Covenant Orthopedic Care Center

Patient Education Booklet

For

Total Hip Replacement

Compiled by Judy Lawley, RN Orthopedic Nurse Specialist

1

Table of Contents

Chapter One: Introduction • Welcome to the Covenant Total Joint Program • Your Healthcare Team • Hospital and Contact Information

Chapter Two: Understanding the Operation • The Healthy Hip • The Problem Hip • The New Hip

Chapter Three: Preparing For Surgery • Getting Medical Clearance for your Operation • Attending the Covenant Total Joint Education Class • Planning for your discharge from the hospital • Preparing your home for a safe return • Exercises for a speedy recovery • Diet for a speedy recovery

Chapter Four: What to Expect during Your Hospital Stay

• What to bring to the hospital • Coming to the hospital • Your daily care plan • Tips To Make Your Hospital Stay Easier • Exercises and Therapy use

Chapter Five: What to Expect after You Leave the Hospital Stay • Discharge instructions • Home Exercises • Do’s and Don’ts • Getting back to normal • When to see or call the doctor

Chapter Six: Additional Resources • Discharge Equipment • Community resource directory • Online Resources and Information • Implant Card • Glossary

This booklet contains material compiled from patient education classes presented at the Orthopedic Care Center, Covenant Medical Center, Lubbock, Texas.

2

CHAPTER ONE

INTRODUCTION

***** WELCOME Welcome to the Covenant Joint Replacement Program. We feel that our program is one of the finest joint replacement programs in the region. In fact, Covenant is the 3rd largest joint replacement program in the United States. Our team is committed to making sure that your experience at Covenant is a positive one. Many of our patients and families have found it helpful to learn as much as they can before surgery. Our goal is for you to feel confident with your decision to have surgery and ensure that you have the best possible outcome. This informational booklet has been prepared as a resource to help you understand your hip replacement. It will explain what to expect before, during, and after your hospital stay. You will learn about your daily routine while in the hospital, as well as exercises, incision care, medications, therapies, and much more. Since this book contains comprehensive information it might seem overwhelming so don’t try to read it all at once. Instead, we recommend that you read those sections that apply to where you are in your journey through surgery and recovery. This book is only a guide designed to increase your general knowledge regarding your surgery. You should not use it as a substitute for medical or professional advice. If you read this booklet and follow the instructions, your recovery will be timely, and you will achieve optimal results from your surgery. THE AMOUNT OF PROGRESS YOU MAKE IS DEPENDENT ON YOUR PARTICIPATION IN YOUR CARE. Please bring this book with you each time you are scheduled to see your surgeon, as well as when you come to the hospital for surgery.

3

YOUR HEALTHCARE TEAM During your stay in the hospital, a team will work with your surgeon to help you through your recovery. The team has been specially trained for orthopedic care and includes the following members: Nursing Staff Nursing staff will instruct, support, and guide you. They will coordinate your daily activities and help you with mobility, treatments, personal care, pain management and discharge planning. Physical Therapists Physical therapists will tailor an exercise program to your specific needs. They will work with you to strengthen your new hip and supporting muscles, instruct you in mobility, and transfer techniques and teach you to safely use a walker. Occupational Therapists Occupational therapists will teach you how to do daily tasks as independently as possible, following the precautions outlined by your doctor. Examples of these tasks include getting in and out of bed, dressing, personal hygiene and kitchen chores. Orthopedic Service Attendants These attendants will help you walk at least two times each evening during your stay in the hospital. This will help build strength and endurance for a speedy recovery. Social Workers/Case Managers Social Workers/Case Managers will work closely with you to help you handle your hospital stay and plan your discharge. They will also work with you family and friends to identify the support they can offer while you recover as well as provide you with information on community resources available. They will help you understand your insurance benefits and how they can meet your discharge care needs.

4

You may also come in contact with other healthcare professionals, including home health, dietary, pastoral care, and respiratory care. HOSPITAL AND CONTACT INFORMATION

Covenant Medical Center Campus 3615 19th Street

and

Covenant Medical Center – Lakeside Campus

4000 24th Street

5

CHAPTER TWO

UNDERSTANDING YOUR HIP

*****

A HEALTHY HIP The hip is a “ball and socket” joint. The “ball” is formed by the head of the femur (the thigh bone). The “socket” is part of the pelvis called the acetabulum. In a healthy hip, the ball and socket are covered with a smooth layer of cartilage. The cartilage allows the ball to glide easily inside the socket and provides a cushion to your hip joint. Muscle and ligaments hold the hip joint in place. When the surrounding muscles support your weight and the joint moves smoothly, you can walk without pain. A PROBLEM HIP Total hip replacements are performed most commonly because of progressively severe arthritis in the hip joint. In a problem hip the surfaces of the ball and socket, which make up the hip joint, become rough and jagged. This causes intense chronic pain together with impairment of daily function including walking, climbing stairs, and even rising from a sitting position.

