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Kootenai

Total Joint Program

Your Guide Through Joint Replacement Surgery www.kootenaihealth.org


Kootenai Total Joint Program Table of Contents Introduction ......................................................................................................... 1-3 Appointments .......................................................................................................... 4 Program Overview ................................................................................................. 5-8 Medical Information ............................................................................................ 9-10 Insurance ........................................................................................................ 11-12 Preparing for Surgery ........................................................................................ 13-20 Hospital Course ................................................................................................ 21-27 Following Discharge .......................................................................................... 28-32 Therapy/Exercises ............................................................................................. 33-49 Appendices ...................................................................................................... 50-52 Maps ............................................................................................................... 53-55 Contacts/Notes ...................................................................................................... 56 Notes............................................................................................................... 57-59

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Kootenai Total Joint Program Pre-Operative Book Introduction Welcome to Kootenai Health’s total joint program. We are honored that you have selected us to guide you on your journey to improved function, decreased pain and a better quality of life. Our entire organization is here to help you on this journey. We will provide you with high-quality, compassionate care, helping you achieve your goals after having a total joint replacement. This book is here to help guide you during this time. It will help you to understand our philosophy and the approach we use in the care of total joint patients. This book will help collect important information that will be essential in ensuring that we have accurate information so we can provide care based on your individual needs. The book will also provide you with detailed information of the hospital stay with a daily account of your post operative schedule, pain management philosophy/principles and specific exercises that are pertinent to your recovery. An account of each department involved in your time while in the hospital and what their roles are is also covered so you will know who is involved in your care and what to expect from them. This book will also help you plan for the post-hospital portion of your recovery. This includes considerations for an extended care facility, or acute rehab, or home health and assistance needed during your post-operative recovery. Finally this book will also help to answer some questions that may arise following your time here at Kootenai Health. Thank you for allowing us to be a part your journey.

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Kootenai Health Mission, Vision, and Values Kootenai Health’s core commitment is to provide quality health care to all people regardless of their ability to pay. By upholding our Service Excellence Standards, including privacy, etiquette, professional attitude and courtesy, sensitivity to customer wait time, and communication, Kootenais goal is to treat you as a member of our family.

Our Vision By 2020, Kootenai Health will be a comprehensive regional medical center delivering superior, patientfocused care and will be recognized among the premier health care organizations in the United States.

Our Mission We improve health one patient at a time in a friendly and professional culture committed to superior quality and safety.

Our Values Superior Quality & Safety: Ensure measurably superior quality, safety and patient experience. Patient-Focused: The patient is the focus of decision making. Healthy Culture: We will nurture the quality and vitality of our workforce. Stewardship: We will use our resources wisely. Visionary Leadership: Our leadership style will be forward thinking.

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Our History Kootenai Health’s history is one of progress and success. Here’s a look back at some of the milestones along the way. In November 1966, Kootenai Memorial Hospital was opened with half the cost of construction funded by a federal grant. The other half of the funds was provided through a general obligation property tax levy, approved by over two-thirds of Kootenai County’s voters in a special election. Kootenai Memorial replaced the outdated 36-bed Lake City General Hospital and the 36-bed Coeur d’Alene General Hospital. Both were acquired by the Kootenai Hospital District and closed with Memorial’s opening. Building projects in 1970, 1972, and 1978 doubled the hospital’s bed capacity to 181. In 1984, a new facility was opened and named Kootenai Medical Center. Kootenai Medical Center is a 246bed community-owned district hospital. It is guided by a publicly elected board of directors with daily operations overseen by administrative staff. In 1987, the Kootenai Cancer Center opened its doors. More than 20 years later, the Cancer Center continues to grow. In 2007 the Kootenai Cancer Center at Bonner General Hospital opened in Sandpoint, Idaho, and in 2008 the Kootenai Cancer Center at the Kootenai Health Park in Post Falls, Idaho opened. In 1999, Kootenai acquired a behavioral health component. Today, Kootenai Behavioral Health Center offers adult inpatient and outpatient care, chemical dependency treatment and both residential and acute programs for youth. In September 2003, Kootenai expanded its cardiac services with the opening of the Kootenai Heart Center. Since that time, over 1,000 open-heart procedures have been performed at the Heart Center. In 2009 they were recognized as a Blue Distinction Center for Cardiac Care. In recent years, Kootenai has also partnered with a variety of health care providers to form joint ventures dedicated to delivering advanced diagnostic imaging, radiation therapy, laboratory services, outpatient surgery, and better access to physicians. By creating these collaborative relationships, Kootenai has helped ensure better care for everyone in our region. Kootenai Health’s forward-thinking board of trustees and management team, its dedicated staff and supportive community are helping to ensure that Kootenai Health’s future will be as successful as its past.

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Appointments Pre-Operative Class: (at Kootenai Health): Date: ______________________________Time:______________________________________

Primary Care Visit If Necessary Prior To Surgery: Date: ______________________________ Time: _____________________________________

Specialty Provider Visit If Necessary Prior To Surgery: Date: ______________________________ Time: _____________________________________

Specialty Provider Visit If Necessary Prior To Surgery: Date: ______________________________ Time: _____________________________________

Pre-Operative Appointment with Your Surgeon’s Office: Date: ______________________________ Time: _____________________________________

Surgery: Date: ______________________________ Time: _____________________________________

First Post-Operative Appointment: Date: ______________________________ Time: _____________________________________

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Kootenai Total Joint Program The total joint program has been developed by our staff and is designed to ensure the delivery of high quality patient care for individuals having a total joint replacement. The program allows for our facility to collectively help you to achieve your goals of a successful total joint replacement surgery.

General Principles of our Program 1. You must be an active participant in your recovery. The most critical part of reaching an excellent outcome following total joint replacement surgery is your motivation and willingness to work hard. 2.

We understand that you are not going through this alone. Recovery from surgery often involves family or close friends as a support network. For you to be successful, family must be prepared to assist you. We will include your family in this process by helping them to be prepared to assist you in your recovery following surgery.

3. A comprehensive pain management program to control your pain following surgery is essential to allow you to participate in therapies in order to achieve an excellent outcome following surgery. 4. You should feel supported in this process by all members of our staff and providers. 5. You are here for an elective surgery and as such we will make your time here as pleasant and relaxed as possible by allowing you to wear your own clothes and promoting social interaction with fellow participants in the program. 6.

The recovery process does not stop once you’re discharged from the hospital. As a result a successful program we will prepare you and your coach for the recovery period following discharge from the hospital. To achieve this we will ensure that you fully understand the basic principles of rehabilitation following your total joint replacement and what to expect in the recovery process.

7. Every part of our system will work together with one another to provide coordinated care and help you achieve the best possible outcome. 8. The program and its treatments was created using evidence-based medicine (care that has been proven to be effective through research), and best practice guidelines. 9. Our goal is for everyone to safely discharge home.

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Steps In The Total Joint Surgery Process 1. Decision for surgery. 2. Your Surgeon will determine what labs and tests you will need prior to surgery as well as if you need to see any other providers in preparation for surgery (i.e. primary care provider (PCP), cardiologist, pulmonologist or endocrinologist). 3.

