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TKR: Day 3

     blood draw: A blood drawing technician will draw your blood at 6 AM (will test for your red blood cell level
         - hematocrit - and possibly chemitry level).  Ask your nurse about your hematocrit (should be above 30 and if
         the hematocrit is below 26 we may recommend a transfusion)
         On day three, a platlet level will also be measured as low platlets counts can occur as a side effect of Lovenox (blood thinner).
         Don't be afraid to ask the nurse about this.

         vitals and monitoring: The nurse or aid will measure your vitals (temperature, pulse, blood pressure, and
         respirations, as well as noting the oxygen saturation rate).  It is normal to have an elevated temperature for
         2-3 days after surgery.  Remember that the pulse oximeter machine will measure a continuous heart rate and
         blood oxygen level.  The pulse should be below 100 and the oxygen saturation should be above 95% (or you will need oxygen) 

         bath: the nursing staff will give you a sponge bath.

         breakfast: Try to restart a normal diet.  You really should be out of bed on day 2.  This makes eating easier and lets the nursing staff
         clean your linen.Try to restart a normal diet.

         tubes: The bladder catheter has already been removed unless you are having trouble mobilizing. The nasal oxygen will have already
         been removed unless you are having trouble breathing. (O2 sats on room air should be above 90%). The IV fluids will be discontinued
         once you are drinking fluids well.

         physical therapy: The physical therapy service will pick up where they left off on day one.  This is a good day to walk down the hall.
         They will probably leave you in a chair for at least 2 hours.
         CPM  The therapists will show you how to increase the range of motion about 10-20 deg a day.  On day 3, you should get the COM
         up above 90 deg. When in bed, the patient should keep the CPM for at least 50% of the time.  If the machine helps you sleep, feel
         free to keep this running during the night.
         blood clots:  The nurse will give you a shot in the abdominal fat to prevent blood clots (Lovenox).   Ask her to teach you how to
         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 drop
         with Lovenox shots.  You are encouraged to move your feet back and forth for two minutes every 30 min (2 min during each TV
         commercial).   This will also help prevent blood clots.

         hospitalist: The hospitalist will continue to see you on a daily basis.  He may change around some of your home medications.

         wound dressing: Typically, the wound dressing is left alone for several days unless there is bleeding.
         bowel movement: If you have not had a bowel movement, then you will be given 1 tsb of milk of magnesia (MOM) every 6 hours
         until there is a BM.  If the MOM is not successful, then we will recommend a fleets enema.

         discharge planning: You need to start thinking about how you will function at home.  The discharge planner will introduce herself
         and will help you think through the transition to getting back home.  In most cases, patients will go straight home rather than going to 
         a rehabilitation center.  You may need special occupational therapy items such "pick up sticks and shoe horns", elevated commodes,
         hospital bed, and home nurses aid and therapy.  Typically you will go home with a CPM.  
         blood clots:  You must decide on a plan for preventing blood clots.  Most patients elect for a few weeks of subcutaneous Lovenox.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Daren Sipes, MS on Monday, December 17, 2007 12:17 pm