UNC Colorectal Surgery Enhanced Recovery Pathway

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1 UNC Colorectal Surgery Enhanced Recovery Pathway Information for You! Surgery can be scary. To help decrease your fears, this booklet gives information about what to expect during your hospital stay. The booklet will also let you know what you can do to help your recovery. The Day Before My Surgery o How will I know when to come to the hospital? The hospital will call you with the time to come. o What should I expect? o For the day s first surgery, you will come at 6 am. o For other times, you will come two hours before your surgery is planned. o What if my doctor asked me to do a bowel prep? o Please do your bowel preparation as taught the day before surgery. o What if I get sick to my stomach or can t finish the bowel prep? o That s ok. You can stop the bowel prep and drink clear drinks only. Clear drinks include tea, water, Gatorade, apple juice and jello. o What do I do with the Gatorade (12oz)? o Drink one supplement the night before surgery. Drink the second drink two hours before surgery. A good time to drink this would be at registration. The Day of My Surgery=Day 0 o Where do I check in? o On the first floor of the main hospital, check in at the Registration Desk. o Staff will send you to the second or fourth floor. o What happens here? o You will meet with the anesthesiologist (doctor who will give you medicines to keep you safe and asleep during your surgery) and the operating room nurses. o The nurse will get you ready for surgery by giving you a gown, placing an IV and performing other orders. o You will be taken to the operating room o Where can my family wait? o They will wait in the OR waiting room. o How will my family know my surgery is done? How will they know I am ok? o Your surgeon will find your family and let you know how your surgery went. o Where do I go after my surgery? o You will go to the recovery area, sometimes called the PACU (Post-Anesthesia Care Unit.) A nurse will take care of you and get you ready for your hospital room. o When can my family see me?

2 o Ninety minutes after your surgery is complete or when it is determined you are ready. o When do I go to my hospital room? o When you are doing well after the surgery, you will be moved to your room. Your room will be on a floor where nurses know how to give care for your type of surgery. o Can my family come to my room? o Your family is welcome in your room. Only one family member can stay the night. o How will I feel? o You may be very sleepy. This is normal. o You may feel sick to your stomach. Ask your nurse for drugs to help ease this. o Will I be in pain? o There is always pain after surgery. You may have a button you can push so a machine can give you pain drugs into your IV. o You may be offered pain pills. o If your pain is still too much, let your nurse know. o We can t get rid of all of your pain, but we will make you as comfortable as we can. o Can I drink or eat? o You can drink liquids for your pleasure. o What if I can t drink enough? o You will be getting fluid in your IV, which will give you enough fluids. o What should I do? o The nurse will teach you how to use a breathing device (incentive spirometer) to help your lungs. Use the breathing device ten times an hour. o You will be helped out of bed so you can sit in a chair. o Rest o What else can I expect? o Staff will check on you a lot to make sure your breathing, temperature and heart rate are good. o Staff will give you drugs as needed to help any pain or nausea. o You may have a tube, which drains your urine into a bag. o You may get blood drawn. After Surgery-Day One o Will my doctor see me? o Every day you are in the hospital, your team of doctors, who work under your main surgeon, will see you in the morning. They will make sure you are doing ok and will make a plan for your daily care. o How will my pain be controlled?

