Hip Replacement Patient Notebook - Christiana Care Health System

Notebook for Hips

Notebook for Hips
Christiana Care
Center for Advanced Joint
Replacement
Your surgery date: __________________________________________________________________
Return to your orthopedic physician for your final pre-operative check up on:
_______________________________________________________________ at ________________ .
Please Bring This Book With You To:
■ Every office visit.
■
■
■
■
Your physical therapy evaluation before surgery.
Your hospital joint replacement information class.
The hospital on admission.
All physical therapy visits after hospital discharge.

Welcome
Thank you for choosing the Center for Advanced Joint Replacement to help bring back a
higher quality of living to your life with a new joint. We were recognized as a Magnet
facility in 2010 and the Joint Commission recognized our program in 2011 with the
designation of “Disease Specific Certification”. We are very proud of these awards that
show we are meeting our pledge to you to give the best care possible.
We are patient and family centered, during your stay we work as a team to meet your
needs. We will also include your family or whomever you tell us is important to be there
to support you if you wish.
Every year, more than 700,000 people have total joint replacement surgery in our country.
Total knee replacement patients usually recover quickly. Most patients are out of bed and
walking the same day as their surgery. Generally, you may return to driving in two to
four weeks, dance in four to six weeks and golf in six to twelve weeks. However, your
rate of recovery will depend on what your activity was before surgery, everyone is
different.
We have a planned course for your care. We believe that you play a key role to a
successful recovery. We will involve you through each step. This patient guide will give
you the necessary information needed for a safe and successful recovery.
Your health care team will include:
■ YOU!
■ Your family
■ Doctors
■ Doctor assistants
■ Nurses
■ Patient care technician
■ Physical therapists
■ Occupational therapists
Every part, from before surgery (pre-operative) teaching to after surgery (post-operative)
exercises, will be reviewed with you. Together we will plan your treatment program and
guide you through it.
The Purpose of the Notebook
For the best results preparation, education, and a pre-planning what will happen when
you go home (discharge) is needed. Communication is important; this notebook is a tool
for you to review with your doctors, physical therapists, occupational therapists, and
nurses. It will help you know:
■ What to expect every step of the way.
■ What you need to do.
■ How to care for your new joint for life.
Remember this is just a guide. Your doctor, nurse or therapist may add to or change any
of the recommendations. Always use their recommendations first and ask questions if
you are unsure. Keep your notebook handy for at least the first year after your surgery.
Take your Notebook with you to the hospital, rehab/subacute facility, outpatient physical
therapy and all your doctor visits.
Take your Notebook with you to the hospital, rehab/subacute facility, outpatient physical
therapy and all physician visits.

Overview of Christiana
Care’s Center for Advanced
Joint Replacement
The Center for Advanced Joint Replacement has dedicated centers located within
Christiana and Wilmington Hospitals.
The program includes:
■ A case manager who organizes all preoperative and discharge planning.
■ A pre-operative physical therapy evaluation.
■ A pre-operative education class.
■ Nurses who dedicate themselves to the care of joint replacement patients.
■ Physical therapists who help get you moving again: from getting out of bed to climbing
stairs.
■ Group activities as well as personal care.
■ A special lunch for you and your coach on the second day after your surgery.
■ Occupational therapist to make sure you can care for yourself.
■ Family and friends are encouraged to participate as coaches in your recovery process. We
will teach them how to help you.
■ Organized care when you leave the hospital.

Role of the Center for
Advanced Joint Replacement
Case Manager
The Center for Advanced Joint Replacement case manager will be responsible for your care
needs from the pre-operative course through discharge.
Your case manager will:
■ Take your medical history by phone.
■ Consider your needs at home including someone to help you when you go home and order
any equipment you may need.
■ Help you understand and plan for your special needs: special anesthesia needs or medical
clearance for surgery.
■ Coordinate your hospital care with the other Total Joint Team members.
■ Work with your insurance provider to get answers to insurance questions.
■ Coordinate your plan when you leave : to home with help; to an outpatient physical therapy
facility or to home health services. Consult with a social worker if a rehab/subacute facility is
needed.
■ Act as your contact throughout your treatment.
Shortly after your surgeon’s office has scheduled your surgery you will called by the a case
manager who will:
■
■
■
coordinate your care before surgery between your doctors’ offices, the hospital and any
testing, if needed.
Arrange with you a schedule for both the pre-operative physical therapy evaluation and the
joint replacement class.
Answer questions.
You can reach a case manager :
Monday through Friday between 8 a.m. and 4 p.m.
You may call the case manager at any time to ask questions or concerns about your
surgery. If the case manager is not there, you may leave a message for a return telephone call.
Center for Advanced Joint Replacement cas manager
Case manager for Wilmington Hospital patients: 302-428-2460
Case manager for Christiana Hospital patients: 302-428-2430
Secretary: 302-428-4377
Fax: 302-428-4644

About Total Hip Surgery
and FAQs
We are glad you have chosen the Center for Advanced Joint Replacement to care for your
hip problem. Below is a list of the most often asked questions along with their answers. This
notebook gives added information. If your have any other questions, please ask your
surgeon or the Center for Advanced Joint Replacement case manager. Our goal is for you to
be fully informed about this procedure.
What is arthritis and why does my hip hurt?
In the hip joint there is a layer of smooth cartilage on the
ball of the upper end of the thigh bone (femur) and
another layer within your hip socket. This cartilage
serves as a cushion and lets smooth motion of your hip.
Arthritis is a wearing away of this cartilage. This wears
down to your bone. Rubbing of bone against bone
causes pain, swelling and stiffness.
What is a total hip replacement?
A total hip replacement is an operation that removes the
ball of the upper thigh bone (femur) as well as harmed
cartilage from your hip socket. The ball is replaced with a
metal ball that is fixed solidly inside the thigh bone.
BEFORE: Raw bone
rubbing on raw bone
AFTER: A new
surface creates a
smooth functioning
joint
The socket is replaced with a plastic liner that is most often fixed inside a metal shell. This
makes a smoothly working joint that does not hurt.
When should I have this type of surgery?
Your orthopedic surgeon will decide if you may have the surgery. This will be based on
your history, exam, X-rays and response to treatment that has been tried to now. Your
surgeon will ask you to decide if your pain, stiffness and inability to do the things you wish
warrant having surgery.
Am I too old for this surgery?
Age is not a problem if you are in reasonable health and have the wish to keep on living a
productive, active life. You will be asked to see your personal doctor for his/her opinion
about your general health before your surgery.

FAQs about
Total Hip Surgery
How long will my new hip last and can a second replacement be done?
We expect most hips to last more than 10-15 years. But there is no guarantee and 5-10
percent may not last that long. A second replacement may be needed.
Why do they fail?
The most common reason for failure is loosening of the artificial ball where it is set in the
thigh bone, or loosening of the socket. Wearing of the plastic spacer may also result in the
need for revision.
What are the major r isks?
Most surgeries go well, without any problems. Infection and blood clots are two potential
serious complications. To skirt these problems, we take special precautions in the operating
room to lower the risk of infection and we use antibiotics and blood thinners post
operatively. The chances of these happening in your lifetime are one percent or less. Having
your hip joint fall out of place after surgery is also a potential problem. Your orthopedist
and
PT will talk ways to lower that risk.
Should I exercise before the sur gery?
Yes. You should talk about physical therapy/exercise choices with your surgeon. Exercises
should begin as soon as possible.
Will I need blood?
You may need blood after the surgery. You may:
(1) Donate your own blood, if you can, (ask your doctor his/her choice)
(2) Use the community blood bank supply.
When will I be able to get out of bed?
Your surgeon will ask that you get out of bed the day of your surgery. The next morning
you will get up, sit in a chair or recliner and walk with a walker with help from our staff.
Most patients will get out of bed the day of surgery.
How long will I be in the hospital?
Most patients will be in the hospital for 2-3 days after their surgery. Before your surgery set
up to have someone stay with you for a minimum of 3 days when you go home from the
hospital.
How do I make ar rangements for surgery?
After your surgeon has scheduled your surgery, the Center for Advanced Joint Replacement
case manager will call and guide you through the program. The role of the case manager is
described in this notebook. The case manager’s phone number is 302-428-2460.

How long does the surgery take?
We say roughly two to two and a-half hours for surgery.
What are my anesthesia options?
You may have a general anesthetic which most people call "being put to sleep." Some patients
have a spinal anesthetic. The choice is between you and the anesthesiologist. For more
information read “Anesthesia” in the FYI section of your notebook.
Will I have pain after surgery?
Yes, but we will keep you comfortable. Generally most patients are able to stop strong
medication within one day. The day of surgery, most patients control their own medicine with
a special pump that delivers medication directly into their IV. Your surgeon will talk with you
what pain control option is best for you. For more information read about Patient Controlled
Analgesia (PCA) in the FYI section of your notebook.
Who will be doing the surgery?
Your orthopedic surgeon will do the surgery. A physician's assistant often helps during the
procedure.
How long and where will my scar be?
The scar will be six to eight inches long and found along the side of your hip.
Will I need a walker, crutches or cane?
Yes. Until your muscle strength returns after surgery, you will need a walker, a cane or
crutches. Your needs will be decided by the PT and ordered for you by the Center for
Advanced Joint Replacement case manager and delivered to you before you leave the
hospital.
Will I need other supplies?
After hip replacement surgery, you may need a high toilet seat for three months.
You might also think about installing grab bars in your tub or shower and buying a bath seat
for safety. If needed, an OT will teach you how to use adaptive tools to help you with lower
body dressing and bathing.
Where will I go after go home from the hospital from the hospital?
Most patients are sent home and carry on with their PT in an outpatient office. Some will
need in home therapy three times a week for two weeks which will be arranged by the case
manager. Others need a short inpatient stay at an extended care facility. This stay is most often
from three to ten days. Check with your insurance company to understand your rehabilitation
benefits. For more information about the Rehabilitation Services available through Christiana
Care, see the FYI section of your notebook.
Will I need help at home?
Yes. The first several days or weeks you will need someone to help you with making meal,
housekeeping, etc. If you live alone, please set up to have someone in your home around the
clock for at least the first three days when you go home.

