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Scan the code to learn more Throughout this guide, we’ve included QR codes to sources for additional information. To view these resources on your phone: 1. O pen your phone’s camera app. 2. P oint your phone at the QR code and hold still. 3. Click the link that pops up.

In This Guide 2 Our Commitment to Care 3 Inpatient or Outpatient? 4 Take Charge of Your Care Protect Your Health Be Informed Prepare for Safe Care Explain Your Pain 5 Ways to Fight Infections 10 Post-Procedure Recovery 11 Taking Opioid Pain Medications 12 Prevent Hospital Infections 13 Sepsis 14 Taking Antibiotics 15 Pressure Injuries & DVT 16 Taking Blood Thinners 17 Managing Diabetes 18 Managing High Blood Pressure 19 Depression 20 Navigating a Diagnosis

The editorial content displayed here is the responsibility of Patient Guide Solutions, LLC. This material is for your educational use only. It does not contain, nor should it be construed as containing, medical advice. Talk to your doctor before making any lifestyle or treatment changes. Your healthcare provider’s participation in the program does not represent an explicit or implied endorsement of any material presented. The people shown are models and are not known to have any health condition. Images are for illustrative purposes only. Image credits: Getty Images. ©2024 Patient Guide Solutions, LLC | All Rights Reserved 1-800-759-4332 | info@patientguidesolutions.com | patientguidesolutions.com What to expect during your stay What symptoms to watch for How to share concerns How to get ready for discharge How to manage your medical condition after you leave You Are the Most Important Member of Your Healthcare Team Help us give you the best care we can. Speak up and ask questions to make sure you understand your care every step of the way. Use this guide to learn: Healing Begins Here

21 Caregiver Support 22 Before You Leave

Checklist for Discharge Planning Ahead

24 After-Hospital Care 25 Adult Vaccines 26 Rights & Responsibilities 28 Advance Care Plans 29 Your Privacy Matters 30 Puzzles 31 Medication Tracker 32 Notes

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Our Commitment to Care

Patient Satisfaction Matters to Us Welcome to our hospital. We consider it a privilege to serve the healthcare needs of our community, and we want to thank you for choosing us for your care. We Care About Your Care Our goal is to provide the best quality healthcare. So we want feedback from patients like you: How’s your stay going? Are your needs being met? Are your doctors and nurses listening and responding to your questions and requests? If you have questions or concerns about your care, speak with your nurse or the nursing supervisor. We will try to resolve them as quickly as possible. } If you feel your concerns are not being properly addressed, you can contact any of the organizations listed on p. 27. We Value Your Feedback Once you leave our facility, we may ask you to take the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. It is used to measure and report patient satisfaction. It’s made up of simple

Want to Know How We Score? You can review and compare the quality, care, and safety ratings for different hospitals using Medicare’s Care Compare tool, which uses HCAHPS results and other data. Visit medicare.gov/ care-compare .

questions on key topics, such as: Doctor and nurse communication Medication and discharge information

Staff responsiveness Overall quality of the hospital

If you’re selected to receive this survey, please take the time to complete it. The results will help us know what we’re doing right and where we can improve.

Inpatient or Outpatient?

What Your Hospital Status Means

Any time you visit a hospital for services, the hospital gives you a status that tells your insurance provider what level of care you need. There are two hospital statuses: Outpatient status includes emergency department visits, observation services, X-rays, tests, and some surgeries. You may be an outpatient even if you stay in a hospital bed overnight. Inpatient status begins when a doctor writes an order to admit you to the hospital. This can be planned (like a hip surgery) or unplanned (like an emergency department visit).

Sometimes, you may have to stay in the emergency department or another part of the hospital for observation . Observation is a type of outpatient service your doctor may use to help decide whether to admit you as an inpatient or discharge you. Hospital Status and Insurance Some health insurance providers, including Medicare, pay different amounts for inpatient and outpatient hospital services. This means the amount you pay may change when your status changes. It’s Okay to Ask If you’re not sure whether you’re an inpatient or outpatient, ask your doctor, a social worker, or a patient advocate. And ask every day if your status has changed. Your doctors and nurses will not treat you differently because of your hospital status.

After-Care Services If you need additional medical care after discharge, Medicare may cover temporary home health services or a limited stay in an approved skilled nursing, rehabilitation, or other facility. If you or your loved one needs these services and you have questions about Medicare coverage, call 1-800-MEDICARE (1-800-633-4227) or visit medicare.gov . } For more on after-care options, see p. 24.

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CONTINUED ON NEXT PAGE Take Charge of Your Care

You’re in charge.

Check IDs. Pay attention to staff IDs so you know who’s caring for you. Help staff confirm who you are by always stating your name and birthday before you are treated or transported.

You are the center of your healthcare team. Know what’s happening every step of the way to get the best results from your hospital stay.

