How To Prepare For A Major Surgery

Transcription

1 Before Surgery To prepare for surgery we have created this check list for you, so that you do not forget anything. Please review each item and check it off as it is completed. Bring this book with you to all appointments and to surgery, so that you can record instructions and take notes If you need a handicap parking placard please check with your state's Department of Motor Vehicles to secure the application. Complete your part of the application and bring it with you so that doctor can complete and sign it. You will then return it to your state's DMV along with the appropriate payment to secure your parking placard. The night before surgery your meal should be light; you don't want to over-due it. Your body works hard to digest a high fat, high calorie meal and this can contribute to nausea after surgery. Your lab work must be current, that is within 30 days of your surgery. You may be contacted by your doctor with your CBC results and given instructions on how to take your medications. Bring the following with you on the day of surgery: Copy of your OrthoCarolina Coordinate Care Patient Card List of all medications you are taking and the dose Your medical history Copy of Living Will and/or Power of Attorney (if you have one) Medications to STOP before surgery: Review the list of medications on page 34. Highlight the medications that you are currently taking and note when you need to stop taking them. Medications stopped prior to surgery may be taken 48 hours after your last dose of Coumadin. You are NOT to eat or drink anything after midnight the night before your surgery. Remember this includes food, candy, gum, mints, or water. Special Instructions: 1 P age

2 You have been given a special cleansing solution called Hibiclens. Starting three (3) days before surgery you need to bath using this solution. See more information in section. You may only take the medications on the morning before surgery that the Anesthesiologist tells you to take. You should take them with just enough water to swallow them. List those medications here: It is suggested that you bring your walker, or one that has been provided for you, to the hospital the morning of surgery. Please leave it in your car until after surgery. Your care coach can bring it to you after you are settled in your room following surgery. The post-op instructions are important. For any questions or concerns remember to contact your Patient Navigator between the hours of 8:00 AM 5:00 PM. After hours and on weekends call A physician or the physician s assistant will be directed to return your call promptly. Remember if you call after hours to tell the operator that you are a Coordinated Care Program patient. Journal entries and questions regarding before surgery: 2 P age

3 MRSA Methicillin-Resistant Staphylococcus Aureus (MRSA) are organisms (bacteria) that are resistant to some antibiotics. It is possible for an individual to carry MRSA on their skin or in their nose and be free from symptoms and never get the infection. A simple nasal swab can determine if you are a carrier of the bacteria. If you have a history of MRSA or have a positive culture extra precautions will be taken to prevent the bacteria from becoming in infection. The following precautions may be taken: Bactroban Ointment: You will be given a prescription for Bactroban Ointment that is to be placed in your nostrils twice a day for five days. You will begin using it three (3) days before surgery and continue to use it for an additional two (2) days while you are in the hospital. Hibiclens Soap: Starting three (3) days before surgery you will wash from neck to toe with Hibiclens soap (an antiseptic skin cleanser). This cleanser helps to kill germs and bonds with your skin so that it continues killing germs after you use it. You will use the Hibiclens soap for an additional two (2) days while you are hospitalized. Please see the Pre-Op Hibiclens Bathing Instructions sheet. Hand Hygiene: Everyone entering your hospital room (hospital staff, physicians, and visitors) need to wash their hands or use a hand gel sanitizer. We encourage you to make sure they do this by asking them if they have washed or used gel on their hands. Journal entries and questions regarding MRSA and hygiene: 3 P age

