Angiography
Why is this procedure done?
This procedure takes pictures of the blood vessels. Often it is used to look at blood vessels in the heart.
It can also be used to look at other blood vessels in the kidneys, brain, lungs, or other parts of the body.
It helps find problems like blockages or vessels that are not formed the right way. Damage in the heart blood vessels
may cause chest pain or heart problems. Sometimes, the doctor can treat a blocked blood vessel during this procedure.

What will the results be?
The results may tell your doctor if you have a problem with a blood vessel. Your doctor may learn what is causing your heart
problem or chest pain. Talk to your doctor about the test.

What happens before the procedure?
• Your doctor will take your history and do an exam. Talk to your doctor about:
o All the drugs you are taking. Be sure to include all prescription and over-the-counter (OTC) drugs, and herbal supplements.
Tell the doctor about any drug allergy. Bring a list of drugs you take with you.
o If you take diabetes drugs. You may need to change your diabetes drug before the test.
o Any bleeding problems. Be sure to tell your doctor if you are taking any drugs that may cause bleeding. Some of these are Coumadin®,
ibuprofen, Aleve® (naproxen), or aspirin. Certain vitamins and herbs, such as garlic and fish oil, may also add to the risk for bleeding.
You may need to stop these drugs as well. Talk to your doctor about them.
o Allergies to any drug or other substances.
o When you need to stop eating or drinking before your procedure. Often you will need to stop eating and drinking after midnight the night before your test.
• Your doctor may order:
o Lab tests
o Ultrasound
• You will not be allowed to drive right away after the procedure. Ask a family member or a friend to drive you home.

What happens during the procedure?
• This may be done in a hospital or an outpatient center. Your doctor may give you drugs to help you relax. You will have an I.V.
started in your hand or arm to give you fluids and drugs during your test.
• You will lie down on an x-ray table. A small tube called a catheter is put in a blood vessel in your arm or leg.
The doctor gives you a special drug called dye or contrast through the tube to see the blood flow in the blood vessels of your heart.
Pictures are taken when the dye is injected.
• You may feel warmth or a burning when the dye is injected, but it will pass quickly. Be sure to tell the staff if you have any pain or other problems during the test.
• When the test is done, the tube is removed and pressure is placed on the cut site for 10 to 20 minutes. This helps stop bleeding.
• The test takes 2 to 3 hours.

What happens after the procedure?
The staff will check your vital signs for 4 to 6 hours after the procedure. Your doctor will order drugs for pain and talk to you about going home.
The doctor will also talk about the test results with you.

What care is needed at home?
• Rest when you get home for the rest of the day. Ask a friend or relative to spend the evening with you to help you and to look after you.
• Do not do any heavy activity for at least 12 hours after the procedure.
• Drink lots of water for the next 2 days to help clear the dye from your body.

What follow-up care is needed?
• Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits. Together you may make a plan for more care.
• It is important to talk to your doctor about the test results. More tests may be needed.

What lifestyle changes are needed?
You may need to make lifestyle changes based on the results of your test. Eat a healthy, balanced diet. Do not smoke or use any tobacco products and avoid secondhand smoke.
Talk to your doctor about whether you can drink beer, wine, and mixed drinks (alcohol).

Will physical activity be limited?
You may go back to your normal activities 2 days after the procedure. Talk to your doctor about your activity level and any changes you may need to make.
Ask about how much exercise you should be getting.

What problems could happen?
• Infection
• Bleeding
• Swelling
• Pain
• Allergic reaction to dye
• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf

Rhinoplasty
Why is this procedure done?
Rhinoplasty is a surgery done on your nose. It is done to repair or reshape the nose. It can also be done to:
• Make the size of your nose larger or smaller
• Correct a broken or deformed nose
• Narrow the opening of you nostrils
• Change the bridge or tip of your nose
• Improve breathing

What will the results be?
Results may be seen slowly as your nose heals. The desired size and shape of your nose is often seen over time.
Your “new” nose will seem natural to you.
Breathing problems will improve as the swelling goes down.

What happens before the procedure?
• You and your doctor will talk about how your nose will look. Your doctor may take pictures of your nose and face.

• Your doctor will take your history. Talk to the doctor about:
o All the drugs you are taking. Be sure to include all prescription and over-the-counter (OTC) drugs, and herbal supplements.
Tell the doctor about any drug allergy. Bring a list of drugs you take with you.
o Any bleeding problems. Be sure to tell your doctor if you are taking any drugs that may cause bleeding. Some of these are Coumadin®,
ibuprofen, Aleve® (naproxen), or aspirin. Certain vitamins and herbs, such as garlic and fish oil, may also add to the risk for bleeding.
You may need to stop these drugs as well. Talk to your doctor about them.
o When you need to stop eating or drinking before your procedure.
• You will not be allowed to drive right away after the procedure. Ask a family member or a friend to drive you home.

• Your doctor will do an exam and may order:
o Lab tests
o X-ray of facial bones
o ECG or chest x-ray

What happens during the procedure?
• Once you are in the operating room, you will be given a drug to make you sleepy. It will also help you stay pain free during the surgery.
You may also be given a drug to help you relax.
• Your doctor will make a small cut inside or outside your nose. The skin of your nose will be lifted from your face.
• Some nasal bones may be taken out, fixed, or reshaped. The hard tissue, called cartilage, will also be trimmed.
Tissue grafting may also be done. This uses tissue or cartilage to change the shape of your nose. It may also be used to fill in areas to give a smoother look.
It may be taken from the cartilage of your nostrils or from the ear. The shape or size of your nostrils may change.
• Your doctor will close the cut with stitches and cover it with clean bandages. The doctor will put the skin back on to your new nose.
The skin will be tightly taped to keep it in place.
• A special splint and bandages are used to help keep the shape of your new nose as it heals. Gauze materials, called nasal packs,
may also be put into your nose to support it.
• This procedure may take 2 to 4 hours.

What happens after the procedure?
• Your nose and face may be swollen and painful for a while. Your doctor will give you drugs for pain and swelling.
• You can go home within hours after the surgery when the staff is sure that you will not have any problems.

What care is needed at home?
• Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says.
This way you will know what you need to do.
• Get a lot of rest at least for the first few days after the surgery.
• Keep your head up on 2 to 3 pillows when you lie down to help with swelling.
• Do not use machines, drive, or drink beer, wine, and mixed drinks (alcohol) for at least 24 hours after your surgery.
• Place an ice pack wrapped in a towel over the painful part. Never put ice right on the skin. Do not leave the ice on more than 10 to 15 minutes at a time.
This will help with the swelling.
• Do not blow your nose at least for a month. This can cause more swelling and may cause injury to your new nose.
• Wash your face gently and carefully. Do not touch or rub your nose.
• Protect your nose from injury.
• Do not wear glasses until your doctor says it is OK.
• Do not stay in the sun for more than 15 minutes. This will help to avoid getting sunburn on your nose.
• Avoid activities that put pressure on your face, like bending over or holding your breath.
• Avoid tiring activities and exercise for at least 3 weeks. Do not play sports for 6 months.
• Do not lift heavy things for 2 to 4 weeks.