Meet with surgeon’s scheduler to: • Pick a surgery date • Schedule appointments for pre-operative (pre-op) clearance if necessary with PCP/specialist • Set a date for a pre-operative class at Kootenai Health • Receive a total joint program binder prior to leaving office

4. Follow up with pre-op visits with PCP/specialist to ensure that you are as healthy as possible prior to surgery (seven to fourteen days prior to pre-op visit with surgeon/PA-C/nurse practitioner). 5. Kootenai total joint program pre-operative class (14-21 days prior to surgery and seven to fourteen days prior to pre-op with surgeon/PAC/nurse practitioner). 6. Pre-op appointment with surgeon/PA-C/nurse practitioner (seven to fourteen days prior to surgery). 7. Patient to arrange for post hospital care, transportation and assistance with Activities of Daily Living (ADLs). 8. Surgery at Kootenai Health and short post operative hospital stay (average of two days with a range of one to three days). 9. Discharge safely home if appropriate with or without home health. 10. Some individuals may need a short stay in an extended care facility (ECF) or rehabilitation facility prior to being safely discharged. 11. Outpatient rehabilitation in a physical therapy clinic. 12. Follow up with your surgeon as they indicate for monitoring following surgery.

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Departments Involved in Our Program Surgeon Your surgeon is responsible for assessing your initial orthopedic concerns and determining your appropriateness for joint replacement surgery. Once that decision is made they order appropriate tests to ensure that you are physically safe to undergo a surgical procedure. Once those decisions have been made they will be the one performing your surgery. Your physician and their team will be directly involved in every aspect of your care including medication management, pain management, rehabilitation, seeing you daily while in the hospital, and managing any issues that may arise and helping to organize your discharge plan.

Physician Assistant/Nurse Practitioner/Orthopedic Navigator Nurse Practitioner The physician assistant and nurse practitioner may be employed by your surgeon. They work together with the surgeon as a team to help provide for your needs as listed above. The orthopedic navigator nurse practitioner (though employed by the hospital) may also function in this role with supervision/ direction of your surgeon.

Anesthesia The anesthesia department here at Kootenai Health consists of both anesthesiologists and nurse anesthetists. They are here to provide intra-operative management of your needs from sedation/intubation, pain management, and general anesthetic issues related to your chronic medical conditions.

Orthopedic Navigator Nurse Practitioner The orthopedic navigator nurse practitioner is directly involved in all aspects of the total joint program. This individual is responsible for ensuring that all departments work together to provide high quality health care. The orthopedic navigator nurse practitioner may also help the surgeon directly in patient care such as managing pain, visiting you during rounds if the surgeon is unavailable and helping to manage any complications that may arise.

Nursing The nursing department is here to attend to your health care needs. They will be directly involved in supporting your overall health following surgery. They will monitor your wound healing, ensure that you are receiving your necessary medications for management of your chronic health conditions and monitor you for complications during your stay here at the hospital. The nurse is also directly involved in your pain management program.

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Departments Involved in Our Program Physical Therapy The physical therapy department is responsible for helping you begin your rehabilitation following surgery. They will work with you on a daily basis to improve function, return to strength and regain motion of your joint.

Occupational Therapy Occupational therapy is here to help you function in your activities of daily living following surgery. They will help you with tasks such as putting on your shoes, getting in and out of bed safely and getting dressed.

Pharmacy The pharmacists are here to help you with medication. They play an active role in making sure that your mediations are tailored to your specific needs as an individual.

Social Services Social Services is here to assist you and your family in arranging post-hospital care. Your social services representative will help to ensure that you have adequate social and health care support for your recovery. They will interact with your insurance company to ensure that you fully understand your insurance coverage/benefits. They will then assist in arranging for your medical equipment needs and post hospital care. If you do not have insurance they will do their best to connect you and your family with assistance programs.

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Important Medical Information We Need Before Surgery Primary Care Provider: _______________________________________________________

Specialty Providers: (i.e. cardiology, endocrinology and pulmonary) ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

Allergies: ______________________________________________________________________________________ ______________________________________________________________________________________

Medications: (prescribed and over the counter, please attach additional pieces of paper as necessary to complete you list)

Medication Dose/Strength Frequency Purpose ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

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Important Personal Information To consider before surgery 1. Do You Live Alone?

If you live alone, do you have someone that can stay with you or you can stay with, during the recovery process. You will need assistance at home following surgery. The length of time you will need this help will vary. Typically having someone, for the first three to five days following surgery, available and checking on you periodically through the day is advisable as well as having someone present at night. The amount and length of assistance is based on your physical health and individual needs.

2. Is your spouse/significant other capable of helping you recover following discharge from the hospital?

In order to be safe going home you will have to be able to be fairly independent with your mobility. Despite this you may need some assistance navigating steps, preparing food and some assistance in the bathroom.

3. Do you have a home that has multiple steps or levels?

Though you will practice steps at the hospital, and will need to demonstrate the ability to complete enough steps to move safely in your home, you will not be able to navigate steps immediately after your surgery as you do now. It would be advisable to consider arranging one level of your home to accommodate your daily needs giving you access to as many things as possible (i.e. kitchen, bathroom and TV) until you regain your strength and can reliably go up down steps on a more regular basis.

4. Do you have transportation to and from the hospital as well as your follow-up appointments?

Typically it is four to six weeks before you will be cleared to drive.

5. Do you live outside the northern Idaho area? If so, do you know about your local resources to help you in your recovery process? If not, consider contacting local resources in your area concerning home health, physical therapy and local providers that are willing to help you in case of an emergency or if you are unable to contact your surgeon.

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Insurance It is beneficial to understand your health care benefit and what they will or will not cover such as home health, extended care facility or inpatient rehabilitation. These issues will have an impact on your discharge plan. The following questionnaire and check list will help to ensure you have the appropriate information needed to make an informed decision. If you need assistance in answering these questions please call our Social Services department at (208) 666-2930.