4 Medications That Increase Bleeding or May Interfere with Anesthesia Some medications impair the body s ability to form a clot and stop bleeding. Obviously, failure to normally form clot is undesirable around the time of surgery. ASPIRIN: Ideally, aspirin should be discontinued a minimum of 7 (preferably 10) days prior to elective surgery. This advice includes products containing aspirin, like Percodan. Non-steroidal Anti-inflammatory Drugs (NSAIDs): Non-selective COX inhibitors (NSAIDs, e.g. ibuprofen, ketoprofen, Advil, Motrin, many others) should be discontinued a minimum of 5 (preferably 7) days before elective surgery. The selective COX inhibitor, Celebrex, CAN be continued. If you have a question about your painkiller, ask your surgeon. Vitamins, Supplements, Herbals: Many herbal medications and supplements may increase bleeding and/or interact with medications used for anesthesia. In many cases, the exact composition of herbal supplements and the potential interactions are unknown. Specific recommendations cannot be given. Therefore, DO NOT TAKE these medications for a minimum of 7 days prior to elective surgery. Alcohol and Recreational Drugs: Drink less alcohol as alcohol may alter the effect of the anaesthetic drugs. Do not drink alcohol 24 hours before surgery. Stop taking recreational drugs before surgery as these may affect the anaesthetic drugs. If you have a drug addiction please tell your anaesthetist. Medications Prior to Surgery TAKE DO NOT TAKE (Discontinue 7 Days Prior to Surgery) Cardiac medications (for the heart) Anti-reflux medications (Prilosec, Nexium, Protonix) Seizure medications (anti-convulsants) Bronchodilators (inhalers and medication for the Chewable antacids (TUMS, Rolaids, etc.) Diuretics (water pills, furosemide, hydrochlorotiazide) Oral hypoglycemics (Glucophage, Avandia, 4 P age

5 lungs) Steroids (prednisone) Immunosuppressants Thyroid replacement (Synthroid) Anti-Parkinson medications COX-2 antagonists (Celebrex) Opiates (without aspirin; Tylenol #3, Noreo, fentanyl, etc.) Actos, DiaBeta, Mecronase, Glucotrol, Amaryl) Birth Control Pills & and male or female hormones (including creams or patches)**, such as Emcyt, Estraderm, Estratest, Estrace, Estradiol, Estrogens, Ogen, Premarin, Prempro, Testosterone Aspirin (and aspirin-containing compounds) such as: Alka-Seltzer, BC Powder, Bufferin, Disalsid (Salsalate), Dolobid (Diflunisal), Ecotrin or Uncoated Aspirin* (81mg-325mg), Excedrin, Fasprin (81mg), Goody Powder, Norgesic, Pepto Bismol, Percodan Antniplatelets such as: Aggrenox (aspirin + dipyridamole), Plavix* (dopidogrel), Pletal (cilostazol), Trental (pentoxil) Antithrombotics such as: Ticlid Anticoagulants, such as: Coumadin (discuss the use of Lovenox with y our surgeon you will receive special instructions and a prescription if you are placed on this medication) Non-steroidal Anti-inflammatory Drugs (Ibuprofen, Motrin, Advil, Mobic, Orudis, etc.) Weight reduction agents Vitamins such as: A, C, E, K, Multivitamins, Fish Oil, /Omega 3,6,9, Juice Plus, CoQ10 Herbs such as: Echinacea, Ephedra, Garlic, Ginkgo, Ginseng, Kava, St. John s Wort, Valerian, Saw Palmetto Supplements such as: Glucosamine 5 P age

6 Chondroitin, MSM NOT TAKE (Discontinue 7 Days) PRIOR TO SURGERY Stop all non-steroidal anti-inflammatory (NSAID) medications, such as: Advil (ibuprophen), Aleve (naproxen), Anaprox (naproxen), Ansaid (flurbiprofen), Arthrotec (voltaren + cytotec), Cataflam (diclofenac potassium), Clinoril (sulindac), Daypro (oxaprozin), Diclofenac (voltaren), Feldene (piroxicam), Ibuprofen (motrin), Indocin (indomethacin), Lodine (etolodac), Meclomen (meclofenamate), Mediprin (ibuprofen), Mobic (meloxicam), Naprelan (naproxen), Naproxyn (naproxen), Nuprin (ibuprofen), Orudus (ketoprofen), Oruvail (ketoprofen), Relaten (nabumetone), Tolectin (tolmetin) *If you have Heart Stents and take Plavix and Aspirin: DO NOT STOP ASPIRIN; DO NOT STOP PLAVIX UNTIL SEEN BY A CARDIOLOGIST PRIOR TO SURGERY ** You may wish to use another form of birth control at this time. CONTACT YOUR MEDICAL DOCTOR FOR INSTRUCTIONS if you take any of the following medications: Adderall, Cytoxan, Enbrel, Imuran, Librax, Librium, Methotrexate, Remicade Remember: Stop only the types of medications mentioned above DO NOT STOP taking other prescription medications. 6 P age

