142 Ward Street, North Adelaide SA 5006
Telephone: (08) 8267 3355 Fax: (08) 8361 8822
PATIENT EDUCATION BOOKLET
FOR BOWEL AND RECTAL PROCEDURES
prior to admission
As a person who is about to have bowel surgery and/or rectal surgery, you will already have begun to give some consideration to your proposed operation.
♦ To facilitate your actual admission to hospital, we ask that you complete your admission forms and return to the appropriate hospital as soon as possible.
♦ Any queries you have regarding your procedure can be directed to our practice nurse Monday to Friday 10.00am to 4.00pm on
8267 3355. Any queries regarding your admission, please contact
the hospital directly.
♦ Any queries regarding your anaesthetic please contact your anaesthetist directly. Our Practice Nurse will give you your anaesthetist’s name and contact number at the time of your booking.
♦ All patients being admitted to Calvary North Adelaide Hospital are asked to contact the pre-admission clinic on 8239 9252 to arrange an appointment.
♦ Please ensure you bring all your current medications into hospital with you in their original packaging with their directions of use.
♦ Prior to your admission to hospital it is necessary to make your own arrangements for transport home on discharge.
deep breathing exercises
You will meet your physiotherapist prior to surgery to assess your respiratory function and teach you deep breathing and coughing exercises. These exercises are important to aid your recovery by preventing any possible chest infections. Your physio may give you a
‘tri-flow’ to assist with these exercises. A ‘tri-flow’ is a visual tool which shows you how well you are breathing.
The following is a general program that will suit most people. If you require something different your physio will advise you. These exercises can be practised prior to you surgery to help familiarise yourself with them.
♦ Take a slow, deep breath through your nose sending the air right down to the base of your lungs.
♦ Keep breathing in as much air as you can, hold the breath for 3 seconds at the end and then relax, gently breathing out through your mouth.
♦ Then take a second breath in the same manner.
♦ Take a third deep breath.
♦ Now cough 2-3 times in a row (once is insufficient). This will clear your breathing passages. Ensure you support your tummy with a pillow whilst you cough.
♦ As you cough, concentrate on feeling your diaphragm force out all the air in your chest.
♦ Then take 3-5 normal breaths, exhale slowly and relax. Repeat this exercise at least once each hour.
leg exercises
While you are resting in bed it is important to do some leg exercises to maintain good blood circulation and prevent clots from forming in your legs. The following exercises are recommended as such:
Foot pumping- alternatively push your feet up and down.This should be done vigorously 30 times per hour.
Leg bends- alternatively bend one leg up and down and then the other. Your physiotherapist will advise you with this exercise to ensure no abdominal strain.
As soon as you are able the nurses will help you sit out of bed and get walking.
After your surgery you will need to do these exercises at least once per hour that you are awake. You should continue with these exercises until you are walking about independently.
pain scale
Because surgery causes some degree of pain and discomfort, we will inform you of some of the choices that are available to you during your hospitalisation.
♦ Ask the nurse how your pain medication is ordered for you.
♦ Your pain medication may be scheduled to be given or taken regularly at certain times. However, if it is not let the nursing staff know when the pain first starts.
♦ Do not wait until the pain is bad before you call for or take the pain medication. Trying to “wait a little longer” only allows the pain to worsen and means that it will take longer to control it and you may need higher dosages of medication if it becomes severe. You may be holding off because you are worried about becoming “addicted” to the medication. Remember, you are taking the medication to stop pain. When the pain stops, the majority of people stop taking the medication.
♦ Tell the nurse if the medicine does not help the pain so they can adjust it until you are comfortable.
♦ It is important that you have effective pain management so you can do your regular deep breathing and coughing exercises, turn comfortable in bed and sit out of bed. These are essential activities that speed up your recovery.
Pain scale
A pain scale is a tool used to describe and monitor pain levels. The nursing staff will monitor the effectiveness of the pain relief by asking you to rate your pain on a scale of 0 to 10;
0 = No Pain,10= Worst Possible Pain
You may feel some pain, even with the medication, but tell the nursing staff if the medication does not reduce you pain level or if your pain level increases. This may mean that your pain medication needs adjusting.
Pain assistance available
1. Intravenous Infusion:
This form of pain management is usually commenced in theatre and is
maintained continuously for as long as you require it following your surgery to give you continuous pain control. If this is not adequate, further pain control medications will be instigated.