6

A PROSTHETIC HIP (YOUR NEW HIP) A total hip replacement is a surgical procedure whereby the diseased cartilage and bone of the hip joint is surgically replaced with artificial materials. Total hip joint replacement involves surgical removal of the diseased ball and socket, and replacing them with a metal ball and stem inserted into the femur bone and an artificial plastic cup socket. The metallic artificial ball and stem are referred to as the “prosthesis.”

7

CHAPTER THREE

PREPARING FOR SURGERY

*****

GETTING MEDICAL CLEARANCE FOR YOUR OPERATION After you and your surgeon agree that surgery is the best option for your condition, your surgeon’s office will schedule your surgery and provide instructions such as when and where you are to arrive at the hospital. In most cases, your surgeon will also require that you obtain medical clearance prior to your surgery. Your family physician, internist, medical specialist or the hospital’s Pre-admission Testing Center may perform this clearance. The amount and type of testing will vary depending on your age and medical history. You should not eat or drink anything starting at midnight the night before the medical clearance appointment.

Questions to Ask at Your Medical Clearance Appointment 1. Which medications should I take the morning of surgery? 2. If I take anticoagulants like coumadin or aspirin, when should I stop

taking them before surgery? 3. When should I stop taking aspirin products and non-steroidal anti-

inflammatory medicines (such as Advil or Aleve) before surgery? 4. Are there any other special instructions I should follow as I prepare

for my surgery? THE COVENANT JOINT EDUCATION CLASS When you are scheduled for surgery, your physician may also schedule you to attend the Covenant Joint Education Class. The class will provide you and your family a clear explanation of what will happen during your hospital stay. The class also provides an opportunity to ask any questions you have.

8

The classes are approximately one (1) hour. The class will help you understand the events that will occur before, during, and after your hospital stay. Please call Judy Lawley, RN, Orthopedic Nurse Specialist to schedule a pre-surgery class (806) 725-1222 or 1 (800) 725-0724 ext. 51222. If no answer, please leave your name, phone number, type of surgery and surgery date and Judy will return your call. PLANNING FOR YOUR DISCHARGE Making plans for when you leave the hospital is a very important part of your total hip replacement recovery. Your health care team will work with you and your family to help develop your discharge plan. By using this plan, you and your family can make most discharge arrangements before your surgery. A discharge plan is one of the following. Discharge to Home You can return to your home if you can do the following at the time of discharge: You can get in and out of bed and a chair with minimal help. You can walk with your walker, crutches or cane. You can walk the distance from your bedroom to your bathroom and

kitchen. You can go up and down stairs safely, if needed. You also need to have help from either family or friends on a regular basis until you regain your independence and self-confidence in walking and in daily living activities.

9

Home with Home Care Some patients can return to their home at discharge but need some help beyond what family and friends can provide. Health care professionals can meet this need. These care givers can be physical or occupational therapists, home health aides or nurses who come into your home to help you with walking, strengthening exercises, daily living tasks and safety issues and to monitor your medical condition. You can return to your home with home care providing you can do the following at the time of discharge: You can get in and out of bed and a chair with minimal help. You can walk with your walked, crutches or cane. You can walk the distance from your bedroom to your bathroom and

kitchen. You can go up and down stairs safely, if needed. Discharge to a Skilled Nursing Facility Some patients need more help and services than what can be reasonably provided at home. Such services can include daily skilled nursing care, additional rehabilitative therapy or both. In a Skilled Nursing Facility, you can continue you rehabilitation program and have your medical needs monitored until you can safely return home. Therapy sessions focus on building strength, endurance and safe care skills. You will be cared for by a multidisciplinary team who will work with you and your family so you can return home as soon as possible. Before your hip replacement surgery, your health care team can help you identify a facility with the extended care services you may need following your hospital stay. EXERCISES FOR A SPEEDY RECOVERY Exercising restores free movement, improves function of the operated leg and relieves pain so that you can lead a more active and independent life.

