P a g e 1 Inpatients skip to page 4 Pre-Operative Instructions and Post-Operative Guide This handout will: Help you and your family prepare for surgery Encourage participation in care Explain expectations and conditions for discharge to be the healthiest you can be after surgery PRE-OP INSTRUCTIONS (Follow your physician s orders if they differ from those below) General Instructions If you develop a cold, sore throat, fever or any other illness before your procedure notify your surgeon immediately. Transportation: Same day surgery patients need to arrange for a responsible (over age 18) adult to drive them home and stay with them for a minimum of 6 hours after arrival at home. Childcare: If you have young children, please make arrangements for their care while you are at the hospital. Glasses, hearing aids, dentures, or other assistive devices: Bring items with you to the hospital if you rely on them. They will be given to your family to hold for you when you go to surgery. CPAP mask and/or inhalers: Bring these with to the hospital. Blood thinners: (such as Aspirin, Coumadin, Plavix) Contact your physician regarding a stop date for these medications. Your doctor may ask you to stop these 3 to7 days prior to surgery. Vitamins and herbal supplements: Stop 7 days prior to surgery. Diabetics: Contact your physician for specific instructions on how to manage your diabetes and medications before surgery. Alcohol/tobacco/recreational drugs: Do not drink alcohol or smoke for 24 hours prior to surgery. Notify your surgeon if you are using any recreational drugs, including marijuana. Notify your surgeon if you use medical marijuana and discontinue use 1 week before surgery. Advance Directives (Living Will/Durable Power of Attorney for Health Care/POLST/DNR): If you have these documents, bring them to the hospital for your medical record. Exercise and Be Active: Exercise will help make sure your body is as fit as possible before surgery. If you don t currently exercise, add some into your day, such as a walk around the block or in a local mall. Diet and Fasting Instructions: Eat your normal meals and drink plenty of fluids the day before surgery, unless told otherwise by your doctor (bariatric patients follow your surgeon s diet the day before surgery): Night Before Surgery: drink 30 ounces (800 ml) of either apple juice or Gatorade, in order to prevent dehydration. (Bowel surgery patients should not drink any blue, red or purple liquids)
P a g e 2 Day of Surgery: 1. Six (6) hours before arrival time stop eating all solid food You may continue to have clear liquids (like soda, pulp-free juices, water, black coffee or tea) during this time but no milk products 2. Two hours before arrival time begin drinking 10 oz. of hospital-specified high-carbohydrate beverage (figure A). Finish this drink within 30 minutes. You may not have any more food or liquids after this time, including chewing gum or hard candy. Figure A Recommended: Ensure Pre-Surgery - Clear Surgical Drink Availability: 1. Advocate Good Samaritan Daisy Basket gift shop 2. Advocate Good Samaritan Wellness Center store 3. Internet: 4-count (Amazon.com; Walmart.com) Alternative: 10 oz. Gatorade Showering Instructions: You will need to purchase one small bottle of Hibiclens (figure B). Please shower in the following manner the night before and the morning of surgery (If your doctor has given you specific instructions differing from these, follow your doctor s instructions) ***Dr. Madda s patients should use Dial Soap instead of Hibiclens. Wash your entire body first with your regular soap and shampoo your hair. Rinse well and turn off the shower water. Apply Hibiclens (or similar soap that contains Chlorhexidine Gluconate) to your entire body from the neck down avoiding contact with your face and genital areas. If you are allergic to Chlorhexidine or the patient is under the age of 2 months, shower with an antibacterial soap such as Dial. Use a small amount as a test dose on the top of your hand if you think you might be sensitive to the product. Wash gently with the Hibiclens for 5 minutes and then rinse your body well. Use caution in the tub or shower as Hibiclens can make the surface slippery. Figure B Recommended: Hibiclens Availability: 1. Advocate Good Samaritan Daisy Basket gift shop 2. Advocate Good Samaritan Wellness Center store 3. Retail stores Alternative: Dial soap