How can I get my home ready before my surgery?
Getting ready ahead of time can lessen help needed when you go home for example: having
the laundry done, house cleaned, yard work completed, clean linens on bed, and meals ready.
Evaluate your environment for safety. Consider taking up throw rugs, clearing walkways to
make room for using a walker, and make sure you have enough lighting ready. Check for the
need to add handrails on stairways.
Will I need physical therapy when I go home?
Yes. Physical therapy will continue after you go home with a therapist at an outpatient
physical therapy office or in your home. The length of time needed varies with each patient.
We will help you set this up before you go home. ( A map with the Christiana Care outpatient
physical therapy facilities is in the FYI section of this notebook.)
How long until I can dr ive and get back to nor mal?
Being able to drive depends on whether surgery was on your right leg or your left leg and the
kind of car you have. If surgery was on your left leg and you have an automatic car, you
could be driving in two weeks. If the surgery was on your right leg, your driving could be
limited as long as six weeks. Getting “back to normal” will depend on your progress. Talk
with your surgeon for their advice, you should not drive if you are taking narcotic pain
medication.
When will I be able to get back to work?
We recommend that most people take at least one month off from work, even if your job
allows you to sit often. More strenuous jobs will need a longer absence from work.
When can I have sexual intercourse?
The time to resume sexual intercourse should be discussed with your surgeon. We have a
guide on restarting sexual intercourse and a copy will be given to you when you leave the
hospital.
How often will I need to be seen by my doctor following my sur gery?
Two to four weeks after leaving, you will be seen for your first post-surgery office visit. The
frequency of follow-up visits will depend on your progress.
Do you recommend any limits following this sur gery?
Yes. High-impact activities such as contact sports, running, singles tennis and basketball are
not recommended. Injury-prone sports such as downhill skiing are also dangerous for a new
joint. Ask your surgeon for more information.
What physical/ recreational activities may I participate in after my recovery?
You are encouraged to take part in low impact activities such as walking, dancing, golfing,
hiking, swimming, bowling and gardening.
Will I notice anything different about my hip?
In many cases, patients with hip replacements think that the new joint feels natural. But, we
recommend avoiding extreme positions or high impact activities. Your leg with the new hip
may be longer than it was before, either because of it became shorter with your hip disease, or
to avoid risk of dislocation. Most patients get used to this feeling in time or can use a small lift
in their other shoe. Some patients have aching in their thigh for a few months after surgery.

Before Surgery Check List
What to do 4-6 weeks prior to surgery
Contact Your Insurance Company
Before surgery, you will need to call your insurance company. you will need to ask them if
pre-authorization, pre-certification, second opinion or a referral form is needed before your
surgery. It is important to make this call if things are missed they may not pay for some
portions or delay your surgery. Complete the “Center for Advanced Joint Replacement
Insurance Checklist” form found on the next page and have this information ready when
you talk to your case manager.
If you do not have insurance, please tell the registration staff that you will need help in
making payment arrangements.
Pre-Register
After your surgery has been scheduled, the admitting department will call you to gather
your “pre-registration information” by phone. You will need to have the following
information ready:
■
■
■
■
■
■
■
■
■
■
Your full legal name and address, including county
Home phone number
Religion
Marital status
Social Security Number
Name of insurance holder, his or her address and phone number
Name of insurance company, mailing address, policy and group number
Your employer, address, phone number and occupation
Your retirement date, if applicable
Name, address and phone number of someone to notify in case of emergency (this can be
the same as the nearest relative)
Get Medical And Anesthesia Clearance
When you are scheduled for surgery, your surgeon will tell you whether you need to see
your primary care doctor and/or a specialist before your surgery. Your case manager will
call you to get medical information for the anesthesiologist 1-2 weeks before your operation.
You will need to have a list of all your medications and the doses. The case manager may
ask you to see your primary care doctor and/or a specialist after going over your history
with the anesthesiologist. Call 302-428-2460 if you have any questions.

FYI: Joint Replacement
Insurance Checklist
Member’s Name ____________________________ID#______________Date of Birth__________
Address _____________________________________________________________
City __________________________________________________State __________Zip __________
Group Name/Group# ______________________________________________________________
Lifetime Maximum _________________________________________________________________
Other insurance ____________________________________________________________________
__________________________________________________________________________________
Deduction/Out of Pocket____________________________________________________________
Co-Pays ___________________________________________________________________________
Benefits
Ask your insurance company what benefits you have for the following items:
Where can you have your pre-admission testing done?__________________________________
__________________________________________________________________________________
Rehabilitation: (Skilled Nursing Facility, Subacute, Acute Rehabilitation) __________________
__________________________________________________________________________________
Home Care ________________________________________________________________________
Outpatient Physical Therapy_________________________________________________________
__________________________________________________________________________________
Durable Medical Equipment _________________________________________________________
__________________________________________________________________________________
If I need to be on the medication Lovenox, when I go home would I be covered? ___________
__________________________________________________________________________________

Obtain Laboratory Tests
When you are scheduled for surgery you will get a laboratory-testing order sheet from your
surgeon. Your case manager may also ask for some testing.
Have your testing done at a lab approved by your insurance company 7-10 days before your
surgery or within 30 days of your surgery. Have the results faxed to the Center for Advanced
Joint Replacement at 302-428-4644. Call 302-428-2460, if you have any questions.
Pre-Admission testing is available at Christiana Care. Testing areas are located at both
Wilmington and Christiana Hospitals and are open 7 a.m. – 4:30 p.m. Monday through Friday
and 8 – 11:30 a.m. on Saturdays. No appointment is needed.
Lab Services at Wilmington Hospital Lab Services at Christiana Hospital Campus
501 West 14th Street, Christiana Care Medical Arts Pavilion 1, Suite 100
Wilmington, DE 19801 4745 Ogletown-Stanton Road, Newark, DE 19713
302-428-6801 302-733-6244
Decide Whether to Donate Your Blood (FYI section)
You may wish to donate your own blood, please discuss your options with the surgeon.
Review “About Blood Transfusions” in the FYI section of your notebook.
Choose Your Coach
Your Coach is someone (family or friend) who will be able to share in some of your physical
therapy sessions, help you plan what happens when you go home and be a companion in
your home when you go home to help with your needs. The Center for Advanced Joint
Replacement welcomes coaches’ participation in all of your recovery to make sure you move
smoothly home after your surgery.
Review “What is an Advance Directive” (FYI section)
The law requires that everyone being admitted to a medical facility have the chance to tell us
how future decisions about their medical care should be decided (advance directives). Please
refer to the FYI section of notebook for further information. Although you are not required to
make an advance directive, you may if you wish. If you have advance directives, e.g. living
will, please bring copies with you to the hospital on the day of your surgery.
Schedule Physical Therapy Evaluation
Many patients with arthritis favor their painful joint and become weaker. This delays your
recovery. To help, it is important that you begin an exercise program before your surgery.
We will contact you to schedule a pre-operative evaluation with one of our physical
therapists. Please bring this notebook to your evaluation.
A section in this notebook has some of exercises that your surgeon or physical therapist may
recommend.
Register For Joint Replacement Infor mation Class
A special class is held weekly for patients scheduled for joint surgery. We will schedule this
class with you before your surgery. You only need to attend one class. Members of our team
will be there to answer your questions. It is strongly suggested that you bring your coach
with you to class.

The outline of the class is as follows:
■ Getting ready for surgery
■
■
■
■
■
■
What to expect the day of surgery
What to expect during your hospital stay
Physical and Occupational therapy plan
Role of the coach
Planning for your release home after your surgery a review with the Case Manager
Questions and answers
What to do 4 weeks before Surgery
Read “Anesthesia and You” (FYI Section)
Total joint surgery does require the use of either general anesthesia or spinal anesthesia.
Please review “Anesthesia and You”. If you have questions please contact your case manager
or your surgeon’s office.
What to do 5-10 Days before Surgery
Stop medications that increase bleeding
Seven days before surgery stop taking aspirin or products with aspirin in them. Five days
before surgery stop all anti-inflammatory medications like Motrin, Naproxen, etc. These
medications may cause bleeding. Talk to your doctor about other medications you can take
for pain before surgery that do not cause bleeding. If you are on Coumadin, Plavix or
Pradaxa, you will need special instructions for stopping these medication. Do not stop taking
these medications without medical direction. Your case manager will tell you what to do with
your other medications.
Find Out Your Arrival Time
Your surgeon asks you come to the hospital two to three hours before your surgery to give the
staff plenty time to get you ready for surgery and answer any questions. It is important that
you arrive come in on time because the surgical time can be moved up. If you are late, it may
cause a significant problem with starting your surgery on time. Sometimes lateness could
result in your surgery being moved to a much later time. If you are unsure when to arrive at
the hospital, call your surgeon’s office.
Prepare Your Home
Have your house ready for your to come home. Clean. Do the laundry and put it away. Put
clean linens on the bed. Make meals and freeze them in single serving containers. Cut the
grass, tend to the garden and other yard work. Pick up throw rugs and tack down loose
carpets. Remove electrical cords and other barriers from walkways. Put nightlights in
bathrooms, bedrooms, and hallways. Stop the newspaper. Arrange to have someone collect
your mail and take care of loved-ones or pets, if needed.
Review “Fall Prevention in Your Home” in FYI section.

What to Do the Night Before Surgery
Do not eat or drink anything after midnight unless otherwise instructed to do so.
If you are told to take any medications by mouth the day of surgery, you may take these with
a sip of water.
What to Bring to the Hospital
■ Picture ID.
■ Copy of your Advance Directive, living will.
■ Your Notebook.
■ CPAP OR BiPap Equipment.
■ Personal hygiene items (toothbrush, deodorant, etc.).
■ Loose fitting clothing — drawstring or elastic waist shorts, loose fitting short sleeved t-shirts
(golf shirts, button down short sleeved shirts — avoid long sleeved shirts) Please bring 3
days’ worth of clothing.
■ Button down or zip up fleece or cardigan sweater.
■ Consider nylon underwear for women.
■ Boxers and T-shirts for gentlemen.
■ Night clothes if wished for sleeping (you can wear hospital gown at bedtime).
■ Sneakers or flat soled rubber shoes and socks — avoid shoes without backs
(flip flops and clogs).
■ Technology items can be brought in but Christiana Care is not responsible for lost, damaged
or stolen items. A Wireless network is offered and the Get Well Network is in each patient’s
room allowing internet access from your bedside.
Please Do Not Bring
■ Medications not asked by the case manager.
■
Valuables such as wallets, pocketbooks, jewelry, large sums of money.
Visiting Guidelines
Our visitor guidelines are flexible to meet everyone’s needs. Visits from family members,
friends and clergy are an important part of the healing. Our guidelines were made for safe
and healthy healing for our patients. Children under the age of twelve may visit but must be
with an adult, other than the patient, at all times. If family will be staying overnight with the
patient, please set up this with the case manager or charge nurse before you come to the
hospital.

