Preparing For Your Surgery Centra Lynchburg General Hospital

434.200.3023

On the day of your procedure check in at the Registration Department located at the Terrace Entrance ★ of Centra Lynchburg General Hospital on Thomson Drive. Surgicare is located adjacent to Registration.

Bring photo ID and Insurance cards.

Free valet parking is available for patients and visitors.

★

Centra Virginia Baptist Hospital

434.200.4147

On the day of your procedure, check in at the Registration Department located at the Oak Lane Entrance ★ of Centra Virginia Baptist Hospital.

Bring photo ID and Insurance cards.

Free valet parking is available for patients and visitors. ★ We are here to serve you

Thank you for choosing Centra for your surgery. This is an important time for you and your family. Understanding what to expect can make your hospital experience more positive and improve your recovery. The information in this booklet is intended to prepare you for a smooth and successful surgery and recovery.

Table of contents

Preregistration ...... 2

Details of your scheduled surgery ...... 2

What to do if you become ill or need to cancel before your surgery ...... 2

Preparing to come to the hospital ...... 3

Preparing skin night before surgery ...... 4

Information for family & visitors ...... 5

Admission to The Surgery Center ...... 6

The operating room ...... 6

Post anesthesia care unit (recovery room) ...... 7

Returning to your room after surgery ...... 7

Managing your pain ...... 8

Exercises for your recovery ...... 9

Home care instructions ...... 10

Questions to ask your doctors and nurses before surgery ...... 11

Resources ...... 12

Centra is comprised of Centra Lynchburg General Hospital, Centra Virginia Baptist Hospital, Centra Bedford Memorial Hospital, Centra Southside Community Hospital and numerous other facilities and programs throughout Virginia. Preregistration

If you have not already spoken to one of our representatives, please call 434.200.4545 or toll free 888.671.8923 between the hours of 7:30 a.m. and 6 p.m. It is important this be completed prior to the day of your surgery to facilitate events the day of your procedure.

Details of your scheduled surgery

Centra provides high quality, patient-focused care. You are scheduled for ambulatory surgery (also called same-day or outpatient surgery). Our highly skilled, caring staff will support you throughout your surgical experience.

Day of arrival: ● Your ARRIVAL time is NOT your procedure time. Please arrive early as instructed to allow hospital personnel appropriate time to prepare you for your surgery. Failure to arrive on time may result in your procedure being moved to a later time or cancellation . ● ALL patients MUST STOP at registration. ● Bring a photo ID and insurance cards. (Even if you have been pre-registered by phone).

IMPORTANT: You will receive final CONFIRMATION OF YOUR ARRIVAL TIME the evening prior to your procedure by an automated phone message. Be SURE to provide the hospital with the contact number with which you wish to receive the confirmation call. Your time may change due to scheduling events in the operating room.

DATE OF SURGERY:

Please arrive at the Registration Department at: a.m./p.m. Allow adequate time to park.

Please be aware that your procedure may not start exactly on time due to unforeseen events in the operating room.

If you have any questions or concerns prior to your procedure, please call the Preoperative Nurse Educator at: ● 434.200.2177 between 8 a.m. and 6 p.m., Monday through Friday ● Or, you may call your surgeon’s office directly.

What to do if you become ill or need to cancel before surgery

If you become ill, such as with a cold, cough or fever before surgery, OR need to cancel, please call:

● Centra Lynchburg General Hospital at 434.200.1177 and notify your surgeon’s office.

● Centra Virginia Baptist Hospital at 434.200.7407 and notify your surgeon’s office.

If your surgery date or time needs to be changed for any reason, it is the responsibility of your surgeon’s office to notify you.