Oral Hygiene: Brush your teeth/clean your dentures with a new toothbrush and rinse with an antiseptic mouthwash both the night before and the morning of surgery. P a g e 3 Shaving: Do not shave your body the night before or the day of surgery. Shaving nicks can increase the risk of infection. Deodorant/Lotion/Powder: you may use deodorant the morning of surgery. Do not use any lotions or powders. Arrival Time: Your arrival time will be available after 2 PM the business day prior to your surgery. If your surgeon provided us with your cell phone number, you will receive 2 text messages from us. Please open both texts. The first text will contain your arrival time. The 2nd text contains a link. Please click on the link by 4:30PM to review the instructions provided. This will automatically send us a notification that you have received your arrival time. After 2PM the business day prior to surgery, you can view your arrival time online by clicking this link or by going to this website: http://www.advocatehealth.com/gsam-pre-op, then proceed on the Arrival Time and Fasting Instructions link. You will need to enter your last name, first name, date of birth, and date of surgery (MM/DD/YYYY) in order to obtain your arrival time. If your surgeon s office provided us with an e-mail address, you will also receive an e-mail after 2PM the business day prior to surgery that will give you access to your arrival time. Arrival at Hospital: You may park in parking lot A in front of the main entrance or if arriving after 7:30AM you may use the complimentary valet service provided at the front entrance. Enter through the main entrance on the ground level. Take the elevator up to the first floor and report to the first floor information desk. One person may accompany you during the admission process. After you are admitted, additional visitors may join you in the pre-surgical area. The number of visitors at any one time is limited to two. (Both parents may accompany pediatric patients for admission process.) ***Saturday patients arriving between 6AM and 8AM should go directly to the admitting department on the ground floor for registration.*** Day of Surgery Reminders Medications: The morning of surgery, take only those medications you were instructed to take by the pre-surgical nurse and/or your doctor. Bring insurance card and picture ID to hospital. Valuables: Do not bring valuables to the hospital. Clothing: Wear loose fitting clothes and low-heeled shoes. Makeup/Jewelry/Body Piercings need to be removed before going to the hospital. Pediatric patients may bring a favorite stuffed animal/blanket to help ease anxiety and a special bottle/sippy cup may also be appropriate for use after surgery.
P a g e 4 Your Hospital Experience: Surgical Care Pavilion (SCP) / Surgical Care Area: A registration clerk may come to your room to verify information in your chart. One of your preoperative team, either a tech or a nurse, will begin the preoperative process which may include: o Having you change into your surgical gown o Get baseline vital signs where you will be attached to a heart monitor o Review allergies, health history and current medications o Review and have you sign surgical consent o Verify advance directives o Begin an IV, additional labs may be drawn at this time o Get a current weight o Your tech or nurse will apply sequential compression devices (SCD s) that will help prevent blood clots while you are inactive during your surgery At this time your family may be able to join you in your preoperative room. o Your family will be responsible for all of your personal belongings. o When you go to the Operating Room, your family will escorted to the family waiting room, where they need to check in with the staff member at the desk You will meet your surgeon who will perform the surgery. You will meet your anesthesiologist, who will provide pain management during surgery. You are encouraged to go to the bathroom prior to going to the operating room. You may be given medications, either by mouth or by IV prior to surgery. You will be given a blue bonnet to wear over your hair. If you are cold while waiting for surgery, feel free to ask for a warm blanket. Operating Room (OR): You will be asked to move from the transport cart to the operating room table. Please remember to wait for a safety check by your nurse before moving. Once on the operating room table, monitors will be attached. These monitor your heart and breathing throughout the procedure. Your sequential compression devices will be reattached. A safety strap will be placed across your waist and across either arm to insure your safety on the narrow table. You will be given medications through the IV, which make you drowsy, relaxed and forgetful. The room will be cold so a blanket will be given to you once you are safely on the operating room table. After you are asleep for your procedure, a tube (Foley catheter), may be placed in your bladder to drain urine. You will remain asleep and pain-free during your surgery and will not remember it afterwards. After your procedure is over, you will be woken up in the operating room but will not remember this experience. After you wake up, you will be moved by your operating room staff from the operating room table to your transport bed and will then be transported to the recovery room. After your surgery, your surgeon will speak with and update your family regarding your surgery.