Principle Insurance Company: ___________________________________________________ Secondary Insurance Company: ____________________________________________________ Prescription Plan: ________________________________________________________________ The Following Questions Should be Directed to Your Insurance Provider: 1. I am going to have a total joint replacement at Kootenai Health. Please verify the following:

Deductible

Co-Pay

Hospitalization

☐ yes ☐ no

☐ yes ☐ no

Skilled Nursing Facility

☐ yes ☐ no

☐ yes ☐ no

Acute Rehabilitation

☐ yes ☐ no

☐ yes ☐ no

Home Health

☐ yes ☐ no

☐ yes ☐ no

Outpatient Physical Therapy ☐ yes ☐ no

☐ yes ☐ no

2. What durable medical equipment is covered under my health plan with doctor’s prescription? ☐ Ambulation Aide (walker, cane, crutches)

☐ Elevated Toilet Seat

☐ Tub Transfer Bench ☐ Shower Seat/Hand Rails 3. What home health agencies are covered in my local area? (Please list at least three) a) _________________________________________________________ b) _________________________________________________________ c) _________________________________________________________ 4. What outpatient physical therapy centers are covered under my health plan in my local area? (Please list at least three) a) _________________________________________________________ b) _________________________________________________________ c) _________________________________________________________

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Insurance 5. What skilled nursing facilities are covered under my health plan in my local area? (Please list at least three) a) _________________________________________________________ b) _________________________________________________________ c) _________________________________________________________ 6. What acute rehabilitation facilities are covered under my health plan in my local area? (Please list at least three) a) _________________________________________________________ b) _________________________________________________________ c) _________________________________________________________ 7. Does my prescription plan cover the following medications? Lovenox

☐ yes ☐ no

Fragmin

☐ yes ☐ no

Arixtra

☐ yes ☐ no

Coumadin ☐ yes ☐ no Xarelto

☐ yes ☐ no

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Preparing for Surgery

Discharge planning: preparing to go home begins before you arrive at the hospital Work In general it will take two to three weeks before a patient can return to a sedentary job following surgery. Jobs requiring extended walking or driving may take anywhere from four to six weeks before you can return work. Returning to manual/heavy labor jobs may need to be postponed for up to three months

Transportation In general you will be unable to drive for the first four to six weeks following surgery. Make sure that you have access to transportation to and from your appointments.

Activities of Daily Living (ADLs) In general you will need assistance in your daily life with household cleaning, food preparation, transportation and bathing for the first few weeks following discharge from the hospital.

Medications Anti-inflammatories such as ibuprofen and naproxen generally need to be stopped seven to ten days prior to surgery. (Please see Appendix A for more details)

Home An evaluation of the safety of your home should be made before you leave for the hospital. This would involve removing rugs from the floor, picking cords up off the floor and fixing any lose tiles or boards that may be a tripping hazard. Consider adding grab bars in your shower and around the tub to assist in your hygiene needs. Arrange items in your home so you can access them depending on your restrictions following surgery. Have general household duties completed before surgery, such as grocery shopping and general cleaning, so you and your care giver can focus on your recovery. (Please see Appendix B for the Home Preparation Check List)

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Preparing for Surgery Coach Who is going to be your personal coach during your post surgical time in the hospital and once you have returned home following discharge from the hospital? It is expected that the need for caregiver assistance will diminish with time and recovery. The following list represents some items that your coach may need to be able to assist you with once you have returned home from the hospital. 1. Helping you to move your operative leg in/out of bed 2. Helping you to go from sitting on the edge of a bed or chair to standing with your walker 3. Watching you when you are walking with a walker around your home 4. Helping you walk up/down stairs safely (if required) 5. Helping you perform everyday activities such as dressing, bathing, grooming, toileting and showering. The use of assistive devices may significantly reduce the need for assistance from the coach. 6. Helping you get in/out of a vehicle 7. Management and administration of medicines and, if ordered, Lovenox injections 8. Meal preparation 9. Household cleaning and laundry 10. Assistance with transportation

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Home Discharge Criteria The following criteria will be used to determine if you can be safely discharged home or to an extended care facility. Physical Therapy/Occupational Therapy Goals The patient must be able to complete the following tasks with an approved assistive device, proper weight bearing on the affected limb and minimal assistance to: 1. ☐ Get in and out of bed with the bed flat and the bed rail down 2. ☐ Get in and out of a chair or on and off a bedside commode 3. ☐ Get on and off the toilet 4. ☐ Maintain balance while standing at a sink brushing teeth, washing face, etc. 5. ☐ Get dressed: including undergarments/socks/pants/shoes 6. ☐ Walk a minimum of 50 feet 7. ☐ Complete stairs similar to what you have at home 8. ☐ State and demonstrate all hip precautions (for total hip replacement) 9. ☐ Achieve knee range of motion 10-60 degrees (for total knee replacement) 10. ☐ Understand home exercise program

Patient Stability Goals The patient must accomplish the following tasks to be considered medically safe to go home: 1. ☐ Tolerate an oral diet 2. ☐ Pass gas if discharged within 48 hours of admit or bowel movement if discharged after 48 hours 3. ☐ Urinate without difficulity 4. ☐ Pain plan in place

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Home Care Services If you meet the home discharge criteria to return home but do not have a coach/care giver or the coach/ caregiver cannot meet all your needs, you may be a candidate for additional services to assist you at home. You have two options: the first is to hire a private home private caregiver. This type of service will generally help with custodial needs, such as cooking, bathing, and transportation. However, the private party care services are not covered by insurance. The other option is to utilize a home health agency. The home health agency may or may not be covered by your insurance (Social Services will help to determine this prior to your discharge). If it is covered, the home health agency will generally assist with physical therapy, occupational therapy and skilled nursing care. In general to qualify for home care you must be considered home bound by meeting some basic criteria.

Extended Care Facility (ECF)/Acute Rehabilitation Facility (ARF) If you do not qualify for a safe discharge home, you will generally be transitioned from the hospital to home by going to either an extended care facility or an inpatient rehabilitation facility. In general both facilities are similar in their intent. They are there to bridge the gap between care in the hospital and the point at which you can pass the criteria for safe discharge home. Both facilities have physical therapy, occupational therapy and nursing services to assist you in this goal. Requirements for admittance into these facilities is different. The following criteria must be met for discharge to an extended care facility: 1. You have multiple chronic medical conditions which resulted in decreased mobility prior to your surgery. 2. You have living arrangements on the second story or above and are unable to meet the therapy goal of walking up the number of stairs required to access your home and are unable to make arrangements to stay somewhere else during recovery. 3. You live alone and have no family or support to act as coach to assist with mobility, self care or homemaking activates during recovery. 4. You are unable to go home safely and do not meet requirements for acute rehabilitation.

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Acute Rehabilitation Facility The set of criteria for admittance into an acute rehabilitation facility is more stringent than an extended care facility and most will not qualify for this service because you will either be doing well enough to be discharged home or will not meet the minimum admittance requirements and need to be discharged to an extended care facility. The following criteria must be met for discharge to an acute rehabilitation facility: 1. You have other chronic health issues, such as rheumatoid arthritis, cardiac problems or uncontrolled diabetes. In addition to the knee or hip replacement. 2. You are medically stable. 3. You are able to tolerate, and willing to participate, in three hours of intensive physical and occupational therapy per day. 4. You underwent bilateral knee or bilateral hip replacement surgery. 5. You are obese with BMI greater than 50. 6. You are 85 years of age or older.

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For Your Time at the Hospital

Items to be considered five to seven days prior to surgery Clothing Please bring two to three days of loose fitting comfortable clothing, undergarments, non-skid slippers as well as shoes and socks. In regards to lose fitting clothing we are referencing what you wear on your lower body. Shorts with a draw string or elastic waist band are preferable. Sweats or pajama pants are acceptable. If you prefer sweats or pajama pants please make sure to bring some that are one or two sizes larger than you would normally wear to make sure we have enough room to accommodate your post operative dressing. Please do not bring anything expensive in case they are exposed to bodily fluids.