Know your medications. Understand what they treat, why you need them and how to take them

Speak up. Know how to ask for help, and make sure you have your nurse call button. It’s your body—you

for the best results. } Use the Medication Tracker on p. 31.

have the right to voice your questions and concerns.

PARTICIPATE in your CARE

Educate yourself. Learn about your medical condition, tests, and treatment options.

Find a support person. Pick someone, such as a close family member or friend, to help speak up for your care and needs during your stay.

Check before you go. Make an informed decision when selecting additional healthcare services. Choose only accredited providers who meet patient safety and quality standards. Scan the QR code or go to qualitycheck.org to learn more.

Source: The content within the “Take Charge of Your Care” section reinforces the safety and quality care goals and standards issued by The Joint Commission and other hospital accreditation organizations.

Take Charge of Your Care Protect Your Health

Tell Us What You Need We want to make sure we understand you and create a care plan that fits your individual needs. To help us provide the best possible care for you, please tell us if you need: Help getting comfortable or managing pain Glasses or hearing aids Your bed position, linens, or lights adjusted Changes in your care to meet your cultural, ethnic, or religious needs or preferences Help with emotional, spiritual, or ethical concerns Spoken, written, or signed communication in another language Information explained again or in a different way (for example, in writing or using pictures) More details about your condition, treatment, caregivers, hospital stay, or discharge plan Prevent Falls Patients of all ages are at risk for falls. While you are here, you may feel dizzy or weak. Illnesses, surgeries, medications (especially pain medications), or even just lying down too long can make you less steady on your feet. Your care team will assess your risk of falling. If you think your risk has changed since your last assessment, please let them know, and ask for help making a plan to stay safe. Use the nurse call button for help getting out of bed and anything else you may need between scheduled rounds, procedures, and treatments. Ask for help getting to the bathroom or walking around. Use handrails when they’re available. Wear nonslip socks or shoes. Keep often-used items (glasses, remote, tissues, etc.) within easy reach. If you are using a wheelchair, make sure it’s locked when you stand up or sit down. Never step on a footrest when getting in or out of a wheelchair. } Use the tools on p. 8 to tell your care team about your pain. It’s better to be extra careful and avoid falling than to risk a new medical problem.

We Are Here for You Our doctors and nurses respect and listen to every patient. If you have questions or concerns, you have the right to talk to your care team and get a response that makes sense to you. If you don’t feel your concerns are being heard, speak up, and we’ll do our best to help improve your care.

For Visitors The patient may be weaker or more confused than normal. Ask for help when they get out of bed. If staff has turned on a bed alarm, do not turn it off.

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Take Charge of Your Care Be Informed

Ask Questions Ask your care team questions like these to help you understand your condition and treatment: What tests will I need? When will I know the results? __________________________ _ _________________________________________________________________________________ _ _________________________________________________________________________________ _ _________________________________________________________________________________ What are the short-term and long-term effects of my condition?_ _____________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ How can my condition be treated or managed? _ ______________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ What are signs that my condition is getting worse? _ __________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Learn About Equipment Make sure you can easily reach the nurse call button, and ask a staff member for help if you’re not sure how to use it. Ask about the equipment we use to keep track of your health. You may be startled by alarms, but do not silence them—your care team needs to know if an alarm is sounding so they can help you. Ask for ear plugs if the noises bother you. If your post-hospital treatment involves medical equipment, practice using it with your nurse before you leave. Check Your Understanding Try these tips to make sure you understand and remember the information your care team gives you: Repeat it: In your own words, repeat back what you heard your care team member say. Note it: Write down important facts so you can look back if you forget. Teach it: Tell your support person about your condition, procedures, and medication instructions.

Make Informed Decisions Talk to your doctor and family about whether you want life-saving actions taken in an emergency. } See Advance Care Plans on p. 28 to learn about your options. If you’re unsure about your diagnosis, don’t be afraid to ask for more information or a second opinion. Read and understand all medical forms before signing. Ask for help if you need information explained.

Take Charge of Your Care Prepare for Safe Care

Your care team continuously monitors your healthcare to prevent medical errors. You can help them keep you safe by paying attention to the treatment you are receiving. Prepare for Surgery When you find out you will need a procedure, ask questions like these to be sure you understand what will happen and why: Why is this procedure needed? Will it cure my condition or help me manage symptoms?_____________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Will I be given anesthesia? How might it affect me? What side effects should I watch out for?_________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Are there any other risks I should know about?_ _______________________________ __________________________________________________________________________________ __________________________________________________________________________________ Take Medication Safely Before they give you any medication, your doctors and nurses should: Use your ID bracelet to check that your name matches the name on the medication Have a current list of all the prescription drugs, over-the-counter medications, and herbal or vitamin supplements you take Know any allergies you have to medications, anesthesia, foods, latex, etc. It’s also important for you to understand your take-home medications. For every new medication, ask: What are the brand and generic names of my medication? Why am I taking it? How will it help? When will it start working? What dose should I take? How often? How long? What is the best time (morning, night, etc.) and way to take it (with food, with water, etc.)? What are possible side effects? What do I do if they happen? Are there any foods, drinks, or activities to avoid? What do I do if I miss a dose? Does it replace any medications I was taking before coming to the hospital? Is it safe to take with all my other new and existing medications and supplements?

