOGRAM/EKG

Your physician may order an Electrocardiogram/EKG – A tracing of the electrical activity of the heart through multiple electrocardiograph leads placed upon your chest to check for any abnormalities of the heart.

INCENTIVE SPIROMETRY

You will be provided an incentive spirometry device to help clear the lungs of anesthesia gases following surgery and to maximize your lung capacity. You will be instructed to slowly inhale as deeply as possible during this breathing exercise. This exercise is extremely important in order to minimize congestion and possible pneumonia. The exercise should be performed every two (2) hours while awake.

OXYGEN (O2)

Oxygen is frequently administered following surgery to help maintain oxygen levels in the body. The use of narcotics can also limit your ability to breathe deeply so oxygen may be provided for this reason as well.

HIGH FLOW NEBULIZER (HFN)

If you smoke or have a respiratory condition, your physician may order high flow nebulizer breathing treatments. These are usually given several times a day and your physician will order the desired medications to be administered in the treatments.

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

SLEEPAPNEA

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

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RADIOLOGY SERVICES

PRE-OPERATIVE

A chest and/or hip x-ray may be ordered by your physician and may be done along with other pre-admission testing procedures.

POST-OPERATIVE

X-rays of your hip may be taken following surgery to ensure correct placement and alignment of your new hip joint.

PRIOR TO DISCHARGE

You may have an x-ray of your hip a few days before you are discharged to provide information on your progression of healing.

LAB SERVICES

.

LAB SERVICES Lab Studies

Blood will be drawn on a daily basis if indicated.

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FALL PREVENTION GUIDELINES FOR PATIENTS/FAMILY

Accidental falls may occur in the hospital. These accidents are as distressing to hospital personnel as they are to the patient. Our healthcare team of nurses, doctors, physical therapists, and assistants are here to assist you in a safe and speedy recovery. Your participation and cooperation with this program will help you to prevent unnecessary injury.

Why Falls Happen

Falls may occur in the hospital because: • Medications such as tranquilizers, sleeping tablets, pain relievers blood pressure pills or diuretics may make you dizzy and disoriented.

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

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

• Some falls, such as those associated with illness or therapy, cannot be avoided. However, by following the safety guidelines, you, your family, and friends can help reduce your risk of falling.

Safety Guidelines for Preventing Falls

• When you need assistance, use your call light by your bed or in the bathroom and wait for help to arrive.

• Remain lying or seated while waiting for assistance. Please be patient, your call will be answered as soon as possible.

• Ask the nurse for help if you feel dizzy or weak getting out of bed. Remember you are more likely to faint or feel dizzy after sitting or lying for a long time. If you must get up without waiting for help, sit in bed awhile before standing. Then rise carefully and slowly begin to walk.

• Walk slowly & carefully when out of bed. Do not support yourself on rolling objects such as IV poles or bedside table.

• It is recommended you wear rubber-soled or crepe-soled slippers or shoes whenever you walk in the hospital. If' you do not presently have any, check with your nurse.

• Always follow your physician's orders and the caregiver's instructions regarding whether you must stay in bed or require assistance to go to the bathroom.

A Special Note for Family Members and Friends

Because hospital staff members cannot remain constantly at a patient’s side, arrangements may be made for a private duty nurse, family member, or sitter to stay with a patient. Whenever possible, ask the nursing staff if there are specific times (for example: at sundown, 6-9 PM) when your presence would be beneficial to the patient's comfort or piece of mind.

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PREVENTING BLOOD CLOTS

Deep Vein Thrombosis: Prevent DVT or blood clots

A blood clot is made of tissue, fibrinogen, platelets and white blood cells that collect and form a clot. DVT is one of the 2 types of blood clots. Preventing deep vein thrombosis -- the formation of a blood clot in a deep vein -- is vital. That's because the clot, which usually forms in a calf or thigh muscle, can partly or completely block blood flow and damage valves in blood vessels. If it breaks free and travels through your blood to major organs, such as your lungs – it becomes a pulmonary embolism. By preventing DVT’s we can prevent 90% of the pulmonary embolisms that form.

You will be assessed for blood clots upon admission and during your hospital stay. If you are at risk, measures will be used to reduce that risk.

• • • • • • •

DVT Prevention: Healthy Lifestyle and Regular Checkups

To lower your risk and help prevent DVT, take these steps: Maintain an active lifestyle and exercise regularly -- daily, if possible. Manage your weight with exercise as well as a healthy diet .