7 STOP STOP 7 days before Surgery Ok to take 7 days Before Surgery 3 days before surgery Ok to take 3 days Before Surgery Date: Date: Journal entries and questions regarding medications: 7 P age

8 Dr. would like you to take Acetaminophen (Tylenol) before surgery because it allows your body to tolerate pain better. Taking it for 24 hours before surgery will help you to feel less pain after the surgery and decrease the need for IV pain medication after surgery. You will take two regular strength Acetaminophen (Tylenol) to equal 650 mg, by mouth every 6 hours, starting the day before your surgery. ATTENTION: DO NOT TAKE TYLENOL IF: You are taking any medicine that already contains Acetaminophen (Tylenol). Please check with your doctor or pharmacy if you are not sure. Please let your surgeon know if you have ever been advised not to take Acetaminophen in the past You have liver disease. Date of Surgery: Date to Start Acetaminophen (Tylenol): Check off Time Taken Time of day 11:00 am 5:00 pm 11:00 pm 5 am day of surgery If your surgery is at 7 am take your 5 am dose with a small sip of water 8 P age

9 Please keep this record until after your 1 st Post-Op Visit, unless directed otherwise: 1. Medications First, list the medications that you are taking, and when you take them: Name of Medication Dose Frequency Example: Aspirin 2 80 mg tablets Every 6 hours Week 1: Record the following information when you have taken your medication: Medication Sunday Monday Tuesday Wednesday Thursday Friday Saturday Date/Time Date/Time Date/Time Date/Time Date/Time Date/Time Date/Time Aspirin 2/9 8am 2 tabs 9 P age

10 Week 2: Record the following information when you have taken your medication: Medication Sunday Monday Tuesday Wednesday Thursday Friday Saturday Date/Time Date/Time Date/Time Date/Time Date/Time Date/Time Date/Time Aspirin 2/9 8am 2 tabs 2. Track the following items as well: Week 1: Record the following information: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Fluid Intake Urine / Bowel Movements Temperatur e 1 x/day Waling with walker/ distance Date/Time Date/Time Date/Time Date/Time Date/Time Date/Time Date/Time 2/9 10am 8 oz water 2/9 2pm 1 can ginger ale, etc 2/9 6 am Urine light yellow 2/9 12 pm b.m. 2/9 12 pm /9 12 pm 50 ft 10 P age

11 Week 2: Record the following information: Fluid Intake Sunday Monday Tuesday Wednesday Thursday Friday Saturday Date/Time Date/Time Date/Time Date/Time Date/Time Date/Time Date/Time Urine / Bowel Movements Temperature 1 x/day Waling with walker/ distance 11 P age

12 Extra record sheets if needed: Sunday Monday Tuesday Wednesday Thursday Friday Saturday Date/Time Date/Time Date/Time Date/Time Date/Time Date/Time Date/Time 12 P age

