Coping with Surgery

There are a number of things the hospital will require you to do before you have surgery. These are some basic guidelines for the surgical process so that you and your family will know what to expect.

PAPERWORK
Entering the hospital requires forms and paperwork. Every hospital worker will have paperwork for you to sign or fill out. You should have proof of insurance with you. If you have a durable power of attorney or a living will, make copies and bring it with you. You will be asked to sign informed consents for procedures, anesthesia, and blood.

BLOOD WORK, CHEST XRAY, EKG
These tests are performed to establish your “baseline” values. It is a starting point to show what is “normal” for you. Normal values can vary from person to person depending upon his/her situation. Ask your doctor what your normal values are. You may have completed these tests in your doctor’s office or they may be done before surgery.

HISTORY AND PHYSICAL
You will have a complete history and physical examination by a physician or nurse practitioner. He/she is a member of the surgical team. Your surgeon usually has a team of doctors that work with him to perform your surgery. You should have met your attending (main) surgeon in his/her office before scheduling your surgery. You may have a presurgical appointment where your paperwork, lab work, and physical will be done at the same time. Otherwise, all of this will be completed on the day of your admission to the hospital.

PREOPERATIVE AREA
This is the area where you will get ready for the operating room. They will give you a patient gown and an ID bracelet. Tell everyone about any allergies you have so that it can properly noted in your chart. You should leave all your valuables and jewelry at home or leave them with your family members or friends. If you have glasses, contacts, dentures, or a hearing aide, these will also be removed at this time. Give them to a family member if possible to prevent them from getting lost. Some hospitals will allow a loved one to stay with you up until this point. Ask your hospital or the nurse about the hospital’s policy. Any last minute paperwork will be completed in this area. They may put long, tight stockings on your legs. These stockings help to prevent blood clots from forming in your legs. They may also put a sequential compression device on your legs on top of the stockings. This device has plastic sleeves that are placed around your legs and the sleeves fill with air from the bottom to the top. This device mimics the normal movement and blood flow in your legs that you would have if you were walking around. The stockings and device are temporary until you are out of bed and walking around. You will meet the anesthesiologist here and they will take you to the operating room on a gurney.

ANESTHESIOLOGIST
The anesthesiologist is the doctor in charge of monitoring your vital signs and all your bodily functions during the surgery. He/she will give you medications to help you relax and put you to sleep. They are in charge of inserting the breathing tube (intubation) and controlling the machine that helps you breathe (ventilator). They monitor your blood work, give medications, and blood as needed. They will place one or two IVs if a nurse has not already done so before you enter the operating room. They will place any other type of IV access you might need during the surgery. A foley catheter will be placed in your bladder to monitor urine output. They are also in charge of taking your breathing tube out (extubation) once the surgery is complete and you are awake enough to breathe on your own. In some cases, depending upon the type of surgery, the breathing tube may need to remain in place for a certain amount of time and will be removed in the intensive care unit.

BLOOD PRODUCTS
Because there is a risk of bleeding during surgery, blood will be made available and on hold for you if you should need it. Under optimal circumstances, you may not require a transfusion. However, there is a possibility you may need blood and the surgical team must be prepared for it. You have the option of getting “donor designated ” blood. Donor designated blood is blood donated by someone for a specific person. If you have family or friends that are the same or a compatible blood type and would like to donate blood for you, contact the blood bank at the hospital where your surgery will take place. There is also the possibility of using “autologous” blood. This is blood that you donate for yourself. If you are interested in this, you must ask your doctor if it is safe for you. Your doctor will check your blood levels and see if this will work for you. The blood bank will give instructions about appointments and procedures. The blood bank will tell you how much time is needed to process the blood in time for surgery. The blood will be given to another needy person if it is not used for the designated person.

HOUSING
If you are far from home, your loved ones will have to arrange for lodging. The hospital may have a list of accommodations close to the hospital. Some hospitals can assist you with housing depending upon financial need. Ask to speak to a social worker if you need assistance with housing.

NPO
This is a medical word meaning nothing by mouth. You will be asked not to eat or drink anything the night before your surgery. Your stomach must be empty when surgery is performed. There is a risk of nausea and vomiting before, during, and after surgery. Because you will have a breathing tube in place, your airway will not be protected as it normally is when you are awake. If you should vomit, there is the possibility of stomach contents entering the lungs. The chances of this happening are slim. However, the possibility exists which is why you are asked to keep the stomach empty.

