Gallbladder Surgery. This booklet will help you understand and prepare for your surgery.

Transcription

1 A Guide to PRET SURE Parcours de rétablissement chirurgical du CUSM MUHC Surgery Recovery Program Gallbladder Surgery DM-4031 (REV 2014/02/24) CUSM repro MUHC This booklet will help you understand and prepare for your surgery. Please review it with the nurse and your family. Please bring it with you on the day of your surgery.

2 This document was developed by The MGH Patient Education Clinical Care Pathway Working Group, the Post Anesthesia Care Unit nurses, the nutritionist and physiotherapist and reviewed by the surgeons. We would like to recognize the MUHC Patient Education Office for their support throughout the development of this booklet, the design and layout, as well as for the creation of all the images. This document is copyrighted. Reproduction in whole or in part without express written permission from is strictly prohibited. Copyright 24 February 2014, February 2013, December McGill University Health Centre 3rd Edition I IMPORTANT: PLEASE READ Information provided by this booklet is for educational purposes. It is not intended to replace the advice or instruction of a professional healthcare practitioner, or to substitute medical care. Contact a qualified healthcare practitioner if you have any questions concerning your care. This material is also available on the MUHC Health Education Collection ( and MUHC Patient Education Office ( PRET SURE Parcours de rétablissement chirurgical du CUSM MUHC Surgery Recovery Program

3 Table of contents Introduction 4 What is the gallbladder? 4 What are gallstones? 5 What is gallbladder surgery? 6 Before Your Surgery Preparing for your surgery 7 Preoperative visit 8 Cancelling 9 Instructions 10 Things to bring to the hospital 13 Day of Surgery At home 14 At the hospital 15 Waiting room 16 After your Surgery 17 Pain control 18 At Home 19 Pain 19 Diet 19 Incision 20 Activities 20 Call your surgeon if Follow up 21 Important Resources 22 Stop Smoking 23 Pain Diary 24 Help Us, Help Others 25 Reference Image 26 Notes 27 Map of the Montreal General Hospital 28 3

4 Introduction The day of your surgery you will be taking part in a fast recovery program called a care pathway. The goal of this program is to help you recover quickly and safely. What is the Gallbladder? The gallbladder is a pear shaped organ found under the right side of your liver. The gallbladder stores extra digestive liquid (bile) made by the liver. After eating the gallbladder releases bile. The bile travels through narrow tubes (bile ducts) into the small intestine to help with food digestion. Gallbladder Liver Stomach Pancreas 4

5 What are Gallstones? Introduction Gallstones Bile ducts Gallstones are formed from cholesterol and bile salts. They can vary in size from a few millimeters to few centimeters. The most common reason to have the gallbladder removed is the blockage of bile flow causing pain, nausea and vomiting. Food can still be digested without a gallbladder. 5

6 What is gallbladder surgery (Cholecystectomy)? The surgery can be done 2 ways, laparoscopic or open. This booklet however, is for patients having laparoscopic surgery and that are supposed to go home the same day. 1. Laparoscopic 2. Open OR The surgeon makes four small cuts in your belly. A camera helps to see and the instruments act as hands to help the surgeon remove your gallbladder. The surgeon makes one longer cut in your belly to remove your gallbladder. 6

7 Before your surgery Preparing for your surgery Exercise will help make sure your body is as fit as possible before your surgery. If you are already exercising, keep up the good work. If you are not, start slowly adding exercise into your day. Exercise does not need to be strenuous to be helpful; in fact, a fifteen-minute walk is far better than not exercising at all. Stop smoking: We strongly suggest you stop smoking completely before surgery to reduce your risk for lung problems. Your doctor can help you stop smoking by prescribing medication. Stop alcohol: Do not drink alcohol for 24 hours before surgery. Alcohol can interact with some medicines. Please let us know if you need help decreasing your alcohol use before surgery. Plan ahead: You may need help with meals, laundry, bathing or cleaning, when you first go home from the hospital. Make plans with your family and friends so you will have the help you need. Arrange to have a responsible adult with you to take you home from the hospital and stay with you for the first 24 hours after your surgery. You will not be allowed to leave the hospital alone. You CANNOT take a taxi home by yourself. I Your surgery will be cancelled if you do not have someone to take you home and to stay with you for 24 hours. 7

