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INTRODUCTION

This gives you general information and instruction about your surgery.  It focuses on the needs and responsibilities of you and your family have as you prepare for and recover from surgery.

Depending on the reasons for your surgery, you might be treated as an outpatient or inpatient.

As an out patient, you will come to the hospital with the exception that after your surgery and a recovery period, you will be able to leave that same day.  There are specific criteria that helps your nurses and physicians decide when your are ready to leave the hospital.

If you receive anesthesia or medication to make you sleep during your surgery, it is recommended that a responsible adult stay with you after you the hospital.  It is recommended that two persons accompany a child having outpatient surgery.  This will enable one person to care for the child while other person drives.

Occasionally, patients having outpatient surgery will stay in the hospital for an extend stay to receive nursing care and observation.  This may occur for a variety of reasons, and is the decision of your physician.

If your physician feels you need to be in the hospital longer, you will then become an “inpatient”.  Admission to an inpatient area means that you will stay in the hospital for one or more nights, the nursing staff will assist you and your family in moving to your new room.

Depending on the type of surgery, and whether you will be an outpatient or an inpatient, your surgeon may admit you the night before surgery, or the morning of your surgery.

Ask your physician or nurse any questions your may have after reading this information.
 

Preparing the Your Hospital Visit

What to Bring:
If you use any of the following items, bring them to the hospital.
• Care, Walker, Crutches or other assistance devices, such as leg braces, splints or prostheses.  If you are having a cast changed or removed, or other orthopedic surgery, bring your crutches to the hospital

• Dentures & their containers.
• Glasses or contact lenses with their cases
• Hearing aid(s)
• Special support stocking used to promote circulation.

If you will be staying in the hospital for one or more nights also bring:
• Nonskid slippers
• Toiletries, such as toothbrush, toothpaste, comb, brush or shaving equipments.

If you are planned to be operated under anesthesia.
Do not eat or drink anything after midnight:  Your stomach must be empty before you receive the anesthetic.  This is call “NPO” or having nothing by mouth.  It helps prevent nausea, vomiting & other complications during and after anesthesia.  Your surgery, may be delayed if you eat or drink anything.

Do not wear makeup the morning of surgery. It is important for the staff taking care of you to see changes in your skin color.

Take a shower or bath the evening before morning of surgery.  This will decrease the amount of bacteria on your skin.  It may decrease the risk of infection after surgery.

A good night’s rest is important before surgery.   If you are in the hospital and have trouble falling asleep, please tell your nurse.  A medication to help you relax may be available.

Take only the medications your physician or nurse tell you to take on the morning of your surgery.  Take them with just enough water to swallow comfortable.

Your Healthcare Team.

Each member of your healthcare team has a role in your care and recovery.  A brief description of each member’s role follows.

You and your family are the centre of the healthcare team.

The anesthesiologist  is a physician specially trained in providing anesthetics.  Anesthetics cause  anesthesia, the complete or partial loss of awareness of pain, touch or other sensation.

The dietitian  or dietetic technician  helps provide a well-balanced diet.  He or she will assess your nutritional health and change your diet to accommodate specific need, like and dislikes.

The healthcare aid  or nursing assistant  assists the nurse who is caring for you.   They will help you with grooming, eating, walking and other personal care needs.

The registered nurse (RN) is responsible for your care and helps coordinate, plan and assess your needs throughout your surgical experience.

The resident is a licensed physician who is participant in your health care.  The resident works closely with your surgeon and is responsible for planning and directing your care.

The surgeon determines the surgical options, performs the surgery and supervises your pre and post surgical care.

The Ward secretary  performs clerical functions on the nursing station and is a key person with whom your family will communicate on the day of your surgery.

For Patients With Diabetes
Tell your physician and nurse that you have diabetes.  If you are to be admitted to the hospital the morning of your surgery, do not take your insulin or oral diabetes medication before your come to the hospital.   Your blood glucose will be tested before, during and after surgery.  A physician will decide how much diabetes medication you need that day to keep your blood glucose stable.