3 o Your pain button may be replaced by pain pills. Pain pills allow for longer pain relief and need to be taken before additional IV pain pills. You will be on some scheduled nonnarcotic medication to help reduce the pain. o What about my urine tube? o This will be removed. You will have six hours to urinate after it s taken out. If you are unable to urinate, a new urine tube may need to be placed again. This happens sometimes so don t worry. o What about my IV? o You will get less fluid through your IV. o Continue to drink fluids as you tolerate. You also can eat mild foods if you would like. o If you don t feel like eating, please continue to drink. You will eventually want some food. o What if I get sick to my stomach? o Nausea is common after your type of surgery. o As you nurse for drugs to ease the nausea. o Drop your drinking and eating. o What if I have a new ostomy? o An Ostomy Nurse will begin teaching you about your ostomy on this day. You will receive an ostomy teaching packet from the ostomy nurse. Floor nursing staff will help with your ostomy. o Should I get out of bed? o Moving and being out of bed is very important because it helps your overall recovery and may wake up your stomach and intestines more quickly. o You should walk three times this day. You should spend more time in a chair than in bed. o The nursing staff will help you get out of bed. It s important a nurse help you out of bed the first time you get up so you don t fall. o Keep using the breathing device ten times per hour. After Surgery-Day Two o What about my pain? o The pain button will be taken away if it wasn t on Day One. o Continue to ask the nurse for pain pills as you need them. o What about eating and drinking? o Continue to drink as you desire. o If you haven t started food yet, try to eat some mild food today. o Eat food that sounds good to you. o Ask for nausea drugs if you feel sick to your stomach.

4 o What else can I do to help my recovery? o Continue to use the breathing device ten times per hour. o Be out of bed as much as possible. o Walk at least three time during the day. After Surgery-Day Three o Can I go home soon? o With all of the hard work you have been doing, you may be able to go home today! o What needs to happen for me to go home? o Your pain is controlled with the pain pills. o You are able to drink enough to stay hydrated. o You are eating. You won t be eating the amount you were eating before surgery because it takes a few weeks for your appetite to return completely. o You are passing gas or have had a bowel movement. For those who have a new ostomy, there is gas or stool in your bag. o Your surgeon thinks you have made good progress and are ready. o You and your family feel comfortable going home. o What if I am not ready to go home today? o It s ok. Each patient recovers at his or her own pace. o What if I am bloated, have gas pains and/or am feeling sick to my stomach? o As your gut wakes up, this can happen. Don t be discouraged. You will get through it. Your doctors and nurses will help you. o What else can I do? o Continue to eat and drink as you can. o Walk three times per day. o Continue to use your breathing device ten times per hour. o Ask for pain pills and anti-nausea pills if you are hurting or are sick to your stomach. After Surgery-Day Four o Can I go home now? o Many patients are able to go home on this day after surgery. If you are not ready yet, you are getting closer. Please don t worry as each patient recovers at his or her own pace. o If I am going home today, what do I need to do? o Arrange transport home. o Let your nurses and doctors know any needs you may have. o What is the Discharge Process? o Your doctor will place an order for you to go home. o If you want your prescriptions filled at UNC to be ready at discharge, please let your nursing staff know.

5 After Discharge o You discharge paperwork will give you the information you need to go home. You will receive your follow-up appointment with this paperwork. o Your nurse will go over your discharge paperwork with you. o If you have a new ostomy, make sure you have ostomy supplies to take home with you. o You will be taken downstairs by a patient transport. o What s next? o You will continue to recover at home by drinking, eating, walking and resting. You may have a bad day at times, but overall, you should improve day to day. o You will have a follow-up appointment set-up with your surgeon to make sure you are healing as you should. o If you have an ostomy, you should measure your output for the first week at home. Please record your output and bring to your follow-up visit. o You will have your discharge paperwork to help answer questions you may have. If needed, you can call the GI Surgery Clinic with your questions and/or concerns. o What are some reasons I should call after discharge? o You have a fever. (more than 101 Farenheit) o You are vomiting a lot. o You are not eating or drinking because of nausea. o Your pain is getting worse, not better. o You feel dehydrated. (Your urine is dark. You feel lightheaded.) o Your incision(s) opens or is draining. o You are running out of pain pills. o For those with ostomies, you should call if you have 1.5 liters or more of ostomy output. o Other concerns you may have. Your concern is our concern. Contact Information SURGEON NURSE PHONE NUMBER Mark Koruda, MD Amanda Reza Rahbar, MD Janet Tim Sadiq, MD Ada Donna-Clinic Ostomy Nurse

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