10

Exercises for circulation are taught to you when you are scheduled for surgery. These exercises include foot pumping and tightening of the quadricep muscles and are to be done 10 times every hour during waking hours, before you enter the hospital. In the hospital after surgery, these exercises will increase to 10 times every 30 minutes. These exercises are a VERY IMPORTANT part of your recovery process. Exercising before surgery will also strengthen your upper body. Upper body strength is helpful for pulling yourself up or walking with a walker or crutches. DIET FOR A SPEEDY RECOVERY Good nutrition before and after surgery is important for health and progress. Good nutrition is a balance of calories, protein, fiber and iron. Each of these is very important. Calories are always important after having surgery. Protein is important because it helps to rebuild muscles, repair tissues, fight infection and heal. Rebuilding the muscles and tissue around your new hip will help the joint to heal properly. Constipation is sometimes a problem following surgery for a variety of reasons. Increasing fiber intake will help to eliminate this problem before it becomes serious. Your physician may also put you on a stool softener for a few days post-operatively. Iron helps carry oxygen to blood cells, so it is important to increase iron intake following surgery. Oftentimes your physician will prescribe an iron supplement and/or advise eating iron rich foods for six weeks following surgery. SKIN PREPARATION Five nights prior to surgery, you will need to begin cleansing the skin. This includes washing of the operative area for a 2-minute period using bath soap and a washcloth. Caution should be used as to not irritate the skin. The skin preparation is done in an effort to decrease the normal skin bacteria and, therefore, decrease the chances of post-operative infection. MEDICATIONS One to two weeks prior to surgery you should stop any aspirin, arthritis medication and blood thinners that you take regularly. Extra Strength Tylenol or Anacin can be taken for pain relief. Also, your doctor may

11

recommend that you take an iron supplement (such as Feosol Spansule) twice a day until surgery. If you are unable to tolerate iron preparation, a list of foods that are rich in iron is available upon request. BLOOD DONATION Your doctor may suggest that you donate your own blood once or twice before surgery (usually 4 to 5 weeks before surgery). This will be saved for you to use, if needed, during your recovery. INSURANCE COVERAGE Health care benefits are constantly changing and differ from plan to plan and provider to provider. It is important for you to understand your health care benefits before your surgery. Now is a good time to call your insurance provider and find out exactly what is and isn’t covered under your plan.

Questions To Ask Before Your Hospital Stay: I am scheduled for hip replacement surgery:

1. Does my hospital stay need to be pre-approved? 2. If yes, who should pre-approve my hospital stay? 3. What do I need to do to receive the pre-approval? 4. Will additional hospital days be covered if there are complications? 5. If yes, how many extra days are allowed? 6. If I can’t return to my prior living arrangement immediately upon

discharge, do I have benefits for more rehabilitation and physical therapy?

PREPARING YOUR HOME FOR A SAFE RETURN You will find it helpful to prepare your home prior to surgery so that it is safe when you return. The following information is designed to assist you with this.

Remove throw rugs from the floor. These can cause you to trip and fall.

Remove or relocate electrical cords, which are in the walking paths.

12

Put frequently used items where they can be reached easily. Remember it may be painful and unsafe to bend down or reach up to get things.

Consider preparing and freezing meals in advance that can be easily heated.

Check stair railings to make sure they are secure. If you are adding a railing, extend it a few inches past the end of the staircase.

Consider first floor options (temporary). If your bathroom isn’t on the main floor, do you have access to a portable commode?

Consider a hand-held showerhead. Pick out a chair to sit in when you come home. A good chair is firm

with arms and seat height at least 18 inches from the floor, but one that allows your feet to be flat on the floor and your knees to be lower than your hips.

Walkways Remove throw rugs whenever possible to avoid tripping. If you can’t remove throw rugs, use rugs with nonskid backing to

avoid slipping. Make the transition between types of flooring (such as wood floor to

carpeted floor) as even and secure as possible to prevent tripping. Avoid waxing wood or linoleum floors, to prevent slipping.

Stairs The rise between steps should ideally be no more that five inches. Make sure handrails are well anchored (or install handrails) on both

sides of the stairway. Nonskid treads can be placed on wooden stairs to prevent slipping. Make sure carpeting on stairs is secure.

Furniture Layout Arrange furniture so that pathways are not cluttered. Chairs and tables need to be sturdy and stable enough to support a

person leaning on them. Avoid furniture with sharp edges and corners; if furniture does have

sharp edges or corners, pad it. Chairs with arm rests and high backs provide more support when

sitting and more leverage when getting in and out of a chair. Bed/chairs should be 19-21 inches from the floor.

