remarkable medicine. remarkable care

Remarkable Medicine.Remarkable Care.


Surgery Pavilion at St. Joseph Mercy Hospital

John M. Boyd, EdD, MBABusiness Line Leader Ortho/Neuro/Rehab Services

Welcome

Welcome to… Saint Joseph Mercy Health System

Saint Joseph Mercy Health System offers the latest medical knowledge and compassionate care. We’ve earned a reputation as a top health care system – and not just from the hundreds of thousands of patients we’ve served. Leading national and regional magazines rank us a “Top Hospital” with “Top Doctors” in specialties that include cardiovascular, orthopedics, oncology, neurosciences, gastroenterology and urology.

Our staff wants to make your stay here as comfortable as possible. We understand you may have questions and concerns about having an operation. Feeling nervous or scared is completely normal. Information about what to expect during your hospital stay and recovery process can help reduce these fears.

This book, along with the video, class and web materials were created to help prepare you for your orthopedic patient experience. Take time to review the materials before coming to the hospital. Many patients fi nd it helpful to create a list of questions for our hospital staff and doctors to discuss with you prior to surgery.

Our goal is for you to have a remarkable patient experience at Saint Joseph Mercy Health System.

Refer to “Before and After Your Surgery Book.” Total Knee Replacement Guide1

J. David Denzin, MDTotal Joint Program Director

Total Knee Replacement Guide2

Anatomy of the KneenThe Knee Joint ......................................................................................................... 3nTotal Knee Replacement ........................................................................................ 3

SurgerynDay of Surgery ......................................................................................................... 4nFirst Day After Surgery .......................................................................................... 5nSecond Day After Surgery ..................................................................................... 6nThird Day After Surgery ........................................................................................ 7 nHospital Knee Activity ............................................................................................ 8

Managing PainnPain Management ..................................................................................................... 9nEpidural Analgesia Pain Control ......................................................................... 10nInstructions for Patient Controlled Analgesia (PCA) .................................... 11 nAnticoagulant Therapy .......................................................................................... 12

Physical TherapynGeneral Information ............................................................................................. 13nReasons to Keep Moving After Surgery ........................................................... 13nExercise Program .......................................................................................... 14 / 15 nManaging Stairs ...................................................................................................... 16 Discharge InstructionsnQuestions and Answers .............................................................................. 17 / 18 nNarcotic Pain Medication .................................................................................... 19nBowel Management ............................................................................................... 20nLower Extremity .................................................................................................... 21nPain Medication Log .............................................................................................. 22

Terminology Explanations .................................................................................. 23

Table of Contents


Anatomy of the Knee

The Knee JointThe knee joint is a major weight bearing joint in your body. It is commonly referred to as a “hinge joint.” This joint is formed where the upper leg bone (called the femur) and the bones of the lower leg (called the tibia and fi bula) meet. Over the center and in the front where the femur and tibia meet is the “knee cap” (patella). The knee is surrounded and held together by muscles, ligaments and other soft tissues. A material (cartilage) that cushions the knee and allows the joint to move in a smooth and free manner is found between the two bones.

Total Knee ReplacementDisease and/or injury can damage the knee joint. You and your doctor have decided that a total knee replacement is likely to decrease your pain and make walking easier. During this operation, the disease portions of the joint are resurfaced and covered with a metal prosthesis (artifi cial joint) which is cemented in place. This type of operation usually takes about one to one and one-half hours.

Tibia

Fibula

Femur

Patella

Femur

Tibia

Prosthesis


The Dayof Surgery

Hints for Breathing Deep breathe and use your incentive spirometer ten times every hour while

Hints for Activity Do ankle pumps and circlesevery hour while awake.

Activity

nThe nursing staff will help you turn in bed every four hours or sooner if you are uncomfortable.

nYou may also be helped by the nurse to sit on the side of the bed during the evening (if ordered by your doctor).

nYou will have special pump stockings called SCD’s on both of your legs to help with blood circulation and to prevent blood clots.

nYou should begin your ankle pump exercises.

nThe nursing staff will wake you occasionally during the night to observe your condition and monitor your equipment.

