Preparing For Your Surgery

Centra Lynchburg General Hospital

Centra Virginia Baptist Hospital

434.200.3023

434.200.4147

On the day of your procedure checkin at the Registration Departmentlocated at the Terrace Entrance ★of Centra Lynchburg GeneralHospital on Thomson Drive.Surgicare is located adjacent toRegistration.

Bring photo ID and Insurance cards.

Free valet parking isavailable for patients andvisitors.

On the day of your procedure,check in at the RegistrationDepartment located at theOak Lane Entrance ★ of Centra Virginia Baptist Hospital.

Bring photo ID and Insurance cards.

Free valet parking isavailable for patients andvisitors.

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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. Theinformation in this booklet is intended to prepare you for a smooth and successful surgery and recovery.

We are here to serve you

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 BedfordMemorial Hospital, Centra Southside Community Hospital and numerous other facilities and programsthroughout Virginia.

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

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

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 yourprocedure 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 yourprocedure by an automated phone message. Be SURE to provide the hospital with the contact number withwhich you wish to receive the confirmation call. Your time may change due to scheduling events in theoperating 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 operatingroom.

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.

Details of your scheduled surgery

Preregistration

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’soffice to notify you.

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

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Preparing to come to the hospital

Diet● DO NOT eat or drink anything after midnight

the night before surgery. This includes water,gum, candy and/ or mints.

● NO food or milk products after midnight thenight before surgery. Clear liquids are allowedup to _________ a.m./p.m. the day of surgery.NOTHING by mouth after this time.

CLEAR LIQUIDS INCLUDE: Fruit juice withoutpulp, carbonated beverages, apple juice, whitegrape juice, tea without milk, black coffee,Gatorade, Kool-Aid, Hawaiian Punch, non-pulppopsicle. NO ORANGE OR GRAPEFRUIT JUICE.

Medications● Take medications as instructed by your surgeon

or the preoperative nurse educator.

● DO bring all medications (include insulins,inhalers, nebulizers, CPAP machines, herbs andsupplements, etc.)

● Tylenol/Acetaminophen is the ONLY over-the-counter pain medicine that will not thin yourblood. Ask your surgeon or nurse educatorabout your prescription pain medicines.

Additional preparations● Do NOT use powder, hairspray, lotion or

perfume prior to your surgery.

● Do NOT wear contact lenses to the hospital. Ifyou must have them, be sure to bring a case to

store them in during surgery. Glasses are preferred.

● Brush your teeth; be careful NOT to swallowany toothpaste and/or water.

● Wear comfortable street clothes to the hospitalthat you can wear home after surgery.

● Do NOT smoke before your surgery.SMOKING IS NOT PERMITTED AT ANYCENTRA FACILITY.

● Do NOT consume alcohol prior to your surgery.

● Leave valuables at home if at all possible. DoNOT bring valuables, such as jewelry,pocketbooks and wallet.

● If you will be admitted after surgery, pack onlyessential items such as toilet articles, nightwear,slippers and eyeglasses. Leave your belongingsin the car, and ask one of your family membersto bring them to your room after your surgery.

● DO bring a warm pair of socks. Depending onyour procedure, you may be permitted to wearthem in the operating room.

● It is advised that you bring an extra pair ofunderwear to have if the need arises.

● Bring a pillow and leave in your car for supportand positioning at discharge.

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 isCentra 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.

VERY IMPORTANT: At the time of discharge, you MUST have a driver that will assume responsibility for youwhen 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 afamily member responsible for your personal items, including dentures and glasses. Books, magazines, electronicdevices, etc. are permitted. We encourage their use as they can help with diversion and comfort techniques. However, thehospital will not assume responsibility, and it is recommended your name and address be affixed to any such item.

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 yourshower 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-moistenedcloths. You will receive a package from the Pre-Surgery Center to use the night before your surgery.

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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.

● 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.

Front Back

Information for family and visitors

● A parent and/or legal guardian of a minor isrequired to remain in the hospital duringsurgical procedures. It is your responsibility tobe available in the surgical waiting area to speakwith the surgeon and or anesthesiologist.

● Only two family members or friendsmay bewith you in your room on the day of yoursurgery. Children under 12 years of age are NOTpermitted to visit in the Surgery Center.

● During your surgery, your family will beinstructed to wait in the surgical waiting area orin your assigned room.

● Your surgeon will come to the designatedwaiting area to speak with your family followingyour surgery.

Note: Please remind family members to be availableto speak with your surgeon in the waiting area. Ifyou DO NOT wish for information to be given outabout your procedure, you should discuss this withyour surgeon in advance.

Additional instructions

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Admission to The Surgery Center

The operating room

● You will be assigned a room, given a hospitalgown to wear and asked to remove all necessaryclothing. The gown ties in the back and youwill wear it into the operating room.

● A nurse will complete your admission, whichincludes assessment of your vital signs andlistening to your heart and lungs.

● You will be asked to go to the bathroom toempty your bladder.

