Ambulatory Blood Pressure Monitor Instructions - Pathology: Fill & Download for Free

I hope this helps you if you haven’t had surgery before and you’re really nervous about it or just want to know what to expect. I wrote it really carefully and in such a way that answers the types of questions that I would have if I hadn’t experienced surgery both as a patient and as a caretaker of a patient. Good luck with your surgery and I hope that you have the outcome you are hoping for! Remember: aftercare is usually really important. Get help complying with it, as necessary.So. At the hospitals I’ve been to, which have all been in Massachusetts and New York, the process is very civilized for scheduled (not emergency) surgery. You’ll have a pre-op meeting before your surgery date where a nurse or a PA will test you (an EKG, for example, if you hadn’t had one in a while) to establish that your general health is good enough to green light you for surgery. They explain how you will prepare for your surgery at home, which usually involves fasting from the night before and not drinking anything the morning of unless it’s a sip of water to take your every day medications. They may give you “prep” that makes you poop non-stop the day before until you’re empty, and they may give you a bottle of liquid “soap” to shower with a few times so that your skin is basically stripped of any grubby little germs that could infect your site once they open you up.If you’re going to have surgery that will affect your gait, they’ll give you a little pamphlet that basically says “hey! pick all of the stuff up off the floor and put it on the counter now because you’re not going to be able to bend over or lift and if you trip and fall, you have to come back to the hospital”. You sign papers attesting that you understand their counsel and know what is expected, on your part, both before and after. At this time, if you don’t already have an end of life directive filed (like a “do not resuscitate” order) they’ll ask for you to make some decisions. You’ll assign a health care proxy—somebody to make medical decisions for you if need be while you are unable to give consent (once they’ve given you anesthesia, for example).On the morning of your surgery, you’ll usually be asked to wear embarrassingly comfortable clothing and arrive far before your procedure. You arrive with whoever is going to “be there for you” that day—a friend, family… hopefully not a guard from the prison. In most cases, this person is also your proxy. The pre-surgical waiting area will probably be packed with a full roster of people getting operated on that day and nurses will be calling names in groups to bring you into the secondary areas appropriate for your specific surgery. Your friend can come with you to this pre-op area. You get into the Johnnie. You get the robe. You get the slipper socks. Your stuff gets put into a plastic bag with your name on it. Somebody takes it away or plunks it under your gurney. Soon, you’re in bed in a big room with a lot of other people from the waiting room, except now you’re all dressed the same way. If you are lucky? You get an awesome heated cotton blanket. Or two.The surgeon comes to meet you. The anesthesiologist comes to meet you. Perhaps another doctor, nurse or physician’s assistant. Generally, they are polite and friendly to try and put you at ease so that you can focus on what they are telling you. They can describe what their plan is for once they get you under and open and will answer any questions you might have. You sign papers, papers and papers. Somebody, usually a nurse or anesthetist assistant but, sometimes, a dedicated cath nurse (the fastest and the best!) will fit you with an IV line in your arm or hand and tape it into place. You’ll get electrodes taped to you. You’ll get a pulse ox monitor clamped to your finger and taped on. These items get hooked into machines that go “beep beep: you’re alive” or “beeeeeeeeeeeeep: you’re dead” and also monitor things like your blood pressure. You get a silly paper shower cap thing to go over your hair. If it’s a long surgery, they will fit you with a catheter to collect your urine, but not until you are unconscious.Most people are nervous—that’s part of why you get to have your friend, family or prison guard there to keep you company. Another reason is to have somebody socially familiar with you at your baseline personality to be able to flag an issue for the surgical team which they otherwise mightn’t detect because they don’t know you. Like: if you’re not speaking at all? They want somebody there to say “Yeah, this is normal. He barely speaks to anybody” or “she’s deaf without her hearing aids in so you should yell, because she’s too polite to complain”.With somebody who knows you there, it’ll be easier for the doctor to communicate with you, efficiently, even if you aren’t a reliable self reporter…you’ll likely overhear examples of this with elderly patients being corrected by their grown children about which medicines they take and when, for example. Lastly, because general anesthesia works a bit differently on each individual, they want you to have a witness to the talk you have with your team, in case you can’t remember points in the discussion you’d want to immediately after you wake up…things about how you may feel, initially and what could constitute them deciding to keep an eye on you, overnight, in the recovery room or admitting you to a room on one of the floors instead of just going home. Either would be outside the norm; it’s insurance coverage, nowadays, that pre-determine how long you’ll stay in hospital (more on this later).Somebody (usually a nurse or an anesthetist) will give you ‘a little something’ through the IV to relax you but *not* to knock you out. You will still be conscious the