8 Before Your Surgery Preoperative visit During your preoperative visit, you will: Have blood tests. Have an ECG (electrocardiogram). Meet with a nurse who will tell you how to get ready for your surgery and what to expect on the day of your surgery. Meet with a doctor who will ask you questions about your health. If you have medical problems, you may be referred to another doctor (a specialist) before surgery. I Some medications or herbal products should be stopped before surgery. Please bring a list of your medications to the Preoperative clinic. The clinic doctor will explain which medications you should stop and which ones you should keep taking. Your pharmacist can give you a list of your medications or can fax the list to us at If you have any questions, you may contact the Preoperative clinic nurses at (514) , extension 43778, Monday to Friday, 1:00 p.m. - 3:00 p.m. 8

9 Before Your Surgery Cancelling your surgery If you get a cold or other illness, or become pregnant, please call your surgeon s office as soon as possible. If it is not possible to reach your surgeon, call the Admitting Department (514) ext Call to reschedule if: Su Mo Tu We Th Fr Sa You are not well. You need to cancel. I Please keep in mind that the Montreal General Hospital is a Trauma Centre. This means that your surgery may need to be delayed or cancelled because of an emergency. Your surgeon will reschedule your surgery as soon as possible. 9

10 Before Your Surgery Instructions: Day before surgery The Admitting Department will phone you to tell you what time to come to the hospital. (If your surgery is scheduled on a Monday, the hospital will phone you the Friday before). You will be asked to arrive 1½ to 2 hours before your surgery is planned to start. The time of surgery is not exact. It may be earlier or later than planned. I If you do not receive a call before 2:00 pm, you may contact the Admitting Department at (514) ext Date of surgery:! Time of arrival at the hospital: Room: Surgical Admission Services (D10-124) on the 10th floor of the main building. 10 If you have any questions, you may contact the nurses of the Preoperative Clinic at (514) , extension 43778, Monday to Friday, 1:00 p.m. - 3:00 p.m.

11 Before Your Surgery Can I eat or drink before my surgery? STOP All patients need to stop eating at midnight. Some patients may drink carbohydrate drinks up until their expected time of arrival at the hospital. The Preoperative nurse will let you know if you are allowed to have these. There are benefits to drinking clear fluids. If the Preoperative nurse asks you to drink please choose one of the liquids on the next page. Drink the amount shown on the evening before and on the morning of your surgery. You do not need to choose the same drink for the evening and the morning. 11

12 Before Your Surgery Try to drink the amount shown No diet drinks please P 2CUPS oz 12oz 1 2 Qt CUP CUP apple juice OR orange juice (no pulp) 1CUP oz 4oz 1 CUP 2 3 CUP evening before: 850ml morning of: 425ml evening before: 1000ml morning of: 500ml commercial iced tea cranberry cocktail OR OR OR lemonade evening before: 1100ml morning of: 550ml evening before: 650ml morning of: 325ml evening before: 1000ml morning of: 500ml I You may drink clear liquids until your expected time of arrival at the hospital. For example, if you have to arrive at the hospital at 11AM, do not drink fluids after 11AM. Exception: if your time of arrival is between 6 and 6:30 in the morning you should stop drinking at 5:30 in the morning. 12

13 Before Your Surgery Before going to bed, take a shower or bath using one of the sponges given to you in the Preoperative clinic. Wash your body and belly button, and wear freshly washed clothes to bed. Things to bring to the hospital This booklet. If you wear glasses, contact lenses, a hearing aid or dentures, please bring the appropriate containers with your name on them. If you use a cane, crutches or walker at home, please bring them to hospital with your name on them. Your Medicare card. If you do not speak French or English, please bring someone to translate for you. Please leave all jewelry, credit cards and objects of value at home. The hospital is not responsible for any lost or stolen articles. Your medication in their original containers. Quebec MMI PRENOM ET NOM DE FAMILLE AL LA NAISSANCE Roland H ME 13

