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Copyright © 1996, 2005 by Pritchett & Hull Associates, Inc. All rights reserved. No part of this book may be photocopied, reprinted or otherwise reproduced without written permission from Pritchett & Hull Associates, Inc.
We do not intend to be sexist, but to keep the text simple, we often say “he” or “him” when referring to the patient. Published and distributed by: Pritchett & Hull Associates, Inc. Printed in the U.S.A.
This book is written to help you learn about your bowel surgery. It should not be used to replace any treatment or advice from your health care team.
Y our digestive system After you swallow food, it moves through a long tube (esophagus) to your stomach. Strong stomach juices (enzymes) change food to liquid so it moves through your system faster. After food leaves your stomach, it passes into the small intestine.
Small intestine As food moves through your small intestine, your body absorbs what it can use, and the rest becomes waste. It takes 3 to 6 hours for food to pass through your small intestine to your large intestine.
Large intestine (colon)
esophagus stomach small intestine
Your colon removes water from waste (stool) and moves it toward the rectum. Special nerves tell your brain when you need to get rid of waste. You control this act with muscles in your rectum called sphincters.
rectum 2
large intestine (colon)
B owel surgery Problems in your intestines (bowels) can be caused by injuries, cancer or other diseases. Some problems may need surgery to correct them before they get worse. In bowel surgery, part of your small or large intestine may be removed. If this is done, your remaining bowel is put back together (anastomosis) or rerouted outside your body (ostomy). The part of the bowel that the doctor uses to build an ostomy is called a stoma.
stoma
anastomosis
ostomy
Some people have an ostomy for 3 to 6 months while their anastomosis heals. Then, at a second operation, the surgeon sews the bowel back together and closes the ostomy.
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Ostomies An ostomy is an opening in your belly for waste to pass out of your body. An opening from the small intestine is called an ileostomy. If it is from the large intestine it is called a colostomy. An ostomy may be temporary or permanent.
ileostomy
colostomy
An ostomy does not have a sphincter, so you can’t control the passage of waste. You will need to wear a special, odor-proof pouch under your clothes to catch your stool. This may sound pretty scary, but ostomy products are very light and easy to use. No one will know you are wearing a pouch. If your doctor knows you will have an ostomy, he will discuss the stoma site with you before surgery. Your doctor may also refer you to an enterostomal (ET) nurse before or after your surgery. An ET nurse helps care for people with ostomies.
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B efore surgery Tests You may have some tests done during the week before your surgery. These tests may include: • EKG (heartbeat reading)
• chest X-ray
• blood tests
• urinalysis
Your doctor will check your test results to make sure you are healthy and ready for surgery.
Consent form You must sign a consent form before your surgery. This is a legal paper that says your doctor has told you about your surgery and the risks involved. When you sign this form, you agree to have the surgery and that you know and understand the risks. Ask your doctor any questions you have before you sign. If your surgeon expects more bleeding than usual, he will make plans for blood transfusions, if needed, during or after the surgery. If this happens, you will need to sign another consent form.
C ON S FORENT M
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Bowel prep Although it’s not necessary, it helps if the inside of your intestines are clean for surgery. So a day or two before, you may be given a bowel prep to drink. If you are, you should have liquids only—no solid foods on that day. A bowel prep will keep you near a toilet for 4 to 5 hours as your bowels empty. During this time, you may be asked to drink a lot of fluids to flush your digestive system.
To keep your bowels clean, you must drink only clear liquids on the day before your surgery. Clear liquids include water, apple juice, tea and broth.
If you cannot finish your bowel prep, tell your doctor.
Medicines If you take insulin or any other medicines every day, tell your doctor or nurse. They will make sure you do not miss any medicine you need. Your doctor may give you antibiotics the day before your surgery. Take them as often as your doctor tells you to. Sometimes antibiotics cause cramps or nausea. Tell your nurse if you feel sick to your stomach or have pain. If you take aspirin or any blood thinners, tell your doctor. You may need to stop taking your medicine for a while before surgery.
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Getting ready for the hospital Do not bring things of value (watches, jewelry, cash) to the hospital—you won’t need them. Be sure to bring: • a list of medicines you take (Include how much and how often you take each medicine.) • a list of your allergies (to food, clothing, medicines, etc.) and how you react to each • a pair of flat slippers with rubber soles • a knee-length robe for walking in the hospital halls • personal items like a toothbrush, comb, deodorant, razor, etc. • loose clothing to wear home • glasses, hearing aid, walker, cane or crutches and any other items you use every day • any papers from your doctor,
Put your name on things you take to the hospital.
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The morning of surgery Your stomach must be empty before surgery, so you will not be allowed to eat or drink after midnight. You may have a few sips of water if you must take medicine. When you get to the hospital, you will be asked to remove: • dentures, hearing aids • hairpins, wig, hairpieces • jewelry • glasses, contact lenses • nail polish, makeup • underwear Your family can visit you before you leave for surgery. Have them keep these things for you, or ask your nurse to keep them in a safe place. If you are having an ostomy, your ET nurse may visit you to mark your belly where the stoma will be. Bowel surgery can last from 1 to 5 hours—it depends on the type of surgery. Your family will be told how long your surgery will take. They will be shown where to wait so your doctor can talk with them after surgery.
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Anesthesia This is medicine that numbs your body or puts you to sleep before surgery. Your doctor will help you choose the best anesthesia to have. You may have: • general anesthesia (puts you to sleep) • spinal (epidural) anesthesia (numbs you from the chest down) No matter which type is chosen, you will not feel any pain during your surgery.
