Coach's Guide for the Patient at Home

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• Home Safety and Avoiding Falls

  Pick up throw rugs and tack down loose carpeting. Cover slippery surfaces with carpets that are firmly anchored to the floor or that have non-skid backs.
  
  Place frequently used cooking supplies and utensils where they can be reached without too much bending or stretching.
  
  Place regularly used items such as remote controls, medications and reading materials in easy-to-reach locations.
  
  Widen furniture paths to accommodate a walker or cane.
  
  Be aware of all floor hazards such as pets, small objects or uneven surfaces.
  
  Provide good lighting throughout. Install nightlights in the bathrooms, bedrooms and hallways.
  
  Be sure to remove loose rugs and other trip hazards such as electrical cords and magazine racks from walking paths to avoid accidents or falls. Keep extension cords and telephone cords out of pathways. Do not run wires under rugs; this is a fire hazard.
  
  Un-tuck bedding to allow for easier access in and out of the patient’s bed.

• Body Changes

  The patient’s appetite may be poor. Make sure they drink plenty of fluids to keep them from getting dehydrated. Their desire for solid food should return.
  
  Spine and joint patients may have difficulty sleeping, which is normal. Do not let the patient sleep or nap too much during the day.
  
  The patient’s energy level will be decreased for the first month.
  
  Pain medication that contains narcotics promotes constipation. Follow the surgeon’s recommendations for using stool softeners or laxatives such as milk of magnesia, if necessary.

• Blood Thinners

  Blood thinners may be given to help avoid blood clots. Always follow the surgeon’s recommendations regarding blood thinners. Generally, spine patients do not require blood thinners.

• Stockings

  The patient may be asked to wear special stockings. These stockings are used to help compress the veins in their legs. This helps to keep swelling down and reduces the chance for blood clots.
  
  If swelling in the operative leg is bothersome, help the patient elevate the leg for short periods throughout the day. It is best when the patient lies down and raises the leg above heart level.
  
  Make sure the patient wears the stockings continuously, removing them for one to two hours twice a day.
  
  Notify the physician if the patient notices increased pain or swelling in either leg.

• Incision Care

  Keep the incision dry.
  
  Keep the incision covered with a light, dry dressing until the staples are removed, usually 10-14 days.
  
  Patients should request showering/bathing instructions from the surgeon.
  
  Notify the surgeon if there is increased drainage, redness, pain, odor or heat around the incision.
  
  Take the patient’s temperature if he or she feels warm or sick. Call the surgeon if it exceeds 100.5°F.

• Changing the Dressing (only if directed by surgeon)

  Wash hands.
  
  Open all dressing change materials (ABD pads, 4x4 if needed, Betadine® swab if indicated).
  
  Remove stocking and old dressing.
  
  Inspect incision for the following:

  • Increased redness
  • Increase in clear drainage
  • Yellow/green drainage
  • Odor
  • Surrounding skin is hot to touch

  
  If Betadine® is ordered, take one Betadine® swab and paint the incision from top to bottom. Then turn the swab over and paint the incision from bottom to top. Use remaining swab to paint the drain site.
  
  Pick up an ABD pad by one corner and lay over incision. Be careful not to touch the inside of the dressing that will lie over the incision.
  
  Place an ABD pad lengthwise and place the other ABD crosswise to form a “T” (to cover drain site).
  
  Tape dressing in place.

• Controlling Discomfort

  Pain medicine at least 30 minutes before physical therapy.
  
  Encourage patient to gradually wean him or herself from prescription medication. Follow the surgeon’s recommendations for taking over-the-counter medication in place of prescription medication.
  
  Have patient change position every 45 minutes throughout the day.
  
  Use ice for pain control. Applying ice to the affected area will increase comfort, but do not use for more than 20 minutes at a time each hour. Use ice before and after the patient exercises according to their prescribed program. A bag of frozen peas wrapped in a kitchen towel makes an ideal pack. Mark the bag of peas and return them to the freezer (to be used as an ice pack later).

• Signs of Infection

  Increased swelling and redness at incision site
  
  Change in color, amount or odor of drainage
  
  Increased pain in hip, knee, neck or back
  
  Fever greater than 100.5°F.

• Blood Clots in Legs

  Surgery may cause the blood to slow and coagulate in the veins of the patient’s legs, creating a blood clot. This is why joint replacement patients take blood thinners after surgery. Generally, spine patients do not require blood thinners. If a clot occurs despite these measures, the patient may need to be admitted to the hospital to receive intravenous blood thinners. Prompt treatment usually prevents the more serious complication of pulmonary embolus.
  
  

  Signs of Blood Clots in Legs

  • Swelling in thigh, calf or ankle that does not go down with elevation
  • Pain, heat and tenderness in calf, back of knee or groin area. NOTE: Blood clots can form in either leg

  Prevention of Blood Clots

  • Foot and ankle pumps
  • Walking
  • Compression stockings
  • Blood thinners such as Coumadin® or Heparin (joint replacement patients only)

• Pulmonary Embolus

  An unrecognized blood clot could break away from the vein and travel to the lungs. This is an emergency and you should call 911 immediately if suspected.
  
  

  Signs of a Pulmonary Embolus

  • Sudden chest pain
  • Difficult and/or rapid breathing
  • Shortness of breath
  • Sweating
  • Confusion

  Prevention of Pulmonary Embolus

  • Prevent blood clot in legs
  • Recognize a blood clot in leg and call physician promptly

• Dislocation (hip replacement patients only)

  Signs of Dislocation

  • Severe pain
  • Rotation/shortening of leg
  • Unable to walk/move leg

  Prevention of Dislocation

  AT ALL TIMES

  • DO NOT cross legs
  • DO NOT twist side to side
  • DO NOT bend at the hip past 90 degrees