Ask your doctor about:
• When it is safe to take a bath or shower.
• Drugs needed for skin care and to avoid scarring.
• Nose care. Ask your doctor how and what you need to keep your nose clean.
• Wound care. Ask how and when you need to change the dressings.
• Be sure to wash your hands before touching your wound or dressing.

What follow-up care is needed?
Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits. Your stitches, splints,
and nasal packs will be removed at one of these visits.

What problems could happen?
• Poor healing of the skin
• More risk of nosebleed
• Breathing problems
• Infection
• Bleeding
• Scarring

• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf

Arthroscopy Discharge Instructions
About this topic
Arthroscopy is a type of surgery to check for and treat joint problems. A joint is a part of the body where two bones meet.
The doctor puts a small tube with a tiny camera on the end into the joint. This is called an arthroscope. The doctor uses it to see
pictures of the joint inside your body. This helps your doctor to find out what the problem is in the joint. Then, the doctor can pass tiny instruments into the joint to fix the problem.
It is often done in the knee and shoulder. It may also be done of the hip, ankle, elbow, or wrist. It is done to:
• Find an injury or problem inside a joint
• Repair tendons and ligaments in your joint
• Take out bone and cartilage fragments
• Remove the joint lining that may be swollen or inflamed

What care is needed at home?
• Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says.
This way you will know what you need to do.
• Prop your painful part on pillows to help with swelling.
• Place an ice pack or a bag of frozen peas wrapped in a towel over the painful part. Never put ice right on the skin. Do not leave the ice on more than 10 to 15 minutes at a time.

• Talk to your doctor about how to care for your cut site. Ask your doctor about:
o When you should change your bandages
o When you may take a bath or shower
o If you need to be careful with lifting things over 10 pounds
o When you may go back to your normal activities like work, exercising, or driving
• Wash your hands before and after touching your wound or dressing.

What follow-up care is needed?
• Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits.
• If you have stitches or staples, you will need to have them taken out. Your doctor will often want to do this in 1 to 2 weeks.
• Your doctor may suggest physical therapy or exercises to build muscle strength, increase motion, and help you to recover faster.

What drugs may be needed?

The doctor may order drugs to:
• Help with pain and swelling
• Prevent infection
• Prevent blood clots

Will physical activity be limited?
You may have to limit your activity. Talk to your doctor about the right amount of activity for you.

What problems could happen?
• Infection
• Bleeding
• Swelling
• Blood clots
• Nerve and blood vessel injury
• Joint stiffness
• Ongoing pain

When do I need to call the doctor?
• Signs of infection. These include a fever of 100.4°F (38°C) or higher, chills, wound that will not heal.
• Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge;
foul smell coming from the cut site; cut site opens up.
• Increased numbness or tingling
• Too much pain that is not helped by drugs you are taking
• You are not feeling better in 2 to 3 days or you are feeling worse
Teach Back: Helping You Understand
The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff,
tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly.
It also helps to explain things that may have been a bit confusing.
Before going home, make sure you are able to do these:
• I can tell you about my procedure.
• I can tell you how to care for my cut site.
• I can tell you what may help ease my pain.
• I can tell you what I will do if I have swelling, redness, or warmth around my wound or numbness or tingling.
• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf

C-Section (Cesarean Delivery) Discharge Instructions
About this topic
Cesarean birth is a surgical procedure used to deliver a baby. It is also called a C-section. The baby is taken out through a cut in the mother's belly.
A C-section may be planned or unplanned.

What care is needed at home?
• Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says.
This way you will know what you need to do.
• You can go home 3 to 4 days after the C-section. It may take 6 weeks before you fully recover.
• Talk to your doctor about how to care for your cut site. Ask your doctor about:
o When you should change your bandages
o How to care for your cut sites
o When you may take a bath or shower
o If you need to be careful with lifting things over the weight of your baby. Do not lift older children. Let the child climb into your lap.
o When you may go back to your normal activities like work, driving, or sex
• Always wash your hands before and after touching your cut site.
• You can expect some bleeding from your vagina for a few weeks. You may use pads but not tampons.
• Your bowel movements may take some time to get back to a normal pace. Eat small meals high in fiber to avoid hard stools.
• Make time for you and your partner to be alone and talk.
• Make time for you and your partner to enjoy your baby.
• Breastfeeding is good for the baby and for you.

What follow-up care is needed?
• Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits.
• You may have stitches or staples at your cut site. Some stitches dissolve on their own. Others need to be taken out.
Talk to your doctor to find out about your stitches or staples.

What drugs may be needed?
The doctor may order drugs to:
• Help with pain
• Fight an infection

Will physical activity be limited?
You may have to limit your activity. Talk to your doctor about the right amount of activity for you.

What problems could happen?
• Infection
• Wound opening
• Heavy blood loss
• Blood clots in your legs or lungs
• Upset stomach, throwing up, and very bad headache because of the anesthesia
• Low mood

When do I need to call the doctor?
• Signs of infection. These include a fever of 100.4°F (38°C) or higher, chills, pain with passing urine, wound that will not heal.
• Sudden shortness of breath or a sudden onset of chest pain could be a sign that a blood clot has traveled to your lungs. Go to the ER right away.
• Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched;
yellowish, greenish, or bloody discharge; foul smell coming from the cut site; cut site opens up.
• Problems with pain that does not go away or gets worse
• Swollen, hard, or painful breasts
• You feel very sad or depressed
• Problems passing urine or with bowel movements
• Sudden, large amounts of vaginal bleeding
Helpful tips
• Use a small pillow to put pressure on your cut site. This can make you more comfortable when you cough, laugh, or do other actions.
• Have people help with house work, cooking, and watching the baby. This will let you get lots of rest.
Teach Back: Helping You Understand
The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff,
tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly.
It also helps to explain things that may have been a bit confusing. Before going home, make sure you are able to do these:
• I can tell you about my procedure.
• I can tell you how to care for my cut site.
• I can tell you what I will do if I have large amounts of vaginal bleeding, swollen or painful breasts, or feel very sad or have a low mood.
• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf

C-Section (Cesarean Delivery) Discharge Instructions
About this topic
Cesarean birth is a surgical procedure used to deliver a baby. It is also called a C-section. The baby is taken out through a cut in the mother's belly. A C-section may be planned or unplanned.
What care is needed at home?
• Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do.
• You can go home 3 to 4 days after the C-section. It may take 6 weeks before you fully recover.
• Talk to your doctor about how to care for your cut site. Ask your doctor about:
o When you should change your bandages
o How to care for your cut sites
o When you may take a bath or shower
o If you need to be careful with lifting things over the weight of your baby. Do not lift older children. Let the child climb into your lap.
o When you may go back to your normal activities like work, driving, or sex
• Always wash your hands before and after touching your cut site.
• You can expect some bleeding from your vagina for a few weeks. You may use pads but not tampons.
• Your bowel movements may take some time to get back to a normal pace. Eat small meals high in fiber to avoid hard stools.
• Make time for you and your partner to be alone and talk.
• Make time for you and your partner to enjoy your baby.
• Breastfeeding is good for the baby and for you.