Bowel Through the surgical process you will be exposed to several things that may lead to constipation. It is an expected side effect of pain medications, dehydration and inactivity. We recommend that two to three days prior to coming into the hospital to take a dietary supplement daily to help ensure regularity in regards to your bowel movements. In the hospital you will be receiving Senokot S twice daily in this regard. Other things such as Senna, Mirilax and Metamucil are also reasonable.

Personal Items Please bring personal items that are required for communication and essential functions such as glasses, dentures and hearing aids. Personal toiletries are appropriate. Please leave jewelry, money or wallets at home. Once you have checked in on the morning of surgery you will not need any personal identification material.

Medications Unless otherwise specified you do not have to bring any medications with you to the hospital. If you have any questions in this regard please contact your surgeon.

Medical Devices If you utilize a medical device in the routine management of your medical conditions please bring it to the hospital. For example if you have a history of sleep apnea it is extremely important that you bring your CPAP machine with you to the hospital. Other devices to bring to the hospital include braces for your non operative limb you utilize during ambulation, corrective boots/AFOs for your feet. If you have any questions please ask your surgeon or the presenter of your total joint class at Kootenai Health. If you fail to bring these items with you to the hospital it may adversely affect your recovery and rehabilitation following surgery.

Kootenai Total Joint Program Binder Please remember to bring this book with you.

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Communication At Kootenai Health we use a scale of 0-10 to determine your pain rating. Zero (0) is no pain, while ten (10) is the worst pain imaginable. It is our goal to provide excellent pain relief. In order to do so, you and our staff need to be able to clearly communicate about your pain. Below is a pain communication tool that will be in your room to help in this process.

Pain Scale

0

1

no pain

2

mild

3 discomforting

4

5

6

distressing

7

8

intense

severe

9

10 worst pain

Minor Pain

Moderate Pain

Unbearable Pain

My pain is minor. It can be ignored.

My pain can’t be ignored

My pain is severe. I can’t concentrate and may be dizzy or nauseous.

for more than 30 minutes.

Pain Descriptors Below is a description of what each pain scale number represents. Because individuals feel pain at different levels, it is very important that you discuss the following pain descriptors with your nurse or physician to rate your pain. This way, whether you have a low or high pain tolerance, we can clearly communicate with you about your individual pain and develop an effective pain management plan. 0. Pain free 1. Very minor annoyance – occasional minor twinges 2. Minor annoyance – occasional strong twinges 3. Discomforting – can be ignored, may be occasionally annoying 4. Discomforting – can be ignored, but still distracting 5. Distressing – can’t be ignored for more than 30 minutes 6. Distressing – can’t be ignored for any length of time 7. Intense – makes it difficult to concentrate, interferes with sleep. You can still function with effort. 8. Intense – physical activity severely limited. You can read and converse with effort. Nausea and dizziness set in as factors of pain. 9. Severe – crying out or moaning uncontrollably 10. Worst pain – unable to speak. Near delirium

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Patient Expectations for Pain Management 1. You can expect that the lowest dose of pain medication will be used to achieve pain control. 2. Pain is expected following injury or surgery. A reasonable pain goal needs to be set based upon the patient’s medical history. 3. You should expect to achieve a resting pain goal that allows you to recuperate and be comfortable at rest. 4.

Expect that pain will increase with activity/intervention. It will typically be two to three points higher than the patient’s resting pain goal, but should still have enough pain relief to participate in therapy/ambulate. Once back at rest the patient’s pain should start to return to baseline in ap proximately 30 minutes.

5. Patients requiring regular administration of oral pain medications will be assessed through the night to determine if they need another dose of oral pain medication to maintain consistent pain management. 6. Expect that narcotics/pain medication will be held for concerns regarding over-sedation/ disorientation and medical complications.

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Hospital Course Day Before Surgery: Diet Please do not eat or drink after midnight the day before surgery. Failure to fast after midnight will result in a cancellation of your surgery due to the possibility of complications. This includes chewing tobacco, coffee and gum.

Bowel Bowel movement if possible.

Day of Surgery (prior to surgery): Kootenai Total Joint Program Binder Please bring your book with you to the hospital for your own reference.

Diet Nothing to eat or drink prior to surgery. This includes chewing tobacco, coffee and gum.

Medications It is ok to take pain medications as prescribed by your surgeon on the day of surgery with a small sip of water. Please continue long acting insulin such as Lantus. Do not use any short acting insulin or oral diabetic agents before surgery. You may continue your blood pressure/heart medications except for ace inhibitor such as Lisinopril. (Please see Appendix A for more details)

Check In It is important for you to arrive on time. (Check in will be in Admitting/Registration located by the Emergency Department). Failure to check in on time may result in the cancellation of your surgery.

Family Considerations The total time of surgery includes the pre-operative phase, the surgical phase and the recovery phase; it will usually take three to four hours. Family members will be able to see you once you have arrived on the floor and had an initial evaluation by you nurse.

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Day of Surgery (after surgery): Diet Following surgery you can eat or drink as tolerated.

Pain Management Following surgery you will be taking intravenous/oral pain medications to control your pain and pre-operative nerve blocks may be in effect as well. Cold therapy will be applied to the surgical site.

Treatments • Compression Stockings: Stockings will be on both of your legs. They will sequentially inflate and decompress squeezing your calves. This is to help blood flow and prevent blood clots. • Drains: A drain will be coming from your surgical site. It is being used to help prevent swelling and bleeding complications. • Urine Catheter: A catheter may be in place so the staff can monitor your urine output and allow you to void before you have been able to get out of bed for the first time. • Blood Thinning Medications: These agents will be started the day of surgery or the following day in order to help prevent the formulation of blood clots. • Incentive Spirometer: The device will help you to deep breathe following surgery and will help to prevent the development of pneumonia and respiratory complications following surgery. Low grade fevers are common and expected. Incentive spirometers will help to address this as well.

Activity You will be allowed out of bed as tolerated after being cleared to do so by nursing, physical therapy or occupational therapy.

Physical Therapy/Occupational Therapy The initial steps of physical therapy/occupational therapy will begin. This primarily consists of getting up to a chair and standing at the bed side. If you are doing extremely well you may begin to walk short distances. For total knee replacement, a continuous passive range of motion machine (CPM) may be in place and running to allow for movement of your leg while at rest in bed.

Discharge Planning The initial steps of discharge planning will begin.

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First Day After Surgery (post-op day one): Diet Continue solid foods as directed by your surgeon.

Pain Management

Continue taking oral pain medications to control your pain. If a nerve block was given it will be wearing off between 16-24 hours. Cold therapy will be applied to the surgical site. A slight increase in your pain may occur after the nerve root block wears off and your pain medication will be adjusted as appropriate.