If you receive additional instructions from your surgeon, please follow them.

In Your Hospital Room.
Once you are in your hospital room, You will be shown how to use the hospital bed, the nurse call light and the telephone.  A doctor would ask all questions about your health.  You may have answered many of these questions before and the information may be in your medical record.  However, when you come to the hospital, this information may not be available to the  Doctor since your medical record is in surgery.  The questions help the staff provide special nursing care.  Your height, weight and vital signs (blood pressure, heart rate, temperature and breaths per minute) will also be taken by the nurse.  This is a good time for you to ask questions.

Preparations and Equipment You May Expect
Certain preparations are done before surgery.  Special equipment may be used before and after surgery.  This varies from patient to patient depending on the type of surgery and the length of time spent in the hospital.  Below are some possible preparations and equipment you may expect.  Ask your nurse which of these may apply to you.

Bowel Preparation
Your surgeon may order one or more enemas to clear your bowel before surgery.  In addition to or instead of an enema, your surgeon may order a liquid for you to drink.  It acts as a laxative to empty your bowel.  Emptying your bowel before surgery gives your surgeon a clear surgical area and also helps prevent postoperative problems.

Urinary Catheter
A tube called a catheter may be inserted into your bladder to drain urine during and after surgery.  The catheter may cause a feeling that your bladder is full and you need to urinate.  If you have this feeling or have any other problems with your catheter, please tell your nurse.  The length of time the catheter is left in place surgery varies with the kind of surgery you have and your surgeon's performance.

Intravenous Line
An intravenous (IV) line may be Started the night before surgery or early in the morning on the day of surgery.  An IV line is a flexible needle placed into a vein in your arm or hand.  This is connected to tubing and a container of liquid near your bed.  It will supply your body with fluids, medications or blood as needed before, during and after surgery.

Day of Surgery
The scheduled time for surgery and the amount of time in surgery varies.  Delays or changes in the operating room schedule might change the time you leave or return to your room.  The total time your are gone from your room includes time spent in the preoperative waiting area, operating room and post-anesthesia care unit.

When the Operating Room is ready for you
When the operating –room team is ready for you, the nurse will tell you and your family, and finish preparing you for surgery.

• The Nurse will go through a preoperative checklist with you to make sure all preparations are complete
• You will be asked to urinate (Empty your bladder)
• You must remove any of the following: Wig, hair pins, combs, contact lenses, prostheses, false eyelashes, tampons, underwear, bra, rings & other jewelry.
• The nurse will discuss with you whether or not you should wear your glasses, dentures or badges or hearing aid to surgery.
• You may receive a medication to help you relax.  If it is a medication to be taken by mouth, take it with just enough water to swallow comfortable.
• You may be given an injection.  This may make you feel sleepy and relaxed.  Remain in bed after you receive this injection.

Most of the time you will be taken by cart to the preoperative waiting are.  Sometimes outpatients walk to the preoperative waiting area or are brought by wheelchair.
Visiting hours are usually restricted from 3:30 to 6:30 P.M.

A Special Message to Your Family and Friends
Once your family member has left for surgery, you may leave the unit.  Before you leave, tell the ward secretary or unit assistant where you can be found at all time during the day of surgery.

The family is an important part of the healthcare team.  Take an active role in the postoperative care of your family member.  Ask questions and participate in his or her recovery, education and discharge planning.

Preoperative Waiting Area
Surgical nurses will check your name band, make sure all preparations for surgery are complete and answer any questions you might have.  An anesthesiologist may talk with you about anesthesia.  (Hair on the skin surrounding the surgical area may be shaved to prepare for surgery).  If you have not already had an IV, one may be stared.  You will remain in this area until the surgical team is ready for you.   Then you will be taken to the operation room.