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

Get your blood pressure checked regularly; take steps to lower it, if necessary. Discuss alternatives to birth control pills or hormone-replacement therapy with your doctor. Report any family or personal history of blood-clotting problems to your doctor.

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

Preventing DVT After Surgery or While Bedridden

If you need surgery, your surgeon will review your medical history to help assess your risk for deep vein thrombosis (blood clots) and determine whether you need aggressive measures to prevent DVT.

Your DVT risk can increase immobile and continue for several months following surgery.

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

Researchers continue to look at the best ways to prevent DVT after surgery. For example, some studies show that using regional anesthesia instead of general anesthesia, when possible, can decrease your DVT risks.

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PREVENTING BLOOD CLOTS – Page 2

• • • • • • • •

Measures your doctor may prescribe to help prevent DVT:

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

These may include Aspirin, Heparin, or Warfarin (Coumadin), Lovenox and Xarelto. Depending on the medication, these can be given by injection, intravenously (IV), or by mouth Wearing a sleeve-like device on your legs during surgery to compress your legs and keep blood flowing through your veins.

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

Elevating the foot of your bed.

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

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

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

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REHABILITATIVE SERVICES Physical, Occupational and Speech

Rehabilitation services include physical, occupational, and speech therapies.

PHYSICALTHERAPY

With every total hip procedure there are post operative precautions. Your therapist will instruct you on your specific precautions according to your physician and type of procedure. You will participate in physical therapy daily to improve functional mobility.

An assessment is completed by a licensed Physical Therapist for every patient. The initial assessment involves an evaluation of your health status, review of your medical record and social history, as well as, observations and tests. You will be involved in establishing goals and a treatment plan sufficient to your recovery and your return to an optimal state of health. Your active participation is the key to a successful outcome. Family members or significant others are encouraged to be involved when possible.

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

Patient and family education is a service Northside Medical Center is very proud to offer.

Please do not hesitate to ask any questions that concern you and your care.

• • • • • •

POSTOP ERATIVE DAY ONE:

You will be provided education on proper positioning management and precautions for your lower extremity and hip.

You will be taught and assisted to perform exercises such as ankle pumps and quad and gluteal sets, hip flexion, active or active-assisted abduction and active knee extensions. .

You will be taught Transfer Training to include movement into and out of bed, chair, and commode if necessary. You will be assisted in transferring from your bed to a recliner for several hours a day.

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

The amount of weight placed on the extremity will be determined by your physician.

The ambulation goal you are encouraged to achieve is at least 50 feet, with 150 feet optimal by Post Op Day 2.

.

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REHABILITATIVE SERVICES – Page 2

• • • • • • •

POSTOPERATIVE DAY TWO:

Postoperative day one (1) activities continue.

You will continue to receive patient and family education regarding hip precautions during all activities.

You will continue out of bed activities.

You will continue with transfer activities to/from an elevated commode and/or bedside commode.

You will continue your hip and leg exercises for progression with the assistance of Physical Therapy.

You will ambulate and weight-bear as determined by your physician utilizing appropriate assisted devices.

The ambulation goal you are encouraged to achieve is 100 to 150 feet.

Depending on your progress, you may discharge this day.

• • • • • •

POSTOPERATIVE DAY THREE:

Postoperative day two (2) activities continue.

You will be encouraged to continue independence with bed transfers without utilizing the overhead trapeze bar.

You will progress with your transfers to/from commode and chair.

You will continue to receive patient and family education regarding your care to include specific training for your home exercise program.

You will progress in your hip/leg exercises to progress flexion and strengthening. You will continue to weight-bear and ambulate for increased distance to include stair management.

POST DISCHARGE:

• • • You will continue to use your assistive device until your follow-up appointment with your physician Keep your incision site clean and dry. Do not use peroxide, alcohol or lotion on the incision.

No mechanical home or gym equipment should be utilized during therapy If you have any questions concerning your Physical Therapy, please contact your Physical Therapist at Northside Medical Center (706) 494 – 2165. Your Therapist will provide you with instructions for your home exercise program and discuss the importance of continuing your exercise program and discuss the importance of continuing your exercise program to promote your recovery.

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DISCHARGE PLANNING

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

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

Based on your physician’s orders, your options may be a Home Exercise Program, Outpatient Services, Home Health, a skilled Nursing Facility or Rehab Facility. Your lab work can be done at a local hospital, clinic, or your medical physician’s office; whichever is most convenient and/or economical. Your physician or physical therapist may perform suture/staple removal, if indicated

.

