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    Postoperative Care - Joint Surgery

    Day of Surgery (Postoperative Day Zero)

    Following surgery and initial time in the recovery room, you will be brought to our orthopedic nursing unit on the second floor. A nurse will regularly monitor your temperature, pulse and blood pressure including throughout the night. During the next 24 hours you may expect:

      You will receive fluids and antibiotics through an intravenous line (IV) inserted into a vein in your arm or neck until you are able to drink an adequate amount of fluid on your own. A nurse will measure your fluid intake and output.
      It is necessary at times to administer oxygen following surgery. This is done through a nasal tube. The tube will be removed according to your doctor’s recommendation, usually within 24 hours post-surgery.
      You will be shown how to use a hand-held device called an incentive spirometer to help you take at least 10 deep breaths an hour and clear your lungs. Ask your nurse for assistance if needed.
      Although some pain is unavoidable after surgery, it’s our goal to “stay ahead” of your discomfort by maintaining adequate levels of pain medication in your system. This means that you may be woken during the night for a dose of pain medication. Nurses will regularly assess your pain level on a scale of 0 to 10, before and after you receive the medication.

      A score of zero = no pain, a score of 10 is the worst pain imaginable. Learn more about pain management.
      You may receive medication either as a pill or an injection to help prevent blood clots. If you are receiving injections, your nurse will teach you how to give them to yourself. You will also receive a booklet with information about this type of medication and precautions to follow while taking it. The dietitian will give you information about how your diet may affect blood-thinning medication.
    • DIET
      You will be given a clear liquid diet including water, juices, and tea. You are encouraged to drink liquids throughout the day.
      You will be assisted to the bathroom or with other means of accommodation for relief. You may have a bladder catheter (Foley catheter) to help with urination.
      The surgeon may place a drain at the surgical wound site; blood-tinged drainage is to be expected. Nurses will check the wound frequently as well as monitor your circulation.
      Your doctor will order one of two painless devices to prevent blood clots and to help blood circulate. Your legs may be wrapped from ankle to thigh in plastic sleeves which are gently inflated and deflated by a pump on the floor.

      Another alternative is to apply gentle pressure directly to your arches by attaching a small pump to each foot. You will wear the sleeves or foot pump while lying in bed.
      Your initial assessment by a physical therapist takes place today; depending on the outcome of the assessment you may begin therapy today as well.

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    Postoperative Day One

      Nurses will continue to assess your pain by asking you for your pain level on a scale of 0 to 10. You may receive a dose of pain medication around 4 a.m. to keep you comfortable.
    • LAB WORK
      To monitor your progress the following lab tests will be performed from your blood draw: Complete Blood Count (CBC), Prothrombin Time (P.T.) and Chemistry 4 for Electrolytes (CP4). Other lab tests will be completed as needed or ordered by your doctor.
      You will continue to use the hand-held incentive spirometer to help you take at least 10 deep breaths an hour and clear your lungs. Ask your nurse for assistance if needed.
      If you are still receiving oxygen it may be removed today (depending on your doctor’s recommendation). Use your incentive spirometer frequently.
      Nurses will continue teaching you how to self-inject this medicine. If your doctor has chosen Coumadin® the dose will be adjusted according to the lab results from the blood draw.
    • DIET
      If you are progressing as planned your diet will be advanced to a regular or special diet.
      The nursing staff will assist you with a sponge bath in bed or in a chair. Ask your nurse how you can participate in your personal hygiene.
      Becoming more active is very important in regaining strength. Quickly returning to your normal activity level is the best way to prevent complications.
      Your case manager will visit you today for an initial discharge planning assessment. The assessment allows the case manager to understand your previous level of function versus your current condition. Your case manager will help create a post-discharge plan tailored to assist your recovery including in-home services, focused rehabilitation care, in-home medical equipment, and more.

      Please let us know as soon as possible if you have any questions or concerns about post-discharge recovery so we can assist you as needed.

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    Postoperative Day Two

    • Medications for constipation may be given.
    • Additional blood tests may be needed.
    • Oral pain medication continues.
    • Fluid and the bladder catheter will be discontinued if still in use.
    • Drain from surgical site may be removed.
    • Surgical dressings may be changed.
    • A physical therapist will continue to help you with your rehabilitation therapy; exercises and walking will increase in complexity.
    • An occupational therapist will teach you transfer skills and task skills needed for daily activities, for example, moving from bed to chair, getting into a car, the use of adaptive equipment, and other tasks.
    • A case manager will provide a progress update of discharge arrangements being made on your behalf.
    • As necessary: a representative from the chosen medical equipment provider will visit or call you to discuss any equipment that has been recommended and any associated costs.
    • As required: a representative from the chosen home health services agency will visit or call you to discuss any arrangements made for care at your post-discharge residence and any associated costs.

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    Postoperative Day Three

    • Medically stable patients will be discharged to their home or a skilled nursing facility.
    • Two-week follow-up visit with primary care doctor/surgeon scheduled.
    • As necessary: a case manager will provide you with your final personally tailored discharge plan and answer any questions you may have.

      Please discuss any questions or concerns you may have about post-discharge recovery.
    • Your nurse will provide additional instructions and teaching on how to take care of yourself at home.
    • As an active partner in your care, please make sure all the questions have been answered to your complete satisfaction.

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