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    Learning About Your Health

    Total Knee Replacement: In the Hospital

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    Your Hospital Stay

    After total knee surgery, many patients go home after 3 or 4 days. However, you must meet your therapy goals before you go home. Some patients may need more therapy and more time to recover. These patients may go to a Post Acute Unit before going home.

    The day after your surgery:

    • Your nurse helps you:

      • Change Position: Turn every 2 hours from your back to your sides. While resting on your back, a pillow is placed under the calf of your operated knee to keep it straight.

      • Cough and Deep Breathe: every 2 hours.

      • Do Ankle Pump Exercises: every 2 hours. Remember to bend your ankles up and down. Alternate your feet.
      As you become stronger, you may do these on your own.
    • A physical therapist sees you 1 or 2 times a day to help you to get out of bed, sit in a chair, walk short distances and climb stairs.

    • An occupational therapist sees you once a day to help you with activities of daily living and does an assessment before you leave the hospital to make sure you are safe to use the toilet, shower or bathtub, dress and do simple activities at the sink.

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    Manage Your Pain

    Although there may be some discomfort after your surgery, keeping your pain under control speeds your recovery. Less pain will make it easier to concentrate on getting around safely on your new knee. When you are comfortable, you are better able to walk, deep breathe and cough.

    • Tell your nurses and doctors if you have pain.

    • Do not wait until the pain is severe (very bad) before you ask for pain medicine.

    • You can help your doctors and nurses "rate" your pain using the FACES Pain Rating Scale below. A 0 on the scale means no pain, and a 10 on the scale means the worst pain you can imagine.

    • If your pain suddenly gets worse or you experience chest pain or have trouble breathing, tell your nurses immediately.
    0-10 FACES Pain Rating Scale:

    FACES Pain Rating Scale. Choose a number between 0 to 10 that best describes your pain. 0=No Pain (Smiling). 2=Mild (Slightly Smiling). 4=Moderate (Expressionless). 6=Severe (Slightly Frowning). 8=Very Severe (Frowning). 10=Excruciating (Crying).
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    About Your Diet

    Soon after surgery, you are given ice chips and clear liquids. When you are able to drink liquids without any problems, you may start your regular diet.

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    Your Treatments & Tests

    • You will have a blood test each morning for 3 days to check your blood count.

    • You may have a blood transfusion. Your doctor will speak with you about this.

    • Compression pumps, anti-embolism stockings and/or medications may be used to prevent blood clots in your legs.

    • You will have an intravenous (IV) line for fluids and medications.

    • You may have a urinary catheter. A urinary catheter is a tube placed in the bladder to drain your urine. Your nurse will usually remove this catheter on the 2nd or 3rd day after surgery.

    • If your doctor orders a Continuous Passive Motion (CPM) machine, it will be used after surgery to prevent the operative knee from becoming stiff.

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    Recovery Tips

    • Work with your nurses and therapists to keep your pain under control, so you can move around as much as possible.

    • Spend time out of bed each day. With help from your nurses and therapists, get out of bed 2-3 times each day and walk for short distances or sit in a chair at the bedside for no more than 30 minutes at a time.

    • Change your position, cough, and take deep breaths every 2 hours in bed.

    • Use the compression pumps in bed.

    • Do your ankle pump exercises every 2 hours in bed.

    • Use the Continuous Passive Motion (CPM) machine if your doctor has ordered it.
    Patient doing ankle pumps, bending ankles to move feet up and down, alternating feet
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    Meeting Your Therapy Goals Before You Go Home

    You must meet the therapy goals listed below before you go home. You and your doctor will talk about your goals and your therapy program. A RN case manager or a social worker will meet with you and your family to discuss your discharge plan.

    Your Therapy Goals

    Note: For detailed descriptions of these goals, please see the Caring for Yourself at Home page.

    1. Get in and out of bed by yourself.

    2. Walk on your own at least 50 feet with your walking device.

    3. Dress yourself using special tools without help.

    4. Use the toilet or commode without help.

    5. Stand for 10 minutes at a counter or sink to do simple tasks by yourself.

    6. Be able to bend your knee close to 90° and then straighten it out.

    7. Climb up and down 12 steps, with help. (For people who have stairs at home.)

    8. Be able to do your home exercise program as instructed by your therapist.

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    Getting Ready to Go Home

    • Nurses or physical therapists will help you to start to walk. Ask them questions about the best ways to move.

    • Occupational therapists will prepare you for activities of daily living.

    • RN case managers can help you get ready to go home.

    • Social workers can help with:

      • concerns about financial and family issues.

      • emergencies or difficult situations.

      • information about community resources.
    • Financial counselors can help with health insurance questions or concerns.

    • Chaplains are available at all times. Please let your doctor or nurse know if you would like to arrange for a visit.

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    Continue Your Care at a Post Acute Unit

    Your doctor may decide that you need more time in a hospital to continue treatment or rehabilitation. If your condition is stable, but you still need more care than can be safely delivered at home, you may go to one of the California Pacific's Post Acute Units, or a Skilled Nursing Facility in the community.

    California Pacific's Post Acute Units are licensed, Skilled Nursing Facilities that provide short-term care for people who do not need to be in the "acute" hospital. On a Post Acute Unit, you will continue your rehabilitation until you reach your therapy goals and are ready to go home.

    A team of doctors, nurses, case managers, social workers, pharmacists, dietitians, physical therapists and occupational therapists work together to provide your care. Your primary care (regular) doctor does not change, but he or she may assign you to one of the doctors at the Post Acute Unit. Or, your doctor may be part of the medical team there.

    The Post Acute Units at California Pacific are located at:

    • California Campus: 3698 California Street

    • Davies Campus: Castro & Duboce Streets

    • St. Luke's Campus: 3555 Cesar Chavez Street

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    More Ways to Learn

    Visit the Community Health Resource Center at 2100 Webster Street, San Francisco, (415) 923-3155. Services include classes and written information on a wide variety of health topics.

    Produced by the Center for Patient and Community Education in association with the Department of Outcomes Management and the Communications & Marketing Department at California Pacific Medical Center. Last updated: 7/09

    Wong-Baker FACES Pain Rating Scale from Hockenberry MJ, Wilson D: Wong’s essentials of pediatric nursing, ed. 8, St. Louis, 2009, Mosby. Used with permission. Copyright Mosby.

    Illustrations by: Troy Paiva

    Funded by: A generous donation from the Mr. and Mrs. Arthur A. Ciocca Foundation.

    Note: This information is not meant to replace any information or personal medical advice which you get directly from your doctor(s). If you have any questions about this information, such as the risks or benefits of the treatment listed, please ask your doctor(s).

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