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Caregivers Guide

Patient's Medication/Care | Signs of Complications/Prevention Details

How to care for the Joint Replacement Patient at Home

Your role as a home caregiver is very important for helping your friend or loved one recover. There are many things that you can do in the home to help ensure a healthy recovery of the patient. There are also many things you need to know in terms of their safety, comfort and overall health. The following will help you answer a variety of questions or concerns you may have.

Safety in the Home

  • Remove Loose Rugs: Have all throw rugs removed and loose carpets tacked down. Place carpets, with non-skid backs, on slippery surfaces.
  • Create Easy-to-Reach loactions: Have frequently used items such as remote controls, telephones, medications, cooking supplies and reading materials, placed in easy-to-reach locations.
  • Clear Walkways: Clear and widen walkways through the house to accommodate a walker or cane.
  • Reduce Tripping Hazards: Keep tabs on hazards such as pets and be aware of any uneven surfaces.
  • Increase Lighting & Visability: Make sure to have good lighting throughout the home. Have lights installed where necessary.
  • Properly Run Electrical Cords: When keeping electrical cords out of the way DO NOT run wires under rugs as this is a fire hazard.
  • Restrict Heavy Lifting: Consult the patient’s surgeon before allowing him or her to lift heavy items. It is usually recommended that patients do not lift anything heavy during the first 3 months after surgery.
  • Loosen Bedding: Have the patient’s bedding untucked to allow for easier access.

Body Changes

  • Decreased Appetite: In the beginning the patient may have a poor appetite. To avoid dehydration make sure they get plenty of fluids. Their desire for solid foods will return in time.
  • Sleep Habbits: It is normal for joint replacement patients to experience difficulty sleeping. Try to keep him or her from napping too much during the day.
  • Irregular Energy Level: Expect his or her energy level to decrease during the first month after surgery.
  • Effects of Medication: Follow the surgeon’s recommendations regarding stool softeners or laxatives to reduce constipation which may occur as a result of using pain medications and reduced activity.

Use of Stockings

It is common for the surgeon to recommend that the patient wear special stockings. These stocking are used to keep swelling down and to reduce the chance for blood clots in the legs by compressing the veins in their legs.

  • Continuous Wear: Have the patient wear the stocking throughout the day removing them only for 1 or 2 hours twice daily.
  • Leg Elevation: Have the patient elevate their leg to above heart level for short periods throughout the day is swelling becomes a problem.
  • Contact Doctor: Contact the doctor if the patient has any increased swelling or pain in their leg.

Use of Blood Thinners

The patient may have been prescribed blood thinners to help avoid blood clots in the their legs. Always follow the surgeon's recommendations regarding blood thinners and be prepared to provide the type and dosage of blood thinners being used by the patient to health care professionals should there be an emergency.

Taking Care of the Incision

  • Keep Dry: For approximately 10-14 days after the operation, keep the incision dry and covered with a light dressing until the staples are removed.  
  • Contact Doctor: If there is increased drainage, redness, pain, odors, or heat around the incision, notify the surgeon promptly.
  • Showering: Request showering/bathing instructions from the surgeon.
  • Monitor Any Illness: If the patient feels ill, take his or her temperature. Call the surgeon if the patients temperature exceeds 100.5°F.

Changing a Dressing (ONLY TO BE ATTEMPTED IF SO DIRECTED BY THE SURGEON)

  1. Wash your hands.
  2. Open all dressing change materials (ABD pads, 4x4 if needed, Betadine® swab if indicated). Have them within reach in a clean dry area.
  3. Remove stocking and old dressing.
  4. Inspect the incision for the following:
    • increased redness
    • increase in clear drainage
    • yellow/green drainage
    • odor
    • surrounding skin is hot to touch
    If any of the above conditions are observed complete the dressing change and inform the patients physician promptly.
  5. If the use of Betadine® has been ordered by the physician, take one Betadine® swab and paint the incision from top to bottom in one stroke. Then turn the swab over and paint the incision from bottom to top in one stroke. Use remaining swab to paint the drain site.
  6. Pick up th 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.
  7. Place one ABD pad lengthwise and place the other ABD crosswise to form a "T" (to cover drain site).
  8. Tape the dressing in place with light pressure.

Managing Post Operative Pain

  • Medications: Have the patient take the pain medicine prescribed by their doctor at least 30 minutes prior to physical therapy.
  • Alternate Positions: During the day the patient should change position every 45 minutes.
  • Use of Ice Packs: Apply ice to the affected joint to reduce discomfort. Use it for only 20 minutes at a time each hour. Ice may also be used before and after exercise according to their doctor recommended program.
  • Medication Reduction: Persuade patient to gradually stop taking prescription medications. Follow the surgeon’s instructions for replacing prescriptions with over–the-counter medication.

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Recognizing & Preventing Potential Complications

Infection

Signs of Infection

  • Change in color/amount/odor of drainage
  • Increased pain of joint
  • Fever greater than 100.5° F

Blood Clots in Legs

Blood clots may occur when blood coagulates in the veins of the patient’s leg after surgery. This is the reason for blood thinners after surgery. If a clot occurs despite the use of blood thinners, the patient may need to be admitted to the hospital to receive intravenous blood thinners. Prompt treatment is the best way to prevent the more serious complication of pulmonary embolus.

Signs of blood clots in legs:

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

Prevention of blood clots

  • Foot and ankle pumps
  • Walking
  • Compression stockings
  • Blood thinners such as Coumadin® or Heparin

Pulmonary Embolus

A pulmonary embolus occurs when a blood clot breaks away from the vein and travel to the lungs. CALL 911 if suspected.

Signs of a pulmonary embolus:

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

Prevention of pulmonary embolus

  • Try to prevent blood clots in the legs.
  • Be able to recognize a blood clot in leg and call a physician promptly.

Hip Dislocation

Signs of Dislocation

  • Unable to walk and/or move the leg
  • Intense pain
  • Rotation and/or shortening of the leg

Prevention of Dislocation

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