(Some wound closures will not require staple or suture removal.) Other services can be provided according to your individual needs.

If additional services are required, the Case Manager will notify the appropriate facility the day of your discharge.

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

If you already know that you have specific needs for care following discharge, for instance meal preparation, housekeeping, the desire for sitters, or a personal care home, you must address the needs prior to your admission to the hospital. You will need to speak to your family and friends or private sitters to assist you after discharge. Northside Medical Center Hospital can not facilitate these services for you.

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

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

We look forward to working with you!

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CASE MANAGER PATIENT RESOURCE FORM FOR DISCHARGE PLANNING

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

PATIENT NAME: PHONE NUMBER: LOCAL HOSPITAL: HOME HEALTH AGENCY: PHYSICAL THERAPYAGENCY: NURSING HOME: INPATIENT REHABILITATION CENTER: FAMILY PHYSICIAN: 1/28/2015 Total Hip Rep l acement Patient Guidebook 34

AFTER YOUR DISCHARGE

• •

Family:

Offer support and encouragement.

•

Keep morale high by sharing time with him/her watching movies, playing a board game etc.

Encourage getting the most out of the exercises.

Keep him/her focused on returning to a healthy lifestyle.

On the home field:

•

Prepare healthy meals

•

Keep incision clean and dry

•

Keep legs elevated to prevent swelling.

•

Apply ice to the incision area 20 minutes, twice a day

•

Make sure that your patient does the exercises included in this patient guidebook

. No slacking on this one!

•

A walker or cane should be used until the patient feels confident to walk without it and can function (do something) without a limp or pain.

•

Encourage increased activities gradually – go outside and enjoy a walk as tolerated. Eventually expand the activity to include things that have been avoided because of painful joints. Start enjoying life again.

DOCTOR

F

…

IF…

Wound is leaking abnormally.

Temperature is over 101 Pain increases drastically Swelling increases.

Calf or thigh is very firm.

Uncontrolled Uncontrolled nausea an vomiting.

.

Chest Pain Chest Pain

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PREVENTING FALLS AT HOME

Each year, thousands of Americans fall at home. Many of them are seriously injured and some are disabled. Falls are often due to hazards that are easy to overlook, but easy to fix. Because of your hospitalization, you are at an increased risk for falls. There are many things you can do to decrease the risk of falls in your home. The following is a checklist you can use to prepare your home for your return from the hospital.

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

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

Remove throw rugs or put non-slip backing/double sided tape on the back of rugs so they will not slip.

Remove objects on the floor that may be in your way such as magazines, shoes, boxes, etc.

Adhere electrical cords to the wall or have an electrician put in an extra outlet so you do not have to walk over or near them.

Keep objects off the stairs.

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

Have any loose carpet repaired.

Have any loose or broken handrails repaired.

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

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

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

Put a lamp on each side of your bed.

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

Wear shoes inside and outside the house.

Add lighting to dark areas of your house.

Have your vision checked at least once a year.

Be aware of which medications you take that may cause you to be sleepy or dizzy.

Keep emergency numbers in large print near each phone.

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

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

These can be purchased from security/medical companies.

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WHAT TO BRING TO THE HOSPITAL

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

ITEM

Support person to drive you home upon discharge Driver’s license or picture ID with your name and address Completed Advance Directive Insurance card(s) and any other insurance forms you may deem necessary Any and all forms supplied to you by your physician such as Consents or Physician Orders Pajamas and/or nightgown, knee length robe

Shorts, T-shirts, loose fitting pants, warm up suits for comfort during exercising.

Socks, non-skid slippers & a pair of closed-toe supportive shoes

CPAP/BIPAP machine & accessories Extra pillows for supporting yourself in the car on the way home Basic Toiletries Any assistive devices that you already have, walker, crutches, elevated commode seat, may be brought to the hospital. Please mark your name on these items.; otherwise, we will provide them for you A list of medications with the name of the medication, the dosage and how often taken.

Autologous / Directed Donor Blood information

All recent lab work results, test results and medical consultation information YES NO COMMENT

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WHAT NOT TO BRING TO THE HOSPITAL

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

REMEMBER

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

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

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FREQUENTLYASKED QUESTIONS

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

What is arthritis?

There is a skin like covering over the bones called the periosteum. This covering contains nerve endings. In a healthy joint, there is a gelatin like structure, called cartilage, which cushions the area where two bones meet to form the joint. The cartilage actually prevents the two boney structures from coming in direct contact with each other. Once a person has bone on-bone contact, the nerve endings surrounding the bone become irritated, inflamed and painful. This process is commonly referred to as arthritis.

