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Before and After your Surgery

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Before and After Surgery Instructions

"NPO" or Nothing by Mouth

For a certain time (usually several hours) before your surgery, you will not be allowed to eat or drink anything. This will prevent vomiting during or after surgery. Your nurse or doctor may use the term "NPO," which simply means "nothing by mouth." They will tell you how long you must be NPO. Remember, NPO means no food or drink: that is, no water, no coffee, no toast, no anything. However, you may brush your teeth or rinse your mouth with a little water if your mouth feels dry. Do not swallow the water.

Ask your nurse and doctor to tell you what other routines to expect before, during, and after surgery. For example, you might ask them whether you will need to be shaved before surgery, where your family should wait during your operation, whether you will need an intravenous (IV) line or other equipment after surgery, where you will go after surgery - your room, the recovery room, or the ICU, and when you will be able to get out of bed after your operation. Our patients tell us it is helpful to know what to expect. So don't be afraid to ask questions.

Deep-Breathing

It is important to take frequent deep breaths after surgery to help prevent pneumonia and other lung problems. You should take deep breaths every hour while you are awake. Continue this for 48 hours after surgery or until you are spending most of your time out of bed. You may be taught to use an incentive inspirometer, a small device that will help you deep-breathe.

This is how to deep-breathe:
  1. Sit up as straight as you can.
  2. Breathe in slowly and deeply through your nose. Try to get air down to the bottom of your lungs. You should feel your chest move out as you breathe in.
  3. Hold your breath for three seconds. You can say to yourself - 1 second, 2 seconds, 3 seconds.
  4. Breathe out slowly and completely through your mouth.
  5. Wait a few moments and then take another deep breath in and out.
  6. Do a total of five deep breaths in and out every hour while you are awake. Remember to wait a few moments between each deep breath.

Coughing

If you have phlegm in your lungs, it is important for you to cough as well as deep-breathe to clear your lungs. You should cough every one to two hours while you are awake. Do this for the first 48 hours after surgery or until you are spending most of your time out of bed.

This is how to cough:
  1. Take three deep breaths as explained in the previous section above.
  2. On the third deep breath, cough hard and deep several times as you let the air out.
  3. Now take three more deep breaths.
  4. On the third deep breath, cough hard and deep several times as you let the air out.
  5. After coughing, take two more nice and relaxed breaths.

Taking deep breaths and coughing is something you usually do without thinking about it. Deep-breathing and coughing help keep your lungs healthy and air tubes clear. After surgery, because of the anesthesia, medications, and discomfort, you tend to take shallow breaths. But after surgery it is more important than ever to fully fill your lungs and get rid of the phlegm.

Practice deep-breathing and coughing before surgery so you can do it more easily afterwards. Remember - shallow breaths, coughing weakly, and merely clearing your throat will not help. You need to deep-breathe and cough hard to clear your lungs. Modern sutures and techniques make incisions strong. Do not be afraid to deep-breathe and cough with force.

Splinting

Deep-breathing and coughing may hurt, especially if you have had chest or stomach surgery. To lessen the discomfort, splint your incision while you deep-breathe and cough. To splint means "to hold in place" or "to support." To do this, hold a pillow or some folded towels firmly over the incision while you deep-breathe and cough. Splinting should help you take good, deep breaths and cough hard with less pain. Practicing before surgery will help you splint afterward.

Turning

It is important to turn in bed often after surgery to help prevent lung problems and to help air get to all parts of your lungs. Turning also helps your circulation.

This is how you turn:
  1. Splint your incision, if you wish.
  2. Move slowly.
  3. Reach for the side rail and gently pull yourself over to your side. It makes it easier if you bend your knee and push with your foot.
  4. To turn back, gently push away from the side rail.
  5. Change positions at least every two hours while you are awake.

Your nurse will help you to turn until you can do it yourself.

Exercising Your Legs

To keep your leg muscles strong and help prevent blood clots, it is important to do leg exercises after surgery and until your are spending most of your time out of bed. Exercise your legs five times every one to two hours while you are awake and whenever you wake up at night. You may exercise both feet at the same time, or one at a time.

This is how to do leg exercises:

Toe Points

  1. Point your toes up toward your chin and hold this position for three seconds.
  2. Then, point your toes down (like stepping on the gas) and hold this position for three seconds. You should feel your calf muscles tighten.
  3. Do the up and down toe points five times every one to two hours.

Foot Circles

  1. Circle each foot five times to the right every one to two hours.
  2. Then, circle each foot five times to the left every one to two hours.

After surgery you may also have wraps on your feet or legs. These are attached to a pump and help prevent blood clots.

Getting Out of Bed

You will get up soon after surgery and spend more time out of bed. Getting out of bed helps your lungs and circulation and helps build your strength. You may find it hard to get out of bed at first. The nursing staff will help you get up until you are able to do it yourself.

When you first get up, your nurse will raise the head of the bed to its highest level so you can get used to sitting up straight. The nurse will help you turn your body so you are sitting on the edge of the bed.

You may feel dizzy for a moment; this is normal. Once your dizziness passes, your nurse will help you stand up. It may be helpful to splint your incision while you are getting up. Before you know it, you will be getting in and out of bed with ease and confidence.

Getting More Comfortable

Some pain is normal after surgery. However, it is important that you are comfortable so you can deep-breathe, cough, turn, and get out of bed. Much can be done to reduce your pain.

Pain medication is ordered for you. It should control the pain. Tell your nurse or doctor when you are in pain. Do not wait until your pain is severe. It is easier to reduce the pain before it gets severe. Also tell your nurse or doctor if the pain medicine is not strong enough, so that you can get more effective medicine.

 

When you describe your pain, you may be asked to rate how bad the pain is on a 0-10 scale.

For pain reduction, you may have a patient-controlled analgesia (PCA) pump or an epidural infusion. Your doctor or nurse will explain how these work.

In addition to taking medicine, other things you can do that will make you more comfortable include:

  1. Change your position in bed.
  2. Support your body with pillows.

Try to relax. Taking slow, deep breaths, thinking of a pleasant scene, listening to music, or watching TV may help you relax.

Smoking

Last, but not least, a word about smoking. Smokers are more prone to lung problems after surgery than nonsmokers. Therefore, if you smoke, you should quit smoking as far ahead of your surgery as possible, and you should not resume smoking after surgery. Quitting smoking should speed your recovery and help you keep healthy.

Discharge Planning

Ask your doctor how long you will be in the hospital. Plan who will drive you home and who will stay with you or help you if needed.

It's Up to You, With Our Help

This information should help prepare you for surgery and speed your recovery. As you can see, there is much you can do to get back to normal as soon as possible.

Before Surgery:
  • Stop Smoking.
  • Practice deep-breathing, coughing, and leg exercises.
  • Do not eat or drink anything for the specified time before your surgery.
  • Arrange discharge transportation and help.
After Surgery:
  • While you are spending most of your time in bed, deep-breathe, cough, and do leg exercises.
  • Tell your doctor or nurse when you have pain.
  • Get out of bed and resume normal activities as soon as your doctor or nurse suggests.

These simple steps can be powerful tools to help you recover from your surgery. If you have additional questions or want more information, please let your nurse or doctor know.