Day of Surgery
Wilmington Hospital
Parking at Wilmington Hospital
Garage parking is available; follow the signs to self parking. Valet parking is also available
at the main entrance for a fee. Handicapped vehicles may use valet for free. Driving
directions are available in the FYI section of your notebook for reference.
Where to go once at Wilmington Hospital
On the day of surgery, enter Wilmington Hospital at the main entrance. Take the South
elevators to the 3rd floor, exit to your right and check in at the surgical waiting room on
the left.
What to expect at Wilmington Hospital
Following check in, our surgical staff will get you ready for surgery. Family members will
be directed to the waiting room. The surgeon will call them into the waiting room area once
surgery is over. If family is not present and you would like your sugeon to call them, please
have a contact number/cell phone number available at the time of check in.
While in the operating room holding area, an IV will be started and your joint site will be
scrubbed. Your operating room nurse as well as your anesthesiologist, will talk with you.
They will take you to the operating room.
Christiana Hospital
Parking at Christiana Hospital
Parking at Christiana Hospital is free in the visitor parking areas. Valet parking is available
at the main entrance for a fee. Handicapped vehicles may use valet for free. Driving
directions are available in the FYI section of your notebook for reference.
Where to go once at Christiana Hospital
On the day of surgery enter Christiana Hospital at the main entrance. Stop at the
information desk in the main lobby for directions to the Surgery and Procedure Unit.
What to expect at Christiana Hospital
In the Surgery and Procedure Unit, you will get ready for surgery. You will then be taken to
the operating room holding area.
Family members will be directed to the surgical waiting room area. If your family is not
present and you would like the surgeon to call them, please have the contact number.
While in the operating room holding area, an IV will be started and your joint site will be
scrubbed. Your operating room nurse as well as your anesthesiologist, will talk with you.
They will take you to the operating room.

After Surgery Hospital Care
After Surgery
Following surgery, you will go to a recovery area where you will stay for 1-2 hours. We will
work with you to control your pain and your vital signs will be checked. You will then go to
the Center for Advanced Joint Replacement floor where a nurse will care for you.
Pain medication is available for you throughout your stay. You will be asked to rate your pain
on a scale of 0-10, with “0” being no discomfort and “10” being the worst pain possible. Refer
to the “Pain Control” in the FYI section of the notebook.
Your surgeon may ask that you get out of bed, sit up and walk within hours after your
surgery. It is important that you help with blood clot prevention as soon as possible after
surgery by doing the ankle pumps, quad sets and glute set exercises in this notebook. Along
with walking, these help prevent blood clots from forming in your legs.
To help prevent any congestion, you will be taught and encouraged to use the incentive
spirometer. Refer to the FYI pages in this notebook.
Post-Operative Day 1
The morning after surgery, you will be helped in bathing and dressed in clothing that you
have brought from home. A physical therapy evaluation or your first group physical therapy
session will take place. The physical therapist will check your progress and help you walk
with a walker. Nurses will be help you move from IV pain medication to pain medicine by
mouth. After lunch, you will have your second physical therapy session as a group setting.
Coaches are encouraged to take part in physical therapy sessions as much as possible. Other
visitors are welcome before and after therapy sessions.
Post-Operative Day 2
On day two after surgery, occupational therapy will visit you at your bedside and help you
with your bathing and dressing, giving you adaptive equipment as needed. Following
breakfast, you will take part in your first group physical therapy session of the day. A
complimentary lunch for you and your coach is given this day. After lunch, you will have
your second therapy session and may begin practicing stair climbing and car transfers. Your
coach is encouraged to go to at least one physical therapy session this day.
Post-Operative Day 3 or Discharge Day
On day three after surgery, you will have breakfast and then attend an early morning physical
therapy session. You will usually get to leave the hospital after this therapy session. Your
nurse and physical therapist will give you detailed instructions before your leave. A family
member or friend (or coach) is always encouraged to take part.
The decision to go home or to a rehab/subacute facility will be made together by you, your
surgeon, other members of the health care team, and your insurance company. Every attempt
will be made to have this decision wrapped up in advance, but may be delayed until the day
you are ready to leave depending on your progress.

Heading Home
Someone will need to drive you home. Please make these arrangements before your surgery.
Most patients will leave after morning therapy, after they get their discharge instructions
about medications, physical therapy, activity, etc.. Any equipment, such as a walker, will be
delivered to your room before you leave. Out-patient physical therapy or in home therapy
arrangements will be done. Take your notebook to all physical therapy visits.
If you are going to a Rehab/ Subacute Facility
Someone needs to drive you to the rehab/subacute facility or we can help you arrange for
transportation. There may be a charge if a van or ambulance is used. Transfer papers will be
completed by the nursing staff. Either your primary care doctor or a doctor from
rehab/subacute facility will be caring for you in discussion with your surgeon. Expect to stay
three to 10 days based on your progress. On discharge home, instructions will be given to you
by the rehab/subacute staff. Take this notebook with you.

Center for Advanced Joint
Replacement Exercise
Program – Hip

Exercising Before Surgery
It is vital to be as fit as you can be before having a total joint replacement. This will make
your healing go faster. Your surgeon will decide if pre-operative physical therapy (PT) is
right for you.
You will be taught in the hospital which exercises you should do after surgery. These may be
unalike the exercises in this section. Be sure to check with your surgeon or PT about which
exercises are best for you.

Seated Push-up
1. Sit in chair with arms as shown.
2. Push yourself up from the chair, using your arms as much
as you can.
3. It is OK to use your legs to help if necessary.
4. Hold 1-2 seconds, slowly lower.
5 30 repetitions, 2 times per day.

Ankle Pumps
1. Bend your ankles up and down as if you are pumping
the gas pedal.
2. 30 repetitions, 2 times per day.

Quad Sets
1. Sit or lie on your back with both legs straight.
2. Press the back of your knee down.
3. This will tighten the muscle on top of your thigh and move
your kneecap towards your head.
4. Hold 5 seconds.
5. 30 repetitions, 2 times per day.

Gluteal Sets
X X X
1. Squeeze your buttocks together as tightly as possible.
2. Hold for 5 seconds.
3. Repeat this exercise 30 times.
4. Do 2 times a day.

Exercising After Surgery
Exercise is of great value to get the best results from your joint replacement surgery. You will
need to keep doing your exercise program at an outpatient health site or at home as ordered
by your surgeon when you leave the hospital.
We offer choices for you to keep your PT going once you leave the hospital.
Outpatient PT care can be set up at many places including Christiana Care’s PT PLUS or if
you are not able to travel from your home preparations can be made through Christiana
Care’s Visiting Nurse Association or any other provider. (For a list of outpatient PT clinics,
see “Outpatient PT Facilities” found in the FYI section of your notebook. )Your case manager
will firm up these plans before you go home from the hospital.
No matter what you choose, exercise is of great value to your care. It will support rapid healing
and help you return to a more normal lifestyle.
Please bring your notebook to all PT visits . After each session, ask your therapist to mark in
your Notebook the right exercises for you. The goals and steps to take are listed on the next
few pages.

Heel Slides
1. Lie on back.
2. Bend _____ knee and slide heel up toward body as shown.
3. Hold 1 second, slowly relax.
4. 30 repetitions, 2 times per day.

Windshield Wipers
1. Lie on back.
2. Side your leg out to the side, keeping your kneecap pointing
towards the ceiling and your toes pointing up.
3. Bring your leg back to the starting position.
4. Do NOT cross the center of your body.
5. Hold 1 second, slowly relax.
6. 30 repetitions, 2 times per day.

Seated Knee Extension
1. Sit on edge of table or bed.
2. Straighten knee fully.
3. Hold 1 second, and slowly lower.
4. 30 repetitions, 2 times per day.

Seated Hip Flexion
1. Sit on the edge of the chair or bed.
2. Lift ________ knee ________ your hip level.
3. Hold 1 second.
4. 30 repetitions, 2 times per day.

Short Arc Quads
1. Lie on your back with ________ inch roll under ________ knee.
2. Raise heel off floor until knee is straight.
3. Hold 1 second and slowly lower.
4. 30 repetitions, 2 times per day.

Standing Hip Flexion
1. Stand with legs straight.
2. While holding onto a solid surface, bend ________ knee and
hip upward as shown.
3. Hold 1 second, slowly relax.
4. 30 repetitions, 2 times per day.

Standing Hip Abduction
1. Stand, holding onto solid surface for balance.
2. Raise ________ leg out to side, without letting it come
forward.
3. Hold 1 second, slowly relax.
4. 30 repetitions, 2 times per day.

Standing Hip Extension
1. Stand with feet slightly apart.
2. While holding onto a solid surface, lift ________leg backward
as shown.
3. Keep your body upright.
4. Hold 1 second, slowly relax.
5. 30 repetitions, 2 times per day.

Using the Clinical Diary
A note for Professionals using this book
This Notebook will help passing on information between all the health professionals who
will be caring for our patient. The use of the Clinical Diary will let all important information
be shared. Many patients see many professionals during the first three months.
Upon discharge from the Center for Advanced Joint Replacement please record the following
in the Clinical Diary:
■
■
■
■
■
Patient name, surgeon’s name, date of surgery and diagnosis.
Center for Advanced Joint Replacement therapist’s name and discharge date.
Knowledge of knee precautions.
Discharge functional status for bed mobility, transfers, gait, and stairs.
If the patient is going home, please insert appropriate home exercises in “Exercising After
Surgery” section.
Rehab/ Subacute/ Home Health/ Outpatient PT
■ Please look at the whole notebook so that you are familiar with it and the goals that we
expect the patient to meet.
■ Check all information in the Clinical Diary and document the progress at least
once a week.
■ Include your name, agency or facility, and phone number.
■ Choose the proper exercises and place them in the Exercising After Surgery
section of the notebook.

