Preparing for Outpatient Surgery

Transcription

1 Preparing for Outpatient Surgery Date of Surgery: Your Surgery: Surgeon: UW Hospital and Clinics 600 Highland Avenue Madison, WI Outpatient Surgery Center Located in the Clinic Lobby (608) Ambulatory Procedure Center Off the D Elevator Lobby on Main Street (608) Toll Free: To go to the Outpatient Surgery Center, enter at the clinic entrance. Once inside the lobby, it s the 1 st door on your left To go to the Ambulatory Procedure Center, enter at the hospital entrance. Follow the slate path (Main Street) past the D elevator. Turn left when you see the APC sign. Before your clinic visit, please: Read this booklet Fill out a Power of Attorney for Health Care form, if you wish. Bring this booklet, your medicines, vitamins, and herbal supplements, any medical records that have been given to you, recent X-rays and test results to your pre-surgery clinic visit.

2 Highland Ave Valet Parking is open 5:30 am to 7:00 pm. It is located between the clinic and hospital doors. Outpatient Surgery Center, enter at the clinic entrance. Once inside the lobby, it s the 1 st door on your left. Ambulatory Procedure Center, enter at the hospital entrance. Follow the slate path past the D elevator. Turn left when you see the APC sign. First Day Surgery Unit, enter at the hospital entrance. Follow the slate path to the D elevator. Take the D elevator to the 3 rd floor and turn left to the First Day Surgery Unit entrance. This is the 2 nd floor To get to the Cafeteria: H4/1 H elevator to the 1 st floor ECG: In the Heart & Vascular Clinic - Take Atrium elevator to the 4 th floor. 1

3 Welcome to University of Wisconsin Hospital and Clinics About Outpatient Surgery Today, surgery doesn't always mean a long hospital stay. At UW Hospital's Outpatient Surgery Center or Ambulatory Procedure Center, you can have surgery and go home the same day. Everything from your admission to your recovery takes place in this comfortable environment. Having surgery may be stressful no matter how simple it is. In the Outpatient Surgery Center or Ambulatory Procedure Center, professional staff will help you through each step of your surgery and immediate recovery. At home, it s best if your family and friends are part of the team helping you before and after surgery. Knowing what to expect is an important part of getting ready for surgery. This booklet helps you to learn about: Your Pre-Surgery Clinic Visit... 3 Getting Ready for Outpatient Surgery... 4 Recovering after Outpatient Surgery... 9 Important Phone Numbers

4 Your Pre-Surgery Clinic Visit Members of the Surgery team will meet with you to: Talk with you about having surgery. Learn more about your health history. Perform a physical examination. Complete any tests or procedures that are needed before your surgery, such as a chest X-ray, ECG (electrocardiogram) or blood tests. This clinic visit may take 2-4 hours or more to complete. The risks and benefits of your surgery will be explained. You will be asked to sign a consent form stating that you understand and wish to have the operation. You may also meet with the Anesthesia staff either at your clinic visit or the morning of your surgery. By law, we are required to ask if you would like to complete a Power of Attorney (POA) for Health Care or a Living Will. This decision is up to you. A POA allows you to name a health care agent who could speak for you if you were not able to do so. If you choose to complete an advance medical directive, you must be 18 or older and of sound mind. You have the choice of completing the document or not. It is a voluntary action. If you choose to fill out a document it must be completed, signed and witnessed before arriving the morning of surgery. There is not enough time to complete the forms that morning. The two witnesses cannot be family members or UW Hospital employees, except chaplains, social workers or volunteers. Also the person you named to be your health care agent may not be a witness. We suggest you choose a neighbor or friend. If you need help in filling out this form or have questions, call our Patient Relations office at (608) A videotape that explains advance directives can also be viewed in the Learning Center located at E5/684, just off the D elevator on the 6 th floor. 3

5 Getting Ready for Surgery Your Personal Caregiver If you are having local (numbing) anesthesia, and receive medicine to sedate you, you will need to arrange for a ride home. The extent of your surgery will determine whether you will need a responsible friend or relative to stay overnight with you when you go home. A nurse will discuss this with you before your day of surgery so you can make plans. If you receive regional, spinal, monitored or general anesthesia, you must have someone drive you home and stay with you overnight; preferably someone over the age of 16 who could drive you to the ER or make a phone call should you need something after surgery. We ask this person to be with you when the nurse reviews your discharge teaching. Be sure to ask the nurse about what time this will happen so your friend or relative can be present. If you cannot arrange for transport home and overnight help; your operation will be rescheduled. Two (2) business days before surgery (or on Thursday for a Monday surgery), a nurse will phone you at your home or place of work. The nurse will let you know when to arrive at the hospital and where to go the morning of surgery. If you do not hear from us by 3:00 pm, please call We can be reached until 7:00 pm. You are welcome to call us any time after 9:30 am. If you have a cold, fever or illness the day before surgery, please call the Outpatient Surgery Center as soon as possible. Steps for Getting Ready 1. Your doctor may ask you to stop taking medicine that thins your blood. These include: Seven (7) days before surgery, you may be asked to stop taking aspirin or products that have aspirin in them. This includes Excedrin, Ascriptin and Ecotrin. You may also need to stop taking Plavix, vitamins and herbal supplements. If you are on Coumadin or warfarin, you will be told if and when to stop taking it. 4