Treatments • Compression Stockings: Stockings will be on both of your legs. They will sequentially inflate and decompress squeezing your calves. This is to help blood flow and prevent blood clots. • Drains: May be removed or left in place depending on the amount of drainage present. • Urine Catheter: Will be discontinued if in place • Blood Thinning Medications: These agents will be changed, started, or continued to try and prevent the formation of blood clots. • Incentive Spirometer: The device will help you to deep breath following surgery and will help to prevent the development of pneumonia and respiratory complications following surgery

Activity You will be allowed out of bed as tolerated once cleared to do so by therapy. Up to chair for all meals. After placing your order for food please wait 15 minutes and then call for help up to the chair. Food delivery usually takes 30 minutes, by calling 15 minutes prior to your expected food delivery time, this will allow time for you to use the bathroom and get settled.

Physical Therapy Walk two to three times with physical therapy with a walker. Exercises for range of motion and strengthening will be initiated. You will also receive instructions about safe movement and home exercises. Continued use of CPM for total knee replacement patients.

Occupational Therapy First visit is to begin teaching you how to function in your activities of daily living.

Discharge Planning Home equipment needs will be determined. Social Services will assist if needed in arranging home or post hospital services. Assessment of ability to discharge home versus need for extended care facility is started. Possible discharge home for those patients it is appropriate for.

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Second Day After Surgery: (post-op day two): Diet Continue solid foods as directed by your surgeon.

Pain Management Continue taking oral pain medications to control you pain. Education on appropriate use of pain medications begins for preparation for discharge home.

Treatments • Compression Stockings: Stockings will be on both of your legs. They will sequentially inflate and decompress squeezing your calves. This is to help blood flow and prevent blood clots. • Drains: Drain will be discontinued if not already removed the day prior. • Blood Thinning Medications: These agents will be continued to try and prevent the formation of blood clots. • Incentive Spirometer: The device will be continued.

Activity You will be allowed out of bed as tolerated once cleared to do so by therapy. Up to chair for all meals. After placing your order for food please wait 15 minutes and then call for help up to the chair. Food delivery usually takes 30 minutes, by calling 15 minutes prior to your expected food delivery time, this will allow time for you to use the bathroom and get settled

Physical Therapy Walk two to three times with physical therapy with a walker. Continue exercises for range of motion and strengthening. You will also receive instructions about safe movement and home exercises. Continued use of CPM for total knee replacement patients.

Occupational Therapy Continued teaching regarding strategies of how to function in your activities of daily living

Discharge Planning Possible discharge home for those patients that it is appropriate for. If an extended care facility is deemed necessary arrangements will be made.

kootenaihealth.org • Hospital Course • 24


Third Day After Surgery: (post-op day three): Diet Continue solid foods as directed by your surgeon.

Pain Management Continue taking oral pain medications to control you pain. Education on appropriate use of pain medications begins for preparation for discharge home.

Treatments • Compression Stockings: Stockings will be on both of your legs. They will sequentially inflate and decompress squeezing your calves. This is to help blood flow and prevent blood clots. • Blood Thinning Medications: These agents will be continued to try and prevent the formation of blood clots. • Incentive Spirometer: The device will be continued.

Activity You will be allowed out of bed as tolerated once cleared to do so by therapy. Up to chair for all meals. After placing your order for food please wait 15 minutes and then call for help up to the chair. Food delivery usually takes 30 minutes, by calling 15 minutes prior to your expected food delivery time, this will allow time for you to use the bathroom and get settled

Physical Therapy Walk two to three times with physical therapy with a walker. Continue exercises for range of motion and strengthening. You will also receive instructions about safe movement and home exercises. Continued use of CPM for total knee replacement patients.

Occupational Therapy Continued teaching regarding how to function in your activities of daily living.

Discharge Planning Possible discharge home for if it is appropriate for you. If an extended care facility is deemed necessary discharge will be completed. You will not likely remain in the hospital longer than day three unless a complication has been identified and is being monitored.

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Special Considerations for Total Hip Patients Total Hip Precautions

Anterior Lateral Approach • Do not cross your legs • Do not lean forward past 90 degrees at the hip while sitting • Limit how far you put your leg behind you • Keep your toes pointed forward and avoid turning your leg outward • You may have limited weight bearing

Posterior Lateral Approach • Do not cross your legs • Do not lean forward past 90 degrees at the hip while sitting • Keep your toes pointed forward and avoid turning your leg inward • You may have limited weight bearing

Anterior Approach • Do not lean forward past 90 degrees at the hip while sitting • You may have limited weight bearing

kootenaihealth.org • Hospital Course • 26


Special Considerations for Total Knee Patients Total Knee Precautions

• Do not place a pillow under your knee while at rest. • Try to alleviate pressure on your heel while at rest to prevent the development of heel pain and skin complications by placing a rolled up towel under your ankle/achillies tendon while letting you heal hang in the air.

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Following Discharge From The Hospital Pain Management Once returning home f rom the hospital it is important to continue to use your pain medications as prescribed to achieve effective pain control. You want to continue to be comfortable at rest and to be able to activity participate in therapy. If you have any questions in this regard please call your surgeon.

Bowel It remains important to actively treat for constipation which is an expected side effect of pain medications. We recommend using stool softeners regularly to help ensure that you can continue to have bowel movements. Sometimes it is necessary to use more than one product to help treat constipation. Staying hydrated is helpful as well as remaining active.

Recommended Assistive Devices During your recovery period, assistive devices can be used to help you get back to normal everyday activities. Some of these devices will be covered by your insurance; some may not. Be sure to check with your insurance company before your surgery to know your benefits and what is covered. (Please see Appendix C for suppliers of durable medical equipment)

What’s Covered Walkers or crutches are typically covered. Front wheeled walkers are preferred after surgery.

What’s Not Covered Everything else.

kootenaihealth.org • Following Discharge • 28


What Adaptive Equipment Should You Have for: Total Hips Please purchase the following equipment and bring it to the hospital • Long handled reacher • Long handled shoe Horn • Sock aid If you are over 5-foot 2-inches tall and do not have a raised toilet you should purchase either a toilet riser or three-in-one commode. If you have concerns regarding your ability to perform the following tasks now or after surgery; you should consider purchasing a tub transfer bench or shower chair. • Standing to bathe for 10-15 minutes • Stepping over the tub or shower threshold • Other bathing safety concerns

Total Knees Total knee patients may want to consider the following equipment if you are currently having difficulty with lower extremity dressing prior to surgery. If purchased please bring it to the hospital. • Long handled reacher • Long handled shoe horn • Sock aid If you are currently having difficulty getting off the toilet or believe you will not have enough strength in your non-operative leg to get off the toilet following surgery then please consider purchasing a toilet riser or three-in-one commode. If you have concerns regarding your ability to perform the following tasks now or after surgery; you should consider purchasing a tub transfer bench or shower chair. • Standing to bathe for 10-15 minutes • Stepping over the tub or shower threshold • Other bathing safety concerns (Please see Appendix C for suppliers of durable medical equipment.)

kootenaihealth.org • Following Discharge • 29


Other Items to Consider • Hand Held Shower: this piece of equipment is recommended if you are sitting down on a bench or stool to bathe so that you can control the nozzle. Water temperatures can fluctuate. • Grab bars: these can increase ease and safety when getting on and off the toilet and getting in and out of the bathtub or shower stall. • Clamp on grab bar: this can be used in place of grab bars so you can grab onto it when stepping in and out of the bath tub if grab bars cannot be put up. • Elastic shoe laces: these allow you to turn your shoes that tie into “slip ons” so that you can slip them right on without bending over to tie your shoes. • Leg lifter: this can be used to assist you in lifting your leg up in and out of bed or in and out of the tub. • Non-skid bath mat: this is a safety component that you can put into your bath tub or shower stall to decrease your chances of slipping and falling.