What follow-up care is needed?
• Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits.
• You may have stitches or staples at your cut site. Some stitches dissolve on their own. Others need to be taken out. Talk to your doctor to find out about your stitches or staples.

What drugs may be needed?
The doctor may order drugs to:
• Help with pain
• Fight an infection

Will physical activity be limited?
You may have to limit your activity. Talk to your doctor about the right amount of activity for you.
What problems could happen?
• Infection
• Wound opening
• Heavy blood loss
• Blood clots in your legs or lungs
• Upset stomach, throwing up, and very bad headache because of the anesthesia
• Low mood

When do I need to call the doctor?
• Signs of infection. These include a fever of 100.4°F (38°C) or higher, chills, pain with passing urine, wound that will not heal.
• Sudden shortness of breath or a sudden onset of chest pain could be a sign that a blood clot has traveled to your lungs. Go to the ER right away.
• Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge;
foul smell coming from the cut site; cut site opens up.
• Problems with pain that does not go away or gets worse
• Swollen, hard, or painful breasts
• You feel very sad or depressed
• Problems passing urine or with bowel movements
• Sudden, large amounts of vaginal bleeding
Helpful tips
• Use a small pillow to put pressure on your cut site. This can make you more comfortable when you cough, laugh, or do other actions.
• Have people help with house work, cooking, and watching the baby. This will let you get lots of rest.
Teach Back: Helping You Understand
The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff, tell them in your own words what you were just told.
This helps to make sure the staff has covered each thing clearly. It also helps to explain things that may have been a bit confusing. Before going home, make sure you are able to do these:
• I can tell you about my procedure.
• I can tell you how to care for my cut site.
• I can tell you what I will do if I have large amounts of vaginal bleeding, swollen or painful breasts, or feel very sad or have a low mood.
• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf

Carpal Tunnel Syndrome Discharge Instructions
About this topic
Your median nerve runs from your lower arm into your hand. If this nerve is squeezed at the wrist area, you may feel pain. You may also have weakness, tingling, or numbness in your hand and wrist. Swelling in this area puts pressure on the nerve and causes the signs. This is called carpal tunnel syndrome. The carpal tunnel is the small area in your wrist that the median nerve runs through. A tough band of tissues called a ligament holds everything in place over the carpal tunnel.
Carpal tunnel syndrome is a very common health problem. It is most often caused by doing hand or wrist movements over and over. It can also be caused by using the lower arm muscles too much. Doctors often try different treatments. If these do not work, surgery may be needed.
What care is needed at home?
• Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do.
• Rest your wrist and hand as much as possible. Do not do motions that make your problem worse.
• Place an ice pack or a bag of frozen peas wrapped in a towel over the painful part. Never put ice right on the skin. Do not leave the ice on more than 10 to 15 minutes at a time.
• Prop your hand on pillows to help with swelling.
• Wear a splint or wrist brace to keep your wrist from bending too much. It is a good idea to sleep with the brace on at night.
What follow-up care is needed?
• Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits. Your doctor may send you for tests such as a nerve conduction study, electromyogram, or x-ray.
• Your doctor may send you to see a specialist or a surgeon.
• Your doctor may send you to physical therapy (PT). The PT will teach you exercises to help you get back your strength and motion.
What drugs may be needed?
The doctor may order drugs to:
• Help with pain and swelling, like ibuprofen (Advil, Motrin). These are nonsteroidal anti-inflammatory drugs (NSAIDS).
• Help with pain, such as acetaminophen (Tylenol)
The doctor may give you a shot of an anti-inflammatory drug called a corticosteroid. This will help with swelling. Talk with your doctor about the risks of this shot.
Will physical activity be limited? You may need to rest your wrist for a while. You should not do physical activity that makes your health problem worse. Sometimes you have to do repeat movements with your hand for your job, sport, or hobby. You may have to change the way you do them or do them less often.
What problems could happen?
• Long-term hand numbness or weakness
• Grip weakness
• Loss of function in the hand
• Wound infection after surgery

What can be done to prevent this health problem?
• Avoid doing repeat movements with your wrist and hand, if you can. If you have to do repeat movements, take rest breaks often.
• If you sit at a computer, make sure your keyboard, mouse, desk, and chair are in the right positions so you do not put stress on the wrist.
Think about using a special mouse and keyboard that are made to protect your wrist and hand.
• If you have an assembly job, try alternating tasks, if possible.
• Avoid holding your wrist and hand in the same position for too long.
• Wearing splints or fingerless compression gloves may help:
o Keep the wrist straight
o Keep the muscles warm and flexible
o Prevent swelling
• Do gentle stretching exercises before doing tough movements with your wrist and hands.

When do I need to call the doctor?
• Signs of a very bad reaction. These include wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat. Go to the ER right away.
• Signs of infection. These include a fever of 100.4°F (38°C) or higher; chills; wound that will not heal; yellowish, greenish, or bloody discharge from a wound; or loss of feeling in the hand and wrist.
• More numbness in the hand
• Grip is weaker
• You are not feeling better in 2 to 3 days or you are feeling worse
Teach Back: Helping You Understand
The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff, tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly.
It also helps to explain things that may have been a bit confusing. Before going home, make sure you are able to do these:
• I can tell you about my condition.
• I can tell you what may help ease my pain and swelling.
• I can tell you what I will do if I have more numbness in my hand or my grip is weaker.
• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf

Coronary Artery Bypass Grafting Discharge Instructions
About this topic
Normally, you have many blood vessels that bring blood to the heart muscle. If one of them is blocked, your doctor will try to restore normal blood flow. This surgery uses another blood vessel to let the blood flow around the one with the blockage. You may have surgery on more than one blocked blood vessel. After surgery, you may have more blood flow to your heart muscle. This may lower your risk of heart attack or chest pain.
What care is needed at home? Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do.
Your doctor may want you to take part in a heart rehab program. This will help your healing and improve your heart function. Patients attend the program after their surgery a few days a week. The program teaches exercise and how to lower risk factors for heart disease and stress. It also can help you deal with the low mood that sometimes happens after surgery.
Be sure to follow your doctor's advice about:
• Wound care for your chest and other sites. Your doctor will tell you when or how often you will need to change your dressing. Be sure you know the signs to watch for and when to call your doctor.
• Showering. Do not to take a bath or swim until your doctor tells you it is OK. You may take a shower, but make sure that cut site is covered with plastic wrap so it will not get wet.
• Supporting your chest when you cough, sneeze, or laugh. Use a pillow or hug yourself to ease pain.
• Doing your coughing and breathing exercises.
• Walking and other exercises to help your healing.
• Quitting smoking. Talk with your doctor for help to stop smoking.
• Lowering stress. Find ways to cope with your stress or talk to your doctor about it.
• Taking drugs for high blood pressure, heart rhythm, blood thinning, and lowering cholesterol.
• Having blood tests and exams as ordered after the surgery.