The Operation Room
The operation room (OR) provides a safe, sterile environment for surgery.  It may look crowded to you.  In the centre of the room is the surgical bed.  Many instructions hang in special cabinets at the sides of the room.  Multicolored hoses hang from the ceiling.  These provide oxygen and anesthetic gases during surgery.  Many machines are located near the head of the surgical bed.  These monitor your vital signs and help the anesthesia team during surgery.  The OR itself is brightly lit and may feel very cold to you.  Different sound from the various pieces of equipment can make the room seem very noisy.

Once you are in the OR, you will be transferred to the surgical bed.  One or more safety straps will be fastened across your body.  One of your arms will be extended and placed on a soft, padded board, a blood pressure cuff will be placed on your arm.  Surgeons, nurses, anesthesia personnel and surgical assistants all work together to answer your questions and to see that surgery goes smoothly.

After you are positioned, anesthetics will be given.  There are two basic kinds of anesthetics: regional and general anesthetics.  Regional anesthetics cause the temporary loss of feeling to part of your body.  This numbness or loss of sensation result from injecting a medication into groups of nerves that will block pain signals, causing numbness.

During regional anesthesia, you will be awake, but medications may be given to help you relax or make you drowsy.  With each type of regional anesthesia, a healthcare team member stays with you constantly to ensure your comfort.  Common types of regional anesthetics are local infiltration, spinal, epidural and nerve block.

General anesthesia is a state of deep sleep with loss of awareness and sensation.  To begin anesthesia, a medication is injected through your IV line.  Once you are asleep, an anesthetic gas, mixed with oxygen, is given.  Most general anesthetics use a combination of techniques and more than one medication.  Whether you have a general or a regional anesthetic, someone will always be with you.

After Surgery
After the surgery, your relatives will be told that you are in the recovery area.  One of the most important functions of this area is to manage pain and nausea as you awake from anesthesia.  Nurses and anesthesia personnel will monitor your vital signs, alertness, pain or comfort level and need for medications.  They will also monitor the following if they apply to you.

• Dressings
• IV fluids
• Urinary catheter
• Nasogastric tube (NG tube) – A tube that enters through your nose and goes to your stomach to keep it empty.
• Wound drains – Tubes in or near your incision that may be attached to a suction source to help in the healing process.

You may not remember much about the immediate postoperative period if you received a general anesthetic or IV sedation.  If you received a regional anesthetic only, you may be able to return to your room immediately.

The recovery is brightly lit and as you awaken, the noises may sound louder than usual.  If you feel cold, blankets are available.  It is normal to receive moistened oxygen through a face mask.

The length of stay in the recovery room is determined by:
* Length of time it takes to awaken
* Type of anesthetic
* Amount of discomfort
* Room assignment – You may be transferred to another room or to the intensive care unit (ICU) after your surgery.

The average length of stay varies from ½ hour to 4 hours.  When the anesthesiologist decides you are ready to leave the recovery room, a surgical nurse of a surgical orderly will take you back to your room.

When you return to your room, your vital sings, incision and dressings will be checked frequently.  Your relatives may comment that you look very pale.  This is common after surgery.  As you awaken and begin to move around, your “color” will return.

Usually your surgeon will visit you and your family at the end of the surgery day, or early next morning.  Your surgeon will discuss the operation with you and your family, and answer any questions you may have.

After surgery, you may experience:

• A dry, sore throat  - This may be caused by the tubes used to help you breathe during surgery or simply a result of having nothing to eat or drink for several hours.  If approved by your physician, rinse your mouth or suck ice chips to help soothe the discomfort.

• Sleepiness or forgetfulness -  You may be sleepy and have trouble remembering the events of the surgical day.  This is normal following general anesthesia & will pass in a day or two.

• Nausea or Vomiting – This can be caused by the pain or may be a side effect of some medications.  This is normal following general anesthesia and will pass in a day or so. Tell your nurse if you are nauseated. Medications are available to help if the symptoms persist.

• Pain – Tell your nurse if you feel pain. Pain medications will be available. The medications may not relieve all pain, but it is available to help you be more comfortable. Relief of pain will help you to exercise and move about. It is better to use pain medication than to endure pain that increases your tension and restricts your activity.

