Caring for a patient after surgery is serious business, regardless of the type of procedure. It is important to follow all of the instructions provided by the patient’s healthcare team. This guide can help parents prepare for what to expect after surgery and should never replace the patient’s physician’s at-home care instructions.
Once a patient is stabilized after surgery he or she will be released to go home or will be transferred to an inpatient room.Patients heading home will be provided a discharge plan. Discharge plans are tailored to each patient depending upon his or her age, condition, medical history and procedure. This plan may include instructions on how to take care of the wound dressings, what medications to take, what your child should and should not eat that day; what activities the child may participate in over the next few days, weeks, or months; and signs that you should call your child’s doctor.
It is very important that caregivers follow all of the discharge instructions exactly as they are written, even if the patient appears to be feeling better or seems ready to return to normal activities. Patients should take all medications exactly as ordered by the doctor. All pain medications should be taken with food as they may make the child nauseous if taken on an empty stomach. Other medications, like antibiotics, may have their own dosing instructions. The patient’s nurse or pharmacist can explain how to take the medications and for how long.
Before taking a child home, caregivers should be very clear on the child’s limitations and whether or not the child will need special care, assistance, or equipment following surgery. Below are questions caregivers should keep in mind as they plan how they will care for a child after surgery. Most, if not all, of these questions will be answered by the nurse when the child is discharged from the hospital. Caregivers can also bring these questions to the child’s last doctor’s appointment prior to surgery to get some of the answers ahead of time.
- What are the warning signs that we should contact a nurse or doctor after surgery?
- How long should the child stay in bed after surgery? How often should I get my child out of bed to move around?
- How frequently should my child be urinating?
- How soon before the child can resume his or her normal activities like school, sports, daycare, etc.?
- What are special instructions regarding care of the surgical site?
- How long might the child be in pain?
- What medications can I give the child for pain? How much and how often?
- Do I need special equipment, bandages, supplies or medications for the child after surgery? If so, where can these items be purchased or rented? How long will the child need these items?
- When should we schedule a follow-up visit after surgery?
Download and print the discharge questions worksheet that can be filled out while speaking with the patient’s nurse or doctor.
Whether the patient is sent home from the hospital or to one of the inpatient units, caregivers will be provided with all of the information necessary to care for the child at home. Caregivers will receive a phone call from a CHOC nurse within 72 hours of the patient’s discharge from the hospital. During this call, our nurse will ask about how the child is feeling and be able to answer any questions about the discharge instructions.
Discomfort After Surgery
During the first 24 hours after surgery, patients may have some or all of the following symptoms:
- appear flushed, irritable or fussy
- poor reflexes or coordination
- nausea and vomiting (from general anesthesia)
- soreness in the throat (if the patient had artificial ventilation to assist with breathing during surgery)
- soreness and swelling around the incision site
- restlessness and sleeplessness
- constipation and flatulence (gas)
Complications After Surgery
Watch for and report these complications to the patient’s surgeon:
- Fever over 101 degrees. This temperature should be taken by mouth or by rectum in infants.
- Persistent nausea and vomiting.
- Pain not relieved by the medication recommended or prescribed by the child’s surgeon.
- Numbness, tingling or cold fingers or toes.
- Inability to urinate within six hours of the end of surgery.
- Increased redness, warmth or hardness around the operative area.
- Increasing and progressive drainage from the surgical area.
- Blood-soaked dressing on or around the surgical site. It is normal for there to be small amounts of oozing on the bandages.
- Excessive swelling around the surgical area.
- Odor coming from the surgical site
- Any new or unusual symptoms. Caregivers are the child’s best expert. If the child’s behavior or symptoms become worrisome, it is best to let the surgeon know.
If you are unable to reach the child’s physician, please go to the nearest emergency room. In life threatening situations, call 911.
Misplaced your child’s surgeon’s phone number?
Search for the surgeon’s contact information in our CHOC Docs directory.
Pain After Surgery
After a surgery or procedure, there may be physical causes of pain, but the sensation of pain also depends on complex mental and emotional factors. Determining the level of pain a child is experiencing can be very challenging, especially if the child is very young or has delayed verbal skills. The surgical team may use a scale of 0 to 10 or illustrations of faces to help describe pain. Our doctors and nurses can typically determine what is usual discomfort for a certain operation and give the prescribed medication; however, we know that the best expert on a child is the parent or guardian. If the patient is unusually agitated or withdrawn, caregivers should let us know so we can assess the effectiveness of the prescribed medication.
The child’s surgeon will discuss the need for medications at home before and after surgery. If the patient will require opioid pain-relief medication, caregivers will be given these prescriptions before the patient is discharged to go home. Over the counter medications, like acetaminophen (Tylenol) and ibuprofen (Advil) may be recommended, instead of prescriptions pain medicines. The surgeon will provide information on the correct dosage. Surgery patients should never take aspirin.
When taking pain medication, patients may experience dizziness or drowsiness. Pain medications can also cause constipation. We recommend that patients increase the fluids (especially water) and fiber in their diets. Some physicians may also recommend the child take a stool softener. Adolescent and young adult patients should not drive or consume alcohol while on pain medications.
Taking Care of the Surgical Site
It is natural to feel nervous about caring for a patient’s surgical wound. At the time of discharge, a nurse will provide instructions on how to care for any drains and/or bandages. These instructions will also be available in the patient’s discharge plans.
In general, caregivers should always:
- Keep bandages dry and intact. The patient should not bathe until it is safe to do so according to the nurse or surgeon. Caregivers may be able to sponge bathe the patients, avoiding the bandages and surgical site, as recommended by the nurse or surgeon. If the tape on the bandages become loose, they may be trimmed. If the child appears to be feeling better, the patient must still wait to bathe or shower until the time and date set by the surgeon or nurse. Bathing too soon can cause the surgical site to become infected and may require an unnecessary visit to the doctor to reapply the dressing or bandage and even an extra surgery if the site becomes infected.
- Once the patient’s nurse or surgeon has said that it is safe to bathe or shower, the bandages can be removed but skin tape should be left on and gently patted dry afterward.
- The child’s surgeon may recommend applying ice to the surgery site. Caregivers should refer to the patient’s discharge plan for more information.
- In some cases, the surgeon may request that the surgical site be elevated above the heart in order to reduce pain and swelling. Caregivers should refer to the patient’s discharge plan for more information.