What follow-up care is needed?
• Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits.
• If you have stitches or staples, you will need to have them taken out. Your doctor will often want to do this in 1 to 2 weeks.
• Your doctor may do some tests to check your overall progress. Your doctor may also change your drugs if needed. Together you can make a plan for more care.
What drugs may be needed?
The doctor may order drugs to:
• Lower cholesterol
• Help with pain
• Control blood pressure
• Keep heartbeat regular
• Prevent blood clots
• Prevent infection

Will physical activity be limited?
• You will have to limit your activity for 3 to 6 weeks. Your doctor will give you some precautions you need to follow. Talk to your doctor about the right amount of activity for you.
• Avoid driving for a few weeks until your doctor tells you it is allowed and you are no longer taking prescription pain drugs.
• Ask your doctor when to return to your normal activities like work and sex.
• Exercise often. Talk with your doctor about what exercise is safe for you. Be sure to ask your doctor before you start any new activities.

What changes to diet are needed?
Eat a heart healthy diet with foods low in fat, sugar, and salt. Eat high-fiber foods such as whole grains, fruits, and veggies. Ask your doctor to plan a visit with a dietician if you need help with your diet.

What problems could happen?
• Internal bleeding or bleeding at the cut site
• Infection
• Stroke or heart attack
• Pneumonia
• Blood clot in the lung
• Kidney failure

When do I need to call the doctor?
Activate the emergency medical system right away if you have signs of a heart attack or stroke. Call 911 in the United States or Canada. The sooner treatment begins, the better your chances for recovery.
Call for emergency help right away if you have:
• Signs of heart attack:
o Chest pain
o Trouble breathing
o Fast heartbeat
o Feeling dizzy
• Signs of stroke:
o Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
o Sudden confusion, trouble speaking or understanding
o Sudden trouble seeing in one or both eyes
o Sudden trouble walking, dizziness, loss of balance or coordination
o Sudden severe headache with no known cause

Call your doctor if you have:
• Signs of a very bad reaction. These include sudden shortness of breath or a sudden onset of chest pain; soreness or redness above or below your knee, more pain behind your calf; more swelling in your calf, foot, or ankle. Go to the ER right away.
• Signs of infection. These include a fever of 100.4°F (38°C) or higher; chills; redness, swelling, very bad sore throat, cough, more sputum or change in color of sputum, pain with passing urine, burning, urgency, and blood in the urine.
• Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge; foul smell coming from the cut site; cut site opens up.
• Any signs including pain, upset stomach, throwing up that does not go away even with drugs you are taking
• Rapid heart rate
• You are not feeling better in 2 to 3 days or you are feeling worse
Teach Back: Helping You Understand
The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff, tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly. It also helps to explain things that may have been a bit confusing.
Before going home, make sure you are able to do these:
• I can tell you about my procedure.
• I can tell you how to care for my cut site.
• I can tell you when I can go back to my normal activities.
• I can tell you what I will do if I have signs of an infection.
• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf

Coronary Artery Bypass Grafting Discharge Instructions
About this topic
Normally, you have many blood vessels that bring blood to the heart muscle. If one of them is blocked, your doctor will try to restore normal blood flow. This surgery uses another blood vessel to let the blood flow around the one with the blockage. You may have surgery on more than one blocked blood vessel. After surgery, you may have more blood flow to your heart muscle. This may lower your risk of heart attack or chest pain.
What care is needed at home?
Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do.
Your doctor may want you to take part in a heart rehab program. This will help your healing and improve your heart function. Patients attend the program after their surgery a few days a week. The program teaches exercise and how to lower risk factors for heart disease and stress. It also can help you deal with the low mood that sometimes happens after surgery.
Be sure to follow your doctor's advice about:
• Wound care for your chest and other sites. Your doctor will tell you when or how often you will need to change your dressing. Be sure you know the signs to watch for and when to call your doctor.
• Showering. Do not to take a bath or swim until your doctor tells you it is OK. You may take a shower, but make sure that cut site is covered with plastic wrap so it will not get wet.
• Supporting your chest when you cough, sneeze, or laugh. Use a pillow or hug yourself to ease pain.
• Doing your coughing and breathing exercises.
• Walking and other exercises to help your healing.
• Quitting smoking. Talk with your doctor for help to stop smoking.
• Lowering stress. Find ways to cope with your stress or talk to your doctor about it.
• Taking drugs for high blood pressure, heart rhythm, blood thinning, and lowering cholesterol.
• Having blood tests and exams as ordered after the surgery.

What follow-up care is needed?
• Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits.
• If you have stitches or staples, you will need to have them taken out. Your doctor will often want to do this in 1 to 2 weeks.
• Your doctor may do some tests to check your overall progress. Your doctor may also change your drugs if needed. Together you can make a plan for more care.

What drugs may be needed?

The doctor may order drugs to:
• Lower cholesterol
• Help with pain
• Control blood pressure
• Keep heartbeat regular
• Prevent blood clots
• Prevent infection

Will physical activity be limited?
• You will have to limit your activity for 3 to 6 weeks. Your doctor will give you some precautions you need to follow. Talk to your doctor about the right amount of activity for you.
• Avoid driving for a few weeks until your doctor tells you it is allowed and you are no longer taking prescription pain drugs.
• Ask your doctor when to return to your normal activities like work and sex.
• Exercise often. Talk with your doctor about what exercise is safe for you. Be sure to ask your doctor before you start any new activities.

What changes to diet are needed?
Eat a heart healthy diet with foods low in fat, sugar, and salt. Eat high-fiber foods such as whole grains, fruits, and veggies. Ask your doctor to plan a visit with a dietician if you need help with your diet.
What problems could happen?
• Internal bleeding or bleeding at the cut site
• Infection
• Stroke or heart attack
• Pneumonia
• Blood clot in the lung
• Kidney failure

When do I need to call the doctor?
Activate the emergency medical system right away if you have signs of a heart attack or stroke. Call 911 in the United States or Canada. The sooner treatment begins, the better your chances for recovery.
Call for emergency help right away if you have:
• Signs of heart attack:
o Chest pain
o Trouble breathing
o Fast heartbeat
o Feeling dizzy
• Signs of stroke:
o Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
o Sudden confusion, trouble speaking or understanding
o Sudden trouble seeing in one or both eyes
o Sudden trouble walking, dizziness, loss of balance or coordination
o Sudden severe headache with no known cause
Call your doctor if you have:
• Signs of a very bad reaction. These include sudden shortness of breath or a sudden onset of chest pain; soreness or redness above or below your knee, more pain behind your calf; more swelling in your calf, foot, or ankle. Go to the ER right away.
• Signs of infection. These include a fever of 100.4°F (38°C) or higher; chills; redness, swelling, very bad sore throat, cough, more sputum or change in color of sputum, pain with passing urine, burning, urgency, and blood in the urine.
• Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge; foul smell coming from the cut site; cut site opens up.
• Any signs including pain, upset stomach, throwing up that does not go away even with drugs you are taking
• Rapid heart rate
• You are not feeling better in 2 to 3 days or you are feeling worse
Teach Back: Helping You Understand
The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff, tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly. It also helps to explain things that may have been a bit confusing.
Before going home, make sure you are able to do these:
• I can tell you about my procedure.
• I can tell you how to care for my cut site.
• I can tell you when I can go back to my normal activities.
• I can tell you what I will do if I have signs of an infection.
• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf

Coronary Stenting Discharge Instructions
About this topic
You had a coronary stent placed in a vessel that takes blood to your heart muscle. You may have had a heart attack, heart failure, or chest pain before the procedure. This means you had a narrowed or blocked blood vessel. A stent will help keep a blood vessel open.
What care is needed at home?
• Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do.
• Talk to your doctor about how to care for your cut site. Ask your doctor about:
o When you should change your bandages
o When you may take a bath or shower
o If you need to be careful with lifting things over 10 pounds
o If you can walk up and down stairs
o When you can exercise
o When you may go back to your normal activities like work, driving, or sex
• Be sure to wash your hands before and after touching your wound or dressing.