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W hen you wake up . . . You will wake up in the recovery room or in your hospital room. An intravenous (IV) tube will be in your arm. This lets your nurses give you fluids and medicine during surgery and while you recover. You may also have an oxygen mask over your face to make sure you get enough air. You may have a number of other tubes placed in your body. This is normal. The tubes will not hurt, but they may cause some discomfort. You may have: • a catheter (tube) running from your bladder, through your urinary passage to a bag. This keeps your bladder empty and helps your nurses keep track of your urine output. It is most often removed a day or two after surgery. • a drain tube to help blood and fluid drain from your incision. It is most often removed a few days after surgery. • a nasogastric (NG) tube that goes through your nose to your stomach. It drains your stomach to keep you from vomiting. It is most often taken out after a few days. Do not move or pull at any of your tubes. All of them will be removed as soon as they are no longer needed.
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B ack in your room Pain You may have some pain for a while after surgery, but you will get pain medicine for as long as you need it. You may receive it through your IV, an epidural catheter or in shots or pills. An epidural catheter is a small tube that puts pain medicine right into your spine. You may be able to control your own pain medicine (PCA*). Talk to your doctor before your surgery about your choices.
Eating and drinking Most likely, you will not be able to eat or drink anything for a few days after surgery. If you have an NG tube, it must be removed before you can begin eating or drinking. Usually, you will start by drinking liquids. If you have no problems, you can work up to eating solid food. Your doctor may want you to speak with a registered dietitian (RD) at the hospital. This is a person who plans special diets for people. Work with the dietitian on a meal plan for you at home.
* PCA = Patient Controlled Analgesia
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getting around Right after your surgery, you will need help moving around. You may not want to move, but being active will help you become stronger and feel better. Ask your nurse what exercises you can do in bed to increase your strength. Soon you will be walking the hospital halls without any help.
deep breathing Right after your surgery, take deep breaths and cough every two hours. Your doctor or nurse may ask you to use an incentive spirometer. This is a device that helps you breathe deeply. Using the incentive spirometer correctly and often can help keep your lungs clear. It can help prevent pneumonia and other problems that can slow your recovery and lengthen your hospital stay.
Keep the cylinder “floating� as you breathe in.
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B ack at home Here are some things to keep in mind after you go home: • For 4 to 6 weeks, do not lift anything that weighs more than a gallon of milk. Talk to your doctor before you lift anything heavier. • If you have been given a special diet by your doctor or dietitian, stick to it. The foods you ate in the hospital are good examples of foods you should eat at home. Avoid greasy, spicy and high-fiber foods for 4 to 6 weeks. These include pizza, popcorn, nuts and raw fruits and vegetables. • Begin a walking program as soon as you can. • Take a sponge bath unless your surgeon says it’s OK to take a shower or bath. • Do not drive until your doctor says it is OK. It is not safe to drive a car while you are taking pain pills. When in doubt—DON’T ! If you are not sure if you should do something, ask your doctor before you take the chance.
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talk to your doctor Your doctor will set a date for your follow-up visit. But call your doctor if you notice any of these: • new drainage from your incision • soreness or swelling around the incision • a bad odor from your incision • a fever over 100° • pain not eased by medicine • constipation with bloated feeling or pain
Phone numbers Primary care doctor: • nausea or vomiting Surgeon:
Anesthesiologist:
Pharmacy:
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Q uestions for your doctor Write down any questions you want to ask your doctor. Here are a few to help you get started: 1. Should I take my daily medicines before surgery? 2. How will my bowels work after surgery? 3. Will I need a special diet after surgery? 4. When can I exercise like I did before my surgery? 5. How soon can I take a bath or shower? 6. When will I have my follow-up visit? 7. Will my follow-up visit be with my surgeon, ET nurse or regular doctor? Who should I call if I have a problem? Write down any other questions you want to ask your doctor:
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F ind support If you want to learn more about intestinal problems, bowel surgery or ostomy care you can call or write: American Cancer Society (ACS) (800) 227-2345 www.cancer.org Crohn’s and Colitis Foundation of America (CCFA) 386 Park Avenue South, 17th Floor New York, NY 10016-8804 (800) 932-2423 www.ccfa.org United Ostomy Association 19772 MacArthur Blvd., #200 Irvine, CA 92612-2405 (800) 826-0826 www.uoa.org
Wound, Ostomy and Continence Nurses Society 2755 Bristol Street, Suite 110 Costa Mesa, CA 92626 (888) 224-9626 www.wocn.org
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N otes
C onsultants John S. Kennedy, MD, FACS Surgeon Dekalb Medical Center Atlanta, GA Additional thanks to:
W
Pamela Ann Cowart, RN, MSN, CCRN
e believe that you have the right to know as much as you can about your health. Our goal is to give you enough facts to get the main points clearly in mind. We do this with medical accuracy, warmth and humor. The result for you: less tension, more healing and a good idea of what to ask your doctor, nurse or others.
Betty McGinty, BS, RN, CGRN Beverly G. Hampton, RN, MSN, OCN, CETN Marianne Saunorus Baird, RN, MN, CCRN Paula Erwin-Toth, MSN, RN, CETN LaMar S. McGinnis, MD
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Pritchett & Hull Associates, Inc. 3440 Oakcliff Road, NE, Suite 110 Atlanta, GA 30340-3079 1-800-241-4925
ISBN #0-939838-89-3