whole time that you are in this first staging area. Eventually, you’ll bid goodbye to whoever came with you that morning, and an orderly will appear to wheel you, your bed and your drip line to the surgical suite. You may have to wait in a hallway for a bit but, by then you really might feel that first stage “cocktail” and not be extremely conscious of time, so it’s not nerve-wracking. They may or may not (depending on factors like the type of and projected length of your surgery as well as known intolerances to certain anesthesia protocols) give you a second “stage” of anesthesia at this time. If this happens, it still will not be the dose that knocks you out.Once you’re wheeled into the theater, itself, you’ll see your team again but, this time, they’ll also have silly hats and also paper masks on like they’re ready to rob a bank. They may check to ask if you’re “all set to go” because by then they’ll have placed a little oxygen mask made out of see-through plastic over your mouth and nose which will inhibit your verbal communication and you’re limited to nodding or shaking you head, thumbs up sign, etc. The mask smells like ozone and, by this time, you *are* relaxed.The anesthetist will address you: these are the doctors who are going to monitor your vital signs all throughout the surgery and make sure that you are in the appropriate level of sedation. They are going to adjust any medicine in your lines, as necessary. If you become distressed, they will be sure that you are intubated to secure an open airway. The anesthetist is your friend in that room, cari g for your whole body, while the surgeon is more like the mechanic, just compartmentalizing their focus on one discrete part of your body.If you didn’t get a second stage of anesthesia yet, they might do it here. Or: they may knock you out straight. They’ll let you know before they do anything. If they give you a second stage in the theater it will only take a minute or so before they give you the thing that will induce unconsciousness. When they push the meds to put you out through the IV, sometimes it stings a bit; in my experience, it’s almost always a sensation of cold—like ice water is entering the veins in your forearm. You are asked to count down backwards from one hundred. You probably won’t make it to 90, even if you try really hard. It’s awesome. I love that part. Especially if you’ve been in too much pain to sleep: it’s a relief.They like for whoever brought you in to stay in a family waiting area during your surgery. The surgeon will often go to them and report how the surgery went and, if you are family, they’ll discus any findings—like if they sent any samples to pathology, for example. Most importantly, they want somebody they can find fast should the surgeon, for some reason, need a proxy to make a medical decision for the patient mid-procedure. Somebody present that the can find fast to sign off on such a decision is easier for them than trying to reach the proxy by phone—-for example. When time is of the essence, the fewer layers of complexity, the better.*Here is an un-solicited piece of advice related to your role as somebody’s emergency contact: if your partner or parent feels very ill and they go in to see the doctor by themselves, just make sure your phone is charged. If you are down as their emergency contact, you may well become their proxy. So, if while they are gone, you happen to get a phone call from a number you don’t recognize? Pick it up. In the rare case your friend’s exam has findings that indicate an emergency surgical procedure, they may be unable to give consent. An example of this would be: if the physician has a sudden reason to use an endoscope, they will likely give a relaxing agent first. If they find something exploding in there, and your friend is semi-drugged, they want to obtain permission to operate from a sober person. If the permission involves a choice between clinical approaches with different degrees of risk, the decision can be an important one.Sometimes during regularly scheduled (not emergency) surgery there is a surprise when they open a patient up and they recognize something visual that’s different than what they expected to see based on previous imaging and they have to change horses mid-stream and perform a surgery other than what was planned or have an on-call surgeon with a different specialty “scrub in”. It’s uncommon. Still, without a proxy, in order to gain consent, your team will have to stop the operation and wait a long time for the anesthesia to wear off so that they can ask the patient, personally, what they want to do. I believe the exception to this case is an emergency intervention-you definitely sign an okay for emergency surgery if it’s required. So, if you start having a heart attack when you go in for a nose-job, they know how to prioritize. They won’t bother with finding your contact.Unless you have a poor reaction to the anesthesia, you will probably come into consciousness very slowly and not feel terribly bad at first. Some people experience side effects when coming out from under—-I know my sister (for one) felt really emotional and sad right after she had her wisdom teeth out. It was purely an effect of the drugs. I only had an with general anesthesia once—a terrible acidic burn in my throat from reflux. I have mentioned this every other time since and the anesthesiologist must understand what to do for that because it’s never happened again.For me, coming out from under anesthesia is a slow and gentle becoming aware of my surroundings—sounds first, before the ability to open my eyes. Then eyes need to close again…it’s like that. This is uncanny because we don’t usually wake up in hospital beds but, for me, by the time I can effectively move my body at all, I’ve had enough time to figure out