What follow-up care is needed?
• Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits. You may need more tests or a change in your drugs.
• You may need to go to a special heart rehab program. This will help you get well more quickly and improve your heart function.

What drugs may be needed?
Take your drugs as ordered by your doctor. Do not skip doses or stop taking your drugs. You should keep taking them, even if you feel better. Also, avoid taking any other drugs unless you have already checked them with your doctor. These include over-the-counter (OTC) drugs and herbal supplements. Always check with your doctor first.
The doctor may order drugs to:
• Thin the blood
• Help with pain
• Help your heart

Will physical activity be limited?
You may have to limit your activity. Talk to your doctor about the right amount of activity for you.
What changes to diet are needed?
Eat a heart healthy diet. Ask your doctor or dietitian about a proper food plan. Stay away from fatty foods and fast food.

What problems could happen?
• Internal bleeding or bleeding at the cut site
• Damage to the blood vessel
• Allergic reaction or kidney failure from the dye used
• Blood clot in the stent
• Irregular heartbeat
• Heart attack
• Stroke
• Death
• The arteries become blocked again. This is called restenosis.

What can be done to prevent this health problem?
These may help keep your heart problem from getting worse:
• Keep a healthy weight.
• Do not smoke or use other tobacco products.
• Work with your doctor to control your cholesterol level and blood pressure.
• Eat a healthy diet low in saturated fats and salt.
• Limit how much beer, wine, and mixed drinks (alcohol) you drink.
• Exercise as advised by your doctor.
• If you have diabetes, control your blood sugars with diet, exercise, drugs, and insulin as directed by your doctor.
• Manage stress through techniques like meditation, yoga, or tai chi.
• Ask your doctor what else you can do or change to live a healthier life.

When do I need to call the doctor?
Activate the emergency medical system right away if you have signs of a heart attack or stroke. Call 911 in the United States or Canada. The sooner treatment begins, the better your chances for recovery.
Call for emergency help right away if you have:
• Signs of heart attack:
o Chest pain
o Trouble breathing
o Fast heartbeat
o Feeling dizzy
• Signs of stroke:
o Sudden numbness or weakness of the face, arm, or leg, especially on one side of the body
o Sudden confusion, trouble speaking or understanding
o Sudden trouble seeing in one or both eyes
o Sudden trouble walking, dizziness, loss of balance or coordination
o Sudden severe headache with no known cause
Call your doctor if you have:
• Signs of infection. These include fever of 100.4°F (38°C) or higher, chills.
• Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge; foul smell coming from the cut site; cut site opens up.
• Arm, hand, leg, or foot is numb, painful, swollen, cool, or looks a different color
• Fainting or feel very tired
• You are not feeling better in 2 to 3 days or you are feeling worse
• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf

Hemorrhoidectomy Discharge Instructions
About this topic
Large, bulging blood vessels in and around the anus and rectum are called hemorrhoids. They can be found inside your body or on the outside.
You may need to have a procedure done if your hemorrhoids:
• Are bleeding a lot.
• Are very painful.
• Have a blood clot. This is a thrombosed hemorrhoid.
• Are coming out through the anus. This is a prolapsed hemorrhoid.

What care is needed at home?
• Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do.
• Apply creams or ointments as directed by your doctor.
• Wash your hands before and after applying creams and ointment.
• Ask your doctor about when it is safe to shower, bathe, or soak in water. If your doctor says it is OK, take sitz baths as suggested.
Sit in 2 to 3 inches of warm water in the tub for 10 to 15 minutes each time. Do this 3 to 4 times a day. Carefully wipe your bottom afterwards.
• Move your bowels as soon as you feel the urge. Do not strain, bear down, or hold your breath during a bowel movement.
• Use a stool softener. Do not let yourself get constipated.
• Do not sit on the toilet for long periods of time.

What follow-up care is needed?
Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits.

What drugs may be needed?
The doctor may order drugs to:
• Help with pain and swelling
• Prevent infection
• Soften stools
Will physical activity be limited?
Avoid heavy lifting for 2 to 3 weeks. Talk to your doctor about when you can return to work and your normal level of activity.
What problems could happen?
• Infection
• Bleeding
• Hard stools
• Return of hemorrhoids

What can be done to prevent this health problem?
• Drink 8 to 10 glasses of fluids each day.
• Eat lots of high-fiber foods like fruits, vegetables, beans, and whole grains.
• Work out often.

When do I need to call the doctor?
• Signs of infection. These include a fever of 100.4°F (38°C) or higher, chills, pain with passing urine.
• Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge; foul smell coming from the cut site; cut site opens up.
• Not able to have a bowel movement
• Hard stools
• You are not feeling better in 2 to 3 days or you are feeling worse
Teach Back: Helping You Understand
The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff, tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly. It also helps to explain things that may have been a bit confusing.
Before going home, make sure you are able to do these:
• I can tell you about my procedure.
• I can tell you what changes I need to make with my diet or activities.
• I can tell you what I will do if I have a fever; swelling, redness, or warmth around my wound; or trouble having a bowel movement.
• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf

Hysterectomy Discharge Instructions
About this topic
The uterus is a female organ where the baby grows during pregnancy. The uterus is also called the womb. The womb is in the lower belly between the bladder and the rectum. Women have two ovaries. The ovaries are almond-shaped organs that make the eggs to make a baby. The ovaries also control your menstrual cycle. Women also have two fallopian tubes. The eggs travel down the tube to reach the uterus or womb.
A hysterectomy is done to remove the uterus. Your cervix, which is the lower part of the womb that connects to the vagina, may also be removed. Sometimes, the ovaries or tubes are also taken out. Talk with your doctor to be sure you know what was removed.
What care is needed at home?
• Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not know what you need to do.
• Talk to your doctor about how to care for your cut site. Ask your doctor about:
o When you should change your bandages
o When you may take a bath or shower
o If you need to be careful with lifting things over 10 pounds
o When you may go back to your normal activities like work, driving, or sex.
• Your bowel movements may take some time to get back to normal. Eat small meals high in fiber. Drink 6 to 8 glasses of water each day to avoid hard stools.
• Use a small pillow to put pressure on your belly. The pressure can make you more comfortable when you cough, laugh, or do other actions.
• You can expect some bleeding from your vagina for a few weeks. You may use sanitary pads but not tampons.
• You can wash between your legs with soap and water. Most often, it is OK to start this 24 hours after your surgery.