P a g e 5 After Your Surgery (Post Anesthesia Care Unit PACU): You will recover from surgery in the PACU for approximately 60 minutes. Here you will continue to be monitored Your sequential compression devices (SCD s) will be turned on to reduce risk of blood clots. You will be given oxygen by mask or cannula in your nose; this is important to keep in place to help you wake up. The nurse will check your bandage(s). The nurse will ask about your pain so that it can be managed quickly. You will continue to receive fluids and medicines through the IV. When you are ready for transport to your room, your family will be notified of the room number and may meet you in the room. *It is important to remember that each patient wakes up out of anesthesia in different ways. You may be sleepy, have a sore throat or feel sick to your stomach. These reactions are normal and will wear off in time. Arrival to Nursing Unit Your nurse and patient care assistant will assist in orienting you to your room and making you comfortable. At this point you will begin to follow the Surgical Patient Recovery Pathway to begin meeting your recovery milestones. Nursing staff will be monitoring the distance you walk, oral intake, urine output, and bowel movements. Walking It is very important that you start walking the day of your surgery. A staff member will help you get out of bed. Do not try to get out of bed alone we don t want you to lose your balance and fall. After the day of surgery, we recommend that you are out of bed greater than four hours a day and walk along the unit corridor and back four times. By being out of bed in a more upright position and by walking regularly, your breathing is improved and there is less chance of you developing a chest infection or clots in your legs and your bowel function usually also recovers faster. Pain Management Please remember, when you awake from surgery you will likely experience some degree of pain. This is very common and normal to experience discomfort immediately following the procedure. It will not be possible to eliminate ALL of your pain. Please discuss your pain level with your nurse who will work with you and your surgeon to manage your pain.
P a g e 6 You will be asked over and over to rate your pain on a scale of 0-10 as illustrated below. This pain scale will help you decide when to do something to help manage your pain. If your pain is stopping you from moving, we need to give you something to help manage your pain since movement after surgery is important to reduce risk of blood clots and pneumonia. Why is pain management important? You can be more active, get out of bed and walk around the unit which will help avoid blood clots and other complications You can take deep breaths and cough which will help avoid pneumonia Improves your mood and sleep You can do things that are important to you to get you back to your usual state of health Pain medication may be provided by: Mouth, either a pill or liquid IV Patient Controlled Analgesia (PCA), a method that allows you to push a button and administer small doses of pain medicine directly into the vein through an IV Pain is not only managed by medicine, but also through other forms of pain management: Imagery Deep breathing/meditation Music Distraction *It is important to know that you will NOT become addicted to pain medication used to manage surgical pain.
Prevention of Blood Clots and Pneumonia: P a g e 7 Any patient undergoing surgery is at risk for both blood clots and pneumonia. Follow these tips to reduce the risk of developing these ailments: Wear a compression sleeve on your legs (SCD s) while in the hospital as illustrated below. These sleeves will keep the blood circulating in your legs and should be worn whenever you are in bed, even while asleep. You may be given special stockings to wear (TED hose) beginning in your pre-operative experience. These stockings help maintain a strong blood flow to reduce your risk of developing blood clots. You may be given small injections in your stomach delivering medication to reduce your risk of blood clots., here are some useful exercises you can do to improve your circulation Stay active by walking to reduce the risk of both blood clots and pneumonia. Deep breathe and use your incentive spirometer, a special tool which will be given to you to encourage you to do deep breathing exercises (see illustration below). Deep breathing using the incentive spirometer will reduce the risk of pneumonia. *Remember to tell your nurse if you feel shortness of breath or pain in your legs or calf. Discharge Expectations/How long will you be in the hospital? Your surgeon and medical doctor will see you every day and will determine when it is appropriate for you to be discharged. A Navigator or Care Manager will visit you and discuss your health care needs so we can help you plan a smooth discharge. They will keep you updated on the discharge plan and estimated day of discharge.