13

Lighting Be sure that your lighting is ample to prevent falls and assure that

you can read medication labels and instructions easily. Light switches should be immediately accessible upon entering a

room. Good lighting for hallways, stairs, and bathrooms is especially

important. Medicines Keep medications out of reach of children. Dispose of expired medicines properly. Flushing them down the toilet

is usually a safe method. Sliding Glass Doors Mark sliding glass doors with stickers to prevent someone from

walking through them.

BATHROOM SAFETY

Toilet Use an elevated toilet seat or commode to ease getting on and off the

toilet. Install grab bars around the toilet if you need more support getting on

and off the toilet. Bathtub Install skid-resistant strips or a rubber mat. Use a bath seat if it is difficult to stand during a shower or too difficult

to get up out of the tub. Install grab bars on the side of the tub or shower for balance. Install hand-held shower. Do not use the soap dish or towel bar for balance, as these can pull

out of the wall easily. Remove sliding shower door.

Doors Avoid locking bathroom doors, or use only locks that can be opened

from both sides when you may need assistance in the bathroom.

14

KITCHEN SAFETY Store frequently used items at waist level. Use a Reacher or Grabber

to avoid standing on a chair or footstool when items are not at eye level.

Consider preparing and freezing meals in advance that can be easily heated.

Mark “ON” and “OFF” positions clearly on dials of the stove. Use the front burners of the stove to avoid reaching over burners

(unless there are small children in the home – in that case use the back burners).

Make sure pans/hot handles are not over the edge of the stove. Slide heavy pans across the stove instead of trying to lift them. Keep baking soda near the stove to extinguish small cooking fires,

and keep a fire extinguisher in the kitchen, if possible. Make sure the sleeves of your clothing are not loose or dangling

while cooking; they could easily catch fire. Tables with four legs are more stable than pedestal-type tables.

15

CHAPTER FOUR

WHAT TO EXPECT DURING YOUR HOSPITAL STAY

***** WHAT TO BRING TO THE HOSPITAL

Bring this educational booklet. A current list of your medications, including the dosages and the

times you take them. If you have a health care directive (living will, power of attorney) bring

a copy. Personal care items such as toothbrush, paste, denture cleaner,

comb, brush, skin care products, deodorant, make-up and shaving kit.

If you wear glasses or contacts, bring a storage container for them. If you wear hearing aides, bring a storage container for them. If you want to wear a gown or robe other than what the hospital

supplies, bring your own. Bring slippers or comfortable shoes for walking in the halls. Bring shorts or undergarments to wear under your hospital gown and

robe. Bring comfortable clothing you intend to wear home. DON’T bring valuables – leave them at home or with your family. All rooms have a television and phone, but you may want to bring a

book, magazines or a little money to buy a newspaper.

16

THE DAY BEFORE SURGERY Starting at midnight the night before the surgery, you are to have nothing to eat or drink. You may not even drink water. If your medical physician has advised you to take your morning medications, the morning of surgery, you may take them with one swallow of water only. ARRIVAL Your physician will instruct you when to arrive at the hospital. If your surgery is at Covenant Medical Center you may use Valet Parking or the visitor parking garage, located on the south side of the hospital. At Covenant Medical Center Lakeside, you may park in any visitor lot. When you enter the hospital, proceed to the admitting area for registration. An admitting clerk will escort you to your room. TO YOUR ROOM Upon arrival to your room, you will be oriented to your surroundings and the nursing staff will prepare you for surgery. Your nurse will complete the admission process. TO SURGERY When it is time for surgery, you will be transported to the surgery holding area. Family members or friends are welcome to wait in the surgery waiting room during your surgery. You will be in the holding area for a short time before being taken to the operating room. AFTER SURGERY After the operation is completed, the surgeon will come to the surgery waiting room and visit with your family. The surgeon will explain any instructions at this time. Family and friends are then welcome to proceed to your hospital room to wait for your return.

17

RETURN TO YOUR ROOM When you return to your room, vital signs will be monitored, an assessment will be completed, and you will begin post surgery exercises. Post surgery exercises are:

(1) Deep Breathing/Incentive Spirometry – This exercise involves taking 10 slow, deep breaths in a row and should be performed every 30 minutes while you are awake.

(2) Foot pumping - this exercise

involves moving your feet up and down vertically 10 times in a row every 30 minutes while you are awake.