6 You may be asked to stop taking anti-inflammatory medicines such as Ibuprofen, Advil, Motrin, Nuprin, and Aleve. Celebrex is one drug that does not need to be stopped unless your surgeon has told you to do so. Your surgeon will let your know. If you take any of these medicines listed above or herbal supplements, please let your surgeon or nurse know. It is okay to use acetaminophen (Tylenol ) for general discomfort or pain. 2. Your surgeon may want you to take laxatives to clean out your bowels before surgery. If this is the case, you will get instructions about the bowel prep and what you can eat the day before surgery during your clinic visit before surgery. 3. The night before surgery eat a light supper small amounts of low-fat foods. You will be asked to stop eating solid foods and milk-type drinks at midnight the night before surgery. Most patients are allowed to drink only clear liquids up until 4 hours before surgery begins. Examples are: water apple or white grape juice black coffee or tea protein water If your surgery is the first of the day (before 8:30am); you should have nothing to eat or drink after midnight. Morning medicines may be taken with a sip of water. The clinic staff will tell you which to take. Do not chew gum, tobacco or have candy for 4 hours before surgery. 4. Do not drink alcohol after 8:00 pm. When mixed with anesthesia, it can have serious effects on your body. 5. Try to stop smoking or at least cut back. It takes at least 3 days to rid your body of carbon monoxide from cigarettes which delays wound healing and can increase risks from anesthesia. If you d like help quitting, call the Quit Line: QUITNOW ( ). 6. Refer to Health Facts for You #7938 Getting Your Skin Ready for Surgery with Hibiclens Chlorhexidine gluconate (CHG) Soap-Adult for skin prep instructions. 5

7 7. Remove all make-up and fingernail polish from at least one finger. If you are having surgery on your arm, remove artificial nails and nail polish on that side. 8. Try your best to have a restful night before surgery. If you are coming from out of town, you may wish to stay in Madison. A Housing Accommodations Coordinator, (608) , can provide you with a list of nearby motels and arrange for your stay at a discount rate. 9. The morning of surgery, brush your teeth and rinse, but please do not swallow any water. 10. Your surgeon or primary doctor should have told you which daily medicines to take on the morning of surgery. Take them with a sip of water. If you have not been told by the day before surgery what medicines to take, we will arrange for someone to call you back to answer your questions. If you have diabetes, you will be given special instructions about your insulin or diabetes pills at your clinic visit. 11. Please leave all jewelry, rings, larger sums of money and credit cards at home. 12. Bring along any inhalers, CPAP machines, your glasses, crutches, hearing aids, dentures, prostheses or other special equipment that you will need during recovery. Be sure these items are labeled and in a case. Bring them into with you when you check in. Do not leave them in the car. 13. Wear loose, comfortable clothing and shoes that are easy to get on and off. If you do not have slip-on shoes, you may want to bring slippers. 14. You may wish to bring reading material, needlework or something else to do while waiting. 15. When you return home after surgery, it may take a few days or weeks for you to resume your usual schedule (for example, returning to work, child care, laundry, shopping), so plan accordingly. The length of time you need to recover depends on the type of surgery. During your clinic visit, nurses and doctors will give you special plans on how to take care of yourself at home. Plan to discuss the details with them. You may need to make 6

8 special arrangements before surgery. Keep in mind that even most minor procedures are still surgery. You should plan to take it easy for a while when you return home. 16. Parking in the visitor's ramp is free of charge for the day of surgery. When you enter the ramp, you will receive a parking ticket. Persons at the Clinic Information desk can stamp your ticket. Valet parking is available between the hours of 5:30am-7pm, Monday through Friday. The Day of Surgery When you arrive, go to the Outpatient Surgery Center or the Ambulatory Procedure Center as you have been told to do. A nurse will ask you questions about your health and help you get ready for surgery. If you are to receive anesthesia, a member of the anesthesia staff will see you before surgery. You will have an intravenous (IV) tube started. You may also receive medicine to help you relax. You may see staff wearing gloves, goggles and masks. Family may stay with you until you are taken to the procedure room or the operating room. You will be taken to the Operating Room or Procedure Room on a rolling cart. Once in this room, you will be asked to move onto a small narrow bed. A nurse will be with you to answer questions, make sure you are comfortable and explain what is happening. You may have ECG (electrocardiogram) patches on your chest, a blood pressure cuff on your arm, and a plastic clip on your finger to check your heartbeat and oxygen levels. An anesthesiologist will ask you to breathe oxygen through a soft plastic mask and medicines will be given to you through your IV. After you are asleep, if you are having a general anesthesia, a breathing tube (endotracheal or ET tube) will be placed in your windpipe to breathe for you. Other lines and monitors may be added while you are sleeping. 7