2 Preparing to come to the hospital

If you were provided a BLOOD BRACELET , you MUST bring it to the hospital the day of your surgery. Failure to do so will result in a repeat blood draw and delay in your procedure. Please be advised that it is Centra policy not to perform elective medical procedures on women who are or may be pregnant. As part of your pre-operative procedures and tests, a pregnancy test may be ordered. Diet store them in during surgery. Glasses are ● DO NOT eat or drink anything after midnight preferred. the night before surgery. This includes water, gum, candy and/ or mints. ● Brush your teeth; be careful NOT to swallow any toothpaste and/or water. ● NO food or milk products after midnight the night before surgery. Clear liquids are allowed ● Wear comfortable street clothes to the hospital up to ______a.m./p.m. the day of surgery. that you can wear home after surgery. NOTHING by mouth after this time. ● Do NOT smoke before your surgery. CLEAR LIQUIDS INCLUDE: Fruit juice without SMOKING IS NOT PERMITTED AT ANY pulp, carbonated beverages, apple juice, white CENTRA FACILITY. grape juice, tea without milk, black coffee, Gatorade, Kool-Aid, Hawaiian Punch, non-pulp ● Do NOT consume alcohol prior to your surgery. popsicle. NO ORANGE OR GRAPEFRUIT JUICE. ● Leave valuables at home if at all possible. Do Medications NOT bring valuables, such as jewelry, ● Take medications as instructed by your surgeon pocketbooks and wallet. or the preoperative nurse educator. ● If you will be admitted after surgery, pack only ● DO bring all medications (include insulins, essential items such as toilet articles, nightwear, inhalers, nebulizers, CPAP machines, herbs and slippers and eyeglasses. Leave your belongings supplements, etc.) in the car, and ask one of your family members to bring them to your room after your surgery. ● Tylenol/Acetaminophen is the ONLY over-the- counter pain medicine that will not thin your ● DO bring a warm pair of socks. Depending on blood. Ask your surgeon or nurse educator your procedure, you may be permitted to wear about your prescription pain medicines. them in the operating room.

Additional preparations ● It is advised that you bring an extra pair of ● Do NOT use powder, hairspray, lotion or underwear to have if the need arises. perfume prior to your surgery. ● Bring a pillow and leave in your car for support ● Do NOT wear contact lenses to the hospital. If and positioning at discharge. you must have them, be sure to bring a case to

VERY IMPORTANT: At the time of discharge, you MUST have a driver that will assume responsibility for you when leaving the hospital. If an appropriate driver is not pre-arranged, your procedure will be canceled.

NOTE: The hospital is NOT responsible for the loss or theft of any personal item(s). It is recommended you have a family member responsible for your personal items, including dentures and glasses. Books, magazines, electronic devices, etc. are permitted. We encourage their use as they can help with diversion and comfort techniques. However, the hospital will not assume responsibility, and it is recommended your name and address be affixed to any such item.

3 Preparing skin night before surgery – bathe and shower only as directed

❑ SHOWER (or bathe) before surgery. DO NOT use lotions, powders, perfumes or hairspray after your shower for surgery.

❑ Skin prep applies to you if checked.

To assist in preparing the skin and decreasing the risk of infection Centra has chosen disposable pre-moistened cloths. You will receive a package from the Pre-Surgery Center to use the night before your surgery.

Night before your surgery

● Take a shower if you are able to do so. ● Wait two hours after shower before using the Sage 2 percent Chlorhexidine cloths. ● Ladies, please DO NOT SHAVE your legs or underarms during this shower or until after your surgery. ● Do NOT apply lotions, moisturizers or make-up to your body.

To open the package

● Hold top of package in one hand, lift flap on back of package with other hand. ● Grasp the notch at the top and pull straight across to expose cloths.

Instructions

DO NOT allow this product to come into contact with your eyes, ears, mouth or mucous membranes.

● Remove first cloth.

● Gently pat/wipe body from neck down. (Do not scrub.)

● Dispose of first cloth. Discard in trash can. Do not flush.

● Remove second cloth.

● Gently pat/wipe surgical site area (area circled on diagram).

● Dispose of second cloth. Front Back

● Do Not Rinse. Allow area to air dry for one minute. Skin may feel ''tacky'' for several minutes.

DO NOT SHOWER, CLEANSE OR RINSE YOUR SKIN AFTER PREPARATION. MUST REMAIN ON SKIN UNTIL YOUR SURGERY.