Pause to Check Before your procedure, your surgeon will pause to make sure you’re the right person, getting the right surgery, on the right body part.

Keep Track Write down important information about your medications. Speak up if you think it’s time for your next dose. Never take medication if you don’t know what it is. } Use the Medication Tracker on p. 31.

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Take Charge of Your Care Explain Your Pain

Pay attention to your pain, and use these tools to tell your care team about it: 1. How long have you had your pain?_ ____________________________________________ 2. Where do you feel the pain?_____________________________________________________ _ _______________________________________________________________________________ 3. Is your pain constant, or does it come and go? (circle one). If it comes and goes: How often do you feel it? _ ___________________________________________________ How long does it last?________________________________________________________ 4. List anything that makes your pain worse:_ ____________________________________ _ _______________________________________________________________________________ _ _______________________________________________________________________________ 5. List anything that makes your pain better:______________________________________ _ _________________________________________________________________________________ 6. If you were taking any pain medication before you came to the hospital: What medication(s) did you take?____________________________________________ Did it help with your pain? ____________________________________________________ Have you ever had a bad reaction to a pain medication?_____________________ 7. Is your pain preventing you from (circle all that apply): taking a deep breath, turning in bed, walking to the restroom, getting restful sleep, getting out of bed, sitting in a chair, eating, any other self-care activities? ___________________________ _ _________________________________________________________________________________ 8. List any other activities that are more difficult or that you can no longer do because of your pain: ___________________________________________________________ _ _______________________________________________________________________________

Circle any words that describe what your pain feels like: Aching

Bloating Burning Cramping Cutting Dull Heavy Itching Numb Pinching Pressing Pulling Sharp Shooting Stabbing Swollen Throbbing Tight Tingling

Use this pain scale to let your care team know how bad your pain is:

Moderate (Yellow) 4 - The pain makes some activities uncomfortable. 5 - The pain interrupts some activities. 6 - The pain is hard to ignore, and I avoid some activities. 7 - The pain is the focus of my attention and prevents many activities.

Mild (Green) 0 - I have no pain. 1 - I hardly notice the pain. 2 - I’m aware of the pain, but it’s not distracting. 3 - The pain sometimes distracts me.

Severe (Red) 8 - The pain is awful, and it’s hard to do anything. 9 - I can’t bear the pain, and I can’t do anything. 10 - The pain is as bad as it could be.

Take Charge of Your Care 5 Ways to Fight Infections

At the hospital, you might come into contact with germs that could give you a new illness. Reduce your chances of infection with these safety tips. 1. Clean your hands: After touching surfaces, especially doorknobs and handrails Before eating After using the restroom After sneezing, coughing, or blowing your nose 2. Ask visitors to help you stay safe. Everyone, including all hospital staff and guests, should clean their hands before they touch you. Make sure your visitors wash their hands or use alcohol-based hand sanitizer when they enter your room. Ask friends and family not to visit if they are sick. 3. Cover your cough or sneeze. To limit the spread of germs, cough or sneeze into tissues, then immediately throw them away and clean your hands. Ask staff if you should wear a surgical mask. Even if you don’t feel sick, you could be carrying germs that can make others sick. 4. Keep an eye on bandages, dressings, tubes, and drains. If a dressing on a wound, surgical site, or IV gets wet or loose, tell your nurse. Also let your nurse know if a catheter or drainage tube becomes loose, comes out, or does not seem to be draining well. Speak up if the area around the tube hurts or is hot to the touch. 5. K eep your vaccinations up to date. Make sure you are as protected as possible from the spread of infection. Check with hospital staff about whether it’s safe for you to receive any vaccines you might need. } See p. 25 for information about important vaccines.

Influenza Scan the code for more detailed information on protecting yourself from influenza.

Cleaning Tip Use soap and water or alcohol-based hand sanitizer under your nails, between your fingers, and on the palms and backs of your hands. Rub for 20 seconds (the time it takes to sing “Happy Birthday” twice).

