Hospital Stay

Arriving at the Hospital

You will be admitted to Newton-Wellesley Hospital on the day of your surgery. You will be asked to arrive at the hospital 1½ hours before your operation.

After checking in at the Surgical Center Registration, you will be taken to the preoperative area. Your belongings will be stored and delivered to your room later in the day. A nurse in the pre-operative area will coordinate your preparation for surgery, which includes:

• Meeting the team who will assist your surgeon, which includes nurses, an anesthesiologist and/or nurse anesthetist, and a fellow, resident or PA
• Site verification, in which you will be asked multiple times to verify what type of surgery and on which side – this is a routine hospital procedure and is necessary for your safety
• Checking your vital signs, including temperature, blood pressure, pulse, and breathing
• Placing an intravenous (IV) tube in your arm so that you can receive fluids, medications, and blood transfusions if necessary

Your family is welcome to stay with you until you to go to the operating room (OR). When you are taken to the OR, your family will be directed to the family waiting area where they can wait during your surgery.

Going to Surgery

In the OR, the surgical team will work to ensure your operation goes smoothly. They will be continuously watching your heart rate, blood pressure, and breathing. A catheter (small tube) may be placed in your bladder to keep track of fluids during surgery.
Your surgeon will speak with your family when surgery is completed.

After Surgery: Post Anesthesia Care Unit

After surgery, you will wake up in your bed in the post anesthesia care unit (PACU), known as the recovery room. You may not remember much of this part of your stay there.

Here are some of the routine activities that will be happening as you wake up from your surgery:

• Your vital signs will be taken frequently.
• You will have oxygen and heart monitoring while you wake up from the anesthesia.
• You will be wearing compression boots on your legs to help your blood circulation.
• You may have a small drain from your incision to drains extra fluid from under your skin.
• You may have the catheter (tube) leading from your bladder to drain urine.
• The nurse will check on the IV fluids and antibiotics you receive.
• You will be asked to cough and breathe deeply every hour while you are awake.

Pain Management

You will have discomfort after hip replacement surgery. Your pain management begins before your operation and continues through anesthesia and after your operation.
Your comfort is important to us. Do not wait for someone to offer you medicine. Let your nurse and doctor know right away if you are uncomfortable.
Your nurse will check to make sure you are as comfortable as possible. You will be asked to rate your pain. We will use a scale from 1 to 10.

Please be sure to tell your nurse if your pain becomes worse. We want you to be as comfortable as possible while you heal.
Although feeling pain is a natural occurrence after surgery, there are many pain control methods available:

• If you are not taking fluids, the PACU nurse can give you pain medicine through your IV.
• We use a combination of medications, cold therapy, and injection of medication in the joint at the end of surgery to provide comfort.

You may receive Tylenol, Lyrica and Celebrex before surgery.

• The medication combination after surgery includes Tylenol, Toradol, oxycodone or tramadol, and ice. Other pain medicines are available if you are unable to take any of these medications.
• Cold (ice) therapy can help with pain relief.
• Mobility (moving around) may help with muscle discomfort after surgery.

Your Hospital Stay

During your recovery, the focus of your care will be on managing your medications, caring for your incision, encouraging you to move as much as possible, and keeping your new joint safe.
It is difficult to describe a typical day in the hospital, because each person’s care depends on his or her specific needs. One thing is fairly certain: you will be busy.

Your Daily Plan of Care

Vital signs
A nurse or patient care assistant will take your vital signs several times a day. This may include your temperature, blood pressure, heart rate, oxygen level, and pain levels.

Medications
Your physician will order your medications. If you have any questions about your medicines, please be sure to ask your nurse. DO NOT take medications from home unless instructed by your nurse or doctor. After surgery, you will be on a blood-thinning medication to help prevent blood clots.