4 Additional instructions

Information for family and visitors

● A parent and/or legal guardian of a minor is ● Your surgeon will come to the designated required to remain in the hospital during waiting area to speak with your family following surgical procedures. It is your responsibility to your surgery. be available in the surgical waiting area to speak with the surgeon and or anesthesiologist. Note: Please remind family members to be available ● Only two family members or friends may be to speak with your surgeon in the waiting area. If with you in your room on the day of your you DO NOT wish for information to be given out surgery. Children under 12 years of age are NOT about your procedure, you should discuss this with permitted to visit in the Surgery Center. your surgeon in advance.

● During your surgery, your family will be instructed to wait in the surgical waiting area or in your assigned room.

5 Admission to The Surgery Center

● You will be assigned a room, given a hospital ● You may receive a medication to help you relax. gown to wear and asked to remove all necessary The medicine may make you drowsy, so please clothing. The gown ties in the back and you ask for help before getting out of bed. will wear it into the operating room. ● You will be asked to remove dentures. Cups are ● A nurse will complete your admission, which provided for dentures. includes assessment of your vital signs and ● listening to your heart and lungs. Eyeglasses should be removed and stored in the bedside table or given to a friend or relative. ● You will be asked to go to the bathroom to empty your bladder.

The operating room

● You will be transported from The Surgery personnel will start an intravenous solution (IV) Center to the operating room on a stretcher by to give you fluids and medications. one of our operating room staff. An ● anesthesiologist (a physician who will As you are moved into the operating room, you administer the anesthetic) will talk with you may notice bright overhead lights and equipment. about the type of anesthesia you will receive. ● Our operating rooms are temperature controlled, and you may feel cold. Please request a blanket if ● Anesthesia is medication that keeps you from feeling pain during surgery. For minor surgery, you need it. you may need only local anesthesia to numb ● You will be asked to move from the stretcher the surgical site. For other surgeries, your onto the operating room bed. A safety belt will anesthesia may include: be placed across your legs. Then the nurse or ❍ Regional anesthesia, to numb a single anesthesiologist will put a blood pressure cuff region of your body around one of your arms (or legs). ❍ Monitored anesthesia care (MAC), to make you drowsy or lightly asleep ● They will also place three or four small stickers ❍ General anesthesia, to put you completely on your chest or back. These stickers will asleep connect you to an EKG heart monitor. A monitor also will be placed on your finger to ● About one hour before your surgery, surgical check your oxygen level.

6 Post anesthesia care unit (recovery room)

After your surgery, you may be taken to the PACU (the recovery room) where you will be closely watched until you are fully awake. The amount of time you spend in the recovery room depends on your surgery and anesthetic. In PACU (Recovery Room):

● You may awaken with an oxygen mask on your ● You will be asked to take deep breaths, cough and face to help you breathe. turn with help.

● You may have an automatic blood pressure cuff ● You will feel cold because the temperature in the on your arm. PACU is cool. Let the nurse know if you need a blanket. ● You may have a sore throat, feel tired, groggy and sick to your stomach or have pain as your ● You may hear beeping and noises from the anesthesia wears off. This is not uncommon. If monitors and equipment. you have pain or nausea, please let your nurse know.

Returning to your room after surgery

For outpatient surgery For admission following surgery

● Following your recovery in the PACU, you will ● Following your recovery in the PACU, you will be transported back to The Surgery Center. be transported to an inpatient room in the Your family can visit once you are settled back hospital. Your family will be provided your into your room. room number.

● The nursing staff will monitor your status and ● Once your family has spoken to your surgeon you will be provided pain medication and following your procedure they can take your comfort measures as needed. You will be overnight bag/suitcase to your assigned room. encouraged to drink fluids as appropriate. Your family can visit once you are settled back into your room. ● Once you meet the necessary discharge criteria, home care instructions will be reviewed and ● The nursing staff will monitor your status and provided. you will be provided pain medication and comfort measures as needed. You will be encouraged to drink fluids, as appropriate and postoperative orders written by your physician will be carried out.

● Once your physician determines you are ready for discharge, home care instructions will be reviewed and provided.

7 Managing your pain

Management of your pain is an important part of your healthcare and recovery process. Before your surgery, we encourage you to ask your doctor what to expect regarding pain and plans for pain management.