Caring for Yourself at Home
When you go home there are a many things you need to know for safety, speedy healing and
your comfort.
Caring for Yourself at Home
■ Control your pain.
■ Take your pain meds at least 30 minutes before PT.
■ Do not drive or run machinery while taking narcotics.
■ Use cold for pain control. Putting ice onto your joint will lower your pain and swelling.
You can use ice before and after your exercise sessions. Do not put ice straight onto your
skin. Your nurse will teach you on the use of cold treatment before you are sent home.
■ Change your position every 45 minutes throughout the day to ease after surgery stiffness.
Body Changes
■ A well-nourished body will react better to healing and therapy. You may not feel hungry,
but it is of great value to drink plenty of fluids to keep from being dehydrated. Your want
for solid food will come back.
■ You may have trouble sleeping. This is normal. Don’t sleep or nap too much during
the day.
■ Your drive level will be low for the first month.
■ You may feel like you can not have a bowel movement or constipation. Use stool softeners
or laxatives if needed. For more facts, read about "constipation" in the FYI section of your
notebook.
Blood Thinners
You will need to take a blood thinner for one to six weeks after surgery, based on your condition.
Be sure to take the drug exactly as set by your surgeon. Lovenox is one type of blood
thinner that your surgeon may order for you. If so, you will be taught to give yourself an
shot. Your surgeon may order aspirin as a blood thinner when you go home from the hospital.
(coated aspirin in preferred.)
Coumadin is a blood thinner that may be ordered by your doctor. If you are sent home on
Coumadin, facts will be given to you.

Post-operative Swelling
■ You may have swelling in your legs. To help it is best to lie down and raise your legs above
your heart level a few times a day.
■ Your surgeon may order stockings to help lower limb swelling. If in use, take off the
stockings at least daily and check your skin. Talk over with your surgeon how long stockings
will be needed.
Caring for Your Incision
■ Keep your incision dry.
■ If your incision is without drainage, you may keep it open to air.
■ Your incision will be closed with steri strips (small pieces of white tape) or staples.
■ Most patients are free to shower 24 hours after all drainage has stopped.
■ Tell your surgeon or home health professional if there is added drainage, redness, pain, odor
or heat around your incision.
■ Take your temperature if you feel warm or sick. Call your surgeon if it is over 101° F.
■
Your nurse will teach you on the care of your incision upon go home from the hospital.

Stopping and Recognizing
Potential Complications
Pleae read the FYI Sheets “DVT” and “Bleeding Precautions”.
Signs of Infection
■ Added swelling, redness at incision site.
■
■
Change in color, amount, odor of drainage.
Added pain in knee.
■ Fever greater than 101 degrees F.
Stop Infection
■ Wash your hands before and after you take care of your incision.
■ Take proper care of your incision as explained by your nurse and surgeon.
■ You will need to take antibiotics before having dental work or other treatments from now
on.
■ Tell your doctor and dentist that you have a total joint replacement.
Blood Clots in Legs
Surgery may cause your blood flow to slow and clot in the veins of your legs, forming a
blood clot. This is why you take blood thinners after surgery. If a clot does happen you may
need to be admitted to the hospital for care. Prompt care most often stops the more serious
problem of pulmonary embolus (A blood clot in a vein in the leg and moves to the lung
where it can block blood flow).
Signs of Blood Clots in Legs
■ Swelling in your thigh, calf or ankle that does not go down when you raise your legs above
the level of your heart..
■ Pain, tenderness in your calf.
NOTE: blood clots can form in either leg.
Prevention of Blood Clots
■ Do Post-operative exercises — ankle pumps, quad and gluteal sets.
■
■
Walking.
Blood thinners such as Lovenox, aspirin, or Coumadin. (as ordered by your surgeon)

Blood Clot (Pulmonary Embolus)
An unrecognized blood clot could break off the vein and go to the lungs.
If you suspect that you have a pulmonary embolus, call 911 immediately.
Signs of an Embolus
■ Sudden chest pain.
■
■
■
■
■
■
Find it hard to breathe and/or rapid breathing.
Shortness of breath.
Sweating.
Confusion.
Rapid heart rate.
Fainting.
Stopping a lung Clot
■ Stop blood clots in legs.
■
Know the signs of a blood clot in your leg and call doctor right away if you see any of these.
Signs of Hip Dislocation
■ Severe pain.
■
■
Your leg is shorter than your other leg and rotated in the wrong direction.
Unable to walk/move leg.
Prevention of Dislocation
■ Your PT will tell you about your activity limits.

When Standing Up
from a Chair
Proper Method
Improper Method
Do NOT pull up on the walker to stand!
Sit in a chair with armrests when possible.
1. Scoot to the front edge of the chair.
2. Slide your operated leg out in front of you.
3. Push up with both hands on the armrests. If sitting in a chair
without armrests, place one hand in the center of the walker
while pushing off the side of the chair with the other hand.
4. Balance yourself before putting your hands on the walker.

Walking with Walker
1. Move the walker forward to a comfortable arms length.
2. Ensure all four walker legs are firmly on the ground. Step
forward with the operated leg. Place the foot in the middle
of the walker area.
3. Take your weight on your hands and step forward with the
unoperated leg.
NOTE: Take small steps. Do NOT take a step until all four
walker legs are flat on the floor. Stand tall.

Using a “Reacher” or
“Dressing Stick”
Putting on pants
and underwear:
1. Sit down.
2. Using a reacher
or dressing stick
to guide the waist
band over your
foot, put your
operated leg into
the pants first,
then your
unoperated leg.
3. Pull your pants up over your knees to within easy reach.
4. Stand with the walker in front of you to pull your pants up the
rest of the way.
Taking off pants and underwear:
1. Back up to the chair or bed where you will be undressing.
2. Unfasten your pants and let them drop to the floor. Push your
underwear down to your knees.
3. Lower yourself down. Take your unoperated leg out first and
then the operated leg.
4. A reacher or dressing stick can help you remove your pants
from your foot and off the floor.

Using a “Sock Aid”
How to use a sock aid:
1. Slide the sock onto the sock aid with the toe completely tight
at the end.
2. Hold the cord and drop the sock aid in front of your foot. It is
easier to do this if your knee is bent as much as possible.
3. Slip your foot into the sock aid.
4. Straighten your knee, point your toe, and pull the sock on.
5. Keep pulling until the sock aid pulls out.
6. Do not cross your legs when putting on your socks.

Using a Long-Handled
Shoehorn
1. Use your reacher, dressing
stick, or long-handled shoehorn
to slide your shoe in
front of your foot. Bend your
knee as much as possible
when doing this.
2. Place the shoehorn inside
the shoe against the back of
the heel. Have the curve of the shoe horn match the curve of
the shoe.
3. Lean back, if necessary, as you lift your leg and place your toes
in your shoe.
4. Step down into your shoe, sliding your heel down the shoehorn.
NOTE: Wear sturdy rubber-soled slip-on shoes or shoes
with Velcro closures or elastic shoe laces. DO NOT wear
high-heeled shoes or shoes without backs.

Moving into Tub
Getting into the tub using a bath seat:
1. Place the bath seat in the tub facing the faucets.
2. Back up until you feel the tub with the back of your legs. Be
sure you are in front of the tub bench.
3. Reach back with one hand for the tub bench. Keep the other
hand in the center of the walker.
4. Slowly lower yourself onto the tub bench.
5. Move the walker out of the way, but keep it within reach.
6. Lift your legs over the edge of the tub, one at a time.
Getting out of the tub using a bath seat:
1. Keeping your body and legs in line, lift your legs one at a
time, over the outside of the tub.
2. Scoot to the edge of the bath seat.
3. Push up withboth hands on the tub seat.
4. Balance yourself before putting your hands on the walker.
Tub Seat
Tub Bench

NOTE: To keep soap within easy reach, make a
soap-on-a-rope by placing a bar of soap in the toe
of an old pair of pantyhose and attach it to the
bath seat.
NOTE: ALWAYS use a rubber mat or non-skid
adhesive on the bottom of the tub or shower.
NOTE: While using a tub seat, grab bars, longhandled
bath brushes, and hand-held showers
make bathing easier and safer, they are typically
not covered by insurance.
Getting in and out of the tub using the tub
transfer bench:
■ Follow the steps for getting in/out of the tub using
a tub seat.
■ The advantage of using a tub transfer bench is that
it extends over the edge of the tub giving a larger
area to sit.

Moving to Toilet
When sitting down on
the toilet:
1. Take small steps and turn
until your back is to the
toilet. Never pivot!
2. Back up until you feel the
toilet touch the back of your
leg. If using a commode with
armrests, reach back for
both armrests and lower
yourself onto the toilet.
If using a toilet without armrests,
keep one hand in the
center of the walker while
reaching back for the toilet
seat with the other hand.
When getting up from the toilet:
1. If using a commode with armrests, use the armrests to push
up. If using a raised toilet seat without armrests, place one
hand in the center of the walker and push off the toilet seat
with the other.
2. Balance yourself before putting your hands on the walker.

Moving Into Bed
When getting into bed:
1. Back up to the bed until you feel the bed against the back of
your legs (Position yourself so your head will be on the pillow
when you lie down).
2. Reaching back with both hands, sit down on the edge of the
bed. Scoot back toward the center of the mattress. (Silk
pajama bottoms or satin sheets, may make it easier)
3. Move your walker out of the way, but keep it within reach.
4. Keeping your body and legs in line, move around until you
are facing the foot of the bed.
5. Lift your leg into the bed (if this is your operated leg, you may
use a cane, a rolled bed sheet, a belt, or your leg lifter to assist
with lifting that leg into bed).
6. Keep moving around and lift your other leg into the bed.
NOTE: DO NOT CROSS YOUR LEGS to help the operated
leg into bed.