Home Health Home health will be arranged for appropriate patients. This decision will be made by your surgeon and staff here at Kootenai Health based your needs. Not all patients qualify for home health. Home health patients have a nurse to assist in monitoring anti-coagulant therapy and wound evaluations. Physical therapy and occupational therapy would also be provided by home health.

Extended Care Facility Patients who are not candidates for discharge home may need to stay at an extended care facility. The facility will assist in daily care, continued physical therapy, occupational therapy, medication management, and transition from Kootenai Health to home.

Physical Therapy You will see a therapist two to three times per week for six to eight weeks. The first two weeks may be in home with home health while the rest of your therapy needs are met at an outpatient facility. For other therapy sessions, you will need to follow an exercise program twice daily to improve the range of motion and strength of the operative leg.

Anticoagulation Your surgeon will choose an anticoagulant medication that is appropriate for you and your needs. If you are on Coumadin you may be seen at the Anticoagulation Clinic here at Kootenai Health (for those in the greater Coeur d’Alene area). The clinic will monitor your blood levels and make adjustments as necessary. If your outpatient rehabilitation is done here at Kootenai Health the appointment can be arranged to coincide with your physical therapy appointment.

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Adaptive Equipment

Tub Transfer Bench

Shoe Horn

Shower Chair

Bedside Commode

Sock Aids

Reacher

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Expected Recovery The recovery from total joint surgery is time intensive. For the first few weeks, though you are able to move around and care for yourself with some assistance, you are limited in your ability to work, perform house hold chores or travel outside the home for extended lengths of time. Most of your time will be spent recovering from surgery and rehabilitation. At two to three weeks you should be more functional. You should feel better and be making improvements in your motion and strength. At this time you should be able to go out of the house for short to intermediate trips. At six weeks you will be feeling significantly better and typically needing very little assistance in your care. At this time you are starting to return to normal activities of daily living. At three months you have generally returned to your normal life and activities as allowed by your surgeon.

Surgeon Follow Up Your surgeon will schedule follow up appointments for you so they may continue to guide your care after surgery, will continue to manage your pain. If you have any concerns or questions regarding your total joint replacement, your surgeon will be happy to assist you.

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Physical and Occupational Therapy Exercise is a vital part of your recovery. To reach an excellent outcome following your total joint replacement, it’s important that you actively participate in the rehabilitation process. The following pages are here to help you with this. It is important to understand how to properly perform your exercises and how to function in your activities of daily living with your new total joint replacement We would like you to start with 10 repetitions of your exercises three times a day. This is may not always be possible, you may need to start with fewer repetitions and work up to 10 repetitions. Once you can complete 10 repetitions easily, you can increase to three sets of 10 repetitions. The goal is that you have quality not just quantity. It would be better to do five quality repetitions and work up over time than ten poorly performed exercises. You may find the exercises difficult to perform at first. With time it is expected that your strength and function will improve. You will likely have to increase your exercise frequency and repetitions with time as you improve and regain function/strength. Your outpatient physical therapist will help you progress your rehabilitation program as you continue to recover. Examples of adaptive equipment to help you with your activities of daily living has also been provided.

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1. Ankle Pumps:

While lying on your back, pull your foot toward your head and then point it down, moving your ankle through as much range of motion as possible. Repeat this _________ times per set, for _________ sets. Complete this _________ times per day.

2. Quad Sets (“Thigh Squeezes”):

With your leg straight out in front of you, tighten the muscles on the front of your thigh by pushing the back of your knee down on the bed. Hold the contraction _________ seconds, then release. Repeat this _________ times per set, for sets. Complete this _________times per day.

3. Gluteal Sets (“Buttock Squeezes”):

Tighten your buttock muscles by squeezing them tightly together. Hold the contraction for _________ seconds, then release. Repeat this _________ times per set, for _________ sets. Complete this _________ times per day.

4. Heel Slides:

While lying on your back, slide your heel up the bed towards your buttocks, try to bend the knee as much as tolerated. Use a sheet/belt around the ball of your foot or under your thigh to assist you if needed. Repeat this _________ times per set, for _________ sets. Complete this _________ times per day.

5. Passive Extension Stretch (“Towel Under Heel”):

With your non-operated leg bent lie on your back with your operated leg straight out in front of you. Place a small towel roll under your heel and allow your knee to relax and straighten as much as possible. Make sure your leg DOES NOT ROLL to the side. Lie in this position for _________ minutes. Repeat this _________times per day.

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6. Abduction (“Snow Angels”):

While lying on your back, slide your leg straight out to the side and then back toward the middle of your body. Be sure to keep your leg in contact with the bed. Repeat this _________ times per set, for _________ sets. Complete this _________ times per day.

7. Straight Leg Raises:

Lie on your back with your non-operated leg bent to support your back. Tighten your thigh muscles and raise your whole leg off the bed eight to 12 inches. Repeat this _________ times per set, for _________ sets. Complete this _________ times per day.

8. Short Arc Quads:

With your knees bent over a large towel or coffee can, lift your foot off the bed by straightening your knee. Hold the contraction for _________ seconds, then release. Repeat this _________ times per set, for _________ sets. Complete this _________ times per day.

9. Seated Knee Extension:

While sitting on a firm surface, lift your foot off the floor by straightening your knee as much as possible. Hold the contraction for _________ seconds, and then lower your leg down slowly. Repeat this _________ times per set, for _________ sets. Complete this _________ times per day.

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10. Seated Knee Flexion Stretch:

While sitting towards the front edge of a firm surface, slowly slide your foot of your operated leg back underneath you, bending your knee as much as tolerated. Hold the stretch for _________ seconds, then slowly slide your foot forward and relax. Repeat this _________ times per set, for _________ sets. Complete this _________ times per day.

11. Armchair Push-ups:

While sitting securely in an armchair, place your hands on the armrests and slowly lift buttocks off the seat of the chair by pushing down with your arms. Put as much weight as possible through your arms and as little as possible through your legs. Repeat this _________ times per set, for _________ sets. Complete this _________ times per day.

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Total Hip Replacement Precautions Depending on the type of surgical procedure you are having, you may have the following precautions. Talk with you surgeon if you have questions or to find out exactly how long you will have precautions.

A. Do not allow your hips to bend more than a 90° angle. DON’T

DO

1. DO NOT sit in low chairs,

1. DO sit in a firm and

2. DO NOT lean forward to

2. DO maintain an upright

reach something or bend down to get something off the floor when you are sitting.

posture and avoid reaching. DO use a reacher to retrieve items you need. DO get assistance with lower body dressing or use recommended dressing aids.

