Please bring this handbook with you when you are admitted to the hospital.

Please bring this handbook with you when you are admitted to the hospital. Table of Contents Introduction...1 Benefits of Surgery...1 Risks of Surgery...1 Preparing for Your Surgery...1 Pre-admission...1 Family/Visitor Information...2 Map...2 Getting Ready for the Hospital...3 Admission Process...3 Before Surgery Your Nurse Will...3 In the Holding Room the Nurse Will...4 Operating Room...4 Recovery Room...4 Pain Scale...4 Pain Management...5 After Surgery...5 Medication Management While You are at the Hospital...5 Discharge Process...6 Things to Consider...6 Take Home Prescription Medication...6 Risk of Infection...6 What is a surgical site infection (SSI)?...7 Can SSIs be treated?...7 What is Altru doing to prevent SSIs?...7 What can you do to help prevent infection?...7 What do I need to do when I go home from the hospital?...8 When to Call your Physician...8 6012-0584 JUNE 09

Introduction This handbook is meant to provide you and your family with information regarding your surgery and recovery. Please share the information in this handbook with your family. Benefits of Surgery Correct an injury Reduce or eliminate pain Gain or improve mobility Gain or increase activity level Improve quality of life Risks of Surgery Each surgery carries its own risks that often depend on your own health. Your surgeon will go over your individual risks prior to your signing the surgical consent form. You should not sign the consent until you understand all of the risks to your comfort level. Preparing for Your Surgery Have a complete medical history/examination Complete all pre-op tests such as EKG, chest x-ray or lab tests prior to surgery Prepare a complete list of all your medications, vitamins and any supplements you d bring to the hospital. Be sure to include dosage and times taken. Prepare for your return home after your surgery, consider childcare, a ride home, and the possible need to have someone stay with you at night should be considered. How will the surgery affect your life? What kind of assistance may you need? Will your family be able to help or do you need to find more help? What kind of care is available in the community? A social worker will be available at the hospital to help you plan aftercare if needed. Leave all jewelry, piercings, and valuables at home. Remove nail polish, artificial nails and make-up. If you wear glasses or contacts, bring a glasses case or contact supplies with you. If you live out of town and plan on staying in Grand Forks the night before your surgery, please call (701) 780-5674 and leave a message where you can be reached so you can be notified of any changes that may occur. This message will be left on an answering machine. Pre-Admission A nurse will: Contact you before your admission. Discuss the surgery and recovery routine with you and your family. Review your past and current medical history. Review your current medications, vitamins and supplements. Give you brochures about your surgery stay and may have you view an educational film. Provide directions as to when to stop eating, drinking, and when to stop taking medications. FAILURE TO OBSERVE THESE REQUIREMENTS MAY RESULT IN DELAY OR CANCELATION OF YOUR SURGERY. A nurse will contact you one working day before surgery to tell you where and when to arrive at the hospital. 1

Family/Visitor Information Your family or friends are welcome to be with you during your stay at the hospital. They will be instructed to wait in the front lobby family waiting area, the Same Day Surgery waiting room, or in another designated waiting area during your procedure. Please check in with the Guest Service Representative/Volunteer or staff member in each respective area upon arrival. In consideration of everyone s health, Altru Health System is a tobacco-free institution. Smoking and other tobacco products are not permitted on Altru premises. We thank you for your support in keeping our environment safe and clean. Parking is in the front of Altru Hospital Visiting Hours: posted for each department and may be obtained at the front desk Dining: - Prairie Winds Cafe - located in the lower level of the hospital - Altru Express - located just behind the main lobby waiting area of the hospital - The Clinic Cafe - located in the main lobby at Altru Clinic - Main. You may order guest trays 24 hours a day by calling 5555. Payment is due upon delivery. - 24 hour food vending areas are located on the lower level of the hospital. Cell phone use is allowed in the Altru Hospital accept in critical care areas. Please ask an Altru staff member if you have any questions. A Patient/Family Handbook can be found in each waiting area and by each bed. This handbook contains information such as cafeteria hours, dialing instructions, visiting hours, etc. Ambulance Renal Dialysis TO ALTRU REHABILITATION CENTER Urgent Care Library TO ALTRU CLINIC - MAIN Altru Pharmacy Emergency Room Registration/ Admitting Administration Radiology Chapel Altru Express Information Hospital Lobby Family Waiting Area Business Office Gift Specialty Home Shop Services Blood Bank Elevators Same Day Surgery SDS Waiting Area Cardiology SCCU SCCU Waiting Area Front Entrance 2