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Post-Procedure Recovery

Take the Next Steps to Feeling Better What you do during the first few days after surgery is key for a smooth, successful recovery. It’s common to feel tired, achy, or sick to your stomach after a procedure. Your doctor may prescribe medication to help you feel better. Your care team will tell you when you can start sipping liquids and eating after your procedure. If you have any tubes or drains, they will be removed as soon as safely possible. Make sure you follow your doctor’s orders for moving, getting out of bed, and walking to help your body heal faster. And ask your doctor when you can: Go home Return to a normal diet Start physical therapy or rehabilitation, if needed Go back to work Start normal activities again, such as driving, exercise, and sex Incision Care As your incision heals, you’ll notice swelling, soreness, and bruising begin to go away. Your incision may also itch, but don’t scratch it—scratching can introduce germs that could cause an infection. Talk with your nurse and make sure you know how to take care of your incision before you’re discharged from the hospital. Call Your Nurse Have your nurse call button where you can easily reach it. Call immediately if you: Feel more pain and pain medication doesn’t help Have chest congestion or trouble breathing

Manage Pain It’s normal to have some pain after a procedure, but it should be manageable. Talk to your doctor about the best way to treat your pain. They may prescribe certain medications or show you other ways to lessen pain, like applying ice or heat to the area. Taking non-opioid pain medications on a schedule can help keep pain under control. Your doctor may also prescribe opioid pain medication if you need it. } See p. 11 for information about taking opioids safely.

Wound Care Scan the code for more detailed information on caring for your surgical wound.

See bright red blood at your incision See signs that your incision is opening Notice signs of infection—like drainage, redness, heat, or swelling—around your incision If you have any of these symptoms after you leave the hospital, call your healthcare provider right away.

Know the Risks and How to Use Them Safely Opioids are medications that help relieve pain. They affect your brain by blocking or reducing pain signals and interacting with its reward system. They’re available legally as prescription pain medications like hydrocodone and oxycodone and illegally as heroin. Prescription opioids can be very addictive and dangerous if they’re not used properly. Long-term use can lead to dependence and then withdrawal when you try to stop. You can also develop tolerance to opioids over time, having to take more and more to get the same pain relief. Side Effects You can experience side effects from prescription opioids, even when you take them as directed by your doctor. Opioid pain medications can cause: Constipation Nausea, vomiting, and dry mouth Taking Opioid Pain Medications

Substance Abuse Scan the code

for more detailed information on recovery from addiction and dependence.

Other Pain Relief Methods If you don’t want opioid pain medication during your hospital stay, tell your doctor or nurse. Ask your care team about alternatives that work alongside or instead of pain medication, like massage therapy, physical therapy, electrical nerve stimulation, acupuncture, or heat and cold therapy. You can also try these tips on your own to help relax your body and relieve pain: Dim or turn off the lights. Practice deep breathing or meditation—on your own, with a video, or through a mindfulness app on your phone or tablet. Play calming music. Talk or text with a loved one. Watch a movie, read, or play a game.

Fatigue and dizziness Itching and sweating Slow breathing

Confusion Depression

Long-term use can lead to side effects like: Tolerance Dependence Increased sensitivity to pain

Addiction Overdose

Talk to Your Doctor If you’re prescribed an opioid pain medication, be sure you know the possible risks. Talk to your doctor about safe use, especially if you need oxygen or use a CPAP machine. You may be more likely to have problems with breathing and getting enough oxygen when taking opioids. The best way to avoid side effects is to stop taking opioids as soon as possible. Talk to your doctor about how long you will need to take them, and ask about other options for managing pain. Discuss all of your concerns with your care team, and schedule a follow-up visit. Safe Use Take opioid pain medications exactly as prescribed. Don’t drink alcohol while you’re taking opioids, and ask your doctor for a list of medications to avoid. Never share your opioid pain medications or use another person’s. Store your prescriptions in a secure place that others can’t access. Throw away any leftover pills safely—to find out how, visit fda.gov/drugs/safe-disposal-medicines/ disposal-unused-medicines-what-you-should-know or scan the QR code.

Find Treatment for Addiction

If you or someone you know may be struggling with addiction, don’t wait to get help. Call 1-800-662- HELP (4357) or visit samhsa.gov/ find-help .

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Prevent Hospital Infections

Prevent Pneumonia Scan the code

for more detailed information on keeping your lungs healthy.

Urinary Tract Infections Scan the code

Superbugs A superbug is a germ that causes a bacterial, viral, or fungal infection and doesn’t respond to standard treatments. These germs make you sicker longer and increase your risk of serious complications.

for more detailed information on protecting urinary health.

Reduce Your Risk During Your Stay According to the Centers for Disease Control and Prevention (CDC), 1 in 31 patients picks up an infection during their hospital stay. Your healthcare team will work hard to prevent infections, but there are also steps you can take to protect yourself. Type How It Starts Prevention Symptoms Catheter- Associated Urinary Tract Infection (UTI) Germs enter your urinary tract through a tube used to drain urine Fever Burning or pain in lower belly Bloody or frequent urination Clean hands before touching area Keep urine bag below level of bladder to prevent backflow, and ask for it to be emptied regularly Don’t pull, twist, or bend tube Secure catheter to your leg and ask every day if it’s still needed

Redness Pain

Clean hands before touching area Do not shave surgery site yourself (irritation increases risk of infection) Don’t let visitors touch or dress your wound Ask your nurse to show you how to care for your wound Clean hands before touching area Speak up if your bandage looks or feels loose, wet, or dirty, or if your skin looks red or feels sore Avoid touching tube or letting visitors touch tube Ask when tube can be removed Clean hands before touching area Ask if it’s safe to raise the head of the bed Know the plan for cleaning the inside of your mouth and speak up if needed to stay on track Ask when tube can be removed