Moving Out of Bed
When getting out of bed:
1. Sit up on your elbows.
2. Move to the edge of the bed.
3. Move around keeping your body and legs in line.
4. Lower your legs to the floor and sit up.
5. Check to make sure you are not dizzy.
6. Slide your operated leg out in front of you.
7. Use both hands to push off the bed.
8. Balance yourself before putting your hands on the walker.

Lying In Bed
Keep a pillow between your legs when lying on your back.
Try to keep the operated leg positioned in bed so the kneecap
and toes are pointing toward the ceiling. Try not to let your
kneecaps roll inward or outward. A blanket or towel-roll on
the outside of your leg may help you maintain this position.

Lying in Bed –
Four Weeks Post-op
When rolling from your back to your side, first bend your
knees toward you until your feet are flat on the bed.
Then place at least two pillows (bound together) between
your legs. With knees slightly bent, and pillows between your
knees, roll over on to your side.

Moving into or out of the Car
1. Push the car seat all the
way back and recline the
back.
2. Back up until you feel the
back of your legs against
the car.
3. Reach back for the car seat
with your right hand and
the dashboard with your left,
or the middle of the walker.
4. Place your operated leg in
front of you.
5. Lower yourself down.
6. Watch your head!!!
7. Scoot your bottom
back into the car.
8. Lean back as you lift
your legs into the
car one at a time.
Remember to bend
your hip and ankle
to clear the door.
9. TIP: Place a plastic
trash bag on the seat
of the car to help
you slide and turn
toward the front.

Household Chores:
Saving Energy and
Protecting Your Joints
Kitchen
■ Do NOT get down on your knees to scrub floors. Use a mop and long-handled brushes.
■ Plan ahead! Gather all your cooking goods at one time. Then sit to get ready your meal.
■ Place commonly used cooking goods and tools where they can be reached without too
much bending or stretching.
■ To give a better working height, use a high stool, or put cushions on your chair when
making meals.
Bathroom
■ Do NOT get down on your knees to scrub bathtub. Use a mop or other long-handled
brushes.
Safety and Avoiding Falls
■ Pick up throw rugs and tack down loose carpeting. Cover slick surfaces with carpets that
are firmly anchored to the floor or that have non-skid backs.
■ Be aware of all floor hazards such as pets, small objects or not flat surfaces.
■ Provide good lighting throughout. Install nightlights in the bathrooms, bedrooms,
and hallways.
■ Keep extension cords and phone cords out of pathways. Do NOT run wires under
rugs, this is a fire hazard.
■ Do NOT wear open-toe slippers or shoes without backs. They do not give enough
support and can lead to slips and falls.
■ Sit in chairs with arms. It makes it simpler to get up and down.
■ Rise slowly from either a sitting or lying position so as not to get light-headed.
■ Do NOT lift heavy objects for the first three months, and then only with your
surgeon's okay.
■ Stop and think. Use good wisdom.

Do’s and Don’ts
For the Rest of Your Life
Whether you have reached all your goals in three months or not, you need to have a normal
exercise program to keep up your fitness and the health of the muscles around your joints.
With your doctors okay you should be on a exercise program three to four times per week
lasting 20 - 30 minutes. Impact activities such as running and singles tennis may put too
much stress on your joint and are not advised. High-risk activities such as downhill skiing
are discouraged because of the risk of broken bones around the artificial joint. Infections are
could always be a problem and you will need antibiotics for help stop this, mainly with
dental treatments. Please talk with your surgeon and dentist.
What to Do in General
■ Even If the risks are very low for post-op infections, it is of great value to realize that the
risk stays. A prosthetic joint could likely draw the germs from an infection found in some
other part of your body. If you should get a fever of more than 101 degrees, or have an
injury such as a deep cut or puncture wound, you should clean the wound as best you can,
put a sterile dressing or Band-Aid on it and tell your doctor. The closer the damage is to
your joint, the bigger the fear. Now and then, antibiotics may be needed. On the surface
scratches may be treated with an antibiotic ointment. Tell your doctor if the area becomes
painful or red.
■ When traveling, stop and change position hourly to stop your joint from getting stiff.
■ See your surgeon yearly unless otherwise suggested.
■ Exercise regularly.
■ Start a weight reduction/management program if you are heavy.
What to Do for Exercise
Choose a Low Impact Activity
Suggested exercise classes
■ Home program as outlined in Notebook
■ Regular one to three mile walks
■ Home treadmill
■ Stationary bike
■ Regular exercise at a fitness center
■ Arthritis aquatic classes
■ Low impact sports-golf, bowling, walking, gardening, dancing, etc.
What Not to Do
■ Skip running or engaging in high-impact activities.
■ Skip high-risk activities such as contact sports or downhill skiing.

FYI: Advance Directive
Advance directive are steps you leave for others when you cannot make your own health
choices. These choices are written down while you are feeling well and thinking clearly.
They make clear to your family and your doctors the amount of care you wish to get, or not
to get, should you become not awake or aware or too ill to make a choice at a later point in
your life.
There are two ways to make an advance directive:
■ Individual Instructions (at one time called living will)
A living will is a written record of the care you would choose for yourself during “terminal
injury or illness”. A terminal illness or injury is one that will cause you to die within the
near future. It is called a "living will" because it is used while you are still alive, but your
death is very near. Your living will usually tell your doctors what kind of care you do or do
not want. Your decision maker (agent) and caregivers must follow your instructions in a living
will. Christiana Care offers the 5 Wishes advance directive form.
■
Power of Attorney Health Care Choices
This is a paper where you name some other person(s) as your agent to make health care
choices for you when you are not able to do so yourself.
Federal law calls for hospitals to ask all patients whether they have Advance
Directive for health care. It our policy to honor your wishes for your health care
through your Advance Directive, as long as they follow Delaware law and the rules
of the Christiana Care Health System.
For more information
You can get more information through:
Christiana Care's Patient Relations Department
Christiana Hospital, 302-733-1340
Wilmington Hospital, 302-428-4608
Pastoral Services
Christiana Hospital, 302-733-1280
Wilmington Hospital, 302-428-2780
Delaware's Division of Services for Aging and Adults with Physical Disabilities
Statewide, 800-223-9074
New Castle County, 302-453-3820,
Kent and Sussex Counties, 302-422-1386.
Although it is not required, you may also contact an attorney.

FYI: Anesthesia
Anesthesia is given by a member of the Department of Anesthesiology. Your care will be
given by a team of caregivers, this team is made up of anesthesia doctors (anesthesiologists)
as well as nurses (nurse anesthetists) who are specially trained in this area.
On the day of your surgery, a member of the team will talk to you about your anesthesia,
will put an IV (intravenous catheter) into a vein so that they can give you medicine
and fluids.
Types of Anesthesia
Listed below are some ways that anesthesia can be given. How you will get treated will be
explained in detail to you before your surgery. No matter what type of anesthesia is given,
we will watch over you, check your blood pressure, heart rate, temperature and oxygen
level the whole time.
■ General Anesthesia: You will not be awake. Most major surgery’s need you to be totally
asleep. A breathing tube is most often used; this tube is put in while you are asleep and in
most cases comes out before you wake up, so you will not know it was there at all.
■ Spinal or Epidural: This is given by putting numbing medicine around the nerves in your
back. This keeps the lower half of your body numb. Other drugs will be given to make you
sleepy and relaxed during surgery.
■ Regional: This causes brief numbness and lack of strength to an exact part of your body.
This is done by placing numbing medicine into that part of your body. Other drugs may be
given to make you sleepy and relaxed during surgery.
■ Monitored Anesthesia Care(MAC): the anesthesia team and your surgeon will work
together to keep you relaxed. Medicine to briefly numb the part of you having surgery will
be given by your surgeon. Your heart rate, blood pressure, temperature and oxygen level
will be watched by the anesthesiology team who will give you other drugs to make you
sleepy and relaxed during the operation.
Side effects and risks can happen with all types of anesthesia. You may have a brief loss of
clear thinking and be clumsy after your surgery. Your team will talk to you about this on
the day of your operation.
Special Monitoring
For some surgeries you may need extra monitoring, the types of extra monitoring that may
be used are below:
■ Arterial Catheter: A thin, plastic tube (like an IV) is put into an artery in your wrist. This
tube checks your blood pressure all the time.
■ Central Venous Catheter or Pulmonary Artery Catheter: A small plastic tube (like an IV) is
put into a large vein in your neck or upper chest. This tube keeps a close eye on your vital
signs and heart.
If your team thinks they may need to use any type of special monitoring, they will tell this
to you when you meet. Sometimes the need for these things happens during your surgery.
If so, the team may start this while you are asleep, even though you did not talk about it
before operation. When you sign the Surgical/Procedure Consent, you give consent for the
anesthesia team to be part of your care.

FYI: Bleeding Precautions
Sometimes there are drugs, illness, diseases, and/or surgeries that can put you at a higher
risk for bleeding. Follow the safety tips below to lower your risk for bleeding:
Safe grooming tips
■ Shave with an electric razor.
■ Use a soft bristled toothbrush to clean your teeth.
■ Keep dry skin moisturized. Do not scratch your skin.
■ Skip manicures and pedicures.
■ Wear shoes to protect your feet..
Safety tips for activity
■ Skip activities or sports that could cause injury or bleeding.
■ Wear gloves when gardening.
■ Protect yourself from cutting or bruising your skin.
■ Always wear a seat belt.
Personal habits
■ Skip drinking large amounts of alcohol.
■ Avoid constipation (not able to have a bowel movement).
■ Blow your nose gently.
Medical care
■ Check with your doctor before taking any new medicines, take care with over-the-counter
medicines and herbal medicines too.
■ Do not use suppositories unless your doctor asks you to use.
■ Skip aspirin or any medicine with aspirin in them
■ Check with your doctor before having any operation, dental work, or tests.
■ Hold pressure on a cut or area from which blood is taken until bleeding stops.