Breathing Exercises nDeep breathing and using your incentive spirometer ten times every

hour while awake is very important. This exercises your lungs and helps minimize your risk for pneumonia.

nCoughing is also encouraged.

DietnYou will have a clear liquid diet for lunch / dinner.

Tubes and DrainsnA catheter (Foley) to drain your urine will be placed in your bladder

during your operation.

nDuring your operation a drain (Hemovac) may also be inserted near your incision to remove excess fl uid from around your new joint.

nAn intravenous (IV) fl exible catheter will be placed in your vein to give you fl uids and medications.

Self Care nThe nursing staff will assist you to wash your face and brush your

teeth.

Planning Your Discharge nBefore admission a discharge plan was started with your assistance.

nA case nurse will visit you tomorrow to discuss and review your discharge plan and assist you with any additional needs for discharge.

Surgery


Surgery

ActivitynPhysical therapy begins today. It is important to work with the physical

therapist. They understand you are not feeling your best.

nYour therapist will instruct and assist you with your exercises one or two times today.

nWork on straightening your knee when in bed. No pillows under your knee unless okayed for short periods by your nurse.

nYou will be out of bed at least one time.

nYou will sit in the recliner chair for about two hours. Ask your nurse for help to change your position.

nContinue to do ankle pump and circle exercises while in bed.

nYour blood will be drawn today to check your blood counts.

nYour CPM will be started today.

nThe nursing staff will wake you occasionally during the night to observe your condition and monitor the equipment.

nIce packs to the knee are used to reduce swelling and decrease pain. You will be given an ice pack before surgery, please bring this with you to the hospital. Your knee will be iced several times daily.

Breathing ExercisesnDeep breathe and use your incentive spirometer ten times every

hour while you are awake. This exercises your lungs, helps minimize your risk for pneumonia and helps decrease your body temperature. Coughing is also encouraged.

Tubes and DrainsnYou will have the catheter to drain your urine. It will be removed

tomorrow morning.

nIf you have a drain (Hemovac) it will be removed by the doctor either today or tomorrow.

nYour IV tubing and solution will likely be discontinued today or tomorrow.

Self Care nThe nursing staff will set up supplies for your bath and assist you

with your back, legs and feet.

First Day After Surgery

Discharge Planning nYou will likely be discharged on the third day after surgery (or

earlier) if you are ready.

nThe case nurse and physical therapists will identify the equipment you will need at home. Your case nurse will assist you in obtaining your equipment.


Surgery

Activity

nYou will be out of bed two-three times today. The therapist will help you to walk in the hallway.

nInstructions on how to go up and down stairs will begin today.

nYou will sit in the recliner chair for two hours or longer today. Ask your nurse for help to change your position.

n Continue to do ankle pump and circle exercises while in bed.

n CPM will be on for about two hours.

nYour blood will be drawn today to check your blood count.

nThe nursing staff will wake you occasionally during the night to observe your condition and monitor the equipment.

n Continue to ice your knee frequently.

Breathing Exercises

nContinue to deep breathe and use your incentive spirometer ten times every hour for while you are awake. This exercises your lungs, helps minimize your risk for pneumonia and helps decrease your body temperature.

Tubes and DrainsnYour urinary catheter (Foley) will be removed today.

nIf your Hemovac is still in place, it will be removed today.

nYour IV will be removed today.

Self CarenThe nursing staff will set up supplies for your bath. The staff will assist

you with your back, legs and feet.

Planning Your DischargenYou will be discharged in the morning.

nRemind your coach, family member or friend to be here in the morning to take you home.

nIf you are going to an extended care facility, the social worker will help you arrange transportation.

Second Day After Surgery

COACHPlease be present for either morning or afternoon to observe the patient’s progress and instructions from nursing staff and therapy.