A list of motels and hotels that offer discounts for medical stays is available at the information desk in the front lobby of Altru Hospital. Discount coupons are available there. Getting Ready for the Hospital Bring comfortable clothes (sweat suits or loose clothing are the best) and non-skid shoes to wear once post operative activity is resumed. Bring a complete list of all of your current medications including vitamins, herbal remedies and supplements. If you are unable to keep your scheduled arrival time for surgery due to weather, health, transportation, etc., please call (701) 780-5690, Monday - Friday after 6:00 a.m. This number pertains to the day of surgery only. If an overnight stay is expected Bring personal care products such as shampoo, comb, brush, etc. Bring a short robe (button or snap down the front is preferred). Nursing staff will review your chart and ask you questions to verify correct information. You will be weighed, have your vital signs and health history reviewed. Admission Process Check in at the registration desk in the hospital front lobby to be registered. You will be asked to verify your date of birth and state it back numerous times. You will have an ID (identification) bracelet applied to your wrist. You may have lab or x-rays performed at this time if ordered. You will be directed to or be taken to the location where you will be prepared for You will be provided an orientation to the room setup and hospital routine when staying over night. All of our nursing staff have green badge holders and are wearing navy blue scrubs to help you readily identify your nursing staff. Feel free to ask any questions of the Altru staff while you are here. Before Surgery Your Nurse Will: Address any questions or concerns you have. Have you sign the surgical consent form if you have not already done so. Provide you with a gown to wear. Place your clothing in the garment bag. Remove hairpins, wigs, and any jewelry or body piercings at this time. Assure that nail polish is removed. Check to make sure any pending lab results are ready. Ask that your empty your bladder shortly before going to At this time, depending on your procedure, you may be asked to remove your underwear. Take your dentures, glasses, or contact lenses if applicable prior to going to the holding room. Apply compression hose/socks or a devise to help prevent blood clots may be applied pre or post procedure. 3

In the Holding Room the Nurse will: Bring you in one half to one hour before your Allow you to bring one family member with you to the holding room, please discuss this ahead of time. Verify your ID band and your procedure with you. Have you meet your anesthesia team (a doctor of anesthesia and a nurse anesthetist). They will review your medical history and explain the type of anesthesia available as well as have you sign an anesthesia consent form. Any questions about anesthesia can be asked at this time. Have the Surgeon initial the site of your - This must be visible prior to incision to confirm the correct sight for your procedure. - Have you mark the sight if you wish. Start your IV (needle in your vein). Administer medication that may be given to help you relax. Introduce you to your OR nurse. Operating Room (OR) You will be aware of entering the OR suite, but may not remember any of the events, due to medication you will have been given in the holding room. Your OR nurse will greet you at the door and introduce you to the team. Anesthesia staff will be with you, monitoring you the entire time you are in You will have heart monitor leads and a blood pressure cuff to monitor your vital signs and a finger probe to monitor your oxygen levels. The room is cool, but you will be kept warm through out the procedure. Recovery Room After most surgeries you will spend time in the recovery room. Family is not permitted, but they will be notified of your arrival. The staff will monitor your vital signs as you recover from your anesthesia. They will determine when you are ready to leave this area. Pain Scale 0 No pain 1 Some pain but OK 2 Mild pain worse 2000 Permission by Pritchett & Hull Associates, Inc. Used with permission. Cannot be duplicated. 3 Annoying pain 4 Distracting pain 5 Pain can t be ignored for more than 30 minutes 6 Pain can t be ignored at all 7 Pain makes it hard to think and sleep 8 Pain limits activity; nausea with pain 9 I cry out in pain 10 Passed out 4

Pain Management The goal of Altru Health System is for every patient to be as pain free as possible. However: You should expect to feel some discomfort after Your level of discomfort will be evaluated before and after Keep your nurse informed about your comfort level after - Tell the nurse where the pain is and how strong it is on a scale from 0-10. Pain Management Methods Pain pills by mouth IV pain medications PCA Pumps: Your Doctor may order a PCA (Patient Controlled Analgesia) for you to use to help manage your own pain. Epidural- medication dripped slowly through a tube into areas of your spine. Pain control helps the natural healing process. Without the fear of pain, you should feel less anxious and be able to relax. Pain medications are not addictive when the medication is prescribed for a short time and stopped gradually. After Surgery You may find one or more tubes inserted to your body - IV, drains, catheter, etc. An accurate record of the fluids you take in and put out will be monitored. When and what you are allowed to eat will depend on your doctors orders and on how you are feeling. A device called an incentive spirometer may be ordered to help you take deep breaths. Deep breathing can help prevent pneumonia or other problems that could slow your recovery. The activity allowed after surgery will depend on the type of surgery you had and your doctors orders. Your nurse will instruct you as to what kind of activities you can do and what will help you in your recovery. Medication Management While You are at the Hospital The list of all your current medications, vitamins and supplements will be verified and your doctor will review those needed after Your nursing staff will check your wristband and confirm your name and date of birth before giving any medications. Ask your physician or nurse about new medications. They will give you written information on the medication, including side effects and brand name vs generic name. Don t be afraid to speak up if you think you are receiving a wrong medication. Learn the times when you should be getting your medications. If you get sick or just don t feel well after receiving a medication, let your nurse know. If you can t or don t want to ask, make sure to have a friend or loved one ask the questions for you. Take your time and make sure all of your questions are asked and answered prior to leaving the hospital 5