Surgical Site Infection

Germs affect the site of your surgery—either on your skin or internally

Drainage of cloudy fluid Fever

Red skin and soreness at site

Central Line- Associated Bloodstream Infection

Germs enter your bloodstream through a large tube that’s inserted in a vein near your neck, chest, or groin Germs enter your lungs through a tube in your mouth, nose, or neck used to help you breathe

Fever Chills

Cough with mucus Nausea and vomiting Fever and chills Chest pain Shortness of breath

Ventilator- Associated Pneumonia

Sepsis

Know the Signs and Act Fast

Prevent Infection to Avoid Sepsis Practice good hygiene during your hospital stay and at home to prevent sepsis: Clean hands regularly— Wash your hands or use alcohol-based hand sanitizer throughout the day. Make sure everyone cleans their hands before touching you. Keep wounds clean and covered— Let your nurse know if bandages get loose or wet. And don’t let visitors touch your wound. Pay attention to tubes— If you see redness or drainage around where tubes go into your body, or if any tube gets loose or comes out, tell your nurse. Ask when tubes can safely be removed.

Sepsis is a life-threatening emergency that happens because of an infection in your blood. It usually starts with an infection somewhere else in your body—like in your urinary tract if you’re using a catheter or in a surgical wound. Bacterial, viral, and fungal infections can lead to sepsis if your immune system overreacts to them and attacks your own body. Without medical care, sepsis can cause organ damage or even death. Emergency treatment can help, but it must begin quickly. Warning Signs Quick action is required if you have sepsis. For every hour treatment is delayed, the chances of dying from sepsis go up. If you have any of the symptoms below or an infection that isn’t getting better, notify your healthcare team right away (or call 911 if you have already left the hospital).

Low blood pressure or dizziness Fever, shivering, or feeling very cold Confusion Shortness of breath or breathing fast Rapid heartbeat Extreme pain or discomfort Clammy or sweaty skin

Treating Sepsis Scan the code for more detailed information on how your healthcare team supports

healing from sepsis.

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Taking Antibiotics

How to Use Them Safely and Effectively When fighting infection, antibiotics can be life- saving medications, but using them incorrectly can harm your body. Taking antibiotics when you shouldn’t can lead to antibiotic resistance. Then the medications that were used to fight off harmful germs won’t work anymore.

Clean your hands. This is one of the best ways to prevent the spread of germs that cause infections and to keep you and your family healthy. Ask about symptom relief. Talk to your doctor about other ways to relieve symptoms of your illness so you can feel better. Ask about watchful waiting. Some infections can get better without antibiotics. Your doctor may recommend waiting a few days to see if you get better before prescribing you antibiotics. Take antibiotics as prescribed. Even if you feel better, do not skip doses or stop taking an antibiotic early without approval from your doctor. Never take expired antibiotics. They can stop working effectively and lead to serious infections with resistant germs. Throw leftover antibiotics away. Ask your pharmacist about the best way to get rid of leftover antibiotics.

While you’re in the hospital, your doctor will regularly review your medications, including antibiotics, to make sure you are on the right medication at the right dose. They may change the medication or dose, or they may stop giving you antibiotics if you don’t need them anymore. Take these steps to prevent infection and improve antibiotic use after you leave the hospital: Keep up with vaccines. Vaccines help prevent infections that may require antibiotics. They also help to stop diseases from spreading. } See p. 25 for information about important vaccines for adults. Tell your doctor about any healthcare you received outside the United States in the last six months, especially if you’ve stayed overnight in a hospital or had a medical procedure.

Learn More For tips on using antibiotics after discharge, scan the QR code or visit

cdc.gov/antibiotic-use .

Pressure Injuries & DVT

Know the Signs If you notice any of the following symptoms, tell your nurse right away. Signs of a pressure injury Change in skin color or texture Warm or cool areas on your skin Painful or tender spots Swelling on your skin A new wound that has pus-like draining