COACHCOACHPlease be present for

➧


Surgery

ActivitynYou will be able to get out of bed to the chair with minimal

assistance from the staff.

n Continue to ice your knee frequently.

nThe physicial therapist will see you today as needed.

DietnContinue with your prescribed diet and drink several glasses of

water daily to help prevent constipation.

Planning Your DischargenThe nurse will review directions for your care at home including

care of your incision, taking your anticoagulant medication and when to return to the doctor.

nSuggestion– To help remember when you have last taken pain medication write down the times on your “Discharge Pain Medication Log” (page 22).

Third Day After Surgery

COACHPlease arrive in the morning for review of the patient’s discharge instructions.

COACHCOACHPlease arrive in the morning

➧


Surgery

Ankle Pumps / Circles – both legs

Move ankles through your full range of motion

Quad SetsTry to press your knee down fl at (surgical leg)

Heel SlidesTry to bend your knee (surgical leg) – even just a little movement is helpful.

CPM will be done daily, if ordered, beginning post-op day one.

Every hour, do 5-10 repetitions of the following:


Managing Pain

Managing pain is a key concern for many people facing surgery. People used to think that severe pain after surgery was something they “Just had to put up with.” But with current treatments, that is no longer true. Today, you can work with your nurses and doctors after surgery to help keep your pain at a mild-moderate level.

Facts about Pain ManagementnDon’t worry about getting “hooked” on pain medication. Studies

show that this is very rare unless you already have a problem with drug abuse.

nTake action as soon as the pain starts. It is important to ask for pain medication before the pain becomes severe, since it is harder to get pain under control once it has become severe.

Pain Management can help younGet well faster. With less pain, you can start walking, doing your

breathing exercises and participating in physical therapy.

nImprove your recovery phase. People whose pain is well managed seem to do better after surgery and after discharge.

Managing Pain

(Information adapted from AHCPR Pub. No. 92-0021)


Managing Pain

An effective way that has been developed for treating pain after surgery is epidural analgesia. In order to understand this method of pain control, it helps to first have an understanding of the types of anesthesia you might have during surgery.

Types of AnesthesiaThere are two main types of anesthesia-general and regional. With general anesthesia you are in a very deep sleep and your breathing is controlled by the anesthesiologist. With regional anesthesia, the anesthesiologist gives you medication to numb the lower half of your body or a part of your body. You may still be asleep but not as deeply.

Epidural

One type of regional anesthesia is epidural. With epidural, either just before surgery or while you are in the operating room, your anesthesiologist will place a tiny soft tube (epidural catheter) into your back. Medication will be given through this tube to provide your anesthesia during surgery. This same soft tube may be left in place after surgery and be used to control your pain. This method of pain relief after surgery is called epidural analgesia. Pain medicine is given to you through your epidural catheter continuously using a pump. The catheter will remain in place until the day after surgery. After that time, pain is often easily controlled with pain pills.

Requirements

You will require the following care after surgery:

nYou must have help to walk. Please do not get out of bed without help from the staff.

nYour nurse will frequently check on your catheter and the dressing.

You should let your nurse know when you have pain, nausea or vomiting, or itching. We have medications available to treat all of these symptoms. In addition, please let your nurse know if you have weakness or numbness in your legs, or if you feel lightheaded or dizzy.

Epidural Analgesia Pain Control

Your anesthesia staff will make the final decision and determine if you are able to receive this type of pain control.


Managing Pain

PCA

nThe PCA machine allows you to give your own pain medicine. You do not need to call for the nurse when you have pain.

nWhen you have pain, push the button which starts up the machine. A small dose of pain medicine will go into your IV line.

nAfter pushing the button, your pain should begin to decrease. If you have pushed the button several times and your pain is not decreasing, tell the nurse. He/she will investigate the problem.

nOnly the patient should push the button. This is very important because we do not want you to become over sedated.