Discharge Process Your physician will decide when you may go home. Discharge time may be determined by criteria set by your physician. A plan for your discharge medications and follow-up appointment will be made. There may be take home supplies needed that your nurse will help you arrange. Other Altru health care professionals may need to visit you and assist in your discharge. You will be offered assistance in packing your belongings. Altru Health System staff must escort you to the lobby front door where a friend or family member may pick you up at the covered driveway. Things to Consider Do I need to restrict activity such as housework or childcare? How much can I lift? Can I drive? When can I drive? When may I resume sexual activity? What about sports? Do I have a special diet? Will I need help at home? What are the supplies that I may need? Where can I get them? Who do I call if I have questions when I get home? When and how can I bathe/shower? Pharmacy or you may take your prescription to a pharmacy of your choice. Altru s Retail Pharmacy accepts cash, checks or credit cards. It is located on the main level of the hospital. Please bring your insurance card with you. Phone: 701-780-3444 Hours of operation: Monday-Friday 9:00 a.m.- 8:00 p.m. Saturday & Sunday 9:00 a.m.- 1:00 p.m. 2:00-6:00 p.m. Tips for managing pain at home Take your pain medications routinely as directed. This should keep your pain under control. Take your pain pills with food to prevent nausea. Follow your healthcare provider s recommendations for ice, elevation, rest, etc. Listening to music or watching television may help distract you from your pain. Risks of Infection Any person having surgery could get an infection. The risk of infection depends on many things including: The type of operation The duration of your hospital stay Your overall health before surgery Take Home Prescription Medication You will have the option of purchasing your medications at Altru s Retail 6

What is a Surgical Site Infection (SSI)? An infection that occurs after surgery in the part of the body where the surgery took place. It can be caused by bacteria (germs) in most hospital environments but also from bacteria you normally have on your skin. Most patients who have surgery do not develop an infection. - One to three out of every 100 patients develop infections. - Some surgeries have more risk of infection than others. Some common symptoms of an SSI are: - Redness and pain around the area where you had - Drainage of cloudy fluid or pus from your surgical site. - Fever Can SSIs be Treated? Yes- most SSI s can be treated with antibiotics. Antibiotic given will depend on the type of bacteria that is causing the infection. For some patients, another surgery may be needed to treat the infection. What is Altru doing to Prevent SSI s? A thorough history and sometimes lab tests are taken prior to surgery to determine if you have an antibiotic resistant bacteria on your body. - If you do, you will be admitted to a private room and special precautions called contact isolation will be used to care for you. - Specific antibiotics might be used to help prevent SSI. Antiseptic agents are used by the surgical staff performing your procedure to scrub their hands and arms up to their elbows prior to your - Hand washing with soap and water or an alcohol-based hand rub before and after caring for each patient is done by all staff. The surgical site is cleaned with antiseptic soap just prior to the start of your procedure. Antibiotics may be given prior to your surgery and/or after your Special hair covers, masks, gowns, and gloves are worn during surgery to keep the surgery area clean. Using clippers instead of a razor to remove hair, if needed, is done immediately before Some patients may be screened for antibiotic resistant bacteria prior to their What Can You do to Help Prevent Infection Before your surgery: Be at optimal weight and nutritional state. Tell your doctor about other medical problems you may have. - Allergies, diabetes, and obesity could affect your surgery and treatment If you are diabetic, follow your doctor s instructions about diet and medications so your blood sugar levels are good at the time of - High blood sugar levels can increase the risk of infection. If you have a fever or think you have an infection, tell your physician BEFORE coming to the hospital, this includes colds. 7

Quit smoking. - Patients who smoke heal slower and get more infections. - Talk to your doctor about how you can quit before your Do not shave near where you will have surgery within 24 hours. - Shaving with a razor can irritate your skin and make it easier to develop an infection. Follow all pre-op instructions for bathing and cleaning of the skin prior to - You may be given antiseptic wipes to use at home and again the next day prior to This is to remove as many of your normal bacteria from your skin prior to surgery At the time of your surgery: Ask if you will be getting antibiotics before Be aware that if hair removal is necessary, the surgery staff will use a clipper. What do I need to do when I go home from the hospital? Your doctor or nurse will explain everything you need to know about taking care of your wound. - Make sure you understand what they are telling you. Inspect your incision every day at home. Keep incision clean and dry. Follow your doctors orders as to if you can get your staples or sutures wet. Always wash your hands before and after caring for your wound. - If someone is helping you, make sure they do the same. - Follow the directions on how to and when to change your dressing. - Do not allow family or friends who visit you to touch the surgical wound. Make sure you know who to contact if you have any questions or problems at home before your leave. When to Call Your Physician If you experience: Fever Increased pain not relieved by medications or rest Increase in swelling not relieved by elevation and ice Redness or drainage from the wound Unusual or foul odor from the wound Change in color or temperature around incision Severe nausea Shortness of breath or trouble breathing Chest congestion Chest pain Abnormal cough 8