● How long and how much pain can be expected? Everyone feels and reacts to pain in different ways. Pain can interfere with healing and recovery. ● Discuss pain control options with your doctor. It is important for you to share your level of ● Available methods of pain control comfort or discomfort with the nursing staff. You administration (oral, intravenous, patient are the only one who really knows how much pain controlled analgesia, epidural and you feel and what makes it better. Throughout your intramuscular). hospital stay, the nurses and your doctor will ask you about pain. The pain scale references below are ● Discuss with your doctor any concerns you tools used to help assess your level of comfort. have about taking pain medication.

Numeric

01 2 3 4 5 6 7 8 910

No Moderate Pain Worst Pain Possible Pain

Facial

Reference: Wong, D. and Whaley, L. (1986). Clinical handbook of pediatric nursing, ed., 2, p. 373. St. Louis: C.V. Mosby Company

Following your surgery, your comfort level will be assessed. Your description of pain will help enable us to determine how to help you become more comfortable. Here are some words that may help to describe your pain:

● Dull ● Prick ● Throb ● Sharp ● Ache ● Burn ● Pull ● Cramping

Please notify your nurse if your pain worsens or increases in intensity above your comfort goal. Your surgeon will be notified for additional orders if needed. We may change the medication, dose or timing, if necessary. Following discharge, contact your surgeon’s office if your pain worsens or increases in intensity.

8 Tips for taking your pain medication

● It is easier to remember to take medication if and vegetables may help. Avoid laxatives unless you take it on a schedule. (Try to time your your surgeon has prescribed them. medication by taking it before beginning an ● activity, such as dressing, walking or sitting at Don’t drink alcohol while taking pain the table for a meal.) medication. The combination can cause dizziness, slow your respiratory system and can ● Take pain medications with a little food to help even be fatal. avoid an upset stomach. ● Pain medication can slow your reflexes. Do not ● A common side effect of pain medications is drive or operate machinery while taking pain constipation. Drinking fluids and eating fruits medication.

Exercises for your recovery

It is recommended you practice the following exercises at home prior to your procedure. To improve your recovery process, you should start the exercises as soon as you can after your surgery. Do them about every hour while awake until you are up and about. How to do deep breathing exercises

● Breathe in slowly and deeply through your nose.

● Hold the air for a count of three.

● Breathe out slowly through your mouth as if Windpipe Airways blowing out a candle. (Bronchial Tubes)

Air Sacs ● Repeat the deep breathing exercises approximately four times.

Note: Breathing in and out using a harmonica is an excellent way to perform this exercise. Diaphragm How to do controlled coughing exercises ● Breathe in through your nose slowly and deeply. ● If you have surgery on your chest or abdomen, you may want to “splint” the incision by holding ● Hold the air for a count of three. your hands, a pillow or a folded blanket over the ● Cough two or three consecutive times without incision to ease the strain and discomfort. inhaling between coughs. Several short coughs ● Repeat the controlled coughing exercises one will loosen and remove secretions more more time. effectively and completely. Leg exercises and changing positions ● Turn from left side to right side, using the side ● Push your toes forward, pull them back and rails to assist moving. then relax. Move each foot in a circular motion.

● One at a time, bend each leg at the knee, and then stretch your leg out completely. Repeat this exercise twice.

9 Home care instructions

Before being discharged, you will be provided information on home care and what you can expect. Follow instructions for the care of your surgical site as directed by your physician. The postoperative nursing staff will help to direct you in your postoperative care.

Call your surgeon if you notice any of the following symptoms:

● Excessive bleeding ● Excessive vomiting, lasting longer than four hours

● Unusual swelling, redness or smelly discharge ● Shortness of breath around your wound, if applicable ● No bowel movement within three days ● Pain unrelieved by your pain medicine

● Fever of 101 degrees or higher

Questions to ask your doctors and nurses before surgery

One way you can help lower your risk for problems from your surgery is to talk with a member of your surgical care team before surgery about the type of care you should receive. Your care team includes your surgeon, your anesthesiologist and your nurses. The information on this page is provided courtesy of the Surgical Care Improvement Project Partnership, a large national partnership dedicated to reducing the number of preventable surgical complications.