Instructions for Patient Controlled Analgesia (PCA)

Worst PainPossible

Moderate PainNo Pain

0 1 2 3 5 6 7 8 9 10

PAIN SCALE

4

Describing Your PainnYour nurse will ask you

to rate your pain on a number scale from 0-10. A rating of 0 is no pain while a rating of 10 is worst pain possible.

nReporting your pain as a number helps the nurses know how well your treatment is working and whether

to make any changes.

nThe goal is for your pain to be four or less.


While Taking AnticoagulantsTaking these medications can increase the time it takes for your blood to clot and can increase your risk for bleeding.

If you have or develop any of the following, notify your doctor immediately:

na serious fall or if you hit your head

nbleeding from a cut or your nose

nmore bleeding than usual when: • brushing your teeth • menstrual period or other vaginal bleeding

nblood in your urine or stool

nunusual bruising

nfever, sickness, severe diarrhea or nausea

ndizziness or confusion

npain or swelling in any part of your leg or foot

ncall911,ifyouhavechestpain,shortnessofbreath, rapidorunusualheartbeat

Blood Clots

If you have any signs or symptoms of a blood clot, notify your doctor immediately,

nPain or swelling in your leg, this could include your non-operated leg

nDiscoloration or redness

nWarmth of the calf or the leg

If you experience a fall, are involved in a motor vehicle accident or hit your head, go directly to the emergency department. It is very important that you notify the ER that you are currently taking anticoagulants. These medications may put you at an increased risk for bleeding and without immediate medical treatment, serious side effects may occur.

Anticoagulation

DO NOT take any of these medications, while taking anticoagualants unless directed by your doctor

nAspirin or aspirin-containing products, including ointments or

skin creams

nOther platelet inhibitors

such as clopidogrel

nSalicylates (aspirin-like products)

nNonsteroidal anti-infl ammatory drugs (NSAIDS)

nCold or allergy products or pain

relievers containing any of these drugs

Call911,ifyouhavechestpain,shortnessofbreath,rapidorunusualheartbeat.


On the fi rst day after surgery you will begin your physical therapy. The therapist will initiate your exercises and assist you with getting up. During your hospital stay, they will assist you to progress your walking, work on exercises and knee range-of-motion, and practicing stairs as indicated. They will also help to assess your discharge plan and the equipment you will need.

Exercises

Exercises are critical to your recovery from a knee replacement, and starting early helps ensure a faster recovery and a better outcome. The knee tends to become very stiff after surgery, and the exercises will facilitate the return of your range-of-motion. Exercises will also focus on strengthening the quadriceps muscle in your thigh. Your therapist will progress your exercises to your tolerance, and will design your home exercise program specifi cally for you. It is important for you to be taking your pain medication so that you can make faster progress in therapy.

Before leaving the hospital you shouldbe able to:

nWalk using a walker or crutches, with assistance

as needed.

nGet in and out of a chair or bed with minimal

or no assistance.

nDemonstrate exercises.

nClimb stairs with assistance as needed.

Physical Therapy

Ten Reasons to Keep Moving After Surgery

nReduces your risk for developing pneumonia.

nReduces your risk for developing blood clots

in your legs.

nYour ability to urinate works best in a sitting

or standing position.

nHelps with the return of bowel function so you

can eat a regular diet.

nReduces your risk of developing constipation.

nReduces stiffness and pain.

nSitting in your chair and walking increases your muscle strength and endurance.

nImproves your mental outlook.

nReduces your risk of developing skin breakdown (bed sores).

nHelps your wound to heal.


The purpose of these exercises is to increase motion and strength in your operated knee. We recommend you take your pain medication 30-45 minutes prior to doing these exercises.

Do your exercises 2 times a day.

Repeat each exercise 10 times.

Exercise Program

Quad SetPush the back of your knee down into the bed. Hold for a count of fi ve. Relax. You may be asked to place a small or large towel roll under your heel to assist in extending your knee.

