Pre-Operative Patient Information

Welcome to Memorial Hospital located in the beautiful White Mountains of New Hampshire. The following information is designed to provide you with information regarding your upcoming surgery. Although there are many different types of procedures and surgeries, there are certain things that are done for nearly every patient. After the decision is made that you are to have surgery, your physician may need you to have lab work, x-rays, and/or an EKG to be completed in preparation for your surgery. They will discuss with you the date of your surgery and provide you with paperwork if you need to the previously mentioned tests completed.

A pre-operative Registered Nurse from Surgical Services will call you the day before your procedure. She/he will ask you questions regarding your health history, medications, and previous surgeries. Have a current medication list with doses ready to review. At the end of the telephone interview, she/he will tell you the time we would like for you to arrive in the Surgical Services Department. This time may be 45 minutes to 1 hour before your surgery. This is so that a Registered Nurse and a Certified Registered Nurse Anesthetist (CRNA) can begin the admission process to prepare you for your surgery. This will include review of your chart, getting changed into a gown, obtaining vital signs, starting an intravenous (IV) line, and discussing your surgery with you.

The Day Before Surgery

Expect a telephone call the day prior to your procedure to verify the time you are to arrive at the hospital. Unfortunately, we cannot grant requests as to surgical start times. Sometimes, there are patients with special needs (diabetes) or particular procedures that need to be scheduled earlier in the day. Depending on the type of surgery, the recovery period, and emergency cases, the length of stay varies from patient to patient.

Surgery times are subject to change. Please provide an alternate telephone number where you can be reached should your scheduled surgery time change.

The morning of your surgery, it is recommended that you shower. If you notice a rash at or near the surgical site, please inform your surgeon or call the Surgical Services Department. In addition, if you have recently developed a cough or have a cold, please call.

When you arrive at the hospital, walk through the front lobby. Proceed directly to the Surgical Services Department waiting room and check in with the receptionist. We have a waiting room located off the main lobby of the hospital that is intended only for surgical patients and their family or friends. We ask that the person who is driving you home wait in this area or, if they are leaving to run an errand, that they check back into this area. If you are the parent of a minor, we ask that you remain on hospital grounds throughout the patient’s admission, surgery, and recovery.

Valuables: Leave our valuables at home for safe keeping. Do NOT bring credit cards, money, or jewelry. If you do bring valuables, ask family or friends to keep them for you. Please remove all make-up, nail polish, and perfume. You can bring a book to read in case there is a delay in your case. For pediatric patients, they may bring in a favorite blanket or stuffed animal. This will be present for them upon arrival to the recovery area and will help soothe them.

For certain surgeries, there are special procedures or medications (often called “preps”) that your physician may have ordered. If, for any reason, you have been unable to complete the prep, please call your physician’s office or the Surgical Services Department.

Transportation: If you are an outpatient surgery patient, you need someone to provide transportation home, as you are not able to drive for 24 hours post-operatively.

Clothing: Please wear loose, comfortable clothing. This will ensure that no tight clothing will be pressing on your dressing that you may have after surgery.

Glasses: If you wear glasses, bring a case to place them in so that they are secure while you are in surgery. Do not wear contact lenses. Hearing aids, dentures, and partials: You can wear them to the hospital. We may have you remove them immediately before your surgery begins.

Food and drink: We ask that you do NOT eat or drink anything after midnight, the night before your surgery. This includes gum and mints. You may brush your teeth and rinse with mouthwash, just be sure to avoid swallowing any water or mouthwash. If there are specific preparations involved in your procedure (a colonoscopy prep), we will discuss them with you over the phone the day before your surgery.

Smoking: Do NOT smoke the evening prior to or the morning of your surgery. Smoking causes bronchial irritation and may increase the likelihood of breathing problems during anesthesia.

Medication: Routine heart, breathing, or blood pressure medications should be taken with a small sip of water on the day of your surgery. Begin avoiding the use of Aspirin or Motrin/ Ibuprofen products at the advice of your surgeon. If you take Aspirin or Coumadin daily, you must talk with your surgeon before discontinuing the medication.

Pre-Operative Preparation

When you arrive to the Surgical Services waiting, the receptionist will check you in. You will be admitted to the Ambulatory Surgery Unit where you change into a patient gown and are given an ID bracelet to wear until you go home. Your blood pressure, pulse, and temperature are taken. Before going into the Operating Room, you may have an IV line started. The IV will provide you with fluids and enable you to receive medications (such as antibiotics, pain medication, or relaxation medication.)

Anesthesia

Anesthesia is an important part of surgery. Anesthesia services at Memorial Hospital are provided by White Mountain Anesthesia (356-5461, extension 228.) You will meet with a Certified Registered Nurse Anesthetist (CRNA) prior to surgery to review your test results, and surgical and medical history. After this thorough interview, they will discuss what kind of anesthesia is best for you and give you another opportunity to discuss any questions or concerns you may have.

