by Professor Lynn Basford
Hysterectomy – The PRAM Model
RECOVERY PHASE – FIRST 24 HOURS
Your Hysterectomy has just been performed and you are in the post operative recovery room awaiting transfer back onto the ward. The expert and highly trained team will have monitored you thus far, but before they can hand over to the ward staff there are some checks that they must ascertain before you can be transferred back to the ward. These will include:
- That you are fully conscious and able to maintain a clear airway (breathing)
- That the rate of your breathing is within normal limits and your oxygenation levels are satisfactory. If needed oxygenation therapy will be prescribed.
- Your heart rate, pulse and BP are stable. (indicative of your own normal parameters)
- No indication of post operative bleeding.
- Your pain should be under control and any nausea/vomiting that may result is treated accordingly.
- Your temperature should be within acceptable limits and on no account would you be returned to the ward if you were HYPOTHERMIC.
- Your intravenous therapy will have been assessed and your cannula (a thin tube inserted into a vein or body cavity to administer medication, drain off fluid, or insert a surgical instrument) should not be blocked and functioning normally.
- Any drains and catheters will be checked to ensure they are not blocked.
- Finally, your health records will be updated to include everything that has happened to you, drugs and other therapies given and your post anaesthetic recovery to date.
When all these areas have been checked and documented you can be safe in the knowledge that everything is as it should be prior to you going back to the ward.1
Transfer to the Ward
It is normal practice, although it can vary from hospital to hospital, that transfer from the post theatre recovery room is by two members of staff, one of whom will be fully trained.
There will be a detailed verbal and written account passed onto the the trained member of staff including, anaesthetic record, prescription chart and any other instruction either from the anaesthetist or surgical consultant regarding any issues of concern, infusions and/or pain management.
NB: The check list identified above promotes good safe standards that should be adhered to. Once the check list is complete the receiving member of staff should then sign the handover chart.
On return to the ward, you will be made as comfortable as possible and your post operative observations will commence.
Chiefly, this will include monitoring of your vital signs, wound (if applicable), vaginal bleeding, oxygen levels, pain, IV infusions, catheter (urinary output) and drains.
Depending on the need for hysterectomy and your physical health prior to surgery, you may find that once the health team feel you have made a stable recovery your IV infusion will be removed within a few hours.
For others there there may be a need to maintain the infusion both to re-establish fluid balance and the ability to administer intravenous drugs safely and speedily. You may also need an IV if you are being administered a blood transfusion.
If awake you will be given the opportunity to wash, freshen up and get into your own night clothes under the assistance of the nurse. Feeling good already!
Depending on the Health Professional team’s instructions you may be offered water to drink (very important to maintain hydration) and some light food.
More often most people like to sleep a while and accustom themselves to the reality of what has just happened to them. AND, don’t be surprised if you have mood swings from euphoria that it is all over to feelings of sadness/ tearfulness. This is normal!
Remember, that your recovery commences on day one, don’t forget to do your; i) breathing exercises and ii) drink plenty of water (not only are these elements good for you the deep breathing will enable you to have a speedy recovery).
i) How to do deep breathing after Hysterectomy Surgery?
Regardless of which type of hysterectomy you have had there will be an element of soreness, pain and discomfort. While you might just want to lie there it is important to take an active role in your recovery.
One way is to perform deep breathing exercises. This activity will keep your lungs inflated, your body suitably oxygenated, manage pain and discomfort, prevent lung infections and will further reduce any anaesthetic gases that usually take between 9-16 hours to leave your system.² You may need to modify what you did as part of your preparation phase, but if you did do deep breathing techniques you will now be at an advantage to promote your speedy recovery.
When you feel able, (and your nurse may help you):
- sit upright , (ask the nurse to raise your bed high, unless there are complications that don’t allow this) , or, if possible, hang your legs over the side of the bed.
- If you have had an abdominal incision, or if you feel tender in the lower regions you might want to hold a pillow as tightly as you can without causing distress or pain.
- breathe normally in and out through your nostrils (not mouth) and when comfortable, take a deep slow breath in counting to five, pause, then gently breath out through your nostrils for the count of five (or until you have expelled your breath) and pause.
- You will note that there are four stages to the breath: In, pause, out, pause. So often we forget there is a natural pause between the In and Out breathe.
- Repeat 10-15 times or until you feel you have done enough. (your nurse may guide you here as we are all individual).
- When awake repeat this process once every hour,
- NB. ALWAYS TAKE COUNCIL FROM YOUR HEALTH PROFESSIONAL TEAM.
ii) Intake of Fluids
If your situation is uncomplicated, your intravenous infusion will be removed and you will be encouraged to drink water.
In the beginning your fluid balance ( intake and output ) will be monitored. This is a standard procedure that checks the fluid in through the mouth ( or intra venously), and what you pass through your urine ( if you do have a bowel movement this will also be recorded, but not a usual function within 24 hours).
The chief purpose is to ensure you are not dehydrated as this can lead to complications and slow your recovery.
Pain and discomfort is a variable issue and greatly depends on the individual. You will be given suitable analgesics ( painkillers) to reduce your pain and discomfort.
Reduced pain also means you become mobile quicker and that will reduce the risk of any deep vein thrombosis, and chest infections.
The analgesic given may be oral, by injections or via the IV infusion if it is still in situ.
Any distress you may have through nausea and vomiting will be observed and managed by the attending nurse and suitable drugs given to minimise/relieve these symptoms.
It is standard practice that after your hysterectomy you will have a urinary catheter in situ. This is to enable you to pass urine satisfactory, and to ensure that no damage occurred during surgery.
Depending on the nature of your surgery, this can be removed in one or two days or after seven days if there is satisfactory urinary out put that is free from any abnormalities, in particularly, blood.
If you have had abdominal hysterectomy you may also have a wound drain. This is a drain that leads from the wound area whose purpose is specifically to drain any collection of blood away from the wound. If deemed satisfactory by the team this can be removed in the next one or two days.
Abdominal wounds will have a dressing in place that will be checked regularly for any undue bleeding.
If you have had a vaginal hysterectomy you may have a gauze pack inserted into the vaginal vault to minimise the risk of further bleeding. Often this is removed the next day.
NB: Some women find this uncomfortable and feel as if they want to empty their bowels. All Normal Feelings!
The morning after surgery (if your condition allows) you will be encouraged to take a walk around supported by a nurse.
This is part of the assessment re your ability to go home, but more importantly to encourage a positive circulation to reduce the risk of a deep vein thrombosis (blood clot) forming and prevent chest infections.
You may also be asked to restart your pelvic floor exercises although in a limited fashion – this will be after your urinary catheter has been removed.
Your beautiful compression stockings will be encouraged to be worn for a little longer! It does vary between different hospitals.
Early discharge from hospitals has become the norm these days but you should not underestimate what has happened to you.
Discharge home will depend on the nature of your hysterectomy, the type of hysterectomy and your recovery to date.
It is normal that you will spend a few nights, so relax and begin your TOTAL RECOVERY. Your team will have endeavoured to ensure you have had a reasonable night’s sleep.
For more information on types of hysterectomy and on preparing for hysterectomy see our PRAM Preparing for hysterectomy pages or click on the link below:
The Association of Anaesthetic of Great Britain and Ireland (2002) Immediate Post Operative Recovery.
Dr. Rubenstein-(2014),https://www.healthtap.com/topics/how-long-after-general-anesthesia-is-it-completely-out-of-your-system. 17/07/14.