Hernia – Hiatal Open Repair Surgery – Handwashing – Getting out of Bed – PreOp® Patient Education


Your doctor has recommended that you undergo
surgery to repair a hiatal hernia. But what does that actually mean? Your diaphragm is a muscle that separates
your chest from your abdomen and helps you to breathe. Normally, the diaphragm has an opening for
the esophagus to pass through where it connects with the stomach. A hiatal hernia occurs when part of the stomach
pushes upward through this small opening. Your hiatal hernia may be causing considerable
discomfort, with symptoms like heartburn, difficulty swallowing, chest pain and belching.
The reasons why hiatal hernias form are not known, but they are quite common. A hernia is dangerous only if it becomes strangulated.
That means that the portion of the stomach that is pushed up into the chest may become
pinched – preventing blood from reaching it. If this happens, you may require emergency
surgery to restore blood flow and to repair the hernia.
Patient Education Luckily, the vast majority of hernias are
not considered to be emergencies. However, if you should ever feel a sudden onset of
severe pain in your chest or stomach, you should seek medical attention immediately. So make sure that you ask your doctor to carefully
explain the reasons behind this recommendation. On the day of your operation, you will be
asked to put on a surgical gown. You may receive a sedative by mouth and an
intravenous line may be put in. You will then be transferred to the operating
table. The anesthesiologist will begin to administer
anesthesia, most probably general anesthesia by injection and/or inhalation mask. The surgeon will then apply antiseptic solution
to the skin and place a sterile drape around the operative site. After you’re asleep, the surgical team will
make a mid line incision, from the breastbone to the navel. Opening this incision reveals tissues that
connect the abdominal muscles. Another incision is made through these tissues
to allow access to the abdominal cavity. Your surgeon will use a special oval ring
to hold the incision open during the operation. First, the surgeon gently lifts the liver
up and away from the stomach. The surgical team can now see the place where the esophagus
and stomach join. Then, the surgeon cuts away the tissue that
connects the liver and the stomach. This gives your doctor better access to the diaphragm
and the esophagus. Next, the surgeon pulls the esophagus upward
and closes the hiatus with sutures. Your doctor may insert a rubber tube in your
esophagus to keep the sutures from tightening too much around your airway. Some hiatal hernias can cause persistent and
painful acid reflux and your doctor may decide to correct the problem surgically. In this case, the surgeon divides and separates
the arteries that supply blood to the top of the stomach. After freeing the stomach from the spleen,
your doctor wraps the upper portion of the stomach around the esophagus and sutures it
into place. A rubber tube is placed in the esophagus to
keep the wrap from becoming too tight. The special ring is withdrawn the tissues
that join the abdominal muscles are sewn together and the skin is closed with staples. Finally, sterile dressings are applied. Germs are present always on your hands and
they can be transferred to: * other parts of your own body,
* to the family member for whom you are caring * your patient
* and to any clean object that you touch. By washing your hands correctly: * you remove germs from your hands.
* Handwashing is the single most important way you can prevent infection from occurring
and * prevent the spread of infection. You must carefully wash and dry your hands: * Before and after each time you care for
your family member or your patient. * Before and after you handle your patient’s
and your own food and drink. * Before and after you manipulate any contact
lenses. * Before you apply and after you remove gloves
* After you use the toilet. * After you cough, sneeze or blow your nose.
* After contact with anything that could be soiled or have germs on it.
* After you pick up any object from the floor *
Handwashing takes a minimum of 10-15 seconds,
* longer if your hands are soiled. * The longer you wash, the more germs are
removed. * The friction generated by rubbing your hands
together removes the germs from your skin and
* running water can then wash them away * Every time you wash your hands, take your
time and don’t rush. * Do the handwashing carefully and thoroughly. Use liquid soap from a dispenser. Bar soap
holds germs on its surface. Make sure you have paper towels and a waste
receptacle nearby. Remove all jewelry from your hand except a
wedding band and push your watch and sleeves up, away from your hands.
Turn on warm water. Point your fingers down to prevent water running
onto your arms and wet your hands. Apply soap from the dispenser.
Point your fingers down and rub your hands vigorously together in a circular motion.
Star counting seconds at this point. Intertwine your fingers to clean all surfaces
of the fingers. Rub your fingernails against the palm of the
other hand to get soap under the tips of the nails. If your nails are soiled, clean under
them with an orange stick or brush. Keep your hands down and continue to rub them
together in a circular motion until the end of your count for 15 seconds.
Keep your hands down and rinse them from the wrist to fingertips.
Pick up a clean paper towel and turn off the water, still keeping your hands pointing down. Discard the paper towel into a waste receptacle
Pick up another clean paper towel and carefully and completely dry your hands.
Discard the paper towel into a waste receptacle. The key points to remember are: * that friction is critical for removing germs
* and the friction should be applied for at least 15 seconds.
* Always keep your fingers pointed down * and turn off the water with a paper towel. This program provides you with tips to help
you get out of bed after abdominal or chest surgery.
For the first few days when you come home after surgery, it is always best to have a
family member or friend help you to get out of bed.
Do not get out of bed directly from lying flat. Always sit up in bed for a few minutes.
Move the bedcovers well out of the way. Move nearer to the side of the bed. Pivot your
body and legs so that you are sitting with your legs dangling over the side of the bed.
Hold the mattress with your hands for support and keep your back straight.
Gently swing your legs back and forth, bend and stretch your ankles and twiddle your toes.
If you feel faint or weak, go back to bed. Have your helper put on your socks, and shoes
or sturdy slippers with low heels and non-slip soles.
Use a footstool if the bed is too high for your feet to reach the floor without sliding
off the bed. Stand still on the floor with your feet slightly
apart for a few seconds. Have your helper put on and fasten your robe.
For the first few times out of bed, when you feel strong enough, walk a few steps to a
bedside chair with arms. When you reach the chair, turn round so that
your calves are touching the front of the chair.
Bend your knees, grasp both arms of the chair firmly and lower yourself backward into the
chair. Reverse the process to get out of the chair.
At any time, * if you feel weak
* or dizzy * or have chest pain,
* let your helper get you back to bed * and inform your doctor. Some additional tips for the helper to follow. * Make sure your own footwear has non-slip
soles. * Remove any hazards from the floor, such
as slip rugs, frayed carpet or linoleum, or electric cords.
* Stand at the side of your patient, not directly in front
* Avoid lifting your patient under the arms. This can cause pain or dislocation of the
shoulder joint. * Never let your patient put arms around your
neck