How does arthritis affect my hip?

The hip is considered a ball and socket joint. The “ball” is the rounded head of the thigh bone

(femur)

. The “socket” is a cup like area at the base of the hip bone or pelvis

(acetabulum)

. The cartilage, located between the ball and socket, helps the ball to rotate smoothly in the socket as you move your leg. Over time, the cartilage begins to wear away. With little or no cartilage to serve as a cushion, the end of the thigh bone and the hip bone begin to rub on each other. The nerve endings become irritated. The constant rubbing of bone-on-bone is responsible for the pain, swelling and stiffness that are associated with arthritis.

BEFORE: Bone rubbing on bone

What is a total hip replacement?

The term “total hip replacement” is rather misleading. The hip is not totally removed and a new hip inserted. Rather, the head of the thigh bone is replaced by a metal ball. The area of the hip bone where the thigh bone fits into is reduced and a metal cup with a liner is put into place. The metal ball and cup are referred to as the prosthesis. Once the prosthesis is in place, there is no more bone on-bone contact and the pain is relieved.

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AFTER: Cap and spacer prevents bone-on-bone contact

Total Hip Rep l acement Patient Guidebook 39

FREQUENTLYASKED QUESTIONS – Page 2

Will my new hip set off security sensors when traveling?

Your hip prosthesis is made of a metal alloy and may or may not be detected when going through some security devices. You will be mailed a joint I.D. card indicating that you have an artificial joint.

What is the success rate for total hip replacements?

Approximately 90-95% of patients report good to excellent results in terms of pain relief. Most are able to significantly increase activity and mobility and return to the activities they participated in prior to the onset of arthritis pain.

Am I too old for this surgery?

Your overall health is more of a determining factor than is your age. Prior to the surgery, you will be asked to see your family doctor or see one of the Internal Medicine physicians at Northside Medical Center Hospital to assess any health risks. All measures will be taken to prepare you for a successful surgical outcome.

How long will my new hip last?

There are no guarantees on how long your new hip will last. Various factors such as weight, activity type, activity level, etc., can affect the usable life of your new hip prosthesis.

Current studies indicate that the average hip prosthesis lasts for 10-20 years. With new materials and procedures, this expectation may change.

Will I need to have my hip replaced again in the future?

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

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FREQUENTLYASKED QUESTIONS - Page 3

Are there major risks associated with this type of surgery?

All surgeries carry a certain amount of risk. However, because of our proactive approach in preventing possible complications, most of our joint patients are just fine and are ready to leave the hospital in a few days.

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

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

How long does hip replacement surgery take?

The surgery itself takes about 2 ½ hours. After the surgery you will be monitored closely in a special unit called the Post Anesthesia Care Unit (PACU) until the anesthesia wears off (usually one hour). Once you are awake and stable, you will return to your room.

Who will be doing the surgery?

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

Will I be awake during the surgery?

During the surgery, an anesthesiologist will administer an anesthetic that will provide total pain relief. There are several different forms of anesthetic. A general anesthetic will “put you to sleep.” Other forms of anesthetic, such as a spinal, epidural or nerve block, will numb specific areas so that you will not feel any pain. Often these types of anesthetics will be used with another IV medication to help you relax and go into a light sleep like state.

You and your anesthesiologist will discuss which method is best for you prior to your surgery. Feel free to discuss any concerns you may have at this time.

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FREQUENTLYASKED QUESTIONS – Page 4

What will my scar look like?

The scar will be approximately six inches long and will be along the side of your hip. If you have a scar from a previous hip surgery, it may be possible to enter over the old scar depending upon its location.

There may be some numbness around the scar after it is healed. This is perfectly normal and should not cause any concern. The numbness usually disappears over time.

Other than the scar, will my joint be any different?

For the most part, your hip should feel normal after the recovery period. In some cases, the leg with the new hip may seem to be longer than it was prior to surgery. This could simply be due to the fact that your joint was deteriorating and now has been replaced. Sometimes during surgery it is also necessary for the surgeon to lengthen the hip to avoid dislocation.

Most people quickly adjust to the new length; others may require a small lift in their shoe to compensate for the difference.

Will I be in a lot of pain?