Prolonged Extension StretchIf you’re having trouble getting full extension (knee straight), you may be asked to place a large towel roll under your heel. Relax your leg to allow gravity to stretch the back of your knee. Work up to a 5-10 minute hold.

Straight Leg RaiseLying on your back with knee of non-operated side bent and foot fl at on bed, lock knee of operated side and raise straight leg up 12 inches. Relax. You may need assistance.

Heel SlidesLying on your back, start with your operated leg straight, slide heel toward your body bending your hip and knee as much as possible. Slowly slide heel back to starting position.


Short Arc QuadLying on your back, place a large towel roll under your operated knee. Straighten knee completely, hold for a count of two. Relax. You may need assistance.

Stretch Using Opposite LegSit toward the front of the chair, be sure your foot is able to slide on the fl oor. Bend knee as far as possible. Then assist further bending by pulling with your non-operated leg. Hold for a count of fi ve. Relax. Try to go a little farther each time.

Long Arc QuadSit in a chair with your thigh supported. Straighten knee completely. Hold for a count of two. Relax. You may need assistance.

Prolonged Flexion StretchThis works best if your foot does not slide too well – either barefoot or a good-fi tting slipper. Slide surgical foot backward as far as you can, then slowly scoot your hips forward, causing a light stretch. Hold for 10-15 seconds; then scoot forward a little more to get your knee bending a little further. Again, hold 10-15 seconds. Continue in this manner for 1-2 minutes, then relax. Repeat this sequence two more times.

Ice can be applied to your knee after you are done with exercising, which can help with the pain and swelling. Always have a layer of clothing or towel between your skin and the ice pack. Apply it for about 20 minutes.


Managing Stairs After Surgery

Steps can pose a signifi cant challenge to you after your surgery. You will likely be “weight-bearing as tolerated” after surgery, meaning you can bear as much weight on your leg as feels comfortable. That means for walking and doing steps, you will need to bear the rest of the weight on your arms. Most people with knee replacements put about half their weight on their surgical leg when they go home. This means you should be able to get about half your weight on your arms in order to step up or down.

Ways to Manage Steps

nUsing one crutch and one sturdy rail is probably the best way to manage steps. You have good leverage for bearing weight on your arms and the rail helps provide balance.

nIf you have room to set a walker on each step, landing or threshold, then using the walker to get up or down steps usually works quite well.

nHaving two rails can be the best option, however, many times the two rails are too far apart to be helpful.

Other Options for Stairs

nYour physical therapist will help assess the best option for helping you manage your steps at home. This will be practiced with you prior to your going home.

nIf no handrails, you can use two crutches. This option takes more balance and you will need assistance with this.

nPlace your arms around two strong people who can support you as you step up or down the stairs.

nYou may want to consider having a rail put in anywhere you have two or more steps in a row.

Physical Therapy

Sequence for StairsAlways step up with your non-surgical (good) leg fi rst and down with your surgical (bad) leg fi rst. Remember, “good goes up, bad goes down.”


Questions and Answers

DietContinue your prescribed diet.

Bowel FunctionYou may use a mild laxative such as Milk of Magnesia.

Wound CareKeep your incision clean and dry. If you have no staples then you can shower if there is no drainage. If your incision has staples or sutures, do not shower until they are removed.

BathingYou will be given instruction on showering at discharge. You may be able to use your free standing commode (with bucket removed) to sit on in the shower.

Return to WorkCheck with your doctor.

Additional MedicationYou will need a medication to minimize the risk of blood clots. If you have any questions concerning this medication, please call your doctor.

Automobile TripsOnce you are home, limit your car ride to short trips. Do not drive until your doctor authorizes.

WalkingGradually increase the amount of walking you do at home. If you progress to using only one crutch or a cane, use it on the opposite side of your surgery.

– continued on page 18

Discharge Instructions

Hints for Walking Bend your knee as you bring your foot forward and wear footwear that will stay on your feet and will not allow you to slip or trip.

Questions and Answers(continued)

Rest PeriodsPlan several times during the day when you can lie down and rest. Ice your knee during this time.