What follow-up care is needed?
• Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep your visits.
• You may have stitches or staples. If so, your doctor will often want to remove the stitches or staples in 1 to 2 weeks.
• Your doctor will tell you if you need other drugs like hormone therapy. You may need lubricants for sex if your hormones have changed. Talk to your doctor about changing hormone levels.
• If your fallopian tubes and ovaries were removed with the hysterectomy, your doctor will tell you if you need other drugs like hormone therapy. What drugs may be needed?
The doctor may order drugs to:
• Help with pain
• Prevent infection
• Stop bleeding
• Replace hormones

Will physical activity be limited?
Rest for the first few days after the procedure. Avoid activities like heavy lifting and hard exercise. Talk to your doctor about the right amount of activity for you.
What problems could happen?
• Infertility if the uterus was removed
• Infection
• Wound opening
• Bleeding
• Blood clots in your legs or lungs
• Injury to nearby organs
• Menopause
• Low mood
• Problem controlling urine
• Problems with sex

When do I need to call the doctor?
• Signs of infection such as a fever of 100.4°F (38°C) or higher, chills, pain with passing urine, wound that will not heal, or anal itching.
• Signs of wound infection such as swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge; foul smell coming from the cut site; cut site opens up.
• Lots of blood in your sanitary pads or more than 6 soaked pads per day.
• Upset stomach, throwing up, or very bad belly pain
• No bowel movement after 3 days
• You feel the need to pass urine but it will not come out even after 6 hours
• Smelly green or dark yellow vaginal discharge
• Low mood
Teach Back: Helping You Understand
The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff, tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly. It also helps to explain things that may have been a bit confusing.
Before going home, make sure you are able to do these:
• I can tell you about my procedure.
• I can tell you how to care for my cut site.
• I can tell you what I will do if I have swelling, redness, or warmth around my wound.
• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf

Laminectomy Discharge Instructions
About this topic
The backbone or spine is made of many small bones called vertebrae. The spinal cord is inside of these bones. The nerves that go to other parts of your body exit in between the bones. The spinal bones are separated by spongy discs that help the vertebrae move smoothly.
Pressure on the nerves as they come out of the backbone may cause you to have pain in your back, arms, or legs. You may also have numbness or weakness. The pressure can come from many things such as:
• Discs between your vertebrae can become flat or thinner as we get older
• Injury may also damage the disc.
• Extra area of bone may grow on the vertebrae. These are called bone spurs.
• Ligaments, or strong bands of tissue that connect bones together, get larger as we age and can narrow the space where nerves come out of the spine.
The lamina is on the back part of the spinal bone that surrounds the spinal cord. Back surgery to take off this part of the bone from the vertebrae is a laminectomy. This surgery will give the discs and nerves more space. The goal is to prevent any more damage from happening. Your doctor will do this surgery only after other treatments, such as drugs and physical therapy, have been tried first.
What care is needed at home?
• Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do.
• Place an ice pack or a bag of frozen peas wrapped in a towel over the painful part. Never put ice right on the skin. Do not leave the ice on more than 10 to 15 minutes at a time.
• Your may need a back brace when you get home. Talk to your doctor about when you need to wear your brace and how long your brace will be needed.
• You may need physical therapy. Your physical therapist will teach you the proper way of moving to protect the spine.
• Talk to your doctor about how to care for your cut site. Ask your doctor about:
o When you should change your bandages
o When you may take a bath or shower
o If you need to be careful with lifting things over 10 pounds
o If you need to be careful twisting or turning
o When you may go back to your normal activities like work or driving
• Get lots of rest. Sleep when you are feeling tired. Avoid doing tiring activities.
• Sleep on a comfortable mattress that supports your back.
• When sleeping, practice good posture. Sleep on your side with a pillow between your knees or on your back with a pillow under your knees. Use a moderately firm pillow under your head to keep the shape of your spine.
• Take a few short walks each day. Slowly build up the time you walk each time.

What follow-up care is needed?
• Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits. You may need to have more x-rays.
• If you have stitches or staples, you will need to have them taken out. Your doctor will often want to do this in 1 to 2 weeks.
• You may need to see a physical therapist (PT). The PT will teach you exercises to help you get back your strength and motion.
What drugs may be needed?
Your doctor may order drugs to:
• Help with pain
• Prevent infection

Will physical activity be limited?
• You may have to limit your activity. Talk to your doctor about the right amount of activity for you. If you run, work out, or play sports, you may not be able to do those things until your doctor tells you to.
• Many people can return to a desk job in a few days to a few weeks. Often people can return to normal activities in 2 to 3 months.
What problems could happen?
• Infection
• Nerve damage
• Blood clots
• Bleeding
• Tear of the covering around the nerves called a dural tear
• Bones do not heal well or you still have pain after the surgery

What can be done to prevent this health problem?
• Do weight-bearing and strengthening exercises as directed by your doctor or therapist.
• Keep a healthy weight. This can help prevent straining and pressure on your lower back.
• Practice good ways to lift things so that you do not hurt your spine. Part of your physical therapy will be to teach you safe ways to move and lift things.
• Quit smoking. Smoking reduces the oxygen supply to the discs in your back which can cause more bone collapse.
• Reduce stress and worry. Stress can make your muscles tense and increase back pain.

When do I need to call the doctor?
• Signs of infection. These include a fever of 100.4°F (38°C) or higher, chills, pain with passing urine or not able to pass urine.
• Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge; foul smell coming from the cut site; cut site opens up.
• Very bad pain
• Trouble breathing or swallowing liquids
• Weakness or numbness in your arms, legs, back, or buttocks
• Problem with walking, standing, or moving
• Problem passing urine or loss of bowel or bladder control
• You are not feeling better in 2 to 3 days or you are feeling worse
Teach Back: Helping You Understand
The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff, tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly. It also helps to explain things that may have been a bit confusing.
Before going home, make sure you are able to do these:
• I can tell you about my procedure.
• I can tell you what may help ease my pain.
• I can tell you what changes I need to make with my activities.
• I can tell you what I will do if I have very bad pain; weakness or numbness in my arms, legs, back, or buttocks; or problems with walking, standing, or moving.
• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf

Pilonidal Cyst Discharge Instructions
About this topic
A pilonidal cyst happens at the base of the tailbone. This is where the crack in the buttocks begins. The cyst is most often filled with pieces of hair and skin. The area may become sore and swollen. Fluid may drain from the cyst. If the cyst is infected, it is called a pilonidal abscess.
Then, it also fills with pus. The area may be more painful and red. You may have a fever and upset stomach.
To treat an infected cyst, your doctor will make a small cut in the skin to drain it. Sometimes, the doctor will remove the whole cyst at one time. The doctor will also remove any hair and pus. More surgery may be needed to treat a problem that keeps coming back.
What care is needed at home?
• Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do.
• If you had a procedure to done, talk to your doctor about how to care for your cut site. Ask your doctor about:
o When you should change your bandages
o If you have packing in place, how to care for it
o When you may take a bath or shower
• Be sure to wash your hands before and after touching your wound or dressing.