Our joint center specializes in joint replacement surgery. As such, we have considerable experience in caring for patients after surgery and know how to keep our patients comfortable. Pain meds are given as IM injections, IV or by mouth, which can be received every three hours if needed. Ask for your pain meds before the pain gets bad. It is more difficult to get the pain under control if you wait. Most people do not require strong pain medication after the first day and can switch to oral medications. A few surgeons use patient controlled analgesia (PCA pump). A pump is attached to your I.V. and you are given a button to push when you need pain meds. Your pain will be graded on a pain scale of 1-10.

Will I need a blood transfusion after surgery?

There is a possibility that you may need a blood transfusion after surgery. You have the option of relying on blood from the blood bank or you may donate your own blood prior to the surgery. Your donated blood will be stored for your use only.

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FREQUENTLYASKED QUESTIONS – Page 5

How long will I be confined to bed after surgery?

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

How long will I be in the hospital?

Joint replacement patients usually stay with us about three or four days. Then they are ready to go home. Before you leave, however, it is important to be comfortable using a walker or crutches, and you must meet certain goals.

Will I need a walker, crutches or cane?

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

When can I go home?

Most of our patients go home on the third or fourth day following surgery.

Occasionally, some patients require a short three to five day stay in a sub acute facility, but this is the exception rather than the rule.

Will I need help at home the first week?

Although you will be well on your way to recovery when you leave the hospital or sub acute facility, it may be necessary to have someone assist you with meals, medication, dressing, etc. If you go directly home from the hospital, Discharge Planning can arrange for a home healthcare nurse to visit you as needed. Be sure to alert the joint care team if you live alone or have special needs.

To make the transition to home easier, be sure to plan ahead. Prior to coming to the hospital, take care of such things as getting prescriptions filled, changing the beds, doing the laundry, washing the floors, arranging for someone to cut the grass and walk the dog, stocking up with frozen foods, etc. Your job after surgery is to focus on recovering, not household tasks.

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FREQUENTLYASKED QUESTIONS - Page 6

Will I need physical therapy when I go home?

Your surgeon will order physical therapy after discharge as needed. If you cannot attend outpatient physical therapy, an in-home therapist may be arranged. You will also be given exercises to take home that you will need to do daily.

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

Why should I exercise before surgery?

The better the condition your muscles are in prior to the surgery, the easier and faster your recuperation is expected to be. It is important to learn the exercises and be comfortable with them prior to the surgery so that you can continue them once you return home. Starting the exercises now will build muscle tone and pave the way to a quick recovery.

Read exercise section in this patient guidebook which outlines pre-op exercises.

Begin doing the exercises immediately. Your new joint will be happy that you did.

After leaving the hospital, when do I need to see my surgeon again?

An appointment will be made for you when you are discharged telling you when to see your surgeon.

Are there any activities that I should avoid initially?

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

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

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FREQUENTLYASKED QUESTIONS – Page 7

Are there any activities better than others?

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

When can I return to work?

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

When can I drive?

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

Another consideration is the mechanics it takes to drive your car. If you have had a left hip replaced, you may be able to drive a car with an automatic transmission in as little as four weeks depending upon your own personal progress. If your surgery was on your right hip or you are driving a manual transmission requiring the use of both feet, then you may not be ready to drive for six or more weeks. It all depends on the condition of your joint and how far you have progressed. Regardless of your progress, you should not consider driving if you are still taking narcotic pain medication.

Your surgeon will let you know when it is advisable to drive again.

When can I resume sexual intercourse?

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

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FREQUENTLYASKED QUESTIONS – Page 8

Will my medications affect my ability to engage in sexual intercourse?

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

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

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

Are there any positions that should be avoided during intercourse?

After a total hip replacement, there are certain positions that could place stress on your new hip and cause it to dislocate or pop out of alignment. To prevent your hip from dislocating, you should avoid specific positions and observe some simple yet effective hip precautions especially for the first three months following surgery.

•DO NOT bend the surgical hip joint more than 60 to 90 degrees (depending on surgical procedure).

• DO NOT sit with your legs crossed •When lying on your back, keep your surgical hip/leg straight. DO NOT cross your ankles or roll your surgical hip/leg towards the other leg •When lying on your side, support the surgical hip/leg using pillows between the knees and legs. DO NOT let the surgical hip/leg drop over the other leg and onto the mattress.

Initially, the most comfortable position for both males and females after hip replacement would be to lie on their back with a pillow or two supporting the thigh and knee. Female patients should keep their surgical hip/leg out slightly to the side with toes pointing up. DO NOT bend the surgical hip or overextend the leg.