16 Preparing Your Skin Before Surgery General Pre-Op Hibiclens Bathing Instructions Because the skin is not sterile, it is important to make sure that your skin is as free of germs as possible before surgery. You can reduce the number of germs on your skin by carefully washing before surgery. Chlorhexidine gluconate (CHG) is a special soap that is often used to cleanse the skin before surgery. One common brand is Hibiclens If you are allergic to Chlorhexidine use betadine or whatever your physician has directed you to use. Bathing Start date: Shower or bathe with Hibiclens 3 days prior to your surgery including the night before your surgery and the morning of your surgery. (A total of 5 showers or 5 baths with Hibiclens ) Do not shave the area of the body where your surgery will be performed With each shower or bath, wash your hair as usual with your normal shampoo Rinse your hair and body thoroughly after you shampoo to remove all shampoo residues Apply Hibiclens soap (chlorhexidine) to your entire body ONLY FROM THE NECK DOWN Do not get Hibiclens near your eyes, ears, nose, mouth or genital areas. Wash thoroughly, paying special attention to the area where your surgery will be performed Turn the water off to prevent rinsing the soap off too soon Wash your body gently for 5 minutes. Using a soft wash cloth do not scrub your skin too hard Do not wash with your regular soap after Hibiclens is used Turn the water back on and rinse your body thoroughly 16 P age

17 Pat yourself dry with a clean, soft towel Do not use lotion, cream or powder the day before and the day of your surgery Wear clean clothes Where to get Hibiclens Your Patient Navigator will help you get Hibiclens. Pre-Op You have completed the Hibiclens at home prior to arriving for surgery. After arriving at your facility for surgery you will be taken to the pre-op area and the nurse will help you prepare for surgery. Sage Wipes will be given to you by your nurse. Do not allow this product to come in contact with your eyes, ears, mouth and mucous membranes. Remove two cloths at a time with the foam holder and place onto a clean table. Use one clean cloth to prep each area of the body in order as shown in steps 1 through 6 below. Wipe each area in a back-and-forth motion. Be sure to wipe each area thoroughly. Assistance may be required. Use all cloths in the packages. Pay special attention to the area you will be having surgery on. 1. Wipe your neck and chest. 2. Wipe both arms, starting with the shoulder and ending at the fingertips. Be sure to thoroughly wipe the armpit areas. 3. Wipe your right and left hip followed by your groin. Be sure to wipe folds in the abdominal and groin areas. 4. Wipe both legs, starting at the thigh and ending at the toes. Be sure to thoroughly wipe behind your knees. 5. Wipe your back starting at the base of your neck and ending at your waistline. Cover as much area as possible. Assistance may be required. 6. Wipe the buttocks. 17 P age

18 Do not rinse or apply any lotions, moisturizers or makeup after prepping. Discard cloths in trashcan. Allow your skin to air dry. Put your hospital gown on and tie it in the back. You will remove dentures, contact lenses/glasses and jewelry. Journal entries and questions regarding your skin preparation before surgery: 18 P age

19 Pre-Op at the Facility where you are having surgery: Your vital signs (temperature, pulse, blood pressure) will be taken. An IV will be started to hydrate your body. The nurse will review your medical/ surgical history and medications as well as the results of your pre-surgery testing. Additional testing might be required at this time if ordered by your physician. You will be greeted by the OR staff and transported to the Pre-Op Holding Area. At this time your family/ friends will be escorted to the Surgical Waiting Area. They will be asked to sign in at the reception desk. If your family and/ or friends decide to leave the surgical waiting area, they should tell the receptionist how they can be reached. Pre-Op Holding Area The Pre-Op holding area is where you will meet and talk with your surgical team. The nurse in this area will go over your medical history with you and give you any additional instructions. You will meet your Operating Room (OR) nurses. Your surgeon will be there to answer any last minute questions. Then with your assistance, the surgeon will mark the body part that they will be operating on. An anesthesiologist will speak to you about your anesthesia options. Then to help you relax you will be medication and the you will be transported into the operating room. Operating Room (OR) You will be prepared for surgery by the anesthesiologist and OR nurses. It is not unusual for surgery to be delayed or changed due to emergencies or cancellations. You and your family will be updated by the hospital staff when these changes occur. 19 P age

20 Journal entries and questions regarding the Pre-Op preparations: 20 P age