14 Day of Surgery At home P Take a shower or bath using the second sponge given to you to wash your body and belly button and wear freshly washed clothes Do not put on any creams, lotions or perfume. Do not wear make-up or nail polish. Do not shave the area to be operated. Remove all jewelry including body piercings and leave it at home. Wear loose comfortable clothing. Many patients are bloated after this surgery. 14

15 At the hospital Day of Surgery Report directly to the Surgical Admission Services (D10-124) at the time given. In the Preoperative admitting area, the nurse will: Ask you to change into a hospital gown Make sure your personal belongings are in a safe place Complete a Preoperative checklist with you You may be asked to put on tight elastic stockings to help blood circulate better and prevent blood clots from forming. You should wear them until you get change to go home. When the operating room is ready, an orderly will bring you there. In the operating room you will meet your anesthesiologist and the other members of the surgical team. 15

16 Day of Surgery Waiting room Family and friends may wait for you in the waiting room located in the D wing on the 10th floor (D10-117). The space is small so we ask that you limit the number of people coming with you. The nurse from Post Anesthesia Care Unit (PACU) will call for your escort when you are ready to go home. 16

17 After your surgery You will wake up in the Post Anesthesia Care Unit (PACU). There are no visitors in the PACU intravenous You will have: An intravenous, to give you fluid and medications An oxygen mask oxygen mask Your vital signs (pulse, blood pressure) will be checked often. Your nurse will check your bandages and ask you about your pain. You will stay there until you are well enough to go home (about two hours). This period of time varies with each patient. Remember you must have someone to take you home and to stay with you for the first I 24 hours after your surgery. 17

18 After your surgery Pain Control Pain relief is important because it helps you: Breathe more easily Move more easily Sleep better Recover faster Eat better Do things that are important to you No pain Do not wait until the pain gets too bad before telling us. You will not become addicted to pain medication given to you for surgical pain. Nausea Pain Intensity Scale Pain as bad as you can imagine You will be asked to rate your pain on a scale from The nurse will give you medicine if you have pain. Our goal is to keep your pain score below 4/10. You may have neck and shoulder pain for the first few days after your surgery due to the gas put into your belly. This will go away by itself. Some patients have nausea after their surgery, medications can be given to help this. Always tell the nurse if your pain is more than 4 on the pain scale (where 0 is no pain and 10 is pain as bad as you can imagine.) This will help your nurse decide how to I best manage your pain. 18

19 At Home Abdominal Pain You may have some pain during the first few days following surgery. Please track your pain levels at home using the Pain Diary found on page 24 You will receive a prescription that includes: acetaminophen (Tylenol), a medication against pain and swelling (anti-inflammatory) and a stronger pain medication (Narcotic). Tell your surgeon if you are allergic to any of these medications or if you are already on aspirin or anti-inflammatory medication. Take acetaminophen (Tylenol) and the anti-inflammatory first to relieve your pain. Add the narcotic if your pain is not relieved by acetaminophen (Tylenol) and the anti-inflammatory. If the anti-inflammatory and pain medicine cause burning or pain in your stomach, stop taking them right away and call your surgeon. Diet You can eat anything you want. If you are nauseous start drinking clear fluids and gradually increase your intake according to your tolerance. Some pain medications can cause constipation. If this becomes a problem, increase the amount of fluids you drink, and add more whole grains, fruits and vegetables to your diet. Do not drink any alcohol for 24 hours after anesthesia or while you are taking pain medication. 19

20 At Home Your incision You may notice some pink on your belly. This is the disinfectant used in the operating room. It will wash off once you shower. You will have 4 small plastic bandages on your belly. The bandages are waterproof so you can take a shower after your surgery if you wish to do so. Remove the bandages 2 days after your surgery. Each small cut will be covered with thin pieces of tape. If after 7 days the pieces of tape have not peeled off, you may remove them yourself. You can continue taking showers once the bandages are off. Tell your surgeon if your incision becomes warm, red, and hard or you see pus or drainage coming from it. Activities You may feel more tired after your surgery, so rest. You may begin all your normal activities once you feel ready (including work, exercise and sexual activity). I anesthesia You are not allowed to drive for the first 24 hours after or while you are taking pain medication. 20