As your confidence increases, you may want to try a side lying position. This would involve the female lying on her side with her partner lying in back of her. When assuming this position, the female patient should lay on the nonsurgical hip with at least two pillows between the knees and legs to keep the legs relatively straight and parallel. It is important that the hips DO NOT bend more than 60 to 90 degrees (depending on surgical procedure) at any time and that her surgical hip/leg DOES NOT cross over and touch the mattress. For a male patient using this position, he should lay on his nonsurgical hip. His partner should place at least two pillows between her knees and legs so that her legs are straight and parallel. During sex, the male should support his surgical hip/leg by placing it on top of his partner’s leg being careful to keep his surgical hip/leg from crossing over the other one. Again, his surgical hip should never bend more than 60 to 90 degrees, depending on surgical procedure.

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FREQUENTLYASKED QUESTIONS – Page 9

Later in the recovery process, as your range of motion improves, the male joint replacement patient can assume a top position or can try a sitting position. Just remember NOT to bend the hip more than 60 to 90 degrees (depending on surgical procedure) or overextend your hip joint by crossing the legs until your surgeon says you are ready to do so.

If you experience sudden onset of groin pain or problems moving your leg STOP. There is a possibility that you may have dislocated your hip. Reposition yourself so that you are lying on your back. If the pain continues, remain lying down and have your partner call your surgeon. DO NOT attempt to get up or go the emergency room until you have spoken with your surgeon.

What if sex doesn’t go well?

Remember, you are still healing. Just like other activities that you are returning to, it may take some time to regain your former stamina. Realize that these changes to your sex life are temporary and are needed to protect your new hip. Just relax. You’ll be back to your old self in no time.

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PRE-OP HIP EXERCISE CIRCUITS DO A MINIMUM OF TWO CIRCUITS A DAY

See the following pages for descriptions of the exercises below:

Exercise #1 Ankle pumps Exercise #2 Quad Sets – Knee Pushdowns Exercise #3 Gluteal Sets – Buttock Squeezes Exercise #4 Exercise #5 Exercise #6 Exercise #7 Abduction and Adduction Heel Slides Short Arc Quads Long Arc Quads Exercise #8 Exercise #9 Exercise #10 Armchair Push-ups Seated Hamstring Stretch Mini Squats 20 reps 20 reps 20 reps 20 reps 20 reps 20 reps 20 reps 20 reps 20 reps 20 reps

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EXERCISE # 1 - ANKLE PUMPS

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

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

3. Repeat 20 times.

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EXERCISE # 2 - QUAD SETS – PUSHDOWNS

1.Lie on your back, press knee into bed or couch. Hold and release.

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

3. DO NOT hold your breath.

4. Repeat 20 times.

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EXERCISE # 3 - GLUTEAL SETS – BUTTOCK SQUEEZES

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

2. DO NOT hold your breath.

3. Repeat 20 times.

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EXERCISE # 4 - HIPABDUCTION AND ADDUCTION

1.Lie on your back with legs together.

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

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

4. Repeat 20 times.

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EXERCISE # 5 - HEEL SLIDES

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

2. Slide your heel to the original resting position.

3. Repeat 20 times.

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EXERCISE # 6 - SHORT ARC QUADS

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

2. Lift foot, straightening knee.

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

4. Repeat 20 times.

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EXERCISE # 7 - LONG ARC QUADS

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

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

3. Hold and release, returning to original position.

4. Repeat 20 times 1/28/2015 Total Hip Rep l acement Patient Guidebook 55

EXERCISE # 8 - ARMCHAIR PUSH-UPS

1.

2.

3.

4.

Develop your arm muscles by sitting in a straight armchair.

Place hands on armrests.

Straighten arms, raising buttocks up off chair seat. This may take some practice if your arm muscles are weak. It is important to continue to do this exercise to build up your muscles. Increased arm strength will be needed during your recovery period.

Repeat 20 times.

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EXERCISE # 9 - SEATED HAMSTRING STRETCH

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

2. Lean forward, keeping your back straight.

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

4. NO bouncing or reaching toward your toes.

5. Hold for 20-30 seconds and release.

6. Repeat 20 times.

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EXERCISE # 10 - MINI SQUATS

2.

3.

4.

1.

Holding onto the back of a chair or table top, bend your knees slightly.

Do not allow your knees to go past your toes. Lead with your buttocks with your weight in your heels.

Slowly return to starting position.

Repeat bending a bit further each time.

Repeat 20 times.

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