Household ChoresLimit housework to light chores that can be done while on crutches or a walker (e.g. light dusting). Remember to use your reacher.

GardeningIs permitted after recovery.

KneelingAvoid for several months, then kneeling is permitted only for short periods of time.

ExerciseIt is very important to continue your knee exercises twice a day to get your motion and strength back. After checking with your doctor, playing golf with a cart, swimming, upper body exercise and other moderate activities are usually permitted. More active sports such as tennis and skiing are not recommended.

Sexual ActivitiesResume




The information that follows is for use as an educational aid and does not cover all possible uses, precautions, side effects, or drug interactions. For more complete information about the prescribed medication you are taking, ask your pharmacist or doctor.

* Some of these preparations are combination products and may contain other medications such as Tylenol or Aspirin. Do not take extra Tylenol in combination with your pain medication.

What does it do?Depresses pain signals.

What is it used for?Most products are used to control moderate to severe pain.

What are the side effects?Gastrointestinal symptoms including nausea, vomiting, decreased appetite, constipation, and cramps are the most common side effects. Other common side effects include lightheadedness, dizziness, and sleepiness.

Are there any serious side effects?Serious adverse reactions such as respiratory depression (slowed breathing), respiratory arrest, changes in blood pressure, and slowed heart rate may result, but are less common and usually occur with over dosage.

What precautions should be taken?If you are pregnant, breast feeding, or have serious heart, liver, lung, or kidney disease or any seizure disorders tell your doctor before taking narcotic medication. Also, if you have had problems with drug addiction, report this to your doctor.

Are there any drug interactions I should be aware of? Serious adverse effects may occur if narcotic medication is taken with alcohol, other narcotics, sedatives, barbiturates, antipsychotic medications (such as Thorazine, Trilafon, Mellaril, Vesprin, Haldol, etc.)

Narcotic Pain Medication


Hints while taking Medication

nReport any of the following signs to your physician – allergic reaction (rash/ itching), dizziness, confusion, hallucinations, shortness

of breath.

nAddiction to narcotics can occur when used for extended periods of time.

nUse only as directed, NEVER take more than your prescribed dose.

nDo NOT drink alcohol.

nDo NOT drive or operate heavy machinery.

Possible factors causing slow return of bowel function after surgery include use of narcotics, decreased daily activity/exercise and changes in eating habits.

Laxatives / Stool SoftenersLaxatives/Stool Softeners help prevent constipation and are recommended for short-term use after surgery or hospital stay. It is important to maintain a diet with fiber, drink plenty of fluids and take short walks daily when allowed by your doctor. All products listed may be purchased at your local drug store.

Stool Softeners help fat and water to mix and cause stool to soften. They include Colace (docusate sodium) and Surfak (docusate calcium). The normal dose is one or two capsules, one or two times a day.

Bulk-producing products cause stool to hold more water causing the urge to have a bowel movement. They include Metamucil/Fiberall (psyllium) and Fibercon (polycarbophil). The normal dose is found on each product package and usually mixed with water or juice. Start with the smallest recommended dose unless you have taken the laxative on a regular basis before surgery.

Stimulants and Stimulant / Stool Softener Combination directly stimulate the bowel. You should not use these products until other laxatives or stool softeners have been tried first or unless ordered by your doctor. They include:

nPericolace (docusate/casanthrol)nCorrectol (docusate/phenolphthalein)nDoxidan (docusate/phenolphthalein)nSenokot (senna)nDulcolax (bisacodyl)

For direction in use read the label carefully. Long-term use of these stimulants may cause dependence. Therefore, you should discontinue when bowel habits return to normal.

➧Note: senna and cascara can discolor the urine yellow-brown, or pink-red, red-violet or red-brown. Swallow bisacodyl tablets whole and avoid milk products, or antacids within one hour of dose.

