Our Mission Patient s Guide to Surgery What you need to know As a provider of primary and specialized healthcare services, the CSSS du Suroît is responsible for maintaining and improving the health and well-being of the individuals living in its territory. It does this by making a range of health and social services available to them. It also offers specialized services to individuals living in the neighbouring greater Suroît area. Together with its partners of the local services network, the CSSS organizes, coordinates and provides services to facilitate the patient s journey through the healthcare network and access to continuous, safe, quality services focused on prevention, treatment and support. respect excellence personalized human approach respect excellence personalized human approach 150 Saint-Thomas Street Salaberry-de-Valleyfield, Quebec J6T 6C1 Telephone: 450-371-9920 Toll free: 1-800 694-9920 www.santemonteregie.qc.ca/suroit GRM73756-L100 JUILLET 2014
Welcome to the CSSS du Suroît You are scheduled to have surgery in the near future, and we realize this may be causing you a certain amount of fear and apprehension. We have put together this guide to help you prepare for your procedure. We hope this guide will answer most of your questions and that it will help you prepare for your hospital stay, departure and recovery. Please read the instructions and recommendations carefully. You are in the best position to ensure your smooth recovery. Surgical Team of the CSSS du Suroît 3
Before Your Surgery A week before your surgery, do not take any aspirin or anti-inflammatory medication (Motrin, Advil, entrophen, novasen, ibuprofen, etc.) unless your doctor says you should. N.b.: If you take aspirin daily and your surgeon is aware of this, continue to do so unless he or she has told you to stop. A week before your operation, decrease your alcohol and cigarette consumption. Do not use recreational drugs the week before your surgery. Arrange for someone to accompany you when you are admitted to the hospital and when you are discharged. This person must be available to take you home at any time. When you are discharged, this person should pick up a wheelchair at the main entrance to take you to the car. Arrange for help when you return home after the procedure (e.g., babysitting, meal preparation, pet care). If you will be having day surgery, an adult must stay with you throughout the evening and overnight following your surgery. Acquire any equipment you might need for your recovery (e.g. crutches, walker) if necessary. You may have to shave the surgical area the night before your operation (see checklist at the end of this guide). Also, depending on the nature of your surgery, you may need to begin a bowel preparation the night before your operation. Your surgeon, pre-admission nurse or the admitting service will provide you with this information. Here is some important information to help get you on the road to a smooth recovery. Complications can occur after surgery. It is important to be aware of a few simple and effective ways to prevent them. Pain After an operation, it is normal to experience some pain. Everyone feels pain differently. It is important for you to help us determine how much pain you are in because excessive pain can cause stress and anxiety. The simplest and most effective way for the nurse to determine your level of pain is based on the following pain scale: In the first few days following your surgery, do not wait for the pain to become too strong. Take your pain medication regularly. If your pain is under control after surgery, this will help your recovery because it will be easier for you to move around, breathe and rest. 4 5
Moving Around If you do not move enough after surgery, this can lead to complications. Your position will be changed every two hours following the procedure. This will help your breathing and stimulate blood circulation. Move your legs and ankles, and bend your knees as soon as you can. Once you are allowed to get out of bed, a nurse will help you and show you the proper technique. Begin by turning onto your side. Then use your hand to push against the mattress and lift yourself as you come to a seated position. Reverse these steps to lie down. Support the incision site with a rolled towel or pillow to reduce pain as you move. Breathing Exercises It is important to breathe properly after your surgery. Your lungs need to fill up properly to avoid complications. Regular breathing exercises will aid your recovery. Deep Breathing: Place one hand on your belly and the other on your chest. Breathe deeply through your nose, with your mouth closed. You should see your belly rising. Hold this breath for three to five seconds, then exhale slowly through your mouth. Rest for a few seconds, and repeat. This technique will help you fill your lungs. It is also a great way to help you relax. Depending on the type of surgery, you may receive a spirometer. If this is the case, the nurse or respiratory therapist will teach you how to use it. It is important to clear any mucus that builds up. Cough and spit if necessary, and be sure to support the incision site. Gradually increase your activity level in the days following your surgery. Walking helps with the healing process. It stimulates blood circulation and helps your bowel function return to normal 6 7