Please use the following schedule to record your exercise progress:

18

Day 1 Day 2 Day 3 Day 4 TIME FOOT

PUMP IS TIME FOOT

PUMP IS TIME FOOT

PUMP IS TIME FOOT

PUMP IS

AM 6:30

7:00

7:30

8:00

8:30

9:00

9:30

10:00

10:30

11:00

11:30

PM 12:00

12:30

1:00

1:30

2:00

2:30

3:00

3:30

4:00

4:30

5:00

5:30

6:00

6:30

7:00

7:30

8:00

8:30

9:00

9:30

10:00

10:30

Do footpumping exercises 10 times every 30 minutes. Do Incentive Spirometery 10 times every 30 minutes.

19

DIET After surgery, you will be given ice chips to satisfy your thirst. Your physician will advance your diet from liquids to solid foods, as you are able to tolerate them. It is not uncommon for you to remain on liquids until breakfast the following morning. PAIN AND MEDICATIONS After surgery you will experience varying degrees of discomfort. This is normal and will improve each day. Keeping your pain under control is very important to your recovery. It will help you eat better, sleep better, and get around easier. We ask that you pay close attention to your level of pain and use the following scale to communicate your level of pain with your nurse:

0 1 2 3 4 5 6 7 8 9 10 no pain worst pain Please don’t hesitate to request pain medication, as you need it. Your physician will select the most appropriate pain medication for you. In some cases your pain will be controlled with a PCA (Patient Controlled Analgesia) pump.

This allows you to administer pain medication to yourself. As your pain decreases, the pump will be removed and your physician will change your pain medication.

20

HOME MEDICATIONS Any medications that you have been taking prior to coming to the hospital may be resumed with an order from your physician. You will NOT be allowed to take your own home medications during your stay in the hospital. Your nurse will administer hospital medications as ordered by the physician. PATIENT PLAN OF CARE A smooth and speedy recovery depends on your help and cooperation. Your participation is essential in reaching your goal to return home and avoid complications. Many patients wonder how long they will need to stay in the hospital following surgery. Your healthcare team generally will work with you to determine discharge and home care needs. You can plan to be in the hospital four days or less when its been determined that you will be able to return to your own home or a family members home following surgery. Your hospital stay will follow a standard care plan. The progress you make toward going home will be measured by how you meet the daily goals outlined in the plan. These goals include pain management, activity, and preventing complications.

21

Patient Plan of Care – Total Hip Replacement Day of surgery After surgery day 1 After surgery day 2

Activity Plan Activity Plan Activity Plan Up with assistance Up with assistance Up in chair/commode Sit on edge of bed Up in chair Walk to bathroom and in halls Up to bedside commode Up to bedside commode Bed mobility with minimal

assistance Turn to side in bed with help Turn to side in bed with help Continue independent practice

of hip exercise program Do ankle pumps and

quadricep exercises 10 times each hour while awake

Do ankle pumps and quadricep exercises 10 times each hour while awake

Attend therapy sessions throughout day

Participate in therapy twice a day (take pain medication before therapy)

Participate in personal hygiene

Participate in personal hygiene Pain control Pain control Pain control Use pain scale Use pain scale Use pain scale Use pain medications Use pain medications Take medication before therapy Inform nurse of effects of pain

medication Inform nurse of effects of pain

medication Inform nurse of effects of pain

medication Use cold therapy Use cold therapy Use cold therapy Breathing exercises – do 10 times each hour while awake:

Breathing exercises – do 10 times each hour while awake:

Breathing exercises – continue:

Cough-deep breathe Cough-deep breathe Cough-deep breathe

Use incentive spirometer Use incentive spirometer Use incentive spirometer Use oxygen if needed Use oxygen if needed As ordered by doctor As ordered by doctor As ordered by doctor Abductor pillow Abductor pillow Abductor pillow White elastic socks - TEDS White elastic socks - TEDS White elastic socks – TEDS No pillow under knee, under

calf only to keep heel off bed No pillow under knee, under

calf only to keep heel off bed No pillow under knee, under

calf only to keep heel off bed Review my discharge

plan with the health care team and my family:

Discharge destination

Equipment needed at home

Home Help

Transportation

Discharge Date

Discharge education needed

22

Remainder of stay Activity plan: move toward doing activities independently Walking to bathroom and in hallways 3-4 times per day Minimal assistance to independent transfer in/out of bed/chair Minimal assistance to independent bed mobility – pillow under calf only Safe stair walking Participate in therapy twice a day Perform independent hip exercise program Perform ADLs (Activities of Daily Living) Shower with wound covered Wear elastic white socks (TEDS) Pain Control Take pain medication when needed to minimize pain Use cold therapy Breathing exercises – continue with: Cough-deep breathe Use incentive spirometer Finalize discharge plans Discharge date/destination Transportation Home equipment ready Family/friend support established Prescriptions identified and filled All discharge education reviewed All my questions answered

23

PHYSICAL THERAPY (PT) Physical Therapy (PT) is the process of restoring movement and strength, enabling you to get in and out of bed and walk without assistance following

surgery. Usually, there will be two therapists assisting you, especially in the beginning of ambulation training. The physical therapists will begin by assisting you to sit on the side of the bed. They will then put a gait belt around your waist to assist them in ambulating you safely. Once you are in a sitting position on the bed, the therapists will assist you in standing up. They will then instruct you in how to walk with the walker. The goal of PT is to help the patient return home and resume normal activities as quickly as possible.

Walking with a walker is very simple if you follow the instructions. The walker is used for balance and weight bearing precautions. The therapists will instruct

you to move the walker first, then to move the “bad leg” (the operated leg) and then to move the good leg. This helps you to use upper body strength from your arms to support your operated leg. The use of walker is only temporary. Once you feel confidant (usually takes 4 – 6 weeks) you may walk short distances without it if weight-bearing status is “Weight Bearing as Tolerated” or “Full Weight Bearing”. You will be walked at least twice a day by someone from the physical therapy department and twice a day by the nursing personnel. The daily goal is for you to walk farther each time you get up and the therapists and nurses will encourage this. The goal is for you to be walking 2000 feet a day by the time you leave the hospital. 2000 feet is equivalent to 6 city blocks. This distance is to be broken down into about three or four walks each day. OCCUPATIONAL THERAPY (OT) Occupational Therapy (OT) is the restoring of your daily routine and activities such as your ability to get up, get dressed, grooming at the sink, go to the bathroom, take a bath or shower and prepare meals. The occupational therapists will be working with you while you are in the

24

hospital and will show you easy ways to be as independent as possible following your surgery. The therapists will teach you and your family the activities that you will need to know when you go home. They will practice activities of daily living (ADL’s). These include daily hygiene, getting in and out of a bathtub or shower, toilet transfers, dressing and how to get in and out of a car. The therapists will ask questions about your home environment and help assess obstacles that need to be overcome.

25

TIPS TO MAKE YOUR HOSPITAL STAY EASIER Hospital stays can be made easier for you and your family by doing a few simple things that will make you more comfortable. If you are a very social person, let your friends and your pastor know

about your surgery well ahead so they can call and talk to you. Most churches in the Lubbock area also send their representatives to come and visit you in the hospital.

Try and take an active role in planning your care such as planning your diet for the next day, keeping track of your goals and achievements, and keeping track of your medicines etc.

If you have any hobbies, try to bring along with you so that you can enjoy your hobbies while you are in the hospital. For example reading, knitting, quilting, listening to radio and newspapers etc.

Bring along your make-up set or shaving set so that when you can, you can enjoy involving yourself to make yourself look good. This will help your self-image in the hospital.

Bring along your favorite clothes. When you are permitted to wear those clothes, it is better to be in your own clothes than to be in the hospital gown. This will help your self-image in the hospital.

Bring along your family pictures (specially the little one’s) which will work as unspoken motivators.

Try to keep the greeting cards that people send to you in the hospital close to your bed because they will work as unspoken motivators.

Try and rest adequately so that you would have enough energy to do all your hospital activities such as your therapies.

Have someone bring your mail to the hospital so that you can make all your payments and not worry about them.

Try and make arrangements for your pets so that you need not worry about them during your stay in the hospital.

Ask for clean linen every day. Because having the sense of freshness will help your motivation.

Set yourself small goal everyday and try and achieve them by the end of the day.

If you are permitted, have someone bring you food from outside so that you can enjoy your meals. Eating well is very important after your surgery because that will give you energy.

If you do not wish to have too many visitors to come by to see you, ask the floor staff to put a notice on your door so that you can enjoy your privacy.

26

At least for the first one to two days have your family stay with you in the room so they can help if needed.

Take as much pain medicine as you are prescribed, so that you will be able to participate in therapies with limited amount of pain. If possible, talk to your therapists and see if you can take your medications before they come for therapies.