Bowel Management



Recipe for Severe Ongoing ConstipationMix together:n1 cup applesaucenI cup coarse unprocessed brann3/4 cup prune juice

This mixture will be like a thick paste. Refrigerate in a covered container between use. Take one-two tablespoons of mixture every day with a glass of water. Take in evening for a morning bowel movement. Increase the bran mixture by two tablespoons each week until your bowel habits are regular. Always take one large glass of water with the mixture.

Adiethighinfiberanddrinkingatleast6-8cupsofwaterdailycanalsohelpwithbowelmanagementduringyourrecoveryperiod.


Lower Extremity

Pain Control

nA prescription for pain medication will be given to you before your discharge.

nUse the pain medication as directed – especially prior to doing your exercises.

nElevate your leg to help reduce swelling and/or pain.

nDo not drink alcohol when taking pain medication.

nDo not drive while taking pain medication.

nCall your doctor if increased pain is not relieved by pain medication.

TemperaturenTake your temperature once per day (between 3-7 p.m.)

nYou can purchase a thermometer at any pharmacy or larger grocery store.

ActivitynUse crutches / walker as directed until your doctor indicates

otherwise.

nGradually increase your activity each day.

nWhile sitting, elevate your leg to reduce swelling.

nPerform your ankle exercises as instructed by your nurse to promote circulation.

nDo your exercise program twice / day.

nAs your knee improves, try to use it more. For example, bend your knee and use that leg when getting up and down from sitting.

➧ Note: Your new knee prosthesis is metal, and you may activate metal detection

devices, such as at the airport.


Call your doctor if you experience any of the following signs and symptoms for:

Blood ClotsnPain in your calfnRedness, swelling

or warmth in leg /calfnChest painnShortness of breath

InfectionnIncreased temperature • 100 degree temperature for three days• 101 degree temperature for one daynIncreased drainage from your woundnFoul odor from your woundnRedness, swelling and/ or warmth of woundnIncreased pain in wound



Time Medication TakenDay

Pain Medication

Other

Day

Pain Medication

Other

Day

Pain Medication

Other

Day

Pain Medication

Other

Day

Pain Medication

Other

Day

Pain Medication

Other

Day

Pain Medication

Other

Discharge Pain Medication Log

Following your operation you will hear new words and see different equipment. Here are some of them:

C.P.M. (Continuous Passive Motion)A machine that bends your knee for you while you are in bed. It is used about two hours every day, beginning the fi rst day after your operation. The use of this machine will be explained to you by your physical therapist and your nurse.

Epidural AnalgesiaContinuous method of pain control after surgery.

HemovacA small tube near your incision that drains excess fl uid from the wound. Usually removed 24-48 hours after the operation.

Incentive SpirometerA device to help you with your breathing exercises. Your nurse will teach you how to use it.

IV (Intravenous fl uids)Medication and fl uids can be given through this line and any blood transfusions if necessary.

P.C.A. (Patient controlled analgesia)A machine connected to your IV that allows you togive your own pain medication.

P.T.Physical Therapy

SCD’sThese are compression stockings used to reduce blood clots and increase the circulation in your legs.

Terminology Explanations


Questionsand Notes




St. Joseph Mercy Hospital5301 East Huron River Drive, P.O. Box 995

Ann Arbor, MI 48106-0995

www.sjmercyhealth.org8551 N 1/07T

Special thanks to the following people for theircontributions to this booklet:

Theresa Brown, RN, BSNDavid Denzin, MDSandy Graham, PT, MS, EdKaren Helinski, RN, BSNJohn Henke, MDJean Hergott, PA-CDon Kuck, PTHenrietta Mac, RN, BSN

Photos by Anne Marilyn Tyler, RSM and Ben Weatherston, Audiovisual Services

Paula Nedala, RN, MSThomas O’Keefe, MDDavid Rhode, RN, BSN, Molly Sieffert, RN, BSNBruce Stubbs, MD Jackie Travis-Mitchell, RNSusan Werner, RN

remarkable medicine. remarkable care

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