FYI: Blood Transfusions
Transfusion is the word that we use when we talk about giving blood to a you in your IV.
Christiana Care gets most of the blood we need from the Blood Bank of Delmarva, which
runs many blood bank centers (where you go to give blood) in Delaware and Maryland.
Blood is donated by a volunteer who meets all the rules that make sure their blood is safe to
use.
All blood is tested to see the type (A, B, O), antibodies (things that could make you sick), and
certain illnesses, like syphilis and viruses like AIDS and hepatitis. Once the blood gets to the
hospital, it is tested to make sure the blood type ( A, B, O) matches your blood type.
Risks
Your doctor is aware of all the risks of giving blood to you and will make sure the you get
only what is needed for your care. With all the testing done when the blood is given at the
blood bank, the risks of getting blood is less than the risks to you if you do not get blood
when you need it.
Here is what we know of risk for getting blood in the United States:
Viral Risks
■ HIV ...................................................................................1 in 2,300,000
■ Hepatitis B.......................................................................1 in 220,000
■ Hepatitis C ......................................................................1 in 1,800,00
■ HTLV (can cause leukemia) .........................................1 in 2,900,000
Getting a virus can happen even with all the strict rules of donor testing that are used.
The largest risks when you get blood are written below::
■ Acute Hemolytic Reaction............................................1 in 50,000
■ Bacterial contamination in red cells (infection).........1 in 30,000
■ Anaphylaxis (serious allergic reaction) .....................1 in 30,000
■ Bacterial contamination in platelets (infection).........1 in 3,000
■ Delayed Hemolytic Reaction........................................1 in 2,000
■ Transfusion Related Acute Lung Injury (TRALI) .....1 in 1,500 - 1 in 190,000
■ Allergic reaction or hives ..............................................1 in 100
■ Fever .................................................................................1 in 500
Blood is given as red cells (PRBC), platelets, frozen plasma or cryoprecipitate
(this helps your blood clot).
Other Choices
Other Choices to the standard transfusion are:
■ Autologous (Your own blood): Giving your own blood before you come for surgery.
Your blood is kept cold and can be used for 42 days. Your doctor can set
this up with the Blood Bank of Delmarva.
■ Blood Salvage (Cell Saver): Blood that you lose during your operation is gathered,
cleaned and given back to you.
■ Directed Donation: You can ask a friend or family member to give blood for
you. This blood is tested like all other blood; your doctor can set this up with
the Blood Bank of Delmarva.
Your doctor can give you more facts about blood transfusion risks, benefits, or other choices.

FYI: Constipation
Constipation, when you are not able to have a bowel movement, happens when waste is
slow to move through your gut. The result is less than three stools (BMs) a week. Surgery,
not exercising, a change in your eating/drinking habits, and certain drugs can cause constipation.
Constipation may cause cramping, bloating/gas, loss of hunger, stomach or back pain, and
upset belly. Many people use this term when they feel they haven't emptied their gut, or
when they feel they should have BMs more often.
Recommendations
■ Keep a written record of your BMs.
■ Drink 6 to 8 (soda can size) glasses of liquid each day. The best liquids to drink are water
and fruit juice.
■ Limit the amount of caffeine you drink such as coffee, tea and soda.
■ Eat a well-balanced high fiber diet; it makes BMs softer and simpler to pass. Good choices
are fresh fruits and vegetables, whole-grain breads, oatmeal and bran cereal and brown rice.
■ Skip milk and dairy products and foods high in sugar because they can make it worse.
■ Plan time for BMs, when you don't have to hurry.
■ Exercise will help, walking, swimming and biking are good choices.
(Note: Be sure to talk with your doctor before starting any exercise program.)
■ Your doctor may order medicine to put off constipation. Take these meds as ordered.
■ Talk with your doctor or nurse before using laxatives, enemas, or suppositories for constipation.
Call your doctor or nurse if you have:
■ Constipation that lasts longer than two weeks
■ Fever and belly pain with the constipation
■ Bright red blood in your BMs
■ Loose Bowel Movements

FYI: Deep Vein Thrombosis
(DVT) Prevention
What is a DVT?
Deep vein thrombosis (DVT) is a blood clot inside a vein. It usually happens in the veins of
your thighs or calves.
What are some of the risk factors for A DVT?
■ Major surgery which limit mobility ■ Cancer
■ 40 years of age or older ■ History of heart and lung disease
■ Activity level less than normal ■ History of DVT
■ Sitting still for too long ■ Pregnancy
■ Birth control medication ■ Blood clotting diseases
■ Hormone replacement medication ■ Smoking
■ Chronic breathing problems ■ Traumatic injuries
What are some of the signs that I could have a DVT?
■ Redness and warmth in a leg or arm
■ Pain or tenderness in a leg or arm
■ Increased swelling in a leg or arm not better with elevation
■ May have no signs at all
What are the risks of DVT?
Clots that form in your veins can break in bits and travel to other parts of the body,
including your lungs. A blood clot in the lungs is called a pulmonary embolism (PE).
These types of clots can be life threatening and must be treated right away.
Signs of PE
■ Trouble breathing ■ Sharp chest pain
■ Rapid heart beat ■ Anxiety or nervousness
■ Fever ■ Cough that may make bloody discharge
■ Fainting
If you have any of these, call your doctor or nurse right away or dial 911 if you are at home.

How do I prvent DVT?
DVT precautions
■ Start walking as soon as possible after surgery/injury with your doctors say-so.
■ Do your post-operative exercises:
Ankle pumps: Pump your ankles like you would on a car gas pedal.
Gluteal sets: Squeeze your thighs and buttocks and hold them tight for 3 seconds.
■ Wear compression
■ Wear compression boots at all times unless you are walking, until you go home from the
hospital.
■ Drink plenty of fluids; skip caffeine and alcohol.
■ Skip tight socks, shoes and clothing, which could cut off blood flow to your legs.
■ Do not cross your legs or ankles.
■ Stop smoking.
■ Do not sit for long periods of time.
■ When you watch TV, stand up and stretch and walk around the room
during commercials
■ When you are driving long distances, stop and get out of the car and walk around for 10-
15 minutes every hour.
■ Your doctor may order medicine to help avoid clotting; these come in pills, shots or IV
infusions; your doctor will decide what is best for you.
■ For more information on DVT prevention, complication, and treatment watch these
patient education videos:
■ Lovenox
■ Coumadin
■ Smoking Cessation
■ Pulmonary Embolism
■ Anticoagulants
Ready in the “Get Well Network” or by calling 7620 on your phone. Ask your nurse for
help to play the videos.

FYI: Disposal of Needles,
Syringes & Lancets
in the Home
Don’t get stuck
■ Every time you need to throw away a needle/syringe or lancet, drop it into a plastic container
(such as a bleach or laundry detergent bottle) as soon as you have used it.
■ When the bottle is filled to the bottom of the handle, screw on the cap and throw it away
in your trash.
■ Store in a safe place away from children.
Safety tips
■ Have the throwaway container open and next to you when using a needle/syringe
■ Never hand a needle/syringe to some other person. Never walk with an open
needle/syringe in your hand.
■ Never set a needle/syringe down after using it; always place it inside the bottle.

FYI: Fall Prevention
in the Home
Falls occur in all age groups. The chance of falling grows with age. Each year three out of
every ten people over the age of 65 will fall. Often these falls happen at home and can lead
to serious injury. The good news is that many of these falls can be avoided. We want to
help make your home a safer place. Please use these tips to help avoid falls in your home:
General
■ Be sure hallways, stairs and other areas are brightly lit.
■ Remove all clutter (boxes, stacks of magazines, toys, extra furniture).
■ Get rid of throw rugs. Tack down loose or torn carpet.
■ Use non-slip wax on floors.
■ Put safety tape where there is a change in level so that they are simpler to see.
■ Put in night-lights or motion-detector lights in most often used areas (hallways, bathrooms
and bedrooms).
■ Keep electrical and phone cords out of your walkway.
■ Tape down or hide extension cords.
■ Be aware of pets that can get under your feet.
■ Think about a personal emergency response set-up or cell phone if you live alone or spend
most of the day alone.
■ Keep important phone numbers close to the phone your doctor, family, etc.
■ Keep the phone close to your bed.
Medications
■ Some drugs may place you at a higher risk for falls (such as, some heart pills, blood pressure
pills, sleeping pills, nerve pills, water pills, allergy and cold drugs). Check with your
doctor if you feel dizzy or lightheaded.
■ Share a list of all medicines you are taking with your doctor. Be sure to list all the things
you take prescribed drugs, herbs and natural products that you take.
■ Keep your drug list with you at all times. Also place this list close to the phone in case of an
emergency.
Clothing
■ Be sure to wear your glasses or hearing aid if you need them.
■ Wear shoes that fit and have no heels. Or, wear sturdy slippers with non-skid soles. Do not
wear shoes with thick heavy soles. Try using shoes with stretchy laces or Velcro closures.
■ Do not wear clothes that are too long.
Kitchen and other rooms
■ Make an open pathway throughout the house.
■ Arrange furniture to keep from tripping or bumping into it.
■ Use a normal height bed or lower bed if likely to fall from bed.
■ Handrails can be used for balance when walking.