27

EXERCISES AND THERAPY USE PT: You will be instructed in how to get in and out of bed properly, stand up, and walk using a walker with the assistance of your physical therapists. They will also begin an exercise program with you. These exercises are very important to build strength and endurance, improve circulation and decrease pain. You will be encouraged to do these exercises frequently. The exercises include: Hip and Knee Bending: Bend at the hip and knee sliding your heel up the bed. Slowly lower. Do not allow leg to roll in or out, or the heel to leave contact with the bed.

Knee Straightening: Lying with a roll (tight towel roll or coffee can wrapped in towel) under your knee: Pull your foot up at the ankle, slowly straighten knee and lift foot off bed. Hold for a count of 5. Relax and lower foot to bed.

Leg Sliding to Side: Legs straight: Pull your foot up at the ankle. Keep your knee straight and toes pointed to ceiling. Slide your leg out to the side. Relax, then slide leg back in.

28

You will also be instructed in hip precautions. Hip precautions are VERY important to follow after having a Total Hip Replacement. Hip Precautions are as follows: 90 DEGREE RULE The safest position for a hip patient is feet separated, knees separated, and the hip must always down slope to the knee. This means you must not sit on a chair, couch or commode if it will make your knees higher than your hips. This is called the “90 degree rule.” Failure to follow these rules could lead to a dislocated hip prosthesis.

*knees must always be equal to or lower than the hips.

29

HIP PRECAUTIONS These are things you MAY NOT DO for 6 weeks to 3 months following your hip replacement surgery. You should NEVER bend over more than 90 degrees. This rule means that doing activities such as putting on shoes and socks or tying shoe laces or reaching things that have been dropped on the floor are not to be done for at least 3 months. The following pictures are examples of what NOT to do. Appropriate adaptive equipment and instructions in how to use them will be provided to assist you in doing these tasks.

30

CHAPTER FIVE

WHAT TO DO AFTER YOU LEAVE THE HOSPITAL

******

NEW WAYS TO DO FAMILIAR TASKS You will be instructed by the physical therapists and occupational therapists in how to follow the hip precautions while doing activities such as getting in and out of bed and on and off the commode. They will also teach exercises to help strengthen your arms since good upper body strength is important to use the walker effectively. They will review your home situation and identify any problems that might arise when you return home.

EXERCISES TO PERFORM AT HOME It is very important for you to continue at home the exercises you have been doing in the hospital. These exercises will help you achieve the goals that you and your physician want from your total hip replacement. You should continue to do these exercises for at least 6 weeks after dismissal from the hospital. Remember that exercising is important because it improves circulation, promotes healing and decreases pain.

1) Foot Pumping (see page 17) – continue doing these 10 times every hour for six weeks or until your doctor tells you to stop.

2) Breathing Exercises with your incentive spirometer (see page

17) – continue doing these 10 times every hour for six weeks or until your doctor tells you to stop.

3) Walking 3 – 4 times a day with your walker.

4) Continue to follow your hip precautions and use your adaptive

equipment for 6 weeks. INCISION CARE

1) Your incision may still have the staples in it when you go home. Keep your incision clean and dry at all times. Further care will be instructed upon discharge.

31

2) Do not shower if there is any drainage coming from your incision. You may shower when the drainage has stopped. Clean the incision with alcohol after showering and your physician give you permission.

3) There may be some bruising on your leg as a result of the

surgery, but this is normal. It should resolve in 4-6 weeks. MEDICATIONS Your physician may give you some prescriptions when you leave the hospital. You will need to get these prescriptions filled and take them as prescribed. You may also need to get some over-the-counter medications.

32

WHEN TO SEE OR CALL YOUR DOCTOR After you leave the hospital, you should plan see your surgeon in: • 2 weeks to check your wound and remove sutures or staples; and • 4 to 6 weeks for x-rays and instructions on driving, walking, work, and

other activities. In addition, if you experience any of the following symptoms, contact your physician: 1) cough 2) cold 3) burning time 4) tooth abscess 5) temperature above 100oF 6) boil on your skin 7) any dental appointments. OTHER IMPORTANT THINGS TO DO AT HOME 1) KEEP DOING YOUR EXERCISES

2) Always elevate your leg after you have been up for a long while.

3) Elevate the foot of your bed by putting pillows or a rolled up

blanket underneath the mattress at the foot of the bed. (In between the mattress and the box spring.) This helps to reduce the swelling. Do NOT place pillows directly under your knee.

