The Hospital Experience

Mary E. Dixon RN, MSN Senior Director, Core Services Inova Fairfax Hospital

Q: What do I need to do to prepare for hospitalization?
The surgeon will give you specific instructions regarding preparation for colorectal surgery.

• Most individuals are required to have specific laboratory blood tests, a chest x-ray, and an electrocardiogram (EKG) done prior to surgery. Based on the individual's medical history and physician's requirements, the blood tests need to be done within 1-2 weeks of surgery, the EKG needs to be done within 3 months of surgery, and the chest x-ray needs to be done within 6 months of surgery.
• Usually, on the day before surgery a person is permitted only a clear liquid diet and is not permitted to eat or drink anything after midnight.
• The surgeon will order a specific bowel preparation. This will include some type of medication or procedure to eliminate any feces from the bowel. Many individuals are also ordered a particular antibiotic medication to "sterilize" the bowel.
• Chemotherapy or radiation therapy may be ordered in preparation for surgery to shrink the tumor, depending on the type and location of the tumor.

Q: How long will I be in the hospital and what type of unit will I be on?
The average length of stay for a person having colorectal surgery is 5 to 7 days, depending on the extent and type of the surgery performed, whether the individual has any pre-existing conditions that may slow recovery, and whether there are any complications after surgery. Routinely, the individual is admitted post-operatively to a medical/surgical unit and not an intensive care unit. If an individual requires specialty care, he/she may be placed on an intensive care unit until one's condition improves.

Q: Who will care for me in the hospital?
The individual is cared for by many members of the health care team throughout the hospitalization, to include physicians, nurses, therapists, pharmacists, social workers, etc. The team is lead by the surgeon and a comprehensive, individualized plan of care is developed and followed by all team members.

Q: What will I be able to eat during my hospitalization?
Most individuals begin with a diet that is advanced from nothing by mouth (no eating or drinking) immediately after surgery to a regular diet (balanced diet) by the time of discharge from the hospital. The individual will advance first to a clear liquid diet and then to a soft diet, before advancing to a regular diet. The diet is advanced as the bowel function returns. The diet will be adjusted to meet pre-existing conditions (i.e. diabetes).

Q: Will I have any problems with pain after surgery?
Pain management is an important part of care post-operatively. The goal is to diminish pain to a level where the patient is comfortable, but not necessarily pain-free, and able to participate in the post-operative recovery process. The surgeon or consulting physician (i.e. anesthesiologist) orders the medications used for pain management, usually starting with some type of intravenous or intramuscular medication and progressing to an oral (by mouth) medication.

Q: What kind of tubes will I have after surgery?
Many different tubes can be used post-operatively, to include:

• A nasogastric tube (coming out of the nose) for drainage of any stomach contents. This tube is in place for approximately 24 hours until bowel function begins (presence of bowel sounds).
• A foley catheter for draining urine from the bladder. This tube is usually in place for a minimum of 24 hours after surgery. The tube may be in place longer depending on the type of surgery performed, and the type of medication for pain management being used.
• A drain from the incision site. This is in place until the drainage from the wound site is minimal.
• An epidural infusion tube into the back for pain control. This pain management system is in place for usually 3 to 4 days, until the patient advances to another form of pain medication.
• An IV (intravenous) catheter (sometimes more than one catheter is needed) into the arm for administration of intravenous fluids. Individuals are maintained on IV medications until taking adequate fluids by mouth and bowel function returns.

Q: What type of activity will I be allowed to do post-operatively?
Each individual progresses at a different pace with activity. Activity is so important to maintaining normal breathing, reducing pain, and preventing other complications. Routinely, within 12 hours post-operatively, an individual is assisted with "dangling" at the bedside (sitting on the side of the bed), or assisted with walking within the hospital room. During hospitalization, the individual advances from requiring assistance from others in moving, to independence in activity. Also, the frequency of walking and amount of time out of bed increases daily until discharge.

Q: What medicines will I be taking while I am in the hospital?
The surgeon may order antibiotics to prevent any infections and anticoagulant therapy to prevent blood clots post-operatively. An individual continues most medications routinely taken at home after surgery, per the order of the physician. These medicines routinely are dispensed by the hospital's pharmacy and administered by the nurse.

Q: Will I have a wound, what will it look like, and what will I need to do to care for this?
Yes, the individual has a wound after colon surgery. The wound is usually an abdominal midline wound secured by stainless steel staples. These staples are removed 10 to 14 days after surgery in the surgeon's office.

The wound incision routinely starts above the belly button (umbilicus) and ends above the pubic bone. A dressing is in place for the first 24 hours and then the incision is often left open to air as long as it is clean and dry. The wound is monitored regularly for any signs of infection or problem: redness, drainage, tenderness, or warmth.

Q: Will I have needs when I go home?
Most individuals return home after this hospitalization. Discharge instructions are given to the individual at the time of discharge, and address: wound care, activity limitations, medications, follow-up with the physician/surgeon, and diet.

Some individuals require assistance at home that would be determined and arranged prior to discharge. Certain individuals may need to be transferred to another health setting for a temporary period for on-going recuperation/recovery.