9 A Note to Families The amount of time you spend in the operating room depends on your type of surgery. Family members and friends should wait either in your room or they may be brought to a Waiting Area where they will be comfortable. When your family arrives or leaves the area, they should stop at the nurse s station to obtain a pager so they may be reached if needed. There is space for only 2 family members or friends in your room. We suggest that children be left at home if at all possible as they become easily bored and restless. At some point following surgery, your surgeon will talk with your family. Food may be purchased in the cafeteria. Recovering after Outpatient Surgery If you receive local anesthesia, we will return you straight to your room. If your surgery requires regional, spinal, monitored or general anesthesia, you may go to the recovery room. The length of time patients are in the recovery room varies. In the Recovery Room, nurses will check your blood pressure, pulse and surgical area carefully. They will keep you as comfortable as possible. The time spent in the Recovery Room may be an hour or more depending on the extent of your surgery. You will hear noises from the equipment in the room. Family and visitors are not allowed in the Recovery Room. When your time in the recovery room is complete, you will return to your original room. Nursing staff will continue to check you often. At this time, your family and friends may join you. Your care after surgery depends on the type of anesthesia and surgery you had. When you are fully awake, you will be offered fluids and helped to walk before you are discharged. Most patients stay 1-2 hours after surgery is done. You must meet certain requirements before discharge. These include pain control, home care instructions, control of nausea if present and walking (use of crutches, if needed). Some patients may need to be able to empty their bladder before they go home. Your primary nurse works with you, your family, doctors and other caregivers to help you recover. He or she will review special instructions with you and the person who will care for you at home. 8

10 Pain Control People used to think that severe pain was something you just had to put up with. That s no longer true. Today, you can work with your nurses and doctors to prevent or relieve pain. Good pain control helps you to: 1. Enjoy greater comfort. 2. Heal faster. 3. Start walking, breathing and gaining strength quicker. 4. Leave the hospital sooner. 5. Have better results and avoid later problems. Drug and non-drug treatments can help prevent and control pain. Don t worry about getting hooked or addicted to pain medicines. Studies show that this is very rare unless you have had a problem with drug abuse. For best results: 1. Discuss your options with your doctor and nurses. Work with your doctor and nurses to make a pain control plan. 2. Take (or ask for) pain relief drugs when pain first begins. Waiting until your pain becomes severe limits how well the medicine works. 3. You will be asked to rate your pain using this scale: 0-10 Number Pain Intensity Scale No Mild Moderate Severe Worst Pain Pain Possible 4. The goal should be at a level that will allow you to walk and sleep with minimal pain. Rating your pain helps us to know how well your pain medicines are working. 5. Tell the nurse or doctor about any pain that won t go away. Don t worry about being a bother. Pain can sometimes be a sign of problems. Pain medicine may cause you to become drowsy, dizzy or lightheaded. Do not drive, use machines or drink alcohol while taking prescription pain pills. Narcotics often cause constipation. To help prevent this when you go home, you may want to increase your daily water or fluids to 6-8 (8 ounce) glasses. It may help to increase the fiber in your diet also. 9

11 What can I do to prevent constipation? Once you go home, you will need a plan to avoid this problem. Stick to it as long as you are taking narcotic pain medicine. Review your plan with your doctor or nurse. Here are some things to include in your plan. Eat foods that have helped you to relieve constipation in the past. Eat foods high in fiber or roughage. This includes foods such as uncooked fruits, raw vegetables, and whole grain breads and cereals. Try prune juice. Buy some unprocessed bran and add 1 or 2 tablespoons to your food. Keep a shaker of bran handy at mealtimes and sprinkle it on foods. If you are not hungry, do not force yourself to eat fiber. Drink plenty of liquids. Eight to ten 8-ounce glasses of fluid each day will help keep your stools soft. Warm liquids often help your bowels to move. Have a warm drink about half an hour before your planned time for a bowel movement. Exercise as much as you are able each day or at least every other day. Increase the amount you walk. Check with your doctor or nurse about the exercises that are best for you. Plan your bowel movements for the same time each day, if you can. Set aside time for sitting on the toilet or commode. The best time is after a meal. What about stool softeners and laxatives? Many people taking narcotic pain medicine need the help of a stool softener. This alone may not work. You may need to add a gentle laxative. Be sure to check with your doctor or nurse before taking any of these on your own. Your doctor or nurse may suggest taking a laxative on a regular schedule rather than waiting for constipation to happen. There are many types and brands of laxatives, and most need no prescription. Talk to your doctor about which may work best for you, and at the best price. 10