● You may receive a medication to help you relax.The medicine may make you drowsy, so pleaseask for help before getting out of bed.

● You will be asked to remove dentures. Cups areprovided for dentures.

● Eyeglasses should be removed and stored in thebedside table or given to a friend or relative.

● You will be transported from The SurgeryCenter to the operating room on a stretcher byone of our operating room staff. Ananesthesiologist (a physician who willadminister the anesthetic) will talk with youabout the type of anesthesia you will receive.

● Anesthesia is medication that keeps you fromfeeling pain during surgery. For minor surgery,you may need only local anesthesia to numbthe surgical site. For other surgeries, youranesthesia may include:❍ Regional anesthesia, to numb a single

region of your body❍ Monitored anesthesia care (MAC), to make

you drowsy or lightly asleep❍ General anesthesia, to put you completely

asleep

● About one hour before your surgery, surgical

personnel will start an intravenous solution (IV)to give you fluids and medications.

● As you are moved into the operating room, youmay notice bright overhead lights and equipment.

● Our operating rooms are temperature controlled,and you may feel cold. Please request a blanket ifyou need it.

● You will be asked to move from the stretcheronto the operating room bed. A safety belt willbe placed across your legs. Then the nurse oranesthesiologist will put a blood pressure cuffaround one of your arms (or legs).

● They will also place three or four small stickerson your chest or back. These stickers willconnect you to an EKG heart monitor. Amonitor also will be placed on your finger tocheck your oxygen level.

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Post anesthesia care unit (recovery room)

Returning to your room after surgery

● You may awaken with an oxygen mask on yourface to help you breathe.

● You may have an automatic blood pressure cuffon your arm.

● You may have a sore throat, feel tired, groggyand sick to your stomach or have pain as youranesthesia wears off. This is not uncommon. Ifyou have pain or nausea, please let your nurseknow.

● You will be asked to take deep breaths, cough andturn with help.

● You will feel cold because the temperature in thePACU is cool. Let the nurse know if you need ablanket.

● You may hear beeping and noises from themonitors and equipment.

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

For outpatient surgery

● Following your recovery in the PACU, you willbe transported back to The Surgery Center.Your family can visit once you are settled backinto your room.

● The nursing staff will monitor your status andyou will be provided pain medication andcomfort measures as needed. You will beencouraged to drink fluids as appropriate.

● Once you meet the necessary discharge criteria,home care instructions will be reviewed andprovided.

For admission following surgery

● Following your recovery in the PACU, you willbe transported to an inpatient room in thehospital. Your family will be provided yourroom number.

● Once your family has spoken to your surgeonfollowing your procedure they can take yourovernight bag/suitcase to your assigned room.Your family can visit once you are settled backinto your room.

● The nursing staff will monitor your status andyou will be provided pain medication andcomfort measures as needed. You will beencouraged to drink fluids, as appropriate andpostoperative orders written by your physicianwill be carried out.

● Once your physician determines you are readyfor discharge, home care instructions will bereviewed and provided.

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Managing your pain

Management of your pain is an important part of your healthcare and recovery process. Before yoursurgery, 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?

● Discuss pain control options with your doctor.

● Available methods of pain controladministration (oral, intravenous, patientcontrolled analgesia, epidural andintramuscular).

● Discuss with your doctor any concerns youhave about taking pain medication.

Everyone feels and reacts to pain in differentways. Pain can interfere with healing and recovery.It is important for you to share your level ofcomfort or discomfort with the nursing staff. Youare the only one who really knows how much painyou feel and what makes it better. Throughout yourhospital stay, the nurses and your doctor will askyou about pain. The pain scale references below aretools used to help assess your level of comfort.

0 1 2 3 4 5 6 7 8 9 10

NoPain

Moderate Pain WorstPossiblePain

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 describeyour pain:

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

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

Numeric

Facial

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Exercises for your recovery

It is recommended you practice the following exercises at home prior to your procedure. To improve yourrecovery process, you should start the exercises as soon as you can after your surgery. Do them about everyhour 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 ifblowing out a candle.

● Repeat the deep breathing exercisesapproximately four times.

Note: Breathing in and out using a harmonica isan excellent way to perform this exercise.

Windpipe

Airways(BronchialTubes)

Air Sacs

Diaphragm

How to do controlled coughing exercises

● Breathe in through your nose slowly and deeply.

● Hold the air for a count of three.

● Cough two or three consecutive times withoutinhaling between coughs. Several short coughswill loosen and remove secretions moreeffectively and completely.

● If you have surgery on your chest or abdomen,you may want to “splint” the incision by holdingyour hands, a pillow or a folded blanket over theincision to ease the strain and discomfort.

● Repeat the controlled coughing exercises onemore time.

Leg exercises and changing positions

● Turn from left side to right side, using the siderails to assist moving.

● One at a time, bend each leg at the knee, andthen stretch your leg out completely. Repeatthis exercise twice.

● Push your toes forward, pull them back andthen relax. Move each foot in a circular motion.