Bathroom(s)
■ Put In grab bars to help get in and out of the bathtub, shower, or on and off the toilet.
■ Use non-skid bath mats or rubber strips on the bottom of the bathtub or shower.
■ Use a shower chair, tub bench or raised toilet seat.*
■ Leave the bathroom door unlocked, so it can be opened from both sides.
Assistive devices
■ Use walkers, canes, and wheelchairs as recommended.*
* Medicare, Medicaid or other insurance may cover some of these items.
Check with your insurance provider.
Activity
■ If you have lightheadedness due to low blood sugar or low blood pressure, eat soon after
waking up. Keep a drink or snack at your bedside.
■ Change position slowly. Dangle your legs at the side of your bed, sofa, etc. for a few minutes
before standing.
■ Place things that you use often within easy reach.
■ Avoid climbing and reaching to high shelves. Use a reacher or stable step-stool with
handrails. Do not stand on a chair reach high shelves.
Stairs
■ Cover stairs with tightly woven carpet or non-slip treads.
■ Put In sturdy handrails on both sides of the stairway and outside steps.
■ Tighten loose handrails.
Community Resources - Local:
■ Agility, Balance & Coordination Program -
(Eugene du Pont Preventive Medicine & Rehabilitation Institute)
■
■
■
■
■
A six-week exercise program to improve stability. 302-661-3300.
Balance & Mobility Center
Check with your doctor if you have problems with balance and need a special evaluation.
302-428-6780
Home Safety Evaluation
You may qualify for a home safety evaluation. Please check with your doctor or Christiana
Care Health System’s referral service, 302-428-4100, for more information
Are You OK? (Dover City Police Program)
Daily telephone reassurance for seniors or the disabled living in Kent County.
302-734-1200, ext. 128.
Delaware State Health and Social Services
Division of Services for Aging and Adults With Physical Disabilities
256 Chapman Road, Newark, DE Phone – 302-453-3820
1901 N. DuPont Highway, New Castle, DE Phone – 302-577-4791
Booklet available: Guide to Services for Older Delawareans. Home care agencies and home
medical equipment agencies are listed in this book.
Delaware Safety Council, Inc.
3 Old Barley Mill Road, Wilmington, DE 19807
302-654-7786 - Fax 302-654-4617
800-342-2287 (outside of New Castle County)
Email: desafe@mail.del.net

■
■
■
■
■
Delaware Stroke Initiative
Newark, DE
302-633-9313
Email: destrokeinitiative@yahoo.com
Offer names and addresses for resources and supplies for patient with CVA
Home Medical Equipment Agencies
For walkers, raised toilet seats, and other assistive devices. Check with your physician.
Medicare, Medicaid or other insurance may pay for equipment and devices. Agencies are
listed in the Yellow Pages of the phone book or in the Guide to Services for Older
Delawareans.
Home Care Agencies
Check with your physician. Some offer a home safety evaluation. Medicare, Medicaid or
other Insurance may pay for services. Agencies are listed in the Yellow Pages of the phone
book or the Guide to Services for Older Delawareans.
Visiting Nurse Association
One Reads Way
New Castle, DE 19720
302-327-5200
Out-patient Providers
Community Resources - National:
■
■
■
National Stroke Association
9707 E Easter Lane, Building B
Centennial, CO 80112
303-649-9299 - Fax 303-649-1328
Web site: www.stroke.org Email: info@stroke.org
American Academy of Orthopaedic Surgeons
6300 North River Road Rosemont, Illinois 60018-4262
800-824-BONES (2663) Web site: ww.aaos.org
National Institute Of Aging
A clearinghouse for health information. For information on preventing falls and fractures,
call 800-222-2225. Web site: www.nih.gov/nia
Personal Emergency Response Systems:
■
■
■
American Red Cross - Life Line
215-299-4000
800-959-6989
Web Site: www.redcross-philly.org
BERS Corporation
Med Alert
215-699-5766
800-985-4357
PERSYS
800-631-7370
Web Site: www.amcest.com
Exit Alarm Resources:
■
Col Com, Inc.
800-864-7778

FYI: Guided Imagery
for Relaxation
Guided imagery is a simple way to use the power of your own imagination to help you
relax, help your body to heal, or simply relax! By listening to a guided imagery story, you
will be helped to think positive, pleasant thoughts while you picture a pleasant image
such as a tropical beach, mountain meadow.
These pleasant images can feel real. This is often called the “mind-body connection.” You
may have felt this when you read a recipe or just think about a certain food that you really
like makes your mouth start to water! It is of great value to understand that guided
imagery is used as well as common nursing and medical care, not as an alternative.
Some good result of guided imagery are:
■ Lower stress and worry
■ Lower stress, anxiety and pain
■ Help with sleep
■ Get ready for surgical or procedures
■ Help with stopping smoking
■ Lower upset belly/vomiting
■ Help you sleep
Guided imagery can be felt by listening to an audiotape/CD, being guided by a coach or
teacher, or alone.
Getting Started
■ You may listen to a guided imagery story or music.
■ Two guided imagery stories are on hand. One story takes you to a tropical beach and the
other walks you through a mountain meadow. Each story lasts 20 minutes.
■ When you are ready, you will be given a headset and we will help you get started.
■ Get cozy. You may want to use the bathroom first.

Guided Imagery Programs
To select the program you would like to listen to, follow the directions below for either the
Patient Education Television or the Get Well Network.
Patient Education Television
1. Dial 7620 on your telephone.
2. Listen to the instructions and enter the
3 digit code of the audiotape that you
would like to listen to:
• Tropical beach story: 0 6 9
• Mountain meadow story: 0 7 0
• Music only selection: 0 9 8
3. Change the TV channel as instructed.
4. Plug the headset/ear plug into the TV.
5. Close your eyes and listen to the story
or music.
Get Well Network
1. From the Welcome Screen, select “My
Health”
2. Select “My Health Videos”
3. Select “Health Video Library”
4. Select “Guided Imagery Relaxation”
from the main menu.
5. Choose the audiotape that you would
like to listen to:
• Tropical beach story
• Mountain meadow story
• Music only selection
6. Plug the headset/ear plug into the TV
or listen via the pillow speaker
7. Close your eyes and listen to the story
or music.
When you are done listening to the program, stretch slowly and enjoy how you feel!
Listen to a story or music as often as you would like. The benefits of guided imagery often
grow when used more than once.
If you would like to buy any of the guided imagery audiotapes, they are on hand in the
hospital gift shop.
Note: DO NOT use guided imagery while operating machinery or driving a motor vehicle.

FYI: Incentive Spirometer
An incentive spirometer is a tool that
helps deep breathing and measures the
size of each breath. Incentive spirometry
also helps you cough and get rid of
extra mucous in your lungs.
How to use your incentive spirometer
1. Sit in a good position to take
a deep breath.
2. Make a tight seal around the
mouth- piece with your lips.
3. Slowly breathe in deeply through
the mouthpiece.
4. Take the mouthpiece out of your
mouth and breathe out.
5. Repeat this 10-20 times.
6. When you have done this,
cough several times.
7. Repeat the 10-20 deep breaths and
coughing as ordered by your doctor.
8. If you have had belly or chest surgery,
placing a pillow or your hand over
your incision for support will make
taking deep breaths.
➳
Mouth
Piece

FYI: Pain Control
■
■
We believe the treatment of your pain is a vital part of your care. Pain is your body's way
of reacting to injury or illness. There are two types of pain:
Acute pain follows an injury to the body and most often goes away when the injury heals.
Chronic pain lasts for six months or longer and can get in the way of normal movements.
Your nurse will ask you to use a number scale to rate your level of pain:
No pain Moderate pain Worst pain possible
Or, you may choose the face below that best fit the pain you are feeling. Each face is for a
person who feels happy because he has no pain (hurt) or sad because he has some pain.
Face 0 is very happy because he doesn’t hurt at all. Face 2 hurts just a little bit. Face 4 hurts
just a little bit more. Face 6 hurts even more. Face 8 hurts a whole lot. Face 10 hurts as much
as you can imagine, though you don’t have to be crying to feel this bad.
It is vital to tell your nurse when you are having pain. By knowing what your pain feels
like to you, we can better handle your pain.
Some things that may be used to control your pain are:
■ Medications
■ Patient controlled analgesia (PCA)
■ Epidural analgesia
■ Relaxation techniques
■ Changing your position
■ Heat or cold treatment
■ Physical therapy (PT)
■ Direct you to a pain center
You and your doctor will work together to find what pain control care are best for you.
The goal is to control your pain, keeping you as comfortable as possible.

FYI: Patient Controlled
Analgesia (PCA) Pump
PCA lets you run your pain medication. Instead of calling for a nurse when you need pain
medicine, you can simply push the PCA pump button. This gives you the right dose of pain
drug your doctor has ordered - no more, no less.
Your doctor will order the amount of pain medicine that you can get. The pump is set to
give you medicine in one of three ways:
■
■
■
■
■
■
■
Only when you push the button.
All of the time.
All of the time, with an extra dose of drug when you push
the button. (Your nurse will let you know how your doctor has
ordered your pain medication).
If your pump has been set to give drug when you push the
button, push the button with your thumb and let go, a beep
will sound, letting you know that the drug has been given.
You cannot by accident make the machine work by rolling
over onto the button.
You cannot give yourself more drug than your doctor has
ordered because there are safety checks built into the
pump. The pump will alarm to alert your nurse when the
drug supply is low or if it is not running the right way.
Do not wait until you are in bad pain before pushing the
button. Push the button when you first have pain so that
you can better curb your pain. It is also a good idea to take
pain medicine before activities such as coughing and deep breathing, therapy or walking to
the bathroom.
You should let your nurse know if your pain is not being controlled. Also let the nurse
know if you are having dizziness, constipation, upset belly, vomiting, itching or pain at the
place where the needle goes into your skin.
Important visitor information
It is expected that family members and guests are worried for their loved one’s pain. A
patient can have serious harmful reactions, such as becoming too sleepy, and may stop
breathing if a well-intentioned family member or friend were to push the button for them.
The pain button is to be used by the patient only. If you feel your family member is having
trouble pressing the button or have other concerns, please talk to the nurse right away.

