1. Nursing Instruction
  2. Overview
  3. Women's Health
【Major points】
  1. Before surgery, please remove nail polish, jewelry, contact lenses, and removable dentures.
  2. If the doctor has instructed patients to follow a clear liquid diet and take a laxative, please remember to take them as scheduled.
  3. After surgery, avoid activities that increase pressure on the abdomen, such as lifting heavy objects and straining too hard during bowel movements.
  4. The wound should be kept clean and dry. Pay attention to any signs of inflammation such as redness, swelling, heat, or pain.
What is gynecological surgery?
Gynecological surgery involves the surgical removal of organs related to the female reproductive system, including the uterus, ovaries, fallopian tubes, cervix, vagina, and perineum, for the treatment of benign or malignant tumors. The physician evaluates the size and location of the affected area and recommends the appropriate surgical approach for patients, such as a Da Vinci surgery, laparoscopic surgery, or open abdominal surgery. For conditions like uterine prolapse or urinary incontinence, suspension surgery may be performed. (Further reading: Care of patient with pelvic reconstruction surgery)
 
Why is gynecological surgery needed?
Surgical intervention is used to improve the related issues caused by gynecological diseases.
 
Preoperative Preparation:
  1. Pre-operation survey: Blood sampling, chest X-ray, and EKG; ultrasound examinations, Computed Tomography scan, Cystoscopy, and Colonoscopy can be considered if necessary.
  2. Consent form: Prior to an operation, the surgeons will explain the clinical condition, operation procedure, risks, and complications to the patients and patients' family members in detail. With full understanding, patients need to sign consent forms for anesthesia, blood transfusion, and self-pay medical supplements.
  3. Anesthesia visits: The anesthesiologist will assess and explain the anesthesia method and assist patients in completing the anesthesia consent form. Patients can discuss with the anesthesiologist whether they will need to use self-paid pain control medication after the surgery. If patients prefer not to use self-paid medication, there are pain medications covered by health insurance that patients can choose from.
  4. Skin preparation: Hair on the skin from below the chest to the upper one-third of the thigh needs to be shaved.
  5. Colon preparation: Depending on the procedures, the doctor will instruct patients on how to begin bowel preparation, which may involve taking laxatives and receiving enemas administered by a nurse  one to three evenings before surgery.
  6. Nail polish (including gel nail polish) needs to be removed.
  7. Patients are fasting (including food and water) after midnight on the day before surgery. However, you need to consult doctor if you need to stop taking special medications such as antihypertensive drugs.
Operation day:
  1. Patients should wear surgical gown, remove the objects such as dentures, watches, glasses, jewelry, or other metal objects.
  2. Urinate before surgery.
  3. The operating room will notify patients of the surgical time. It is required to have a family member present.
  4. After surgery, patients will be observed in the recovery room for approximately two hours. Upon assessment by the anesthesiologist, patients will return to the unit for rest.
Principles of postoperative care:
  1. Pain:
    1. Medication for pain relief: The nurse will assess patients’ pain level and administer pain medication according to the doctor's orders. If patients experience any discomfort or pain, patients can inform the nurse at any time. 
    2. Supporting the abdominal incision: When coughing or changing positions, patients can use patients’ hands or a pillow to support the abdominal incision, reducing pain caused by pulling on the incision.
  2. Activity: On the day of the surgery, patients can perform deep breathing exercises, coughing, and limb movements to promote lung expansion and prevent avoid venous thrombosis in the lower limbs. The following day, patients can start by elevating the head of the bed and sitting up. Once patients feel comfortable and without dizziness, patients can have a family member accompany patients when getting out of bed for activities.
  3. Diet:
    1. After surgery, the doctor will assess whether patients can have food and water. Avoid consuming beans, milk, and spicy foods to reduce discomfort and bloating in the abdomen. 
    2. Patients can consume high-protein foods such as fish, meat, and eggs, as well as fruits and vegetables rich in vitamin C, such as guava and cauliflower, to promote wound healing. Consuming high-fiber foods like brown rice and sweet potato leaves can help prevent constipation.
  4. Care for surgical tubing:
    1. After surgery, patients may have an intravenous injeection line and a urinary catheter. Generally left in place for one to several days and will be removed after evaluation by the doctor. The nurse will assist with perineal cleansing. If patients experience any difficulty urinating after the removal of the catheter, it is important to inform the healthcare staff. If patients go home with a urinary catheter, it is important to maintain catheter clean and personal hygiene.
    2. If patients have a wound drainage tube, it is important to avoid pulling or twisting it to ensure that the tubing remains unobstructed.
