4:40AM Feb 23, 2021
Hey everybody. Welcome to our Homage Web Series. So today, we'll be talking about some tips on post surgery and post operative care at home. So today I'm very honoured to speak to Sally, Norsalawati actually. She's our Care Specialist based in Johor for our Homage Web Series and Sally has been a registered nurse for over 25 years right Sally?
So in both government and private and her experiences include working in all fields, medical, surgical, critical care and cardiothoracic care right. So, it's so good to have you on board Sally for your first Homage Web Series. So, so yeah let's move on to the first question that we have. What should I prepare at home before my loved ones or a senior comes back to the home after surgery?
Okay, first of all, thank you for inviting me. So, based on my experience, I believe that, you know, when it come to the preparation. You know, so it's not only after the operation but also before the operation. But again, the point or the tips that I'm going to share with you today, it will be like overlapping here and there. Because actually, if we can do it before, then the post will be very smoothly process. For me, I use 5 S.
Okay, the 5 S.
The first S is safe space.
Safe space okay.
Safe space or safe environment. Okay, means that the first S mean is, if for example previously before operation the elderly is staying in the room upstairs.
Please look for a, I mean a convenient room downstairs. Not- no need for the elderly to climb the stairs, you see. Yeah, so that is most important thing. And, of course, and try to clear the pathway means that there's adequate space in the room, because we need to assist him to, you know, or the elderly to wake up from the bed you see and using - walking slowly to, to encourage ambulation so we need a very spacey environment. So try to clear the pathway.
Clear the pathway. Okay.
Yeah, sempit you see. So for example like the pathway going to the bathroom, for example, you know. Try to clear and then try to make sure the floor is trip hazard. Trip hazard means that anything that can cause the elderly to trip. So, for example like carpet, you know that's not convenient for him, try to clean it away, put it away. And also most important is they need full things. For example, you have a bed and then beside the bed is all the needful things for - I mean it's reachable for him or for the, for the, for her, for the elderly. So you don't want them to move so much until you know they can - you know there's risk of fall there. This is the first S. The second S is suitable bed.
Suitable bed. Okay.
Yes. Okay. So, if we can afford. They can buy or prepare or rent, even rent, hospital bed. Because hospital bed it is, it's adjustable at the head and also at the leg.
So we can prop up the head, or we can bring down. Or we can prop up the leg. So it's very convenient. So -
How much do you think is a normal hospital bed like price range?
Usually, certain - my experience they go for the second hand, we can get below 1000 - 800 actually. Because once the, you know, there are a few secondhand that's still very good, actually. But again, if you think that you know the the care - the caregiver or the primary caregiver think that this is not important, maybe we can go for the standard bed. But again cannot be too high and cannot be too low, and please do not let them sleep on the mattress on the floor. Because it will difficult with the incision wound with the operation cound, they want to wake up from the, from the mattress on the floor it will is - they will be very painful, very difficult for the elderly. Okay, that is the second S. The third S is sanitise means clean environment. Okay, so due to ageing factor. So this elderly, their immune system is declined due to age you see. So they need a clean environment because we must remember they have a wound, wound. So we need to try not to expose the wound to any, you know, unclean environment. So make the environment must be clean and most important if you need to sanitise first, please sanitise before the elderly come back home. That is our third one. And the fourth one is the safety walking device.
Or safety working aids because a certain operation, the elderly may need us not only for us to hold them to assist them in their ambulation. Do the walking for example, but we want them to feel that okay, yeah, confident to walk on their own slowly in progress. So they might need a walking aid. So that's see the safety - safety walking devices that we can get for example like crutches, walking frame, the one that's suitable for them according to the operation.
I see. Okay.
Okay and last but not least is the surgery diet, our fifth S. So there are five S, last is surgery diet means, we know, after operation, there are certain- you know they won't have very good appetite, no appetite to eat. So we must prepare in advance, you know and think, maybe we can Google and see what is the food that can simulate their appetite, you see. So, of course when in the hospital, they'll be stuck with oral fluid first.
Okay, oral fluid.
Yeah, oral. Usually clear fluid - clear oral fluid first, and after a few days, once they already like the- I mean they're able to pass gas, you know, after the operation. They will start with the noursihing fluid and slowly with soft diet like porridge. But again, I don't think most of the elderly like soft diet you see so think of how to serve the diet that they like most. And most important is, it's suitable with their type of surgery.
That is the 5 S that I can, you know, that I can give as a tips.
Okay, so the first S is -
The first S is safe, safe space or safe environment, safe environment easy to remember. Second is suitable bed.
Suitable bed, okay.
Okay. Three is sanitise, clean environment, clean sanitise the room, make sure the room must be clean. Number four is safety walking device.
If required, according to their type of operation. And number five is surgery diet that's suitable to enhance back their appetite, you see, for teh elderly.
To all the viewers out there, there are 5 S. And, you know, Sally is also starting with an S. So it's very easy to remember. Okay, thank you, Sally.
Okay, welcome welcome.
So, for the second question I have, like, what are the kind of tips that you think will be very helpful for loved ones at home that are caring for seniors who just post surgery right or post operative care?
In our life, we cannot predict what will happen, you see. So again, one of the tips because when we call surgery, of course, there's- there must be an incision we call it an operation wound. There's no operation without any- either it's small or big. The incision wound or we call it the operation wound. So the wound management number one for me most important is how to manage the wound.
That's the most important thing.