4) Continue to wear your TED stockings on both legs during the

day and night, for 6 weeks. You may remove them every 4 – 6 hours for 1 hour.

5) Do not drive for at least 6 weeks or until you see your

physician in the office and you are instructed otherwise. 6) Do not tie your own shoe laces or put on socks without use of a

sock aid. You might wear slip on shoes.

33

7) Do not bend forward from an upright position. 8) Do not lie on the operative side. You may lie on the non-

operative side with 1 or 2 pillows between your legs.

34

CHAPTER SIX

ADDITIONAL RESOURCES

DISCHARGE EQUIPMENT To ensure a safe recovery following your hip replacement surgery, you may need to use some special equipment. The following pages show and describe the equipment. You must use a walking aid after your hip replacement surgery. Any other items are optional based on your needs. Insurance will only cover the purchase of a walker. You must purchase any other equipment needed. There is a Case Management Department in the hospital that can assist you in getting the equipment or services you might need when you go home.

Walker/crutches A walker or crutches will help you walk after surgery.

35

Hand-held shower head A hand-held shower head allows you to control the spray of water while sitting.

Raised toilet seat/commode A raised toilet seat will make it easier for you to get on and off the toilet. Elastic laces/long-handled shoe horn Elastic laces let you slip in and out of your shoes easily while keeping them tied. The long-handled shoe horn helps you guide your foot into an already tied or slip-on shoe

Sock aid A sock aid helps you put on socks without bending.

Long-handled sponge A long-handled sponge can be used to wash your feet when you can’t bend and to wash your back so you avoid twisting

Grab bars Installing grab bars around your toile, bathtub or shower will increase your safety during transfers.

Reacher A reacher helps you get things from higher and lower levels. It can also help you put clothes on the lower part of your body.

Tongs Tongs can be used in place of a reacher.

36

COMMUNITY RESOURCE DIRECTORY Goodwill Industries of Lubbock 1940 34th Street 797-3733 1109 Broadway St. 744-1112 715 28th Street 747-3348 American Council of the Blind 1508 34th Street 762-1453 Catholic Family Services 2218 34th Street 763-8315

37

GLOSSARY

The following are important terms that you might hear during your hospital stay: A D L’s – Routine self-care, including dressing, eating,

personal hygiene, transfer in and out of bed, ambulating or using a wheelchair, manual tasks, and job activities.

Ambulation – “To walk” is a very important part of your

recovery process. You will begin ambulation on your first day after surgery.

Anesthesia – A partial or total loss of sensation, with or

without the loss of consciousness. Anesthesiologist – A physician specializing in the field of

anesthesiology. Assessment - An evaluation or appraisal of a patient’s

condition. A V I – A pump that delivers fluid directly through your

veins. C P M – A machine that continuously provides passive

motion to the leg which prevents stiffness and helps you to bend and straighten your knee better.

E K G – A method of recording electrical activity

generated by the heart muscle. Feosol Spansul – An Iron supplement in the form of a pill Foley – This is a tube that is placed into the bladder to

drain urine. Gait Belt – A leather or nylon devise that is placed around

the patients waist that enables a health care worker to assist in walking.

38

Incentive Spirometer – A device used to assist the patient in

achieving maximum inspiratory capacity. I N T – An IV line that has been capped to allow

medication to be given intermittently. This gives easy access for medication, but frees you from any line or pump on a continuous basis.

I V – “Intravenous line” used to supply liquids

through your veins directly to your system. This is used while you are unable to take adequate fluids by mouth.

N P O – “Nothing by Mouth” is often ordered prior to

surgery. No liquid or food may be consumed. Occupational Therapy (OT) - The process of restoring upper extremity

movement and your ability to perform tasks that you do every day to take care of yourself such as get up, get dressed, go to the bathroom, take a bath or shower and prepare meals.

“PCA” – Patient controlled Analgesic pump – pain

medication machine. Physical Therapy (PT) – The process of restoring movement and

strength enabling you to get in and out of bed and walk without assistance, following surgery.

Pulse Oximeter “Pulse Ox” – A machine that measures the amount of

oxygen in your blood. T E D Hose – Stockings worn to increase blood flow back to

your heart. VITAL SIGNS – The measurements of pulse rate, respiration

rate, body temperature and blood pressure.

39

Walker – An extremely light, moveable apparatus, about waist high, made of metal tubing used to aid a patient in walking.

ONLINE RESOURCES AND INFORMATION IMPLANT CARD