  5. Wound care:
    1. The day after the surgery, the nurse will perform wound dressing change. During the two weeks following the surgery, it is essential to keep the wound as dry as possible. If there is any wound discharge, please inform the medical staff immediately.
    2. After the surgery, the doctor may place gauze inside the vagina, which the nurse usually removes the next day. If the vaginal secretions become bright red in color or if there is an increase in bleeding (like the amount on the second day of menstruation), please notify the medical staff immediately for further handling.
  6. After the surgery, the doctor will assess whether to administer antibiotic treatment and warm water baths. (Further reading: Warm water sitz bath)
  7. For patients undergoing laparoscopic surgery, carbon dioxide is injected into the abdominal cavity during the procedure. Therefore, after the surgery, patients may experience shoulder pain, discomfort in the diaphragm while breathing, and bloating. It is recommended that patients raise the foot of the bed, elevate patients’ legs, or get out of bed and move around to help alleviate these symptoms.
Home care after discharge:
  1. Personal hygiene:
    1. Patients can shower after getting home. If there is no waterproof dressing on the abdominal wound, it is not advisable to let the wound come into direct contact with water for the first two weeks. Patients can wash or bathe in sections to keep your body clean. 
    2. After using the toilet, wipe from front to back to avoid wiping back and forth, which may cause urinary tract infections.
  2. Wound care: Keep the wound clean and dry. If the wound shows signs of redness, swelling, heat, pain, and abnormal discharge, it may indicate inflammation, and immediate medical attention is required.
  3. Exercise: Patients may take a 30-minute walk every day. Within the first three months, avoid engaging in activities that put pressure on the abdomen, such as lifting heavy objects weighing more than three kilograms with one hand, weight training, and sit-ups. Avoid exerting force on the abdomen to prevent interference with wound healing.
  4. Bowel Movements:
    1. If there are no other restrictions, it is recommended to consume about 1500-2500 c.c. of fluids daily. However, reduce fluid intake before bedtime to avoid nighttime urination.
    2. If patients have trouble urinating, pain, frequent urination, or a burning sensation while urinating, seek medical attention at the Obstetrics & Gynecology clinic as soon as possible.
  5. Vaginal Discharge: It is normal to have light pink, odorless vaginal discharge within the first month after the surgery, and it will gradually decrease. It is advised to use sanitary pads and change them approximately every 2 hours to maintain cleanliness of the perineal area.
  6. Follow-up Appointment: On the day of discharge, patients will be given an appointment for patients’ first follow-up visit. If patients experience unexplained fever, acute abdominal pain, excessive bleeding from the wound or vagina, patients should immediately return to the outpatients or seek emergency medical attention.
  7. Sexual Activity: The timing for resuming sexual activity will be determined by the doctor during patients’ follow-up examination.
References
  1. Ferrari, F., Forte, S., Sbalzer, N., Zizioli, V., Mauri, M., Maggi, C., Sartori, E., & Odicino, F. (2020). Validation of an enhanced recovery after surgery protocol in gynecologic surgery: an Italian randomized study. American Journal of Obstetrics and Gynecology, 223(4), 543.e1– 543.e14. https://doi.org/10.1016/j.ajog.2020.07.003
  2. Lee,H. L., & Pan, W. L. (2019). Benign tumor disease. In Feng, R. C., Yeh, Y. C., Lu, M. F., Tang, Y. Y., Chyi, A. M., Lin, L. G., Lee, H. L., Pan, W.L., Chen, S. J., Tien, S. F., Chang, F. W., Chao, H. L., Zen, F. W., & Chang, B. F. Practical gynecological nursing (6nd ed., pp.201-225). Farseeing.
  3. You, H., Lei, A., Li, X., Liao, X., & Chang, J. (2022). Discharge teaching, patient-reported discharge readiness and postsurgical outcomes in gynecologic patients undergoing day surgery: a generalized estimating equation. BMC surgery, 22(1), 166.https://doi.org/10.1186/s12893-022-01607-x
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    Taipei Veterans General Hospital 
    No.201, Sec. 2, Shipai Rd., Beitou District,  3e72dadb9904d06fa0fb3744e4ed2612.png
    Taipei, Taiwan 11217, R.O.C.
    Tel: +886-2-2871-2121 #04
    • Smoking and chewing betel nut significantly induce oral cancer. Obesity will potentially increase the risk of breast cancer and colorectal cancer. Please control body weight and keep away from tobacco and betel nut.
    • Information provided above can’t overcome physician's treatment and replace physician patient relationship.
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