where I am. So, it’s better than having jet lag from international travel, and waking up in a hotel room with no idea where TF you are for a full minute.The post op recovery area (PACU), where you’ll wake up, is another big room with all of your surgery friends whose names were being called that morning, before you went in. You’ll be awake but groggy before your proxy/friend/guard is called to visit you, bedside. Sometimes, the nursing staff will allow only a brief visit at first and then send your buddy out to wait again until you have more of your bearings back. Depending on what surgery you had, you will likely begin to feel some degree of pain while you are still in the post-op recovery room. The nurses there will help manage your pain as it develops, usually through your IV line. If you are scheduled for surgery with aftercare and a two night stay (for example) you’ll get wheeled to your room by an orderly when a bay becomes available.If your insurance code is for a 23 hour stay surgery, the idea is not to admit you to the hospital (a floor); you’ll stay overnight in a quieter corner of the recovery room and be discharged from there if everything goes fine. A complication will probably get you moved to a floor/admitted. If you’ve had day surgery, specifically, this is the graham cracker and apple juice room, baby. Here, the goal is to discharge you as soon as you can meet certain bench marks—usually you have to be able to talk, swallow—even if it’s just ice chips, walk without assistance unless you usually need assistance (like a cane, etc) and pee. These are all signals that you’re awake enough to understand and sign off on the post op directives they give you explaining which scrips you need to get filled and how to take care of the surgical site so that it doesn’t get infected and what symptoms to watch out for because it means you’re having a complication and need to come back into hospital.As mentioned before, different people come out from under anesthesia different ways; some people take longer. The person who has waited for you (and is responsible for getting you home and set up in your regular bed) will have been paged or otherwise fetched from the waiting room by this time and should be present to hear your post-op instructions about how to change the wound dressings, and get any phone numbers for emergency questions, visiting nurses, physical therapy, etc. It is really important that your friend listen closely, ask any questions and make any notes they need to at this time. It’s very possible that you won’t really remember it afterwards because of how anesthesia works on our memory.Usually, you’ll get dressed back into the comfy clothes you came in that morning. If the surgical site makes this impossible you may be the lucky winner of a free Johnnie and robe or paper trousers (like scrubs with a draw string). Your friend will drive you or accompany you on your way home with livery and will (hopefully) help set you up before leaving you alone. This means: picking up your prescriptions for you, feeding your hungry cat, minding your dressing/wound care, and making certain that you have what you need, within reach, at your bedside, such items as you may have brought home from the hospital like a walker, cane or crutches, bandages, your regular medicines, tv remote, etc.The exception to these options is more rare: if your surgery goes poorly or you were in critical care to begin with, you’ll be going to the ICU instead of a regular surgical floor. This is the area they try to keep super-sterile because there are a lot of really sick people inside. There are doctors around all the time. You will likely be poked and prodded more than really allowed to rest as they try different techniques to stabilize your condition.Another alternate outcome is a stint in rehab—either one that’s planned for before surgery or appears necessary after surgery. It’s a midway stop between the hospital where you had your surgery and wherever you call home. Rehab is still a hospital, but it’s not in the same building as where you had your surgery. It will have a less-critical level of care and usually the focus there is on therapies that will help you bridge the gap between your procedure and being able-bodied enough to be able to get up and use the toilet by yourself (for one example).A lot of the risk you undertake with surgery is not going to happen in the operating room, but from post-op complications. If you live alone and require more care than your proxy can offer (we all have jobs) then you MUST NOT leave that hospital without a plan in place for some level of in-home care. They *have to* hook you up with services. They cannot, in good faith, let you leave with no plan. No plan makes it reasonable to expect you will have to be readmitted after a few days of inadequate home care. Unless you fill and take your prescriptions appropriately and clean and monitor your wounds, can get around easily on your own, and have a relatively clean area with fresh laundry and linen…your chance of a fall is high, your chance of infection is high.A second hospital admission and possibly a second surgery is much more expensive than preventative care such as a visiting nurse who can help assess any reason to call the hospital : allergic reactions, infections, worsening of condition. You are entitled to care if you can not appropriately care for yourself after a surgery, have nobody who you can rely on to check in on you, and you are not yet ambulatory enough to visit a drop in clinic for services. Insist on securing aftercare before you go to surgery. What happens between your hospital discharge and your first scheduled post op visit with your doctor is a critical yet enormously under-rated part of the healing process—of which surgery is only the initial stage.