How to Spot and Prevent Them During your stay, you may lie in bed for many days—putting you at risk of getting a pressure injury (sometimes called a bedsore or pressure ulcer) or deep vein thrombosis (DVT). These can cause a longer hospital stay, make recovery harder, and lead to serious medical problems. Take the steps below to help prevent them. . Pressure Injuries A pressure injury is damage to an area of your skin and the tissue beneath from lying on it for too long. This happens most often on skin that covers a bony part of the body, like the hips, tailbone, heels, or ankles. To help prevent pressure injuries: Change position every two hours. Have your nurse help you switch between lying on your sides and back. Keep skin dry and clean. If you become wet or soiled, be sure your nurse cleans your skin as soon as possible. Use pillows and foam. Prop up parts of your body with pillows, and ask for foam wedges to help you lie on your side. Check your medical devices. This could be a cast, restraint, or ID band. Have your nurse check that everything is the right size and secure, and let them know if any devices are uncomfortable. Maintain a healthy diet. Ask your care team how to make sure you stay hydrated and get the nutrition you need while you’re in the hospital. DVT DVT happens when blood clots in a vein deep beneath your skin, usually in your leg or pelvis. The clot could break lose and move to your lungs, causing a potentially life-threatening condition called pulmonary embolism. To help prevent DVT: Have your nurse help you change position every two hours. Get up and walk if you can. If you can’t, move your feet in circles to exercise your legs. Your doctor may prescribe compression stockings or a blood thinner medication. } See p. 16 for information about blood thinners.

Signs of DVT

Sudden swelling of your leg or arm Soreness or cramps in your legs Change in skin color on your legs, arms, or neck Warm area on your skin

Preventing DVT at Home Scan the code

for more detailed information on protecting yourself from blood clots after discharge.

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Taking Blood Thinners

Possible Side Effects Severe bleeding is rare, but ask your doctor about your risk and other possible side effects. Immediately call your nurse (or 911 outside the hospital) if you notice any signs of dangerous bleeding: Blood in your urine Bleeding that doesn’t stop Headache, stomach pain, or dizziness Some blood thinners can cause birth defects, so tell your doctor if you could be pregnant or are considering pregnancy. or bowel movements Vomiting or coughing up blood

How to Use Them Safely Blood thinners are medications you take to prevent blood clots or keep them from growing larger. Your doctor may prescribe a type of blood thinner called an anticoagulant to reduce your risk of clots after surgery or a stroke or to treat a long-term heart or lung condition. Types of anticoagulants include warfarin, heparin, and direct oral anticoagulants (DOACs). Each type works differently. How long you take them depends on your medical conditions, risk of blood clotting, age, and other factors. Safe Use When you take blood thinners, it’s harder for your blood to clot to stop bleeding. This can make injuries more dangerous. Follow these tips to stay safe while taking blood thinners: Take blood thinners exactly as prescribed. Don’t skip doses or double up if you forget. Tell your doctor all the medications you take, especially any with aspirin in them. Talk to your doctor about your diet. Changes in the amount of vitamin K you eat (from foods like green leafy vegetables, avocados, soy products, and canola oil) can interfere with some blood thinners. Before any medical or dental procedure, tell healthcare staff you take blood thinners. Don’t skip blood tests. Regular blood tests can help your healthcare team make sure you are getting the safest dose of blood thinners. Avoid sports and activities that increase your risk of injury. If you can’t avoid them, use protective gear like gloves or a helmet. Use grooming products that are less likely to make you bleed, like a soft-bristle toothbrush, waxed dental floss, and an electric razor.

Reversal Agents These medications help stop bleeding in urgent situations by reversing the effects of some blood thinners. Ask your doctor if the blood thinner you take has a reversal agent.

Managing Diabetes

Blood Sugar Complications Scan the code for

more detailed information on blood sugar highs and lows.

Follow These Tips During Your Stay

Avoiding Infections Having diabetes puts you at a higher risk of getting an infection, so it’s important to be extra careful during your hospital stay. Tell your nurse about any cuts, sores or bruises you have. } See p. 9 for more tips to prevent infections. Planning for Meals Once you’re admitted to the hospital, ask if there’s a special meal plan for patients with diabetes. You can also ask to see the hospital’s dietitian if your blood sugar is too high or too low during your stay. If you need to take medication or insulin before your meal, make sure you’ve worked out a schedule with your nurse. Ask your nurse what you should do if you can’t eat.

Keeping your blood sugar under control takes careful attention. To help, make a diabetes care plan with your doctor or nurse as soon as possible. Let them know how you manage your diabetes at home. Include information like: How often you check your blood sugar How often you take your medications and insulin How to handle your insulin pump if you have one Your healthcare team may use a different routine while you’re in the hospital. Let them know if you Sicknesses, surgeries, or new medications can cause your blood sugar to rise or fall. Tracking your blood sugar can provide valuable information about how your body is working. Your nurse may check your blood sugar more often than you are used to. They’ll adjust your care if your numbers are generally too high or too low. Taking Medication or Insulin Your insulin needs may change when you are sick or after surgery. You’ll still need your insulin (if you take it) and other medications while in the hospital, but do not take them yourself. Your nurses will give them to you. If you have questions about your medication schedule, it’s okay to ask. have any questions or concerns. Tracking Your Blood Sugar

When to Call If you have symptoms of high or low blood sugar, like feeling thirsty or shaky, call for your nurse.

Choose an Advocate You may want to ask a friend or family member to be your diabetes advocate. Together, you can work with hospital staff to follow your diabetes care plan.