THE WAITING GAME
Your loved ones will be asked to wait in a designated surgical waiting area. There is usually an estimated time for the length of the surgery. Remember to add a few hours for the preoperative and postoperative periods. Occasionally there are delays in the actual time the surgery starts. Delays can happen for many reasons. There are many people involved in the process so keep this in mind. Once the surgeon has completed the surgery, he/she will speak to your family about the outcome. You will spend some time in the recovery room to be stabilized and wake up. Your family can see you when you are settled and stable in a room or the ICU depending on where you are sent. This usually translates into a long wait for loved ones. They should bring things to keep them busy or occupied while waiting for news.

RECOVERY ISSUES
Visitors after surgery

Your loved ones will want to see you following the surgery. The best time to see the patient will be determined by the medical and nursing staff. The staff’s highest priority at this time is the stability of the patient. Vitals signs and respiratory status need to be closely watched. Different hospitals have different policies for visitation.

Dry mouth
Because of the medications used during the surgery, you will have the feeling of a dry mouth. You may also have a sore throat from the breathing tube. These are normal sensations after surgery. You will be thirsty but you may not be allowed to drink anything right away. You are susceptible to nausea after the surgery because of the medications and your stomach may still be “asleep”. The staff will decide when it is safe for you to drink. Nausea and vomiting will cause more pain and discomfort. In the meantime, they may allow swabs to wet your mouth, brushing your teeth or ice chips.

Coughing and Deep Breathing
You will be asked to cough and take deep breaths after the surgery. Mucous can accumulate in your lungs and your lungs do not fully expand as a result of the surgical process. Because of this, you are susceptible to infection and pneumonia. Atelectasis is the collapse of alveoli in your lungs. Alveoli are small, balloon like sacs in your lungs. Coughing and deep breathing help to keep these sacs open so that they can do the job of bringing oxygen into your body and getting rid of carbon dioxide. It is important to do breathing exercises to help reexpand the lungs and remove mucous. You may be asked to use an incentive spirometer, which is a device that will help you to expand the lungs and make you cough. You will be taught how to use this device at the hospital.

Out of Bed
It is important to get out of bed as soon as possible. This could mean getting out of bed to a chair or walking out in the hall. You may be dizzy the first time you get up. A nurse or an assistant should be with you at this time until you have the ability to get up safely on your own or with a family member. Getting out of bed is good for your lungs and your circulation. Bedrest slows the venous return in your legs and make you susceptible to blood clots. Walking improves your circulation and minimizes this risk. Walking also encourages normal movement of your stomach and GI tract so that you pass gas and restore normal bowel function. Movement and activity will also help to restore normal lung function. Restoring normal body functions will help you to get home faster.

Pain and discomfort
It is normal to have pain after surgery. The amount of pain will vary depending upon the type of surgery and the person’s individual tolerance. You may feel uncomfortable with all the tubes and wires that are attached to you. The Medical team will work with you to ensure that your pain is managed. It is important to let the staff know when you are having pain, where and how much. They may teach you to report your pain on a scale of 0-10 to judge the amount of pain you have and if the medications you are given are effective. It is important not to let the pain get out of control. Some people will wait a long time before asking for pain medication out of fear or anxiety. It will take longer for pain medication to work if your pain is at a very high level (i.e. 9-10 out of 10 on the pain scale). Pain medication is more effective if there is a steady level in your blood stream. Taking medications at regular intervals will make them work more effectively. Some people worry about addiction to pain medications. There is very little chance of addiction when pain medications are used after surgery. It is more important to manage your pain so that you are able to do the activities necessary for your recovery (coughing, deep breathing, and walking). Relaxation techniques such as visualization, meditation and breathing exercises can also help in the management of pain.

Discharge
When you are ready to go home, you will receive some instructions from the team. You should know how to take care of your incision/wound and if there are any restrictions with bathing. You must watch your incision for any signs or symptoms of infection such as redness, swelling, or drainage. You should know when your next follow-up appointment will be or given a number to call to make an appointment. You should have prescriptions for any medications you will need at home. You may have restrictions for driving especially if you are taking pain medicines that make you drowsy. Someone should drive you home or you should take a taxi. You need to know what your activity restrictions will be. You should maintain good nutrition, good fluid intake (unless restricted) and rest at home for optimal healing. If no one gives you instructions, ask for them. Go home and heal.

References:
Brunner L, Suddarth D: Textbook of Medical-Surgical Nursing,
6th ed. Philadelphia, JB Lippincott, 1988
Taylor C, Lillis C, Lemone P: Fundamentals of Nursing: The Art and Science of Nursing Care,
1st ed. Philadelphia, KB Lippincott, 1989