What follow-up care is needed?
Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits.

What drugs may be needed?
Your doctor may order drugs to:
• Help with pain and swelling
• Prevent or fight an infection

Will physical activity be limited?
You may have to limit your activity based on your treatment. Talk with your doctor about the right amount of activity for you.

What problems could happen?
• Infection
• Cyst may come back

When do I need to call the doctor?
• Signs of infection. These include a fever of 100.4°F (38°C) or higher, chills.
• Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge; foul smell coming from the cut site; cut site opens up.
• Signs that the cyst is returning, such as redness, swelling, drainage from the skin, or pain when you put pressure on the area
Teach Back: Helping You Understand
The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff, tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly. It also helps to explain things that may have been a bit confusing.
Before going home, make sure you are able to do these:
• I can tell you about my condition.
• I can tell you how to care for my cut site.
• I can tell you what I will do if I have swelling, redness, or warmth around my wound.
• I can tell you what I will do if I think the cyst is returning.

• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf

Shoulder Replacement Discharge Instructions
About this topic
Three bones make up your shoulder joint. These are the upper arm bone, the shoulder blade, and the collarbone. The shoulder is a “ball and socket" joint. The “ball" part of the joint is the top part of your upper arm bone. The “socket" part of your joint is a cup shaped indentation in your shoulder blade. A smooth tissue called cartilage lines the ends of the bones. This helps the joint glide easier. Four muscles called the rotator cuff surround the joint. They help with movement and stability.
With normal wear and tear or other problems, the cartilage can wear down. Then, the joint can become damaged. This can lead to pain and loss of motion. Surgery may be done when PT and drugs for pain have not helped and the problem gets worse. In a shoulder replacement surgery, the ball or both the ball and the socket are replaced with man-made parts.
What care is needed at home?
• Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do.
• Take all your drugs as ordered by your doctor.
• Place an ice pack or a bag of frozen peas wrapped in a towel over the painful part. Never put ice right on the skin. Do not leave the ice on more than 10 to 15 minutes at a time. Do this a few times a day.
• Prop your arm on pillows. Keep it raised above the level of your heart to help with swelling.
• Wear your sling to keep the shoulder supported. Your doctor will tell you for how long you need to wear it.
• Do the exercises that your physical therapist shows you. It is important to do these to get full recovery of your shoulder.

• Talk to your doctor about how to care for your cut site. Ask your doctor about:
o When you should change your bandages
o When you may take a bath or shower
o If you need to be careful with lifting things over 10 pounds
o When you may go back to your normal activities like work, driving, or sex
• Be sure to wash your hands before and after touching your wound or dressing.

What follow-up care is needed?
• Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits.
• If you have stitches or staples, you will need to have them taken out. Your doctor will often want to do this in 1 to 2 weeks.
• You may also need to see a physical therapist (PT). The PT will teach you exercises to help you get back your strength and motion.

What drugs may be needed?

The doctor may order drugs to:
• Help with pain and swelling
• Prevent infection

Will physical activity be limited?
You will need to wear a sling for 2 to 4 weeks after surgery. You will also need to go to PT for the next 4 to 6 weeks. It may take 2 to 4 months before you will be able to return to your normal daily activities. Your doctor may suggest that you avoid activities that can have heavy impact on or stress the joint. Activities that should be avoided are contact sports, overhead throwing sports, chopping wood, and heavy lifting. Ask your doctor if it is safe to swim or play tennis or golf.

What problems could happen?
• Infection
• Bleeding
• Ongoing pain and stiffness
• Nerve or blood vessel injury
• Hardware failure or loosening of hardware
• Allergic reaction to metal plates and screws

What can be done to prevent this health problem?
Stay active and work out to keep your muscles strong and flexible.

When do I need to call the doctor?
• Signs of infection. These include a fever of 100.4°F (38°C) or higher, chills, wound that will not heal.
• Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge; foul smell coming from the cut site; cut site opens up.
• Increased numbness or tingling in the arm and hand
• Hand feels cold
• Health problem is not better or your are feeling worse
Teach Back: Helping You Understand
The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff, tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly. It also helps to explain things that may have been a bit confusing.
Before going home, make sure you are able to do these:
• I can tell you about my procedure.
• I can tell you what may help ease my pain.
• I can tell you how to care for my cut site.
• I can tell you what I will do if I have more pain, numbness, or tingling, or my fingers are cool or blue.
• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf

Total Hip Replacement

Why is this procedure done?
The hip joint is a “ball and socket" joint. The “ball" part of the joint is the top part of the thigh bone. It is the femoral head. The “socket" is a part of the pelvic bone. The “ball” fits into a groove called the acetabulum. Cartilage covers the parts of the joint in a normal hip. This lets the hip glide easily. The cartilage can become worn and cause bone to rub on other bone. This often leads to pain, stiffness, and trouble walking. Sometimes, drugs and exercises can help you with the pain. When they stop working, you may need hip joint replacement (arthroplasty) surgery.
What will the results be?
• Less pain
• More movement in your hip
• Easier to walk and do other daily activities

What happens before the procedure?
• A few weeks or days before the surgery, your doctor may have you:
o Get some tests to make sure you are healthy enough for surgery.
o Meet with a physical therapist. You may learn exercises for after surgery. You may also learn how to use crutches or a walker.
o Get some exercises from your doctor so you can start before the surgery.
o Donate blood in case you need a blood transfusion.
o Stop smoking if you are a smoker.
o Avoid beer, wine, and mixed drinks (alcohol) at least 48 hours before the surgery.
o Stop taking some drugs. Be sure to tell your doctor about all the drugs you are taking including herbals and supplements.
• The night before your surgery, you will need to stop eating and drinking at midnight.

What happens during the procedure?
• Once you are in the operating room, the staff will put an I.V. in your arm to give you fluids and drugs. You will be given a drug to make you sleepy. It will also help you stay pain free during the surgery.
• Your doctor will make a cut in your outer hip/upper thigh.
• Your doctor will next remove all the damaged parts of the joints and replace them with man-made parts. These are the implants or prostheses.
• Your doctor may put in a drain to get rid of some fluid at the site.
• Your doctor will close your cut with stitches or staples and cover it with clean bandages.
• The procedure will take about 2 hours.

What happens after the procedure?
• You will go to the Recovery Room and the staff will watch you closely. You may have to stay in the hospital for 1 to 2 days.
• Within a day or two, you will get out of bed to a chair. The staff will help you start to walk around. Doing coughing and deep breathing exercises will help keep your lungs clear. You will get drugs to help with your pain.
• The staff will look at your wound and may need to clean the site.
• You will have long, tight socks to put on or a cuff put on your leg that is hooked up to a machine. Either of these will keep the blood flowing to avoid blood clots.
• Most of the time, you will start physical therapy (PT) the same day. Sometimes, you start the day after surgery. Your doctor will let you know how much weight you can put on your operated leg. You will need to use a walker or crutches to help you walk.
• Most people stay in the hospital for 1 to 2 days.