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Managing High Blood Pressure

Warning Signs People with high blood pressure don’t usually have any noticeable symptoms, but in a hypertensive crisis, you can experience: A severe headache Chest pain Blurred vision Get Checked Scan the code for more detailed information on blood pressure readings. Dizziness Confusion Trouble breathing If you notice any of these symptoms, get medical help right away. A hypertensive crisis can lead to a stroke or death if not treated.

Healthy Choices for Healthy Numbers High blood pressure damages your arteries and stretches them out, interfering with blood flow to your vital organs. It can delay your recovery and cause complications that increase your time in the hospital. What the Numbers Mean Healthy blood pressure is below 120/80. The first number (systolic blood pressure) is the force of blood on your arteries when your heart is contracting. The second number (diastolic blood pressure) is the amount of pressure still in your blood vessels when your heart is resting between beats. Elevated blood pressure is between 120/80 and 130/80. Hypertension is above 130/80 and below 180/120. Blood pressure above 180/120 is called a hypertensive crisis . This is a medical emergency. Managing Blood Pressure Lifestyle Practicing good habits and avoiding harmful substances can support healthy blood pressure. Eat a healthy diet with a variety of fresh fruits, vegetables, and whole grains. Limit dairy, fat, sugar, and salt. For more information, check out the DASH (Dietary Approaches to Stop Hypertension) diet at nhlbi.nih.gov/education/dash-eating-plan or scan the QR code. Aim for 30 minutes of moderate aerobic exercise five days a week. Aerobic exercise strengthens your heart. Some examples are walking quickly, jogging, and cycling. Manage sleep. According to the American Heart Association, getting 7–9 hours of sleep per night on a regular schedule is best to support healthy blood pressure. Quit smoking. Tobacco raises your blood pressure. If you smoke, call 1-800-QUIT-NOW. Limit alcohol. Alcohol leads to high blood pressure and can be more dangerous if you take certain blood pressure medications. Medications If lifestyle changes alone are not enough to control your blood pressure, your doctor may prescribe medications. Some medications can lower your heart rate or increase the force of your heart pumping. Some help your kidneys remove extra water as urine. } See p. 7 for a list of questions to ask about new medications.

Depression

Suicide Prevention Scan the code for more detailed information on staying safe through a mental health crisis.

Learn the Signs and Types of Treatment If you’re in the hospital or have a chronic condition, you may feel sad or angry for a little while. This is normal—but when depression interferes with your daily life, it can be harmful to your healing process. Depression can make recovery harder, hospital stays longer, and readmissions more frequent. It’s important to notice the signs and share them with your care

team. Treatment is possible! Symptoms of Depression Symptoms can be different for everyone and may include: Mood swings or feeling unusually sad, irritable, angry, or empty Low energy or motivation, making normal tasks harder Loss of interest in or avoiding

Problems with memory or attention Headaches or other pains with no known cause Pacing or restlessness Paranoid thoughts Abusing drugs or alcohol Thoughts of death, suicide, or harming yourself or others

family, friends, or hobbies Eating or sleeping too much or too little Feeling guilty, worthless, or hopeless

If you or someone you know has any of these symptoms of depression, you can find free resources at nami.org . Treating Depression Treating depression is different for everyone. Your doctor may recommend talk therapy, medication, or a combination of both. Talk therapy provides treatment through conversation and problem-solving with a therapist. Antidepressant medications balance chemicals in your brain that control mood. Take antidepressants only as prescribed, and never stop taking them without talking to your doctor first. Let your doctor know if your medication is not helping enough. What You Can Do In addition to professional treatment, you can try these tips when you’re back home: Exercise at least three days a week. Physical activity creates mood-lifting chemicals. Schedule workouts with an exercise buddy. Think about what you eat and drink. For a healthy mind and body, eat more nutrient-rich foods and limit processed foods. And avoid alcohol until your depression improves. Spend time with people. Share activities or meals with a family member or friend. Open up to loved ones about your depression and tell them what you need. They can help you navigate your symptoms and treatment and support you in a mental health emergency. Postpone important decisions, like getting married or changing jobs. Stress can make depression worse. Focus on feeling better before making a life-changing decision.

Depression in Older Adults Some causes of depression, like chronic conditions, social isolation, and major life changes, are more likely to affect older people. But depression is not a normal part of aging—and you don’t have to cope with it alone. Share your feelings with your care team, and take steps to prevent loneliness. Visit eldercare.acl.gov to find support services near you.

Ask for Help For immediate help in a mental health crisis, contact the Suicide and Crisis Lifeline by calling or texting 988 , or chat with a crisis counselor online at 988lifeline.org/chat .

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Navigating a Diagnosis

Accept Your Emotions A new diagnosis may make you angry, sad, or scared. You may be accepting one day, then upset the next. You may also be relieved to finally know what’s going on. All your feelings are normal and will get better with time. If they don’t, consider talking to your nurse, doctor, or a counselor.