3. DO NOT bend forward at

3. Do use a reacher to pick

the hips or squat down to pick something from the floor.

4. DO NOT bend forward as

4. DO scoot to the edge of a

soft sofas or on low toilets without an elevated seat. NEVER sit with your knees higher than your hips.

you are standing up from a chair.

elevated chair, preferably with arms. DO add an elevated seat to your toilet.

up objects. If you must stoop to get something, keep your operated leg behind you at all times.

chair before attempting to stand. DO push with one hand on the walker and one hand on the chair and maintain a straight spine when standing up.

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B. Do not allow your knees to cross your midline DON’T

DO

1. DO NOT sit or lie

1. DO keep your

2. DO NOT allow

2. DO keep your legs

with your knees crossed at any time.

your legs to cross when getting in and out of bed.

3. DO NOT lie on

your non-operative side with your operated leg crossing over.

knees apart when sitting or lying in bed.

slightly apart at all times when getting in and out of bed.

3. You may lie on

either side with pillows between your knees to keep them apart.

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C. Do not allow your leg to rotate. Keep your toes and knees pointed forward. DON’T 1. DO NOT allow

your foot or leg to roll in or out while lying in bed or sitting.

DO 1. DO make sure

to keep your leg in “neutral” at all times.

2. DO NOT turn

2. DO turn your body

3. DO NOT turn your

3. DO swivel your

upper body when sitting.

4. DO NOT Turn

4. DO be sure to

5. DO NOT allow

5. DO keep your

your upper body when lying down.

while standing WITHOUT also turning your leg at the same time.

your leg to turn in or out as you are standing up.

as a whole, so that your hips move in line with your shoulders.

whole body toward the side you are turning to, rather than just your upper body.

pick up and turn your foot in the direction of your operated hip

knee straight and point forward as you assume a standing position.

kootenaihealth.org • Therapy/Exercises • 39


Steps for Getting out of Bed: 1. You may bend your non-operative leg to help slide towards the edge of the bed. 2. Push yourself to a partial sitting position using your arms. At the same time, bring your legs

over the edge of the bed, keeping you operative leg straight.

3. Sit on the edge of the bed supporting yourself with your arms. While keeping your operative leg straight,

place the foot of your non-operative left flat on the floor.

4. Push from the bed with your arms and stand up on your non-operative leg. 5. Hold onto the walker while bringing your operative leg under you. Stand on both legs.

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Steps for Getting into Bed: 1. Back up to the midpoint of the bed until you feel the mattress on the back side of your legs while

holding on to the walker.

2. Slide your operative leg out in front of you as you reach back with both hands to sit on the edge of

the bed.

3. Once you are seated, scoot back toward the center of the mattress. Scoot your hips around so you are

facing the foot of the bed while keeping your operative leg straight

4. It may be helpful to bend your non-operative leg while scooting your hips to lift your leg onto the mattress.

5. Keep scooting and lift your leg into the bed.

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Steps for Getting into and out of Your Car: 1. Push the car seat all the way back; recline it if possible. 2. Place a plastic trash bag on the seat of the car. (This will help you to slide and turn forward.) 3. Back up to the seat until you feel the seat touch you on the back of your leg while holding onto your

walker. If you have a “high clearance” vehicle, you may need a small step to assist you to reach the seat. (see photo)

4. Reach back to the car seat and lower yourself down, keeping your operative leg straight out in front

of you.

5. Tuck your head down, so you don’t hit your head on the door frame. 6. Scoot your bottom back into the car as far as possible. 7. Turn forward, leaning back as you lift your operative leg into the car. 8. Be sure that you have enough room for the knee to bend comfortably and —if your physician has

prescribed hip precautions — DO NOT bend your hip more than 90 degrees.

kootenaihealth.org • Therapy/Exercises • 42


Steps for Getting on and off the Toilet: 1. Take small steps and turn until your back is to the toilet while holding onto your walker NEVER pivot.

2. Back up to the toilet until you feel it touch the back of your leg. 3. If using a commode with arm rests, reach back for both arm rests and lower yourself onto the

toilet. If using a raised toilet seat without arm rests, keep on hand on the walker, while reaching back for the toilet seat with the other.

4. Slide your operated leg out in front when you are sitting down. 5. When getting up from the toilet; if using a commode with arm rests, use the arm rests to push up. If using a raised toilet seat, place one hand on the walker and push off the toilet seat with the other.

6. Slide the operated leg out in front of you when standing up. 7. Balance yourself BEFORE you grab the walker.

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Steps for Getting in and out of the Tub Using a Shower Chair: 1. Place shower chair in the tub, facing the faucets. 2. Back up to the tub until you feel it at the back of your knees while holding onto the walker. 3. Reach back with one hand for the back for the shower chair. 4. Slowly lower yourself onto the shower chair, keeping your operative leg straight. 5. Lift your legs over the edge of the tub, keeping your operative leg extended, as you turn your hips

to face the faucet.

kootenaihealth.org • Therapy/Exercises • 44


Steps Putting on and Taking Off Socks/Knee High Stockings: 1. Place sock over stocking aid. 2. Drop stocking aid to the floor and slip foot into sock. 3. Pull up on straps. 4. Release straps.

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Steps for Putting on Pants: 1. Sit on edge of bed or chair, put your operated leg in pants first and then your non-operated leg, using

a reacher to guide the waistband over your foot.

2. Pull your pants up over your knees with the reacher BEFORE reaching for pants with your hands. 3. Stand up with the walker in front of you and balance yourself. 4. Once balanced, pull up your pants to complete the task. 5. Release straps.

kootenaihealth.org • Therapy/Exercises • 46


Steps for Putting on Shoes: 1. Sit on edge of bed or chair, while keeping your toes pointed out slip your foot into your shoe. 2. Use a long handle shoe horn. Lift your heel up and slip the shoe horn behind your heel. 3. Using light pressure, push your foot downward. 4. Remove the shoe horn.

kootenaihealth.org • Therapy/Exercises • 47


Exercise and Adaptive Equipment Continuous Passive Motion Machine (CPM)

kootenaihealth.org • Therapy/Exercises • 48


Equipment not Pictured 1. Hand held shower: this piece of equipment is recommended if you are sitting down on a

bench or stool to bathe so that you can control the nozzle. Water temperatures can fluctuate

2. Grab bars: these can increase ease and safety when getting on/off toilet and getting in/out of

the bathtub or shower stall.

3. Clamp on grab bar: this can be used in place of grab bars so you can grab onto it when

stepping in and out of the bath tub if grab bars cannot be put up.

4. Elastic shoe laces: these allow you to turn your shoes that tie into “slip ons” so that you can

slip them right on without bending over to tie your shoes.

5. Leg lifter: this can be used to assist you in lifting your leg up in and out of bed or in and out

of the tub.

