1. Nursing Instruction
  2. Overview
  3. Women's Health
Purpose:
To surgically remove benign or malignant gynecological tumors.
 
Pre-operative Preparation:
  1. Pre-operation survey: Blood sampling, chest X-ray and EKG; ultrasound examinations, Computed Tomography(CT scan), Cystoscopy and Colonoscopy can be considered if necessary.
  2. Prior to an operation, the surgeons will explain the clinical condition operation procedure, risks and complications to the patient and patient’s family members in details. With full understanding, patients need to sign consent, anesthesia, blood transfusion and self-paid medical supplements.  
  3. The night before operation: skin preparation, colon preparation, cleaning off nail polish and inform pre-operative NEED-TO-KNOWs (task carried out by nursing staff)
  4. Fasting after the midnight before the operation in order to avoid post anesthesia nausea and vomiting. Patient who takes medication such as antihypertensive drugs should consult doctor about stopping medication  if necessary.
 
Operation day:
  1. Patients should wear surgical gown ,  remove the objects such as dentures, watches, glasses, jewelry or other metal objects.
  2. Voiding is required before the operation.
 
The guidance of post-operative care:
  1. Mandatory post-operation monitoring (vital signs ) at recovery room. after doctors visiting, patients can go back to the ward when she is stable enough.
  2. Early ambulation is suggested.
  3. Nursing staff will guide patient to do some gait training exercises like rollover and getting into or out of bed progressively.
  4. Early deep breath and cough, expectoration, using  a pillow to press down abdomen wound to decreased wound pain. 
  5. Nothing by mouth prior to flatus. Diet feeding sequence: liquid diet to soft diet; soft diet to regular diet as tolerated and  in order to avoid bloating.
  6. Do not bend or compress the drainage tube in any conditions. keep semi-Fowler's position in order to drain smothly.
  7. Keep the gauze dry and clean; Contact medical staff to change dressing when there is exudate.  
  8. Contact medical staff immediately if reddish vaginal discharge,increased drainage amount, or severe abdominal pain were noted. 
  9. Flush foley catheter with water, Contact medical staff immediately if patient has dysuria after urine catheter removal.
  10. Post-operation antibiotics and  warm bath(four times daily) may be prescribed by doctors. (Further reading :Care of warm sitz bath)

Post operation home care:
  1. Cleansing/bathing
    1. You can shower when  backing home. 
    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.Sanitary pads should be replaced every two hours so premium can stay clean and dry.
  2. Wound care
    1. Keep the wound clean and dry. 
    2. If the wound shows redness/swelling/ pain/heat/purulent discharge, come back to our  OPD immediately.
  3. Exercise : Avoid vigorous exercise like running or jumping. Daily activity may take a walk ( 30 minutes per day).Avoid lifting up objects over 3 kg in the first three months.
  4. Nutrition : Maintain high protein diet (meat/fish/eggs/milk) and high vitamin C food (vegetables/fruits).Avoid eating any food that will make your abdomen fullness  for 3 months after the operation.   
  5. Excretion
    1. Encourage 1,500~2,500 c.c. water intake daily.Control water intake before sleep to prevent nocturia.
    2. To prevent constipation, eating a large amount of high fiber diet (vegetables/fruits) is recommended.
    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 : The OPD follow-up appointment would be arranged .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 evaluated by the physician.
 
References
  1. Lee, Y. T., Chen, F. M., & Kuo, T. C. (2020). The clinical effect of enhanced recovery after gynecologic surgery. Medical Journal of South Taiwan, 16 (1) , 44-50. https://doi.org/10.6726/MJST.202006_16(1).0007
  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. Tien,S. F., & Chang, F. W. (2019).  Cervical cancer. 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.262-284). Farseeing.
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    1. Nursing Instruction
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    Surgery / Procedure
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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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