12 What about bulk laxatives and fiber, like Metamucil? Bulk laxatives and fiber like Metamucil absorb water and expand to increase bulk and moisture in the stool. They are not the best to use for constipation from narcotics. They should only be used if you are able to drink plenty of fluids throughout the day. What about suppositories and enemas? Both can be used as an added step to treat constipation. It is not a good idea to rely on enemas as part of a regular plan to avoid constipation. Talk to your doctor or nurse before using either of these options. What are the important points in my plan? Put together a plan to prevent constipation and stick to it as long as you are taking your narcotic pain medicine. Do not stop taking your pain medicine even if it is harder to control the constipation than it is to control the pain. Aim for a bowel movement every second or third day rather than every day. Call your doctor before taking any stool softeners or laxatives. What are examples of high fiber foods? Cereals and flours Fruits Vegetables Bran cereals, whole-wheat bread, rye bread and crackers, wheat germ, corn, cornmeal, wild rice, brown rice, barley, popcorn Fresh, canned, or dried fruits, especially those with skin or seeds (apples, plums, pears, peaches, tomatoes, berries, raisins, and dates) Any raw or cooked vegetable (not overcooked) such as carrots, cabbage, peas, dry beans, and lentils 11

13 High Fiber Home Recipes Fruit Pudding 1-2 tablespoons one to three times a day Pudding recipe (in blender combine) 3 oranges peeled 4 apples with skins 2 cups raisins and dates 2 cups prunes Add prune juice to consistency of sauce or pudding These can keep in refrigerator 7-10 days or can be frozen. Bran Muffins 1-2 muffins daily Bran muffin recipe 2 ½ teaspoons baking soda ½ quart buttermilk 2 ½ cups flour (1 ½ whole wheat; 1 white)* 1 cup sugar ½ package (15 oz.) Raisin Bran cereal 1 teaspoon salt 2 eggs slightly beaten or 1 cup egg substitute ½ cup oil * ½ cup wheat germ may be substituted for ½ cup whole-wheat flour Combine all ingredients. Bake in greased muffin pans at 400 degrees for minutes. This makes two dozen muffins. 12

14 Going Home Once you go home, you may feel weak and drowsy for up to 24 hours, so plan to take it easy. Keep in mind, this is not a good time to make important decisions or sign legal papers. Also, you may want to eat lightly and avoid fatty foods. You will leave the hospital when your doctor and nurses think you are ready to go home. If they feel that you are not ready, you may be admitted to the hospital for several hours or overnight. We ask that your friend or relative be present to receive instructions before you go home. As you get ready to leave the hospital, the nurse will give you supplies you will need at home. If your doctor orders medicine, you may have the prescriptions filled at the hospital while you recover. (Group Health Cooperative members may need to fill prescriptions at a GHC pharmacy.) If you need a follow-up doctor appointment, we can schedule it before you leave. We will provide you with phone numbers so you may speak to medical staff 24 hours a day with questions or concerns. Outpatient Surgery staff will try to contact you the day after surgery for follow-up. The staff at UWHC is dedicated to giving you the best care possible. We hope this booklet has been a helpful start. We strongly encourage you to bring this booklet with you when you come to your clinic visit. 13

15 Important Phone Numbers If you have questions about Outpatient Surgery or any related service, please call. Our staff is here to help. Ambulatory Procedure Center (608) (6:00 am to 5:30 pm, Mon Fri) Hospital Paging Operator (608) Housing Accommodations (608) Outpatient Pharmacy (E5/236) (608) Outpatient Registration (608) Outpatient Surgery Center (OSC) (608) (6 a.m. to 7 p.m., Mon- Fri.) OSC FAX Number (608) Patient Information (for inpatient (608) hospital rooms) Patient Relations Office (608) SAFE Clinic (Anesthesia) (608) (9:00 am to 5:00 pm, Mon Fri) Spiritual Care Services (608) Toll Free Phone Number (800) The Spanish version of this Health Facts for You is #5300 Your health care team may have given you this information as part of your care. If so, please use it and call if you have any questions. If this information was not given to you as part of your care, please check with your doctor. This is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person s health needs are different, you should talk with your doctor or others on your health care team when using this information. If you have an emergency, please call 911.Copyright 5/2015 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#