FYI: Preventing Infection
We are committed to your safety. We want your hospital stay to be safe. Please tell us if you
have questions or concerns. By regularly talking to the people caring for you, a mix-up may
be skirted. If you are not sure why something is being done, just ask.
Everyone has a part in making health care safe. We want you to ask questions. If something
does not seem right, it is okay to speak up. We want you to get the safest care.
Everyone in a health care setting, whether in a hospital or doctor's office, is at risk for infection.
Hands can carry and spread germs. Many germs can live a long time on objects, mostly
items that are handled often, such as pens, countertops, faucets and side-rails. Hands can
pick up and carry millions of germs without even looking dirty.
Washing your hands is the best way to stop infection. Alcohol hand gel may also be used to
clean hands unless they look dirty. Alcohol hand gel cleans hands by killing germs. A dimesized
amount of gel is rubbed over the hands and let dry. Ask our staff if they have washed
their hands before starting your care. We will not be offended.
All hands can spread germs, not just those of health care staff. It is just as important for you
and your visitors to keep your hands clean.
Handwashing
■ If your hands are dirty, place your hands under warm water, lathering with soap for at least
15 seconds.
■ Rinse your hands well with plenty of warm water and dry them with a paper towel. Wash
or clean your hands often:
■ Before eating or drinking and after using the bathroom.
■ After wiping or blowing your nose, sneezing or coughing.
■ After touching anything that is known to be dirty or has germs (pets, plants, floor/ground,
mouth, etc.)
■ If you cannot get to a sink to wash your hands, ask your nurse for help. Washing your
hands at the bedside can be done.
Please remind your guests to clean their hands before and after they visit you. Bottles of
alcohol hand gel are on the walls inside patient rooms. All staff and guests can use these.
Also, ask friends and family members not to visit you if they are sick, because they can also
spread germs, putting you and other patients at risk for infection.
For More Information
Ask questions and stay involved. If something does not seem right, speak up! While in the
hospital, you can learn more about safety by watching our Patient Education TV System.
Turn your TV to channel 32 to see a list of available videos.
We suggest watching:
■ Medication safety ■ Infection control
■ Patient rights ■ Fall prevention

FYI: Preventing Falls
We are committed to your safety. We want your hospital stay to be safe. Please tell us if you
have questions or concerns. By regularly talking to the people caring for you, a mix-up may
be skirted. If you are not sure why something is being done, just ask.
Everybody has a part in making health care safe. We want you to ask questions. If something
does not seem right, it is okay to speak up. We want you to get the safest care.
Most falls in the hospital will take place if you try to get out of bed or a chair on your own.
While in the hospital, remember:
■ Drugs that you get may make you feel drowsy, dizzy or light-headed.
■ Having surgery or other procedures may make it hard for you to get out of bed.
■ You may have equipment attached to your body that may raise your risk of falling.
■ Being in a different place might make you feel a little disoriented, mostly at night.
■ Having pain can make it hard to move around.
If you want to get out of bed:
■ Keep your call button nearby so you can easily call your nurse. Call the nurse before getting
out of bed.
■ Do not ask your family members to help you get out of bed without speaking to the nurse
first. We want you to get up and move , but also want to protect you from falling.
■ Wait for your nurse to help you get up if you have equipment attached to you. Some equipment
on your body may need to be taken off such as a blood pressure cuff or leg boots.
Other equipment may need to be handled with care like an IV or urine drainage bag. We
may, at times, use equipment to help you sit up, such as a patient lift.
■ Seek help from your nurse if you are using oxygen. Moveable equipment will be brought
into your room so you can use oxygen while you are up walking in the halls.
■ Wear slippers or socks with a non-slip sole.
■ Do not lean on your IV pole for support when you are trying to walk. The wheels could
roll, making you lose your balance and fall.
While in the bathroom:
■ If you should feel lightheaded, dizzy or drowsy while in the bathroom, sit down and pull
the call-light string. This will let your nurse know that you need help.
■ We may not leave you alone in the bathroom , we respect your privacy but we want to
make sure you are safe.
For More Information
We are committed to your safety. We need your help to do this. Ask questions and stay
involved. If some- thing does not seem right, speak up! While in the hospital, you can learn
more about safety by watching our Patient Education TV System. Turn your TV to channel
32 to see a list of available videos.
We suggest watching:
■ Medication safety ■ Infection control
■ Fall prevention ■ Patient rights

FYI: Rehabilitation Services
After surgery, your surgeon will order rehabilitation services (Health care services that help
a you keep, learn or improve skills for daily living. These services may include physical and
occupational therapy, speech-language pathology and other services for people with disabilities).
Based on how well you do and the help you have at home, your doctor may order
more treatment to help you return home safely and pick up your daily activities. You
should plan to have someone to help you for a short time after you go home.
Our team will work with you to set up care when you go home if needed. We will check
with your insurance company to make the right choices for you.
Rehabilitation services provided by Christiana Care Health System:
■ Acute inpatient rehabilitation unit at Wilmington Hospital.
■ Outpatient rehabilitation services at Wilmington Hospital, Christiana Hospital, and at a
number of local sites including Physical Therapy PLUS.
■ Home care therapy with Visiting Nurse Association.+
We invite you to call us for more information and/or a tour of our facilities. Please talk to
your doctor about your rehabilitation choices.
Center for Rehabilitation at
Wilmington Hospital
302-428-6667
Outpatient Rehabilitation
Wilmington or Christiana hospitals
302-428-6600 or 302-733-1950
Visiting Nurse Association
302-327-5200 or 888-VNA-0001
Our main focus is to help you reach your goals, we are always more than happy to help, so
please give us a call.
* There are many providers in the area, not associated with Christiana Care, who can treat
you after you leave the hospital. Christiana Care has a non-exclusive list of people who supply
care in the area. This list is on hand to you upon request. Your doctor may know of
other providers in the area who can meet your needs. Also, your insurance may have preferred
providers for you to use after leaving the hospital. Please talk with your doctor and
insurer to learn about services that are on hand to you once you leave the hospital.
+ The Visiting Nurse Association and Christiana Care Health Services are affiliated entities.

FYI: Outpatient Physical
Therapy Facilities
Christiana Care Physical Therapy PLUS sites
New Castle
One Read's Way
Suite 300
New Castle, DE 19720
302-327-5755
Newark
Healthcare Center at Christiana
200 Hygeia Drive
Newark, DE 19713
302-623-0390
Middletown
Middletown CareCenter
124 Sleepy Hollow Drive
Middletown, DE 19709
302-449-3050
Glasgow
Springside Plaza
Conner Building
300 Biddle Avenue
Newark, DE 19702
302-838-4700
Brandywine
Foulkstone Plaza
1401 Foulk Road
Wilmington, DE 19803
302-477-4305
Wilmington
Wilmington Hospital
6th Floor
501 West 14th Street,
Wilmington, DE 19899
302-428-6662
Pike Creek
Pike Creek Fitness Club
4905 Mermaid Boulevard
Wilmington, DE 19808
302-235-0456
Greenville
Preventive Medicine &
Rehabilitation Institute
3506 Kennett Pike
Wilmington, DE 19807
Phone: 302-661-3350
Fax: 302-661-3310
Dover
230 Beiser Boulevard
Dover, DE 19904
302-736-0994
Convenient evening and Saturday hours and
transportation available.

FYI: Directions to Hospitals
Wilmington Hospital and Roxana Cannon Arsht Surgicenter
From I-95, southbound
Take exit 7 B (Delaware Avenue). Turn left onto Delaware Avenue. At the second traffic
light, turn left onto Jefferson Street and go one block onto the Wilmington Hospital
Campus.
From I-95, northbound
Take exit 7 (Delaware Avenue). Pass through four traffic lights then turn right onto
Delaware Avenue and move into the left lane. At the first light, turn left onto Jefferson Street
and go one block onto the Wilmington Hospital campus.
From I-495, southbound
Take exit 3 (12th Street) north to U.S. 13. Turn left at traffic light on U.S. 13, crossing over
bridge, bearing right and passing through one traffic light. Turn right on E. 10 th Street.
Turn right on Walnut Street. Go two blocks and turn left on 12 th Street. Follow 12th Street
to Jefferson Street and turn right onto the Wilmington Hospital campus.
When you arrive on the Wilmington Hospital campus, follow signs to the appropriate
location.
Christiana Hospital
From I-95, southbound
Take Exit 4B onto Route 58 west (Churchmans Rd.). Follow Route 58 one mile.
Turn left at the light to enter Christiana Hospital campus.
From I-95, northbound
Take Exit 4B onto Route 7/Route 1 north. Take Exit 166 onto Route 58 west (Churchmans
Rd.). Follow Route 58 for six-tenths of a mile.
Turn left at the light to enter Christiana Hospital campus.

Wilmington Area
Directions to Wilmington Hospital Campus
From I-95, southbound
Take exit 7B (Delaware Avenue). Turn left onto Delaware Avenue. At
the second traffic light, turn left onto Jefferson Street and go one block
onto the Wilmington Hospital campus. For the Roxana Cannon Arsht
Surgicenter, turn left into parking lot from Jefferson Street. For
Wilmington Hospital, park in the parking garage.
From I-95, northbound
Take exit 7 (Delaware Avenue). Turn right onto
Delaware Avenue and move into the left lane.
At the first light, turn left onto Jefferson
Street and go one block onto the Wilmington
Hospital campus. For the Roxana Cannon
Arsht Surgicenter, turn left into
parking lot from Jefferson Street.
For Wilmington Hospital, park
in the parking garage.
Pennsylvania Ave.
52
Delaware Ave.
Exits
7 & 7B
Brandywine Park
95
Brandywine Creek
Wilmington
Hospital
Jefferson
Baynard Blvd.
14th Street
202
Concord Pike
Washington Street
North Market Street
13
Fourth Street
95
MLK Blvd.
Washington Street
Orange Street
Market Street Mall
Train
Station
King Street
12th Street
11th Street
Walnut Street
10th Street
Church Street
Northeast Blvd.
13
Gov. Printz
Market Street
13
Christina River

Christiana Hospital Campus
From I-95, southbound
Take Exit 4B onto Route 58 west
(Churchman’s Road).
Follow Route 58 for one mile.
Turn left at the light to enter Christiana
Hospital campus.
Follow signs for Parking at the Main
Entrance.
From I-95, northbound
Take Exit 4 onto Route 7/Route 1 north.
Take Exit 166 onto Route 58 west
(Churchman’s Road).
Follow Route 58 for 6/10 of a mile.
Turn left at the light to enter Christiana
Hospital campus.
Follow signs for the Parking at the
Main Entrance.
Lot F
Lot G
Lot F
Lot E
Textile
Services
Service Building
Lot J Lot K Lot L
To Rt.7
To I-95
Lot D
MD Lot
E
Education
Building
Emergency
Department
Christiana Hospital
D C B A
Lot B
Women’s
Health
Services
MRI
Medical Arts
Pavilion 1
Lot P
Christiana
Surgicenter
Lot N
Medical Arts
Pavilion 2
Lot M
Churchmans Road (Rt. 58)
Lot C
Lot B
Lot A
Lot R
10
Helen F. Graham
Cancer Center
To Rt.7
Hygeia Drive
Blood Bank
of Delaware
Ogletown-Stanton Road (Rt. 4)
Entrance to buildings
HealthCare Center
at Christiana
Handicapped Parking