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In hospital

While in hospital it is important that you are able to answer these 4 questions. Please ask any of the staff if you are unsure of the answers.

  1. What is wrong with me?
  2. What is going to happen today/tomorrow?
  3. What needs to be achieved to get me home?
  4. When is this going to happen?

The day of your admission and surgery

You will usually be admitted to hospital on the morning of surgery. It is understood that prior to admission you will have had a thorough shower using the chlorhexidine body wash (provided at your pre assessment visit). If you have any further questions for your surgeon or anaesthetist please write them down in this book and bring it with you to hospital.

Please do not wear make-up, nail polish, false nails or jewellery (including body piercing studs). These will all need to be removed before your surgery.

You do not need to shave the operation area before surgery.

Shaving is no longer considered necessary, however you may have hair from the operation area clipped by the Surgical staff prior to your surgery.

During the admission process, your surgeon, anaesthetist, admission nurse and theatre nurse will see you. This will mean that different people will ask you the same questions. This is a safety issue, and although it can be frustrating, it is important. Use this time to ask any questions that you may have.

Once you have been admitted and changed into your theatre gown and stockings to prevent leg clots, you will wait in the preoperative area until theatre is ready. A final check between the theatre staff and the admission staff takes place before you are taken into the theatre. If you currently use CPAP, your machine will be sent to the recovery room to be used after your surgery is finished.

You will move onto the theatre bed, which is narrow and firm. A blood pressure cuff, ECG and an oxygen monitor will be attached to you so your anaesthetic team can monitor you closely throughout the procedure. Your anaesthetist will place a drip into a vein and ask you to breathe some oxygen through a plastic facemask. Your anaesthetist will then gently send you off to sleep.

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Your Operation

Before surgery you will be given a gown to wear and you will be fitted with compression stockings. These specially designed stockings which help to reduce the risk of developing a deep vein thrombosis. (DVT) in your leg(s). A DVT is a blood clot that can form in a deep vein during periods of inactivity such as during surgery and bed rest. If you require further information this can be provided by the nurse at Pre-assessment clinic.

Your blood pressure, temperature and heart rate will be taken. You may be given an enema to help empty your bowel.

You will be escorted to the pre-operative area and here you will be seen by an Anaesthetist. If it has been agreed that an epidural anaesthetic is best for you, this will be commenced in the operating room.

After your surgery you will wake up in recovery and then be transferred to the ward or the HDU (High Dependency Unit).

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Recovery Unit

You will wake up in the recovery unit with monitoring attached to you. You will have a drip in your arm, urinary catheter and possibly a drain (plastic tube connected to a container) into your abdomen,

Once you are awake and comfortable you may be transferred tothe High Dependency Unit (HDU) located on the first floor.

Recovery-unit

Pain relief

It is important that you receive effective pain relief to enable you to get out of bed and to cough. You will have either an epidural, or intravenous PCA (patient controlled analgesia) to provide pain relief. The decision about which type of pain relief will be suit you, is made by you and your Anaesthetist. Further information about each of these methods of pain relief is available for you, should you require it.

You will also receive paracetamol four times a day. Please notify staff if you are having continued pain.

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Deep breathing and coughing

As soon as you wake up, staff will regularly encourage you to take several deep breaths and show you how to support your wound when you cough.

Nausea/vomiting

If you do feel sick (nauseated) or if you vomit, please tell the nursing staff so that we can treat these problems quickly.

Diet and fluid

When you can eat and drink will depend on instructions from your surgeon. You may be able to start drinking fluids and eating 4 hours after surgery. You will be encouraged to drink 2 high-protein drinks in the evening. This is important to help build your strength after surgery. You will also receive extra fluid through an intra-venous infusion (drip) for approximately 12 hours after your surgery.

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Urine

You will have a bladder catheter (tube) inserted when you are under anaesthetic, allowing your urine to be measured.

Getting up and around

It is important after your surgery that you begin to mobilise. Standing up and sitting out of bed is encouraged. Approximately from 4 hours after your surgery, you will be assisted to sit out of your bed for at least 30 minutes.

Washing

You will be assisted by the nursing staff to have a wash in the evening.

Patient Diary

You will be provided with a Patient Diary to complete daily while you are in hospital. This diary will be collected from you on discharge.

It is important to tell your Doctors and Nurses how you feel and ask them any questions you may have.

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The first day after your surgery

The day after your surgery you can expect the following to happen:

Pain relief - We will continue to give you regular paracetamol four times a day. Your epidural or PCA (patient controlled analgesia) will continue today for pain relief. Please press the pain relief button when you begin to feel discomfort.

Nausea/vomiting - It is important that you start eating and drinking soon after surgery. If you feel sick or feel like vomiting please tell the nursing staff so we can treat these problems.

Diet and fluid - Your intra-venous infusion (drip) will be stopped the morning after your surgery. You will also be offered a light diet and should aim to eat some food during the day. You will be encouraged to drink: 3-4 x glasses of water or preferred fluid and 3 x high-protein drinks

Urine - Your catheter tube will remain in today. Please let your nurse know If your bladder is uncomfortable.