2. Epidural:
Prior to your surgery your anaesthetist will insert a fine catheter (tube) into the epidural space between the bones in your back. Pain control medication is then administered by an infusion pump through this catheter. You will have no sensation around the wound and your legs may feel heavy or may even have no sensation. This is normal and will be managed by your nurse and anaesthetist. This will not prevent you from siting out of bed. The catheter can stay in position for up to 72 hours post operatively and is then replaced with other forms of analgesia.
3. Patient Controlled Analgesia (PCA):
A PCA gives you control over your pain management. Instead of relying on the nursing staff to give you pain relief, you can push a button which makes an extremely accurate and reliable medical instrument, called a PCA infuser, deliver the right amount of pain medication through the drip in your vein – safely, quickly and very comfortably. This sophisticated machine will not over-dose you as it has a lock out device on it that prevents you from doing so.
4. Intramuscular Injection:
To relieve pain throughout your body, medications can be injected into a muscle in your arm, leg or buttocks. This form of pain medication is ordered and administered to you, in consultation with the nurse and doctor.
5. Subcutaneous Injection:
A small plastic tube is inserted under the skin and secured with tape. This is used as an access point to administer your pain medication.
6. Oral Analgesia
This type of pain management is given to you by tablets usually at 4-6 hourly intervals when you request the medication. Oral medication also works for a longer period and is a step forward towards discharge. You will probably be sent home with this type of pain medication.
Managing pain at home
When it comes to effective pain management, the tips you have learned in hospital also work at home. To get the best pain relief possible, remember to:
♦ Use your medication only as directed. If your pain is not relieved or if it gets worse, call your doctor on 8267 3355. If pain lessens, try taking your medication less often.
Remember that medications need time to work. Most tablets need at least 20 – 30 minutes to take effect.
preparation for bowel and rectal surgery
Bowel and rectal surgery can be undertaken via one of two approaches. One method, open surgery, is the established operation in which a cut is made down the midline of the abdomen and the piece of affected bowel is removed. The cut in the abdomen wall is sewn up. The second method, laparoscopic surgery, involves using a surgical telescope to look at the bowel. Long instruments are placed through small cuts in the abdominal wall. These instruments are technically designed to assist your doctor to remove the affected bowel without the need for a large incision in the abdominal wall. Your surgeon will discuss the most appropriate method of surgery with you.
This booklet section outlines the day to day expected progress of those patients having open surgery.This process may be sped up for patients having laparoscopic surgery. All discharges will be appropriate to the recovery process.
Day 1 – Before Your Operation:
♦Please report to the admissions desk at the appropriate hospital to be admitted.
♦You will be escorted to the ward and a nurse will confirm the information you supplied on your admission forms.
♦The nurse will check your temperature, pulse, blood pressure and weight.
♦You may be required to have a routine blood test and be fitted for special white stockings that prevent any risk of blood clots in your legs.
♦If appropriate, it may be necessary to have an ECG (a picture of the electrical impulses of your heart).
♦You would have completed your “bowel preparation” in readiness for your surgery. The purpose of the bowel preparation is to empty and cleanse your bowel. You may be fasting already or be asked to fast from food and fluid soon after.
♦The nurses will show you the Critical Care Unit where you will stay after your operation.
♦The anaesthetist and physiotherapist will visit you prior to surgery depending on the time you are scheduled to go into the operating theatre.
♦It is important to talk to the nurses and the anaesthetist about the sort of pain assistance that will best suit you post op. There are several options available and we encourage you to be involved with the choice of pain relief.
♦You will be dressed in a special gown and white stockings ready for theatre.
You will be taken to theatre on your bed.
♦If you have chosen an epidural for your pain assistance, you will be taken to recovery for the insertion of the epidural catheter (tube).
Day 1 :- After Your Operation:
♦After your operation you will spend 1 – 1½ hours in the recovery room before being transferred to the Critical Care Unit for further recovery.
♦When you wake up, you will have an abdominal wound and a drip. You may also have a urinary catheter (a tube that drains urine from your bladder) , a wound drain (a small tube attached to a bottle that collects the little fluid that drains from the cut), and a nasogastric tube (a tube in your nose that drains any excess stomach fluid).
♦If you are having rectal surgery you may have a drain coming from your bottom wound. The nurse will look after all these tubes.
♦You will be wearing an oxygen mask or nasal specs (little soft plastic tubing that sits in you nose) that delivers oxygen to you while you are still drowsy from the operation.
♦You will probably be attached by small leads to a monitor on the wall, so that the Nurses and Doctors can monitor your heart activity.
♦The nurses will record your heart rate, blood pressure, pulse and temperature regularly.