Discharging Outpatients
To go home, an outpatient must be able to :
• Tolerate the pain level
• Tolerate liquids with minimal nausea
• Walk or move about with an assistive device (wheelchair, crutches, walker)

All outpatients will receive instructions when they leave the hospital. This will include a 24-hour phone number to contact their physician if they have questions.

Post-operative Exercises for the In-patient
Your participation in exercises after surgery is a key to your recovery. The exercises described should be learned and practiced before surgery. You will be instructed in the types and frequency of activities needed after surgery.

Deep Breathing
Breathing exercises may speed your recovery and lower your risk of lung problems, such as pneumonia. To deep breathe correctly, you must use your abdominal muscles, not just your chest muscles.

1. Breathe in through your nose as deeply as possible.
2. Hold your breath for 5 to 10 counts.
3. Let your breath out through your mount, slowly and completely.
4. Rest
5. Repeat steps 1 to 4, ten times.

Coughing
Coughing should be done with both knees bent or when you are in a sitting position. This positioning will help prevent straining of your abdominal muscles. To help support your muscles around your incision, hold your hands or a pillow over it.

To help you cough, take a slow, deep breath. Breath in through your nose and concentrate on fully expanding your chest. Breath out through your mouth and concentrate on feeling your chest sink downward and inward. Then, take a second breath, in the same manner. Now, take a third deep breath. This time, hold your breath for a moment. Then cough vigorously. As you cough, concentrate on forcing all the air out of your chest. Repeat this exercise two more times. For some surgeries, coughing is not advised. Please check with your nurse.

Leg Exercises
You may be told to do leg exercises. Exercising your legs after surgery is one way to promote blood flow and decrease your chance of developing a blood clot. Leg exercises are usually done five times an hour or as instructed by your physician or nurse.

• For leg exercises, bring both knees up as far as possible, then stretch both legs out flat in the bed.  You may also bend one knee at a time, alternating bending and stretching, Relax and repeat.
• To exercise your feet, push your toes toward the end of the bed.  Then, pull your toes up toward the head of the bed. Relax and repeat.
• Make circles with each foot, circle one way, then circle the other way.

Walking
Walking will be encouraged as soon as you are able to get out of bed.  For most people, this will be the day after surgery.  You should gradually increase the time and distance you walk.  Walking promotes circulation and speeds recovery.  Walking also helps relieve gas pain.  For your own safety, the first few times you get up, call your nurse to help you.  You may not be as strong or steady as you think.

Diet and Fluids
The surgical procedure, medications, anesthetics and other factors during surgery may affect your digestive system.  It may take a few days for your digestion to return to normal functioning.  You may not be allowed fluid or food by mouth for a few days.  During this time you may have one or more IV lines that provide fluids and medications.  When you are allowed to eat, your diet will gradually progress from liquids to solids, a dietician is available to help you make good food choices for your recovery.

Bowel Movement
Three or four days may pas before you have a bowel movement.  Please tell your nurse when you begin to pass gas or have had a bowel movement.

Other Suggestions
• Wear shoes or nonskid slippers whenever you are out of bed.
• Discourage family and friends from visiting if they have the “FLU,” a cold or other respiratory symptoms.
• Tell your nurse if your dressing becomes loose, wet or soiled.
• Practice good personal hygiene, such as washing your hands before and after using the bathroom.

Going Home
Your physician and nurses will help you plan to leave the hospital.  You and your family will be taught how to assist with your care when you return home.  Special instructions about activities, medications, diet, equipment or incision care will be explained.

You and your family may find it helpful to consider what you may need in preparing to leave the hospital. If community resources such as home health nursing are needed, you will be helped to make the necessary arrangements.

Recovery is a gradual process.  You will need to allow yourself time after surgery to recover.  Continue increasing your activities to help you gain strength.  Let family and friends help and share this time with you.