What will you do to prevent blood clots? However, infections develop in about 1 to 3 out When you have surgery, you are at risk of of every 100 patients who have surgery. Some getting blood clots because you do not move of the common symptoms of a surgical site while under anesthesia. The more complicated infection are: your surgery, the higher your risk. Your doctor ● Redness and pain around the area where will know your risk for blood clots and steps you had surgery that will help prevent them, such as giving you ● Drainage of cloudy fluid from your surgical the right medicine before surgery. wound ● Fever If I take medicine for heart disease, should I keep taking it? Can SSIs be treated? Taking certain medicines together can cause Yes. Most surgical site infections can be treated problems. Tell your doctor about all the medicines with antibiotics. The antibiotic given to you you are taking, including over-the-counter things depends on the bacteria (germs) causing the like aspirin and herbal remedies. Your doctor or infection. Sometimes patients with SSIs also nurse will tell you which medicines you should need another surgery to treat the infection. continue to take and which medicines you should stop taking before surgery. What are some of the things that hospitals are doing to prevent SSIs? What is a Surgical Site Infection (SSI)? To prevent SSIs, doctors, nurses, and other A surgical site infection is an infection that healthcare providers: occurs after surgery in the part of the body ● Clean their hands and arms up to their where the surgery took place. Most patients elbows with an antiseptic agent just before who have surgery do not develop an infection. the surgery.

10 ● Clean their hands with soap and water or be shaved and talk with your surgeon if you an alcohol-based hand rub before and after have any concerns. caring for each patient. ● Ask if you will get antibiotics before ● May remove some of your hair immediately surgery. before your surgery using electric clippers if the hair is in the same area where the After your surgery: procedure will occur. They should not shave ● Make sure that your healthcare providers you with a razor. clean their hands before examining you, ● Wear special hair covers, masks, gowns, and either with soap and water or an alcohol- gloves during surgery to keep the surgery based hand rub. area clean. ● Family and friends who visit you should not ● Give you antibiotics before your surgery touch the surgical wound or dressings. starts. In most cases, you should get ● Family and friends should clean their hands antibiotics within 60 minutes before the with soap and water or an alcohol-based surgery starts and the antibiotics should be hand rub before and after visiting you. If stopped within 24 hours after surgery. you do not see them clean their hands, ask ● Clean the skin at the site of your surgery them to clean their hands. with a special soap that kills germs. What do I need to do when I go home from the What can I do to help prevent SSIs? hospital? Before your surgery: ● Before you go home, your doctor or nurse ● Tell your doctor about other medical should explain everything you need to problems you may have. Health problems know about taking care of your wound. such as allergies, diabetes, and obesity could Make sure you understand how to care for affect your surgery and your treatment. your wound before you leave the hospital. ● Quit smoking. Patients who smoke get ● Always clean your hands before and after more infections. Talk to your doctor about caring for your wound. how you can quit before your surgery. ● Before you go home, make sure you know ● Do not shave near where you will have who to contact if you have questions or surgery. Shaving with a razor can irritate problems after you get home. your skin and make it easier to develop an ● If you have any symptoms of an infection, such infection. as redness and pain at the surgery site, drainage, or fever, call your doctor immediately. At the time of your surgery: ● Speak up if someone tries to shave you with If you have additional questions, please ask your a razor before surgery. Ask why you need to doctor or nurse.

11 Resources

● For information on preparing for surgery, please visit http://www.ahrq.gov/consumer/surgery/surgery.htm, which offers additional questions to ask your physician and surgeon about your surgery.

● For information on quality of hospital care, visit Hospital Compare at http://www.hospitalcompare.hhs.gov. It includes information on how often hospitals provide some of the recommended care to get the best results for most patients.

● For information on the Joint Commission’s Speak Up™ program, which includes safety tips for surgical patients and infection prevention, visit www.jointcommission.org/PatientSafety/SpeakUp.

● For patient information concerning anesthesia, please visit http://www.asahq.org/patientEducation.htm.

● For more information concerning surgery, visit the American College of Surgeons at http://www.facs.org/public_info/ppserv.html.

If you have any questions prior to your surgery after review of this material, please call the Presurgery Center at 434.528.2177.

Thank you for allowing us to serve you.

12 1.15

Centra 2015 Tate Springs Road Lynchburg, Virginia 24501

434.528.2177

centrahealth.com