by Karen McClellan, RN
Other than childbirth, many women have never been patients in a hospital before. It can be an overwhelming experience, especially when one does not know what to expect. With insurance policies and hospital regulations, most patients stay in the hospital for the shortest possible time. As a result, anything that can be done prior to admission is often done in an outpatient center, including physical examinations, blood work, imaging studies, and operative consents. So, what can a woman expect when she is hospitalized for surgery?
As previously mentioned, before being admitted to the hospital, a woman will have met with some of the members of the hospital's health care team to complete all preoperative examinations, procedures, and paperwork. The preoperative visit is an important time for each woman to ask questions of her surgeon and receive information specific to her surgical plan and treatment. These questions can include instructions on any necessary bowel prep and diet, medications to hold or begin, expected length of hospitalization, type of anesthesia, type of surgical incision, nursing care, pain medication, and expected recovery time, to mention a few.
Writing a list of questions and bringing a spouse, family member, or friend can be helpful in receiving the most information possible. Some hospitals allow a family member or significant other to stay overnight with a patient while hospitalized. Ask your surgeon or health care team what their hospital policy is regarding these accommodations. Taking an active role in one's health plan helps a woman to feel and represent herself as a health client and not just a passive patient.
On the scheduled day of surgery, plan to arrive early to the hospital and be sure to have carefully read and followed any pre-admission instructions. Valuables should be left at home. If taking any medications, bring a list including the name of the drug, dosage, and frequency. After checking in at the admission department, the woman will go to the preoperative area and be prepared for the planned surgery. Consent forms will be explained and signed if not done so already. The patient will speak with the doctor or trained nurse who gives the anesthetic and may be given a sedative to help relax during the time before surgery.
At some point, an intravenous line will be started to administer fluids, medications, and blood, if required, as well as the short-acting drug that induces the general anesthesia. If the woman is to receive a regional anesthetic, which numbs the lower region of the body, a narrow tube (catheter) will be inserted into a numbed area of the back and into the narrow space around the spinal nerves. When the anesthetic is administered, the woman will no longer be able to move or feel below the block. Once asleep, a tube will be inserted through the woman's mouth and down her throat to administer a mix of oxygen and anesthetic gases to keep her deeply unconscious but breathing well. The tube will be removed before she wakes up.
During the operation, the surgeon/gynecologist may use scalpels, scissors, an electrocautery wand, or a laser beam. The surgeon will assess the abdominal fluid volume and samples of the fluid will be analyzed for the presence of cancer cells. When a woman seems to have early stage disease, tissue biopsies may be taken from several areas of the abdomen and beneath the diaphragm to be examined under a microscope. Pelvic and aortic lymph nodes may also be sampled for the presence of cancer cells. The surgeon will also carefully inspect the bowel. The incision site will be closed with staples, sutures, steri strips, or a combination and covered with a bandage. Occasionally, the surgical team must leave the incision open to heal from the inside out. In this case the incision will require irrigation or special dressing changes as specified by the surgeon.
After the operation, the woman is transferred to the post-anesthesia recovery room where she slowly wakes up after the general anesthesia and regains sensation and movement below the waist if given regional anesthesia. Her blood pressure, temperature, heart rate, and respiratory rate will be monitored, in addition to any pain or nausea. Then she will be transferred to the room where she will stay during the rest of her hospitalization. The nurses will help her transfer from the stretcher into bed and orient her and any family members to the room.
Most women will be placed on bedrest immediately following surgery. During the initial post-operative period, a foley catheter remains inserted into the bladder to drain urine and monitor hydration. When abdominal surgery requires bowel involvement, a nasogastric tube is placed which serves to decompress the digestive tract and remove gastric fluid. Other tubes, for example, Jackson-Pratt drains, which drain excess blood or tissue fluid from the surgical area may remain for a few days or possibly until the follow-up appointment. Intravenous fluids continue until a woman can drink clear liquids without experiencing nausea or vomiting. In addition to IV fluids, other IV medications such as antibiotics may be administered as ordered by the surgical team.
Pain control, in regard to comfort and level of activity, is one of the most important priorities in the recovery period. Regarding comfort, the surgeon may order a Patient -Controlled Analgesia pump (PCA), which delivers a programmed amount of pain medication directly into the vein or epidural space when the patient presses a button. Other forms of pain medication may include a shot or an oral pill. Verbalizing one's pain to the nurse and medical team is important in monitoring and treating pain efficiently. The goal is to stay ahead of the pain and therefore be able to recover as quickly as possible and begin increasing activity level.
Nausea is commonly experienced following surgery; it can result from anesthesia, pain medication, or manipulation of the digestive tract during surgery. If you suffer from motion sickness, post-surgery nausea can be more severe and you should tell the anesthesiologist beforehand so that they can use different drugs to better control the nausea. If nausea occurs, it can be treated with medications as needed. If nausea is persistent, the medical team may change the woman's pain medication to see if her nausea resolves.
During the recovery period, it is important for the woman to deep-breathe several times each hour to prevent serious lung problems. The surgeon may have a woman use an incentive spirometer, a breathing exercise to help expand the lungs and aid in producing a cough to clear any respiratory tract secretions. While in bed, compression devices may be placed around a woman's legs to help prevent blood clots in the legs. In addition, as soon as possible, a woman should get out of bed and begin to walk. It will be difficult to get out of bed initially, but with practice and the help of a nurse or family member, it will become easier and less uncomfortable. Walking helps prevent blood clot formation, expands the lungs, increases digestive tract motility, and increases blood flow to the surgical site.
The nurse and nursing staff will provide most of the post-operative care. Some of this care includes monitoring vital signs, emptying drains, inspecting the surgical site, physical examination, wound care, administering medications, assessing pain and effectiveness of pain medications, and assisting the patient in activity. The nursing staff works closely with the team of physicians and reports any changes or needs the patient may have. Many teaching and research hospitals will have a team of physicians that examine and follow each woman during her recovery in the hospital. Throughout the day one can expect to see a variety of physicians as part of the gynecologic team. The actual surgeon and primary gynecologist may only see the patient once each morning or may simply speak with the team that follows the woman. Plan to ask any specific questions related individual treatment and the recovery process.
Discharge preparations will begin on or before the day of operation in anticipation of any special needs, equipment, or care that may be necessary. Nurses, physicians, home health care coordinators, and social workers collaborate in planning each individual discharge. Their goal is to identify all home needs and to establish the necessary resources to ensure that each requirement is met. A home health care nurse may be utilized if a woman will require wound care, special medications,or physcial therapy.
Prior to discharge, the nurse or physician will review activity restriction including driving, strenuous exercise, and heavy lifting. The patient will be given prescriptions for pain medication and any other medications as determined by the medical team. A follow up appointment will be scheduled and a phone number of the physican on call will be given for any questions or concerns that may arise. Once home, enjoy the company of friends and family as a support and comfort while the healing process continues. Focus on the strength and success as each day of recovery builds hope and character. Happy healing!