21 At Home I Complications do not happen very often but it is important that you know what is normal and what is not. Seek medical attention if you have any of the following symptoms: Your incision(s) become warm, red, you see pus or any drainage coming from it. You have a fever (greater then 38 C/100,4 F) You cannot drink fluids or keep them down. You are having more pain that is not relieved by the medications Follow up You may receive a phone call from the recovery room nurse the day after your surgery. He/she will be phoning to see how you are doing. About 3 weeks after your surgery, you will need to see your surgeon. Once at home, call the clinic to set up an appointment. For patients operated at the Montreal General Hospital the number of the clinic is

22 Important Resources If you have any questions, please contact us. Dr. Feldman: (514) extension Dr. Fried: (514) Dr. Khwaja: (514) extension Dr. Vassiliou: (514) extension Dr. Chaudhury (514) extension Dr. Paraskevas (514) extension Dr. Metrakos: (514) extension Dr. Tchervenkov: (514) extension Dr. Deckelbaum (514) extension Other surgeon: Montreal General Hospital Day Surgery Unit (514) (7am to 3pm) Montreal General Hospital Preoperative Clinic (514) ext (1pm to 3pm) Admitting office (514) ext Montreal General Surgery clinic (514)

23 Suggestions to help you stop smoking There are four phases of quitting 1. Preparing to quit 2. Choosing a quit date 3. Coping with withdrawal 4. Fighting relapses Stop smoking now and you will already be on your way to quitting. Take it one day at a time. Think of yourself as a non-smoker. Be proud of what you have already done. Ask your family and friends not to smoke around you. Get a family member or a friend to stop smoking at the same time. Join a stop-smoking group and kick the habit with other people. Speak with your doctor about aids to help you quit such as the nicotine patch. Get more information from: Montreal Chest Hospital (514) extension Quebec Lung Association (514) or

24 Pain Diary Using the Pain Intensity Scale and table below, enter the level of pain you feel during the day. For example: Days After Surgery 1 Morning 4 / 10 Noon Evening Night 4/10 3 /10 3/ No pain Pain Intensity Scale Pain as bad as you can imagine Days After Surgery Morning Noon Evening Night 1 /10 /10 /10 /

25 MUHC Patient Education - Dr. David Fleiszer Help Us Help Others Help support the MUHC Patient Education Office! Donations make a huge difference. They help us create health information materials and programs to deliver the best care for life. All patient materials are freely available on the internet to MUHC patients, and to patients and families everywhere. Make a donation through the Montreal General Hospital Foundation to: MUHC Patient Education Dr. David Fleiszer Online: mghfoundation.com/ By Phone: DATE M.C. SCOFIELD 12 Main Street West Montreal, Quebec PAY TO THE ORDER OF: BANK OF MONTREAL MEMO : : $ /100 DOLLARS CANADA Canadian Pride by Karen Smith Design Issued Dec 10th 2012 Montreal General Hospital Foundation 1650 Cedar Avenue, room E6-129 Montreal QC, H3G 1A4 In Person / By Mail: 1650 Cedar Avenue, room E6-129 Montreal QC, H3G 1A4 Thank you for your support! MUHC Health Education Collection: infotheque.muhc.ca MUHC Patient Education Office: muhcpatienteducation.ca 25

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28 L Clinique Préopératoire Preoperative Clinique D Service d admission chirurgie The surgical admission services. L D E P Entrées / Entrances Stationnement/ Parking Ave. des Cedars / Cedar Ave. A C T Ch. Côte-des-Neiges Rd. B P Rue Guy St. N Ave. des Pins / Pine Ave. Hôpital Montreal General Hospital 1650 Ave. des Cedars / Cedar Ave. Montreal, H3G 1A4. 28