6. Non-skid bath mat: this is a safety component that you can put into your bath tub or shower

stall to decrease your chances of slipping and falling.

kootenaihealth.org • Therapy/Exercises • 49


Appendix A Over the Counter Vitamins • May be continued until the day before the planned operation except for vitamin E that should be discontinued seven to 10 days prior to surgery.

Herbal/Alternative Preparations • Should be discontinued at least one full week prior to the planned surgical procedure.

Non-Steroidal Anti-Inflammatory Compounds (ibuprofen, naproxen, aspirin and others) • Should be discontinued at least one full week prior to the planned surgical procedure.

Cardiac Rhythm Management/Blood Pressure Medications • Should be continued up through and including the day of the operation (unless otherwise directed by your surgeon/medical provider). • Except preparations containing vitamin E, which should be discontinued one week prior to the planned operation.

Narcotics • Long acting narcotics in an oral or patch form should be continued unless otherwise specified by your surgeon.

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Appendix B Home Preparation Check List: (Please note some items included may not be applicable to you and other considerations not on the list may need to be made based upon your unique situation) 1. ☐ Remove all lose area rugs in walking paths. 2. ☐ Move any loose cords and or wiring and clear the walking paths inside your home. 3. ☐ Ensure floors do not have waxed or slippery surfaces. 4. ☐ Move essentials to the top of drawers or dresser/lower shelves of upper cabinets (between shoulder and wrist level) making them easy to reach. 5. ☐ Attach a tote bag to your walker to carry items around the house. 6. ☐ Make arrangements to have a portable phone or personal alarm placed in the tote bag attached to your walker. These can be used to call for help in case of an emergency when you are alone at home. 7. ☐ Have ample reserves of easy to prepare food, frozen dinners/casseroles and individually packaged convenience food items. 8. ☐ Have ample reserves of paper plates and other easily discarded items to decrease meal clean up. Consider obtaining a high stool to use in the kitchen during meal preparation. Also, remember to slide objects across the counter top instead of carrying them. 9. ☐ Consider creating a sleep area on the ground floor, if stairs are required to reach your bedroom. 10. ☐ Place frequently used items in the areas used or on the counter to decrease bending and reaching. 11. ☐ Stock up on essential items such as toilet paper, toothpaste, soap, and shampoo. 12. ☐ Attach a reacher to your walker with sticky backed velcro to retrieve objects from the floor or high cupboards. 13. ☐ Place pet bowls on top of a low table or other raised surface to minimize bending to the floor. 14. ☐ Use a reacher to load and unload clothes from the washer and dryer. A rolling cart helps move clothes to and from the laundry room. Store detergent in an area of easy access that allows dispensing without bending and reaching.

kootenaihealth.org • Appendices • 51


Appendix C

Durable Medical Equipment Suppliers New Durable Medical Equipment Companies Kootenai Health Gift Shop In the lobby behind the information desk

Preferred Medical 1101 W. Ironwood Dr. Coeur d’Alene, ID 83814-2604 (208) 667-1195

Soper’s Mobility Aides 7392 N. Government Way Dalton Gardens, ID 83815-8762 (208) 772-6474

Ironwood Medical Supply 2120 W. Ironwood Center Dr. Coeur d’ Alene, ID 83814-2639 (208) 765-0930

Bellevue Healthcare North Idaho 115 E. Harrison Ave. Coeur d’ Alene, ID (208) 768-9630

Idaho Home Medical 212 W Ironwood Dr., Ste. E Coeur d’ Alene, ID 83814 (208) 765-3387

Cedar Mountain Medical Inc. 503 E. Seltice Way, Ste. 8 Post Falls, ID 83854-6499 (208) 777-9199

Used Durable Medical Equipment Companies St Vincent De Paul 108 E. Walnut Ave. Coeur d’ Alene, ID 83814 (208) 676-8619

Hospice Thrift 1823 N. 4th St. Coeur d’ Alene, ID 83814-3410 (208) 667-5128

Post Falls Hospice 503 E. Seltice Way Post Falls, ID (208) 773-5076

Bellevue Healthcare North Idaho 115 E. Harrison Ave. Coeur d’ Alene, ID (208) 676-1768

kootenaihealth.org • Appendices • 52


1st Floor Map

(South side)

Stairs

Sleep Center

Neurodiagnostics/ EEG

Visitor Entrances

Adult Psychiatry

Check-in

MRI

(lobby)

Inpatient Rehabilitation

Elevator

Heart Center & KOS (2nd floor) Elevator Security

Courtyard Dialysis

1 North

Rm. 101-123

Check-in

Admitting Services

Circle of Life

s om sro as

KMC 1

Information Desk

KMC 2

Big Blue Coffee

Nursing Administration Visitor Entrance

Medical Staff Services Stairs & elevator to Cancer Center tunnel.

Medical Records

Staff Elevator

Visitor Entrance

Administration

Physician Entrance

Chapel

Gift Shop Cafeteria Classroom

Check-in

Laboratory

Cafeteria Cl

Radiology

Check-in

Short Stay Respiratory Therapy

Ironwood Drive

Emergency Services

(North side)

Kootenai Health Way

Lincoln Way

kootenaihealth.org • Maps • 53


2nd Floor Map

Kootenai Heart Center

Check-in

Stairs from main level

Kootenai Outpatient Surgery Check-in

Surgical Services Recovery Room

Ironwood Drive

Rm. 201-210 Birthing Center

Lobby

Rm. 250-275 2 South

Rm. 230-243 Second Floor Critical Care

Rm. 211-227 2 North

2nd Floor Kootenai Health Way

Lincoln Way

kootenaihealth.org • Maps • 54


Kootenai Health Parking Map

McGrane Center

No Parking

Panhandle Health Building

Kootenai Health

Complimentary Valet and Visitor Entrance

Visitor/Patient Parking

Employee Parking

Physician/Permit Only

kootenaihealth.org • Maps • 55


Patient Care Questions If you have any concerns or questions regarding your care here at the hospital please let the staff know so we may address your concerns. If you have already returned home and have patient care concerns or questions please call us so we may help.

Kootenai Health Contact Information Phone Numbers: Kootenai Health.............................................................................................. (208) 666-2000 Rachel Maly (Perioperative Administrative Assistant).......................................... (208) 666-3182 Derek Andersen (Orthopedic Unit Nurse Manager).............................................. (208) 666-2115 Chad Bailey (Orthopedic Navigator Nurse Practitioner)........................................ (208) 819-2187 Orthopedic Unit ............................................................................................. (208) 666-2110 Social Services................................................................................................ (208) 666-2930 Patient Relations............................................................................................. (208) 666-2274 Admitting/Patient Access................................................................................. (208) 666-3113 Chaplain......................................................................................................... (208) 666-3285 Medical Records.............................................................................................. (208) 666-2040 Patient Billing/Business Services...................................................................... (208) 666-1805

Address: Kootenai Health 2003 Kootenai Health Way Coeur d’Alene, ID 83814

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Notes/Questions ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

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Notes/Questions ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

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Notes/Questions ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________

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Kootenai Total Joint Program Binder