Infection Prevention and Control Washing your hands is the best way to prevent infections. It is important to follow this simple rule. Wash your hands before taking your medication, eating, and leaving your hospital room. Wash your hands after blowing your nose, using the bathroom, and returning to your room. Visitors must wash their hands as well, when they arrive and when they leave. Also, friends and families should not visit if they have a cough, fever or diarrhea. Hospital staff must wash their hands before examining you or providing treatment or care. If they forget to do this, do not hesitate to give them a friendly reminder. Hand sanitizers will be available, or you can use soap and water. Isolation Please note that the following situations may arise: Isolation may be required during your hospital stay to avoid the spread of infection. In this case, the hospital staff will provide instructions for you and your family to follow. If an infection is discovered after your discharge, a computerized alert maybe placed in your record to screen or isolate you upon your next visit. The Day of Your Surgery Time and Place: C-section: 5th floor at 6:30 a.m. All other surgeries: 6th floor at 7:00 a.m. If you are admitted to the hospital the day before your surgery, go to Door 25 in the main lobby at 1:30 p.m. Please note that your time of arrival is not your scheduled surgery time. When you are admitted, you will be informed of your surgery time. If necessary, you will be assigned a room where you will be taken after the procedure. When you arrive at the hospital, leave your suitcase in the car. The person who is accompanying you can go back for it later when you need it. What should you bring? health insurance (medicare) card first morning urine sample, if requested by the admitting service or your pre-admission nurse personal effects: containers for dentures and/or hearing aids, case for eyeglasses, contact lens supplies, sanitary napkins if you are having gynecological surgery if you are hospitalized: non-skid slippers and robe toiletries: soap, toothbrush, toothpaste, hairbrush, deodorant, tissue, etc. reading material Leave all valuables at home. The CSSS du Suroît is not responsible for lost or stolen items. 8 9
What should you do? Take a shower. This is a necessary step to prevent infection. Wash your hair. Do not use a moisturizer. Dry off with a clean towel. Wear clean, comfortable clothing. Do not wear jewellery, piercings, makeup or nail polish. Do not eat anything* after midnight. You are allowed to drink water or 7Up until 5 a.m. * For your safety, it is extremely important for you not to eat. Your usual defence mechanisms do not function properly under general anesthesia, and you could accidently inhale the contents of your stomach. This is called aspiration. It is also extremely important to fast if your surgery will be performed under regional or local anesthesia because some patients will require general anesthesia even if this was not planned in advance. You can brush your teeth and rinse your mouth without swallowing. Do not smoke after midnight. Do not wear a tampon the morning of your operation. Use a sanitary napkin instead. Take only the medication you have been authorized to take, with a small sip of water (see checklist on page 14). If you do not follow these instructions, your surgery could be cancelled or postponed. When you arrive at the hospital, the nurse will ask you some questions and check your vital signs. You will need to remove your clothing and underwear, and put on a hospital gown. If you were required to shave the surgical area, the nurse will make sure it was done properly. The nurse will check that you have removed your jewellery, piercings, prosthetics, makeup, nail polish, hairclips and tampon. If necessary, he or she will also give you medication to help you relax. You will be asked to empty your bladder, and a care attendant will take you to the operating room on a stretcher. If you wish, the person who accompanies you (family member or close friend) may remain at the hospital the entire day of the operation. Both parents are allowed to stay in the case of a child. Visiting hours on the days following your surgery are from 2 p.m. to 4:30 p.m., and from 7:00 p.m. to 8:30 p.m. In the Operating Room You will meet your anesthesiologist when you arrive in the operating room. He or she will review your file and ask you questions. If your surgery can be performed with different types of anesthesia, this will be discussed with you. It will depend on the type of surgery, your age and the medications you are taking. If you have questions concerning the anesthesia, do not hesitate to ask. The main types of anesthesia are general, regional and local. General Anesthesia: This type of anesthesia is appropriate for most surgeries. Under general