Bowels - Passing wind or a bowel motion is a signal that your bowel is getting over the surgery. This is an important step in your recovery, so please note this in your Patient Diary and tell the nursing staff when it happens.

Getting up and around - On this day you will be out of bed for at least 8 hours. This includes regular walking within the ward and sitting up in a chair. Nursing staff will assist and supervise you to do this. Aim for 4 x 10 minute walks over the course of the day.

Deep breathing and coughing - Staff will regularly encourage you to take several deep breaths and show you how to support your wound when you cough. Continue these deep breathing exercises hourly. A Physiotherapist will assess your breathing/mobility and assist you with these if problems are identified.

Washing - You will be assisted to have a wash or a shower in the morning and be encouraged to get dressed in your own loose-fitting day clothes.

Patient Diary - Please complete the Patient Diary for today.

Today you will be out of bed and going for short walks, aim for 4 x 10 minute walks today.

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Day Two

Day 2 after your surgery you can expect the following to happen:

Pain relief - Your epidural (or PCA) may be stopped this morning (or it may continue for another day). You will be given a combination of pain relief tablets before this happens. Sometimes discomfort or pain is experienced when the epidural (or PCA) is discontinued, even though strong pain tablets are being used. If your pain relief is not working well, tell the nursing staff so that other pain medication can be given to you.

Diet -You will be encouraged to drink fluids and eat some food. Aim to drink:

  • 3-4 x glasses of water or preferred fluid
  • 3 x high-protein drinks and eat some food

Urine - Your catheter tube will be removed in the morning. You will be passing urine freely. Please let your nurse know if your bladder is uncomfortable or you are unable to pass urine.

Bowels - Passing wind or a bowel motion is a signal that your bowel is getting over the surgery. This is an important step in your recovery, so note this in your Patient Diary and tell the nursing staff when it happens.
Getting up and around - Today you will be encouraged to be up and about independently for at least 8 hours. This includes regular walking within the ward, showering and sitting up in a chair. Aim for 4 x 10 minute walks during the day.
10mins

Deep breathing and coughing - Staff will continue to encourage you to do deep breathing exercises regularly throughout the day.

Washing - Today you will shower independently and once again put on your own loose fitting clothes.
Patient Diary - Please complete the Patient Diary for today.

Going home - Discharge planning - On this day it is important that you and your family/whānau/carers talk to the nursing staff to ensure everything is in place for your discharge.

It is important to tell your Doctors and Nurses how you feel and ask them any questions you may have.

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Day Three

 

Day 3 after your surgery you can expect the following to happen:

Pain relief - Your pain will be controlled with a combination of pain relief tablets.

Diet - You will be eating and drinking a normal diet. You will be encouraged to drink plenty of fluids including 3 high-protein drinks.

Bowels - You need to have passed wind before going home.

Getting out and around - Although you may move slower than normal, you will be able to move around almost as well as you did prior to coming to hospital.

Washing - You will be able to shower independently.

Patient Diary - Please complete the Patient Diary for today.

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Day Four


Discharge - You will be discharged on Day 4 before 11am if your recovery is uneventful. Your safety is most important. If you are not well enough to go home by Day 4, you will remain in hospital until your condition improves. You will continue to build on your recovery and independence each day. If you need to wait for transport, you may be moved to the transit lounge on the first floor where a nurse will oversee your needs.

What about follow-up? - The surgical team will discuss the results of your surgery with you in the outpatient's clinic approximately 2 - 6 weeks after your surgery. An appointment will be posted to you.

Further follow-up will be arranged at this time if needed.

Going home - Discharge Planning - Your safety is most important. It is safe for you to be discharged from hospital when the following has occurred:

  1. You experience good pain relief with oral pain medicines.
  2. You are able to eat and drink.
  3. You are passing wind regularly
  4. There is no fever or other problems that require continued observation in hospital.

Checklist

Following bowel surgery these criteria are usually met by day four  to seven, unless you need to stay in hospital longer than usual you will be discharged between four and seven days after surgery. It is important that you and your family/whānau/carers talk to the nursing staff today to ensure everything is in place for your discharge. Your safety is most important. If you are not well enough to go home by Day 4, you will remain in hospital until your condition improves. You will continue to build on your recovery and independence each day.

Please make staff aware of any needs you may have, well before going home.

Information regarding your recovery at home - Continue taking regular pain relief as discussed prior to your discharge from hospital.

It is important to gradually increase your activity after your surgery, so that you return to your normal ability/mobility levels. Building up the distance you walk, will improve your fitness and strength. Over the first 4 - 5 weeks, aim to build up to 30-40 minutes walking at a pace that starts to make you breathe a little harder than at rest.

For some people 40 minutes of activity at one time is unrealistic. Research shows that three 10-minute walks a day gives nearly the same health benefits as one 40-minute session.

Please avoid lifting any heavy objects for at least 6 weeks following your surgery. You can lift the equivalent of a bag of groceries.

Walking

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Last updated: October 16, 2017