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The tips described here emphasize key points to increase the patient's optimum healing, comfort, and safety after plastic surgery. It is a general guide to enhance your practice's individual patient guidelines for post-operative recovery and is certainly not inclusive of all that needs to be taught pre-operatively.
The following 10 areas can assist your patients in decreasing their recovery time.
1. Smokers: Smokers should not smoke before surgery and for at least 2 weeks after. Smoking decreases the body's ability to heal because it reduces blood flow and therefore oxygen to the tissues. It also injures fibroblasts, which are critical for tissue repair. Smoking even one cigarette causes vasoconstriction for up to 90 minutes. Wound infection rates drop significantly and scar formation is less when smoking is ceased.
2. Caregiver: Who will be there with the patient to drive him or her home; and also to help the patient at home? The patient should not be alone for 48 to 72 hr post-operatively, and should not drive until cleared by the physician. This is not only important for the healing process but also vital to safety: anesthesia takes several hours or longer to be fully out of the system, and pain medications affect driving ability as well.
3. Nutrition: Shop before the surgery, not on the way home as an afterthought. Have plenty of liquid in hand: decaffeinated liquid is the best. It is important to drink plenty of water and other liquid to stay hydrated, increase healing, and decrease complications. A soft diet to start with is usually suggested: pudding, soup, custards, and hot cereals are nice; toast, crackers, bagels, etc. for nausea. Make sure to take pain medications with food to prevent nausea!! "Sandwiching" a pain medication between foods is better than taking it first and then eating. Choose foods wisely, foods that are high in wound healing properties: protein, foods rich in Vitamins A and C, especially as the diet is increased. Vitamin C sources include citrus fruits, strawberries, cantaloupe, kiwi, tomatoes, potatoes, and dark green leafy vegetables. Vitamin A sources include deep orange vegetables, such as carrots, squash, and sweet potatoes, and dark green vegetables (such as spinach), apricots, and egg yolks. There are other food sources for Vitamins A and C but less gas-producing foods are listed here. For patients with diabetes, it is critical to have excellent glycemic control both pre-operatively and post-operatively. Hyperglycemia decreases wound healing significantly.
4. Sleep: Sleep is important for recovery!! Have a plan for the care of the children. If possible, the patient should make arrangements for children to be away for at least for the first few days. Rest and quiet go a long way in the recovery process. This is a time to be pampered, not to do housework or laundry. Taking pain medication before bedtime can assist in more restful sleep. Eating a light snack (e.g., peanut butter and crackers) before bedtime maintains blood sugar level during the night and also aids in sound sleep.
5. Comfortable clothes: Patients need to be dressed comfortably and warmly when they leave for surgery. Surgical suites tend to be cool. Buttoned-down shirts are suggested. A good tip: Make sure to have several comfortable outfits within easy reach at home so as not to stretch. Do laundry before surgery!!
6. Prescriptions: Antibiotics should be taken for the full days prescribed. Get all prescriptions filled before surgery, so as not to stop at a pharmacy on the way home after surgery.
7. Pain relief: Some patients may be reluctant to take pain medicines. For the first few days, it is okay to take them every 4 hr, or as prescribed. Designate significant other, friend, or whoever is the caregiver to give pain medicines for the first few days to time them correctly. Staying "on top" of the pain keeps the edge off the discomfort and helps in healing. Again, take care not to take medicines on an empty stomach. Nausea is an enemy, especially in plastic surgery!! After a few days, extra strength acetaminophen (Tylenol) may be sufficient for discomfort.
8. Make a cozy sanctuary before surgery. Have a place set up on the couch with plenty of pillows and everything within reach (TV remote, drink, telephone, etc.) Pillows provide comfort, decrease movement, and provide elevation to decrease swelling. Be prepared with ice packs in freezer (the standard bag of peas works fine).
9. Preventing infection: Avoid persons who are ill with colds and flu both before surgery and post-operatively, and call the office if sick even with a cold pre-operatively. Simple hand washing before and after changing dressings is important post-operatively to prevent the spread of bacteria from wounds. Washing hands for the count of 20 seconds (singing ABCs is the equivalent). Watch for redness, foul drainage, increase in pain, fever, or chills. Call office immediately.Take no aspirin or nonsteroidal anti-inflammatory products. These may increase bleeding. Avoid them for 2 weeks before and after surgery. This is also important to decrease hematoma formation post-operatively. Herbal products may cause side effects and should be held.
* Ginkgo biloba is a powerful anticoagulant considered being three times stronger than Vitamin E.
* Ginger, garlic, cayenne, and bilberry have antiplatelet activity and may inhibit clot formation.
* John's wort, yohimbe, and licorice root have a mild monoamine oxidase inhibitory effect and may intensify potency of anesthesia.
* Ginseng is associated with hypertension, tachycardia.
* Melatonin decreases amount of anesthesia needed.
* Echinacea may affect the liver when general anesthesia is used. Table 1 contains a list of medication to avoid, but is not inclusive. Many over-the-counter medicines contain salicylate and include trolamine salicylate topical creams such as BenGay or Aspercreme.
Baugh, N., Zuelzer, H., Meador, J., & Blankenship, J. (2007, June). Wounds in surgical patients who are obese. AJN, American Journal of Nursing, 107(6), 40-50.
Conkling, W., & Wong, D. Y. (2006). The complete guide to vitamins, herbs and supplements: The holistic path to good health. New York: Avon Books.
Paryski, P. P. (2003, June). The negative effects of smoking on bones, joints and healing. Retrieved November 26, 2007, from http://www.healthandage.com/public/health-center/35/article/1230/The-Negative-Ef
Smith, J., & Smith, S. B. (2007, January). Cutaneous manifestations of smoking. eMedicine. Retrieved November 26, 2007, from http://www.emedicine.com
Tebbetts, J. B., & Tebbetts, T. (1999). The best breast: The ultimate discriminating woman's guide to breast augmentation. Dallas, TX: CosmetXpertise.
University of California, Riverside. (2004, December). Cigarette smoke a culprit in poor healing and increased scarring. ScienceDaily. Retrieved November 26, 2007, from http://www.sciencedaily.com
The Patient Education department provides readers with practical ideas and solutions to all phases of patient education. Our intent is to offer nurses materials that they can use with their patients. Feel free to apply the materials in the Patient Education department to patients in your practice.
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