anesthesia, the patient is unconscious, does not move and feels no pain. Regional Anesthesia: This type of anesthesia also works well for many types of surgery. It involves anesthetizing (numbing) a specific region of the body. This is also called an epidural, spinal or intravenous block. The patient stays awake the whole time. If you wish, the anesthesiologist can give you medication to help you relax so you will feel less anxious and more comfortable. Local Anesthesia: This is appropriate only for certain types of surgery. It can be administered by the anesthesiologist or the surgeon. Only the area of the surgery is anesthetized (numbed), and this is done through an injection. Next, the surgical team will prepare you for your surgery in the operating room. Your vital signs will be monitored using a heart monitor (electrodes), blood pressure monitor and saturometer (clip on your finger). Depending on the type of surgery, you may also be monitored with other instruments. The surgical team will carefully observe you the whole time. 10 11
After Your Surgery You will be brought to the recovery room. You will be closely monitored until your condition is stable. You may require oxygen. This is an important precaution that will help your recovery. You may have a sore throat when you wake up. This is due to irritation caused by a small tube placed in your throat during general anesthesia. If you have other tubes attached to you, your nurse will explain their function. Once your condition is stable, you will return to your room or to the Day Surgery Department, depending on your situation. Your nurse will provide follow-up. You will be discharged from the hospital when authorized by your doctor. It is important to gradually resume your activities in the days following the surgery. If permitted, gradually increase the amount of time you spend walking. This is important to strengthen your muscles and stimulate bowel function. It is normal not to pass a stool the day after your surgery. Your system can take up to 72 hours to resume its normal rhythm. Be sure to stay hydrated (six to eight glasses of water a day) and eat fibre-rich foods to help normalize bowel movements. As explained earlier in this guide, breathing exercises, pain relief and moving around will aid in your recovery. N.b.: Narcotic painkillers can cause side effects such as drowsiness, constipation and nausea. For more information, ask your pharmacist, doctor or nurse. 12 Leaving the Hospital Before you leave the hospital, you will receive a prescription for painkillers (if necessary) as well as a follow-up appointment with your surgeon. Your surgeon will also give you instructions to follow at home. When you leave, wear loose-fitting and comfortable clothing that is appropriate for the season, and make sure the person accompanying you is available to take you home. Before you leave the hospital: empty the drawers and closet in your hospital room schedule your next appointment with your surgeon obtain a prescription for painkillers, if necessary obtain instructions for home care, if necessary obtain a medical certificate to provide to your employer, if necessary make sure you have your health insurance (medicare) card take home your medications take home any personal effects placed in the vault Stop by the nurses station before you leave to make sure you have received all the necessary information. Get well soon! The Surgical Team When to get help Call Info-Santé (811) or come to the Emergency Department at the hospital if you experience any of the following: difficulty or inability to urinate repeated vomiting in large amounts persistent pain that is not relieved with painkillers fever over 38.5ºC redness or swelling of the incision, or yellow or green oozing persistent bleeding from the incision cast that cuts off circulation (limb is cold, pale or numb) 13
Checklist Type of surgery: Date of surgery: Surgeon s name: Follow the instructions marked with a checkmark Appointment in Internal Medicine Department before your operation:, block B, first floor, door 104. Stop this medication: days before surgery. Bowel preparation the day before the surgery (see attached page). Blood test on between 9 a.m. and 10 a.m. (you may eat before this blood test). Go to block A, 6th floor, door 602 (main lobby), where you will receive a requisition. R R You must shave the area where you will be operated, the day before your surgery: Follow the instructions marked with a checkmark (continued) Do not eat any solid food after midnight. Water and 7Up are allowed until 5 a.m. Do not eat any solid food and do not drink after midnight. Take this medication the morning of your surgery. Do not take any medication the morning of your surgery. Bring a urine sample to the laboratory (2nd floor) when you arrive on the morning of your surgery. Bring the CD of your radiological examinations. Bring your CPAP machine. Name of the nurse you met with in the pre-admission clinic: How to contact us Hôpital du Suroît: 450-371-9920 Toll-free line: 1-800-694-9920 Surgical Pre-Admission Clinic, extension 2150 14 15