What drugs may be needed?
The doctor may order drugs to:
• Help with pain
• Prevent blood clots
• Prevent infection
• Help with other problems you may have like trouble sleeping or hard stools
What problems could happen?
• Dislocation − it is important to keep from doing some movements. These can cause the hip joint to move out of the socket. Follow these hip precautions:
o Do not bend your hip past 90 degrees. Take care so you don't lean forward while sitting or lying down.
o Keep your legs from turning in or out.
o Avoid crossing your legs or ankles.
o Avoid kneeling.
o Don't cross your legs at the knees for at least 8 weeks.
o Don't bring your knee up higher than your hip.
• Blood clot or DVT (deep vein thrombosis) − To avoid these, your doctor may ask you to do ankle pumping exercises. Your doctor also may order blood thinning drugs or compression stockings.
• Lung infection − Taking deep breaths can help keep you from getting a lung infection. Take at least 10 deep breaths each hour while you are awake.
• Infection − Be sure to take all drugs as ordered.
• Other problems during or after surgery may include broken bones, nerve or blood vessel damage, bleeding, the chance of the leg not being the same length as the other leg, or loosening of the prosthesis.
Where can I learn more?
American Academy of Orthopaedic Surgeons
http://orthoinfo.aaos.org/topic.cfm?topic=A00572
National Institute of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov/Health_Info/Hip_Replacement/default.asp
National Institute of Health − Senior Health
http://nihseniorhealth.gov/hipreplacement/whoneeds/01.html
Consumer Information Use and Disclaimer
This information is not specific medical advice and does not replace information you receive from your health care provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or life-style choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider's advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

Total Knee Replacement Discharge Instructions
About this topic
The knee joint is the largest joint in the body and has a number of parts. Cartilage covers parts of the joint in a normal knee. This smooth tissue lets the joint move easily. The cartilage can become worn and cause bone to rub on other bone. This might happen from damage due to wear and tear over time or from an injury. This often leads to pain, stiffness, and trouble walking. Sometimes, drugs and exercises can help you control the pain. When they stop working, you may need knee joint replacement (arthroplasty) surgery.
The doctor replaces your diseased or injured knee joint with a new one. Metal and plastic parts replace your natural knee joint.
What care is needed at home?
• Ask your doctor what you need to do when you go home. Make sure you ask questions if you do not understand what the doctor says. This way you will know what you need to do.
• You may need to have someone help you at home for the first few weeks.
• Keep your house safe and clutter-free. This will make it safer for you to walk.
• Sometimes, the doctor orders a nurse to visit you at home. Physical therapists can also come to your home to help with exercises.
• Take your drugs as ordered by your doctor.
• Sit or lie with your leg above the heart level. This will help with swelling and pain.
• Place an ice pack or a bag of frozen peas wrapped in a towel over the painful part. Never put ice right on the skin. Do not leave the ice on more than 10 to 15 minutes at a time.
• Protect your leg from injury. Be sure to use your crutches or walker. Do not put too much weight on your injured leg.
• Talk to your doctor about how to care for your cut site. Ask your doctor about:
o When you should change your bandages
o How to care for your cut sites
o When you may take a bath or shower
o When you can go back to your normal activities like work or driving

What follow-up care is needed?
• Some people are not ready to go straight home after surgery. You may need to go to a rehab or skilled nursing facility for more therapy.
• Your doctor may ask you to make visits to the office to check on your progress. Be sure to keep these visits.
• When you are able to leave your home, you may need more physical therapy (PT) at an outpatient clinic.
• If you have stitches or staples, you will need to have them taken out. Your doctor will often want to do this in 1 to 2 weeks.
• An x-ray test may be taken at the doctor's office after surgery to check on how the bones are healing.

What drugs may be needed?
The doctor may order drugs to:
• Help with pain and swelling
• Fight an infection
• Prevent blood clots

Will physical activity be limited?
• You will need to use a device to help you walk, such as a walker or crutches. Follow your doctor's orders on how much weight you can put on your operated leg. This can range from no weight-bearing to full weight-bearing.
• You will be able to do more as you get stronger. Your physical therapist can talk with you about a walking program. Most often, you should limit stair climbing to one flight of stairs per day when you first return home.
• Ask your doctor when you will be able to drive again.
• Ask your doctor when you can have sex. Once your doctor tells you that it is OK, do not put full weight on your knee joint. To keep stress off the joint, lie on your back and have your partner support his/her weight.

What problems could happen?
• Fracture
• Nerve or blood vessel injury
• Bleeding
• Leg not the same length as the other leg
• Blood clot or DVT (deep vein thrombosis)
• Lung infection
• Infection
• Stiff joints

What can be done to prevent this health problem?
Keep a healthy weight and lead an active lifestyle. These can help lessen the stress put on your knee joint.

When do I need to call the doctor?
Go to the ER right away if you have:
• Sudden shortness of breath, sudden onset of chest pain, breathing problems, pain or tenderness in your calf.

Call your doctor for:
• Signs of infection. These include a fever of 100.4°F (38°C) or higher, chills, very bad sore throat, ear or sinus pain, cough, more sputum or change in color of sputum, pain with passing urine, mouth sores, or wound that will not heal.
• Signs of wound infection. These include swelling, redness, warmth around the wound; too much pain when touched; yellowish, greenish, or bloody discharge; foul smell coming from the cut site; cut site opens up.
• Blood is soaking through your bandages
• Pain is not helped by taking drugs
• Pain or swelling in your calf muscles
• Your toes or foot look dark in color or feel cool to the touch
Helpful tips
• Do not sit in low chairs. Higher chairs with firm cushions will be easier to get out of.
• A raised toilet seat in the bathroom can help you to get up and down easier.
• When getting up from any surface, push up on the chair, bed, or toilet seat and then grab the walker once you are standing. Pulling up on the walker may cause it to tip and you to fall.
• When going up and down steps, always go up with your stronger leg first. When going down steps, lead with your operated leg.
• Do not turn (pivot) using your operated leg.
• For bathing, a tub bench may be helpful.
• Make sure all hand rails are secure in your home. Grab bars in the shower or near the toilet may be helpful.
• Using special tools like a reacher, long-handled sponge, sock aid, long-handled shoe horn may make your daily activities easier.
• Do not lift heavy objects.
• Always let your dentist know that you have had joint replacement surgery. You will need to take an antibiotic drug before every dental procedure for the rest of your life.
Teach Back: Helping You Understand
The Teach Back Method helps you understand the information we are giving you. The idea is simple. After talking with the staff, tell them in your own words what you were just told. This helps to make sure the staff has covered each thing clearly. It also helps to explain things that may have been a bit confusing.
Before going home, make sure you are able to do these:
• I can tell you about my procedure.
• I can tell you how to care for my cut site.
• I can tell you what may help ease my pain.
• I can tell you what I will do if I have more pain or my foot is cool to the touch.
• Where can I learn more?
• Journal of the American Medical Association
• http://jama.ama-assn.org/content/305/20/2130.full.pdf