Pre-operative Preparation:
  1. Pre-operation survey: Blood sampling, chest X-ray and EKG; ultrasound examinations, Computed Tomography(CT scan), Cystoscopy and Colonoscopy if necessary.
  2. Prior to an operation, surgeon will explain operation procedure, risk and complications to patient and patient’s family members in details. With full understanding, patient would need to sign consent for operation, anesthesia, blood transfusion and self-paid medical supplements.  
  3. The night before operation: skin preparation, colon preparation and inform pre-operative NEED-TO-KNOWs (task carried out by nursing staff)
  4. No oral intake past the midnight before the operation in order to avoid post anesthesia nausea and vomiting.

The guidance of post-operative care:
  1. 2-Hour mandatory post-operation monitoring (vital signs and anesthesia effects) at Recovery Room.
  2. Early ambulation with the assist from nursing staff is recommended.
  3. Early deep breath, expectoration, and chest care with the use of abdomen binder would be helpful for the recovery process. 
  4. Nothing by mouth prior to flatus. Diet feeding sequence: liquid diet to soft diet; soft diet to regular diet as tolerated.
  5. Do not bend or compress the drainage tube in any conditions.
  6. Keep the gauze dry and clean; frequently change dressing when excessive exudate. 
  7. Contact medical staff immediately if reddish vaginal discharge, a dramatic increment of drainage amount, or severe abdominal pain were noted. 
  8. Post-operation antibiotics may not be prescribed, these medications are evaluated by doctor. 

Post operation home care:
  1. Cleansing/bathing
    1. Shower is okay. Bathing should be avoided.
    2. Warm water bath four times daily, 5-10 minutes each time for promoting discharge outflow.
    3. Always wipe from front to back after defecation or when vaginal discharge is noted in order to prevent cross infection.
  2. Wound care
    1. Keep the wound clean and dry. If the wound got wet, while taking a bath, to be cleaned with sterilized towel.
    2. If the wound shows redness/swelling/ pain/heat/purulent discharge, visit OPD immediately.
  3. Exercise
    1. Avoid vigorous exercise like running or jumping. Daily activity may take a walk ( 30 minutes per day). 
    2. Avoid lifting up objects over 3 kg in the first three months.
  4. Diet/nutrition
    1. Maintain high protein diet (meat/fish/eggs/milk) and high vitamin C food (vegetables/fruits).
    2. Avoid taking any food that would make your abdominal fullness.    
  5. Excretion
    1. To prevent constipation, taking a large amount of high fiber diet (vegetables/fruits) is recommended.
    2. Encourage 2000~2500 c.c. water intake daily.
    3. Consult OPD if having any difficulty or symptom in urination/painful urination/frequency of urine/fever.
  6. Vaginal discharge
    Pink and odorless discharge will be noted for one month and then discharge should be gradually improved .
  7. Follow up
    1. The follow-up OPD appointment would be arranged please be on time.
    2. Visit your physician immediately If any of the following symptoms are noted: fever /acute abdominal pain/massive vaginal bleeding/wound infection.
  8. Sexual activity
    Sexual life abstinence until OPD visits recommended by the physician.
 
References
  1. Kuo, J. P., Weng, C. M., & Chen, C. C. (2015). Nursing challenges in post-operative pain magagement. Leadership Nursing, 12 (4) , 11-20.
  2. Morrill, M. Y., Schimpf, M. O., Abed, H., Carberry, C., Margulies, R. U., White, A. B., … Sung, V. W. (2014). Antibiotic prophylaxis for selected gynecologic surgeries. International Journal of Gynecology & Obstetrics, 120 (1), 10-15.
  3. Tang, Y. Y., & Chi, A. M. (2014). Application of surgery in the gynecological cancer. In Feng, R. C., Fang, Y. V., Chiang, M. L., Chyi, A, M.,Lin, L. C. Chang, P. F. (Ed.) Practical gynecologic nursing (5nd ed., pp. 308-309). Taipei : Farseeing.
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