A Step-by-Step Guide

A new diagnosis can be overwhelming and confusing. After you’ve processed the news, follow these five steps to help navigate your new diagnosis: 1. Make a follow-up doctor’s appointment and prepare for it. Bring a list of questions and be ready to write down answers. Have a loved one come to your appointment with you to hear what your doctor says and give you support. 2. Build a support team. Tell trusted family members and friends about your diagnosis. They can help you cope. Also ask your discharge planner for help finding support groups, either online or in person. You can meet other people with the same diagnosis to share information and concerns. 3. Call your insurance provider. Tell them about your new diagnosis and ask about your coverage for treatments. Don’t be afraid to ask how much treatments will cost. Your doctor may be able to offer different treatments that better fit your budget. 4. Learn about your diagnosis . Having a good understanding of your condition will help you feel more in control. Ask your doctor for resources. And remember to keep learning about your condition. You may discover new ways to better manage it. 5. Take time to make decisions . You may not have to decide on a treatment plan right away. Take time to understand your diagnosis and treatment options and talk to your loved ones. Doing this will help you feel more confident in your decisions.

Second Opinion Feeling unsure about your diagnosis or treatment? Tell your doctor you’d like a second opinion. Most doctors will understand that you want to be sure before making decisions about your health.

Caregiver Support

How to Help Your Loved One’s Recovery We encourage patients to pick a key person to support them during their hospital stay. This person can ask questions the patient might not think of and take notes. If the patient becomes unable to make or communicate healthcare decisions, the support person can help make sure they get the care they would want. } See p. 28 for information about advance care planning. Whether you are that primary support person or just one of many people caring for and supporting your loved one, you can play an important role in making sure they get the safest and best care. What to Know Before You Leave As a caregiver, you can help ensure the best outcomes for your loved one after their hospital stay by finding out how you can help with: Arranging appointments for follow-up medical care and advocating for the patient at those appointments Changes in your loved one’s daily routine and ability to complete regular tasks New medical equipment New medications—for example, picking them up from the pharmacy and making sure your loved one takes the right ones at the right time Watching for side effects and knowing who to contact for questions or follow-up care if your loved one’s condition gets worse

Caregivers Need Care Too

If you feel like you need a break or help, reach out to friends and family. You can also find resources from these organizations: National Alliance for Caregiving: caregiving.org Caregiver Action Network: caregiveraction.org Family Caregiver Alliance: caregiver.org Eldercare Locator: eldercare.acl.gov N ational Respite Network and Resource Center: archrespite.org

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CONTINUED ON NEXT PAGE Before You Leave the Hospital

Checklist for Discharge

Records and results

Discharge summary

This includes: Why you were in the hospital Who cared for you Your treatments, including any procedures and medications

Your medical records and test results may be available through the hospital’s patient portal. Ask staff how to sign up for access. You can also request copies from the medical records department.

Medication list

After-hospital services

This may be part of your discharge summary. It should include new and existing prescriptions, over- the-counter medications, vitamins, and supplements. Ask if there are any medications you can stop taking or that are not safe to take together. Also make sure you know why, how, and when to take each one. Check that your pharmacy has your new prescriptions, and make sure you have a plan to get them filled and picked up. } See p. 31 for a medication tracker.

Know if you’ll need support in these areas and make a plan for getting it: Personal care : bathing, eating, dressing, toileting Healthcare : follow-up doctor’s appointments,

physical therapy, wound care, medications, injections, medical equipment Home care : cooking, cleaning, laundry, shopping

Follow-up care instructions

Local resources

Ask your discharge planner for help finding local organizations or programs that provide any medical or non- medical services you may need.

Beyond medication, these can include information about additional tests you may need, recovery activities, and diet changes. } See p. 23 for a list of questions to ask your doctor and space to write the answers.

Before You Leave Planning Ahead

Questions to Ask 1. Who can I call right after I leave the hospital if I have questions or concerns about my condition or treatment?_ ________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 2. Has my follow-up appointment been scheduled? With who? Do I have a ride there?___________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 3. What are key warning signs I need to watch out for? Who do I call if they happen?__________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 4. What special instructions do I need (wound care, injections, new equipment, etc.)?________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 5. What kinds of activities and foods are limited? For how long?_ ____________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 6. Who will provide personal, home, or healthcare services I may need?______ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 7. Who can help me if I have concerns about medical costs?_ _______________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

Need Medical Equipment or Supplies? Medicare may cover the cost of some durable medical equipment (walker, wheelchair, hospital bed, oxygen, etc.) if it is medically necessary and comes from an approved supplier. To find suppliers in your area, call 1-800-MEDICARE (1-800-633-4227) Visit medicare.gov/medical- Not Ready to Leave? You have the right to appeal your discharge if you don’t agree that you are ready to leave the hospital. Speak with your doctor or nurse, and share your concerns. You may also need to reach out to Medicare, Medicaid, or your insurance company.

equipment-suppliers or scan the QR code.

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