♦Pain relief will be given to you in a method decided by you and the anaesthetist. It is important that you advise the nurses if you have any discomfort because there are many ways of controlling your pain. Remember that to help you, the staff need to know how you are feeling!
♦After your operation you will only be allowed to have a few ice chips to suck for the first few days, but you can have regular mouth washes to keep your mouth comfortable.
♦You will be reminded and supervised to regularly undertake deep breathing and coughing, and leg exercises as directed by the Physiotherapist and/or nurse and then continue whenever you think of them.
How Your Bowels Works Post Operatively:
When your bowel is handled in an operation it goes to sleep and stops working. It gradually wakes up. This usually occurs once you become active. Your stomach will start to make rumbly noises and you may experience some wind pains. Eventually you will pass some wind from your bottom. This means that air is being transported by your bowel and that you are ready to commence taking some fluids by mouth. Your diet will change from fluids to a full diet depending upon how you cope with each stage. A sleepy bowel is fairly delicate and we take each stage carefully.
Day 2 and 3 After Your Surgery:
♦You will be cared for in the Critical Care Unit.
♦Your Doctor will visit you and explain how the operation went.
♦Your temperature, pulse and blood pressure will be checked regularly.
♦Pain control will continue in the same manner as Day 1.
♦You may require ongoing routine blood tests.
♦The drip will continue to deliver you fluids and your wound drains and urine catheter is likely to remain in at this stage.
♦You will continue on ice chips and progress to fluids.
♦The nurse will help you with your hygiene needs.
♦It is anticipated you will sit out of bed for ½ - 1 hour at least twice per day and if you are able, a short walk is allowed with assistance from the Physio/ Nurse.
♦Your close family can visit you but, for the first few days, you are not usually up to having a lot of visitors. It is probably best to tell your friends to visit when you are back in the general ward and will appreciate the visit. No flowers are allowed in the Critical Care Unit, therefore it is suggested that family and friends do not send them until Day 4 or later.
♦Usually you are starting to feel a little brighter and well enough to return to the general ward.
♦If you have a wound in your bottom, this will be monitored with a changeable dressing.
Day 4 – 8 After Your Surgery:
♦The Doctor will visit you.
♦The nurse will assist you with showering as required.
♦You will be encouraged to sit out of bed and walk as much as you can manage throughout the day.
♦During this period there are a variety of progressive steps that can happen on slightly different days according to you, but they will all happen.
♦You will become more mobile with short walks gradually increasing in length and your independence in the bathroom will be regained.
♦You will get a rumbly stomach, discomfort and eventually pass wind from your bottom.
♦The urine catheter will be removed when you are able to use the toilet.
♦If present, the wound drain in your abdomen will be removed and if you have one in your bottom this will also be removed.
♦The tube in your nose (if applicable) will be removed.
♦You will have more choice of fluids. When you are tolerating adequate quantities of fluid orally, your drip will be stopped.
♦As your bowels begin to work, you will slowly return to a light and then a normal diet.
♦Your need for pain relief will start to lessen and you will commence on oral tablets for any pain you still may have.
♦The nurses will ask you if you need any help at home and arrange this if you do.
Day 9-11:
♦ During these last few days in hospital, you will be encouraged to regain your independence ready for discharge.
♦ Your doctor will visit you and give you instructions for home as well as a follow up appointment time.
♦ The nurse will confirm any community services (e.g. Home
Nurses) that have been arranged.
♦ Before discharge the staples will be removed from your wound and steri-strips applied. These can be removed 4-5 days after discharge.
♦ Your diet will be returning to a high fibre diet and you should make sure you drink plenty of water when you get home.
preparation for bowel and rectal surgery with stoma
Prior to Day of Admission:
♦You will have a pre arranged appointment to see the Stomal Therapy Nurse
(STN). You need to allow about 1 ½ hours for this appointment.
♦The purpose of this visit is to give you information about your stoma surgery and to ease some of your concerns about living with a stoma.
♦The STN may also use this opportunity to “site” you for your stoma.
♦If you wish you may bring your partner or ‘significant’ other to the appointment as he/ she may also have questions to ask.
Who is a Stomal Therapy Nurse (STN)?:
♦A Stomal Therapy Nurse is a registered nurse who has undertaken further education in stoma care. The role of the STN is to give guidance and education to patients and their families who have had or are about to have surgery that may involve the formation of a stoma. The STN works in close association with medical and allied health members. This is to ensure you receive all the help available to make the transition of having a stoma more comfortable.