The Operating Room

The Operating Room, also called the OR, is staffed by a team of trained professionals and provides the most sterile and safe surgical environment possible. The surgical team is headed by your surgeon, who is responsible for your overall care. A Certified Surgical Technician (CST) will assist your surgeon. The CST is well trained in the cleaning and purpose of instrumentation available. They are trained in anticipating the needs of the surgeon during your operation. There will be a Registered Nurse (RN) who circulates in the Operating Room. You will meet this nurse prior to your transport into the OR. She/he will ensure that sterile procedures are followed, anticipate and act on the needs of the team, and provide a private, safe environment for the patient. A Pathologist may examine any tissue removed during surgery.

During surgery, the CRNA manages your airway, administers medication, and will monitor your vital signs. They will be at the head of your bed throughout your procedure and will not leave until your procedure is complete and you are transported to the recovery area.

The Recovery Room (Post-Anesthesia Care Unit or PACU)

Immediately after surgery, you will be transported to PACU or to the Ambulatory Surgical Unit. You will receive care from a trained Recovery Room Registered Nurse. You are monitored until you are either ready to return to the Ambulatory Surgical Unit or go to your room on the Medical/Surgical Unit. Your vital signs (blood pressure, pulse, respirations, oxygen saturation) are checked frequently during this time. As you awaken, you may notice the bright lights in the PACU and that the temperature is cool. We will provide warm blankets for you, if needed. We want you to be comfortable. You will be asked frequent questions to determine if anesthesia is wearing off. You may have an oxygen mask or cannula on your face.

Coughing and deep breathing are important after surgery to promote adequate air exchange. This will be reviewed with you and encouraged.

After Surgery

After surgery, your surgeon has specific discharge instructions for you to follow. Before you leave the hospital, you will have these instructions reviewed with you. These will be written out and given to you before you leave from home for reference. Information will include diet, activity, incisional care, medications, and follow-up appointment at your doctor’s office.

Walking re-awakes all of your systems, promoting normal body functions. After your surgery, you should expect to get out of bed and walk. Be sure to have help the first time you get out of bed and begin walking. Your doctor may have prescribed TED stockings or SCD (sequential compression device) be placed on your lower legs, which promote circulation and help prevent blood clots. Another thing you can do to help circulation in your legs is to do ankle exercises. To do the exercises, called ankle pumps, sit or lie down with your legs fairly straight and point your toes toward your nose and then back down as far as you can. You should feel your calf muscles tighten and relax. Do ten pumps in a row about every hour after you are awake from surgery. This pumping action is similar to the movement of your calf muscle during walking.

Drinking and Eating After Surgery

What and when you can expect to eat depends on your doctor’s orders. When your doctor orders that you may eat or drink, it is customary for the nurse to start you on a clear liquid such as water, ginger ale, or juice. This is so that the nurse can assess how you tolerate the clear liquid before advancing your diet.

Dressings

If you had the type of surgery which was done through an incision, you can usually expect to have a dressing over the incision. This will be assessed immediately upon your arrival to PACU. This dressing helps to keep the incision clean, dry, and help to prevent infection. Before you go home, instructions about your dressing will be provided to you.

After certain orthopedic surgeries (knee surgery, knee and shoulder arthroscopies), you may have a device called Polar Care prescribed for you. It is a cooling device that helps decrease inflammation. It will be necessary to fill this Polar Care with ice when you are at home.

Pain Medication

After your surgery, you may or may not experience some discomfort. If you do experience discomfort, tell your nurse. Pain medication may be ordered by your surgeon either to be given by mouth or through your IV. In order to help your nurse control your discomfort, you are asked to rate your discomfort on a scale of 0 – 10. It is easier to control discomfort when it is lower on the scale then if it reaches the higher portion of the scale. Before you are discharged, patient discomfort should be tolerable.

Going Home

Before you can be discharged home, you must meet criteria which include the following: your vital signs are stable, you are able to drink fluids, you are able to urinate, you are not experiencing nausea or vomiting, you do not have excessive pain, and you are able to walk. At home, eat lightly for the rest of the day.

Memorial Hospital and the Surgical Services team promote speedy, safe recovery and a smooth transition in this process. Should you have any questions or concerns when you are recovering at home, please refer to your discharge instructions given to you or call your doctor’s office.

Good post-operative care helps you heal quickly and safely. Take care of yourself. You can do a lot to help you body heal by staying comfortable, taking care of your incision and dressing, eating well, resting, and knowing when to call your doctor if a problem arises. Take good care of yourself and before you know it, you’ll be back on your feed, and back to the things you enjoy.

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