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Total Knee Replacement – Day 4 and Beyond:

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div class="bodycopy">         strong>blood draw/strong>: A blood drawing technician will draw your blood at 6 AM (will test for your red blood cell levelbr/>
         - hematocrit - and possibly chemitry level).  Ask your nurse about your hematocrit (should be above 30 and ifbr/>
         the hematocrit is below 26 we may recommend a transfusion)br/>
         On day three, a platlet level will also be measured as low platlets counts can occur as a side effect of Lovenox (blood thinner).br/>
         Don't be afraid to ask the nurse about this.  Usually after day 4, blood draws are no longer necesssary. br/>
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         strong>vitals and monitoring: /strong>The nurse or aid will measure your vitals (temperature, pulse, blood pressure, andbr/>
         respirations, as well as noting the oxygen saturation rate).  It is normal to have an elevated temperature forbr/>
         2-3 days after surgery.  Temperatures after day 3, may represent a problem.  It is unusual to require supplementalbr/>
         oxygen at this point.br/>
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         strong>bath:/strong> Usually the patient can perform bathing activities.br/>
strong>         diet: S/strong>hould be normal at this point.  You should be out of bed for each meal.br/>
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strong>         tubes: /strong>All tubes should be removed at this point.br/>
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         strong>physical therapy:/strong> The physical therapy service will pick up where they left off on day three.  Most patients are navigating downbr/>
         the hallway with assistance and are starting to walk on stairs.br/>
         strong>CPM /strong> The therapists will show you how to increase the range of motion about 10-20 deg a day.  On day 4, you should get the COMbr/>
         up above 110 deg. When in bed, the patient should keep the CPM for at least 50% of the time.  If the machine helps you sleep, feelbr/>
         free to keep this running during the night.br/>
          br/>
         strong>blood clots: /strong> The nurse will give you a shot in the abdominal fat to prevent blood clots (Lovenox).   Ask her to teach you how tobr/>
         give these shots as they are often given for a week or two at home.  Rember to ask the nurse about the platlet count as this can dropbr/>
         with Lovenox shots.  You are encouraged to move your feet back and forth for two minutes every 30 min (2 min during each TVbr/>
         commercial).   This will also help prevent blood clots.br/>
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         strong>hospitalist:/strong> The hospitalist will continue to see you on a daily basis.  He may change around some of your home medications.br/>
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         strong>wound dressing: /strong>Typically, the wound dressing is left alone for several days unless there is bleeding.br/>
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         strong>bowel movement:/strong> If you have not had a bowel movement, then you will be given 1 tsb of milk of magnesia (MOM) every 6 hoursbr/>
         until there is a BM.  If the MOM is not successful, then we will recommend a fleets enema.br/>
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         strong>discharge planning: /strong>You need to start thinking about how you will function at home.  The discharge planner will introduce herselfbr/>
         and will help you think through the transition to getting back home.  In most cases, patients will go straight home rather than going to br/>
         a rehabilitation center.  Before the patient goes home, a home physical therapy consult should be initiated.  You may need special  br/>
         occupational therapy items such "pick up sticks and shoe horns", elevated commodes,  hospital bed, and home nurses aid and therapy.  br/>
         Typically you will go home with a CPM.  br/>
         strong>blood clots:/strong>  You must decide on a plan for preventing blood clots.  Most patients elect for a few weeks of subcutaneous Lovenox.br/>
         strong>first postoperative visit:/strong>  Before you are discharged you should be given an appointment for to see your surgeon within 3-5 days.br/>
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 /div>br/>hr/>br/>br/>br/>Last updated by Clifford R. Wheeless, III, MD on Saturday, March 1, 2008 7:41 pmbr/>

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