● It is easier to remember to take medication ifyou take it on a schedule. (Try to time yourmedication by taking it before beginning anactivity, such as dressing, walking or sitting atthe table for a meal.)

● Take pain medications with a little food to helpavoid an upset stomach.

● A common side effect of pain medications isconstipation. Drinking fluids and eating fruits

and vegetables may help. Avoid laxatives unlessyour surgeon has prescribed them.

● Don’t drink alcohol while taking painmedication. The combination can causedizziness, slow your respiratory system and caneven be fatal.

● Pain medication can slow your reflexes. Do notdrive or operate machinery while taking painmedication.

Tips for taking your pain medication

Home care instructions

Questions to ask your doctors and nurses before surgery

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

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

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

● Excessive bleeding

● Unusual swelling, redness or smelly dischargearound your wound, if applicable

● Pain unrelieved by your pain medicine

● Fever of 101 degrees or higher

● Excessive vomiting, lasting longer than four hours

● Shortness of breath

● No bowel movement within three days

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What will you do to prevent blood clots?When you have surgery, you are at risk ofgetting blood clots because you do not movewhile under anesthesia. The more complicatedyour surgery, the higher your risk. Your doctorwill know your risk for blood clots and stepsthat will help prevent them, such as giving youthe right medicine before surgery.

If I take medicine for heart disease, should Ikeep taking it?

Taking certain medicines together can causeproblems. Tell your doctor about all the medicinesyou are taking, including over-the-counter thingslike aspirin and herbal remedies. Your doctor ornurse will tell you which medicines you shouldcontinue to take and which medicines you shouldstop taking before surgery.

What is a Surgical Site Infection (SSI)?A surgical site infection is an infection thatoccurs after surgery in the part of the bodywhere the surgery took place. Most patientswho have surgery do not develop an infection.

However, infections develop in about 1 to 3 outof every 100 patients who have surgery. Someof the common symptoms of a surgical siteinfection are:● Redness and pain around the area where

you had surgery● Drainage of cloudy fluid from your surgical

wound● Fever

Can SSIs be treated?Yes. Most surgical site infections can be treatedwith antibiotics. The antibiotic given to youdepends on the bacteria (germs) causing theinfection. Sometimes patients with SSIs alsoneed another surgery to treat the infection.

What are some of the things that hospitals aredoing to prevent SSIs?

To prevent SSIs, doctors, nurses, and other healthcare providers:● Clean their hands and arms up to their

elbows with an antiseptic agent just beforethe surgery.

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● Clean their hands with soap and water oran alcohol-based hand rub before and aftercaring for each patient.

● May remove some of your hair immediatelybefore your surgery using electric clippers ifthe hair is in the same area where theprocedure will occur. They should not shaveyou with a razor.

● Wear special hair covers, masks, gowns, andgloves during surgery to keep the surgeryarea clean.

● Give you antibiotics before your surgerystarts. In most cases, you should getantibiotics within 60 minutes before thesurgery starts and the antibiotics should bestopped within 24 hours after surgery.

● Clean the skin at the site of your surgerywith a special soap that kills germs.

What can I do to help prevent SSIs?Before your surgery:● Tell your doctor about other medical

problems you may have. Health problemssuch as allergies, diabetes, and obesity couldaffect your surgery and your treatment.

● Quit smoking. Patients who smoke getmore infections. Talk to your doctor abouthow you can quit before your surgery.

● Do not shave near where you will havesurgery. Shaving with a razor can irritateyour skin and make it easier to develop aninfection.

At the time of your surgery:● Speak up if someone tries to shave you with

a razor before surgery. Ask why you need to

be shaved and talk with your surgeon if youhave any concerns.

● Ask if you will get antibiotics beforesurgery.

After your surgery:● Make sure that your healthcare providers

clean their hands before examining you,either with soap and water or an alcohol-based hand rub.

● Family and friends who visit you should nottouch the surgical wound or dressings.

● Family and friends should clean their handswith soap and water or an alcohol-basedhand rub before and after visiting you. Ifyou do not see them clean their hands, askthem to clean their hands.

What do I need to do when I go home from the hospital?

● Before you go home, your doctor or nurseshould explain everything you need toknow about taking care of your wound.Make sure you understand how to care foryour wound before you leave the hospital.

● Always clean your hands before and aftercaring for your wound.

● Before you go home, make sure you knowwho to contact if you have questions orproblems after you get home.

● If you have any symptoms of an infection, suchas redness and pain at the surgery site,drainage, or fever, call your doctor immediately.

If you have additional questions, please ask yourdoctor or nurse.

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Resources

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.

● 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. Itincludes information on how often hospitals provide some of the recommended care to get the best results formost patients.

● For information on the Joint Commission’s Speak Up™ program, which includes safety tips for surgicalpatients 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 athttp://www.facs.org/public_info/ppserv.html.

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Centra 2015 Tate Springs Road

Lynchburg, Virginia 24501

434.528.2177

centrahealth.com