Managing your pain
Some discomfort is expected after joint replacement surgery. Your care team will make every effort to keep you comfortable. If you ever feel that your pain is not well controlled, you should tell your nurse as soon as possible.
Most patients do well with a multimodal approach to manage pain. We use a combination of Tylenol, Toradol, narcotics, movement, and cold therapy to help provide comfort.
Keep in mind that it is important to take pain medicine when you are having pain. This will help you get up and move around in a shorter amount of time.

Ice
You may receive ice to apply to your hip to decrease pain and swelling.

Care of your incision
Your incision will be covered with a bandage (dressing) for the first few days after surgery. Your doctor, physician assistant, or nurse practitioner will remove the drain tube (if you have one) from your incision and may change the bandage. Before you leave the hospital, we will give you instructions for wound care at home.

IV (intravenous catheter)
Your nurse will also check on IV fluids and antibiotics you receive.

Incentive spirometer (IS)
You will be asked to cough and breathe deeply every hour while you are awake, and to use an incentive spirometer. This is a clear plastic tube to help you with deep breathing.

Diet
Your diet will go from liquids to solids as your stomach settles down after surgery. Plan to be out of bed sitting for meals.
Meal service is provided three times a day. You will be given menus to choose foods that you like, and you will call to order your food. Snacks and beverages are almost always available at the nursing station.

Tests
You may have more tests including lab work or X-rays.

Rounds
Your surgeon is the leader of your health care team. During your hospital stay, various members of your health care team may visit you.

Activity and mobility
Our nursing staff will assist you with bathing and walking. You will be walking the day of your surgery with a physical therapy and/or nurse.
You will be wearing compression boots and possibly elastic stockings to promote circulation and help prevent blood clots.
Depending on the time you return to the nursing unit and how you are feeling, you may see a physical therapist on the day of surgery. A physical therapist will see you twice a day after your initial evaluation session. The goals of PT are safe movement and improving the range of motion and strength in your hip.
Proper positioning is important for the safety and recovery of your new joint. Your nurse and therapists will teach you how to protect your joints when in bed and moving around. These positions will be reviewed with you each day and will be posted in picture form by your bed.
If the plan is for you to go directly home instead of to an extended-care facility, an occupational therapist will also see you prior to discharge.

Discharge planning
Your health care team will work with you and your family to plan for your needs after leaving the hospital.

Your In-Hospital Recovery

Everyone progresses at his or her own pace. Listed below are guidelines for what to expect from therapy during your hospital stay. Your safety and independence guides your stay.

Physical Therapy
You will have two sessions a day, one in the morning and one in the afternoon. Sessions will include:

• Progression of strengthening and range of motion exercises
• Progression of bed mobility, transfers between bed and chair, and walking
• Practice stair climbing

Goals if you are going home

• You will be independent getting in and out of bed.
• You will progress to being able to walk household distances.
• If you have stairs at home, you will practice stair climbing with your therapist.
• Your therapist will provide a list of exercises and activity instructions for you to follow.
• If you are going to an extended-care facility, your physical therapist may see you in the morning depending on your time of discharge.

Occupational Therapy

• Instruction in self-care activities such as bathing, dressing, grooming, and toileting to maximize your safety and independence
• Training in the use of long-handled adaptive equipment such as a “hip kit,” if needed
• Instruction in mobility and transfers including to and from the toilet and tub/shower stall

Goals if you are going home

• You will progress in self-care tasks such as bathing, dressing, grooming, and toileting after instruction by your occupational therapist.
• The occupational therapist will instruct you in using any adaptive equipment for performing tasks at home, to ensure your safety and independence.

Preparing for Discharge

Your nurse will review your discharge instructions, which includes wound care and any medications you will be taking at home such as:

• Pain medication
• Anticoagulation medication
• Medication to prevent constipation

Some prescription pain medications can cause constipation. The best way to prevent constipation is to eat healthy and drink plenty of
water. It is a good idea to pick up a stool softener (such as Miralax) to take after surgery if needed.
A case manager or social worker may come to see you to confirm your discharge plan and address any outstanding questions you may have.