Again, every day we must check for the wound. Any early signs of infection, that's the most important thing. So, as a family member, so we need to have a knowledge or if you need help, you can call the professional caregivers, you know to- to manage the wound. The part that, you know, the viewers that you think that you are unable to observe. For example, you don't have the knowledge how to know that this is infected - already infected. So you can engage professional caregivers to come in to manage, just for the wound.
So it's very important because we have to monitor the wound, every day.
Every day that means you must actually open and clean the wound everyday?
Yes, some - most of the operation, the doctors will suggest to open, open the wound and check for the progress, and after that proceed with that dressing. And of course, it should be, it must be a sterile dressing procedure. It's a sterile procedure with a sterile dressing set. All, everything - the gauze, the swab must be sterile. So only a professional caregiver or nurses only can perform that particular procedure.
Okay. I see.
To understand the sterile field, because this is the aseptic procedure, aseptic technique,
What is asceptic? What does it mean by aseptic?
Aseptic means a - from a septic. Septic means already accumulation of the microorganism. A means without. So without. Anything from aseptic means A means without any microorganism. We - we need to maintain the wound area from any microorganism, either bacteria or virus or fungus, or any parasite, for example like that. So, and when - when we're checking the wound, make sure there's no abnormal oozing. Means that sometimes there's excessive oozing so, and then got smell. Sometimes got faulty smell, maybe, and then excessive bleeding, and maybe it's like swelling so much. So, something's not right. And if you touch surrounding the area, it will feel that warm. The warmness will be there. So that is one of the signs of infection.
I see. Okay.
So, there's. When we do the I mean take temperature we can see that, you know, this elderly might have, you know, temperature, high temperature. So in medical term we call febrile you see, means that fever. If no fever, afebrile, for example. So they might have a temperature there but maybe not so high, but still there's a temperature so that is an early sign of infection. So this is everybody will - everyone that undergone operation will scared about infection so they're very scared about that. And please do not wet, because we're still in the topic of wound. Do not even wet the wound, the incision area. Yes, but usually the doctor will see okay for this because it's just the appendix wound for example so it's small. So, okay, so they will say okay respray of site there, you know. After three days or five days, you know you can bath, you can take a bath. But if big operation, a major operation usually they say okay don't wet the operation site, maybe after three to four weeks. But we can wipe the face, you know, make them more fresh you know comfortable at home. So, but try not - don't ever wet, don't ever wet the wound.
I see, okay.
It's the same - it's the first thing that we must remember, don't ever wet. But in case accidentally wet, so we have to really wipe it because we have to take out and make sure we have to do the dressing, you know according to the asceptic technique as what I say. Sterile, everything must be sterile and cover back to prevent any micro organism to accumulate at the wound area. And the most important, I notice that some of the elderly because they like to put ointment or minyak there, put ointment. Then, suddenly we see the wound become blackish colour, red colour so many thing colour. And then they put some lotion. Don't ever put that.
Don't put any sort of analgesic cream or like that is not prescribed by the doctor like -
Yes, the doctors won't ask to - I mean won't prescribe a topical, means the topical means application analgesic on the wound itself. So, until they come for the next one is, is when they come for the we call it a PCA or doctor's appointment for the wound inspection. Usually, the doctors will say okay. After seven day - seven days operation, you should come for the wound inspection, after the inspection the doctor checked the wound, the doctor feel satisfied, and the doctor said, okay now you can take your bath, you can wet your dressing or something like that. Or if the doctor already notice there's a sign of infection, the doctor might have to open back, you know, and take out all the maybe slough there, you know. And then maybe have to suture back so that's the thing that we try to avoid. Wound management is very, very important. Very, very important.
Besides wound management, what are the other tips that you can recommend?
Okay second is being once we bring our elderly - our loved one being - we bring back home, we need to promote the good circulation. And also to prevent the blood clot, especially for major operation, for example like laparotomy, you know. Major operation that - how we know it's major? Number one is the wound incision is big. Number - number two is take a very long hours, so when, when is take a very long hours the operation. So the blood clot formation will be there. This is one of the complications. So, if the doctor already prescribed in the hospital to wear a compression stockings. Sometimes people call it pressure stocking, some call compression stockings. Continue to wear the stocking at home. And then try to elevate - to elevate the leg.
Okay. How - how many times a day would you recommend to elevate the leg or -
Once the, I mean the elderly is resting or during the night. But again, during the night, don't need too long. Because when they - they turn their body it's. So, it's automatically that they won't be elevated anymore. And try, you know, because of course after, after the operation, some of our elderly will have this we call it a confusion post-surgery.
They have this you see, because of the anaesthesia, the side effect of the drugs to make them sleep. So we try to encourage them to ambulate, ambulate or we call it walking around. But again, we need to hold them either they are walking with walking aids as I told in the first question or we need to hold them, be beside them. And, you know, make them walk because we want to encourage smooth blood circulation, especially towards the in and out. The bllod circulation surrounding the wound area. That is most important. And some, you know, for walking for me - walking is one of the good thing that as exercise. Number two that some doctors, they will encourage us to for the elderly to buy the we call it, incentive spirometer. It's a - it's a. There's a 3 balls there. Then it's a some tools, you see. So, usually the elderly need to like suck them in. When they suck, the ball will go up. Then, there's a reading for it so maybe for today how many, you know, how many the ball can come up. So then from there, actually the. This incentive spirometer is to expand their lungs and loosen up the secretion because during the - any major operation, they are under general anaesthesia. So, that time their lungs are not functioning. The machine will take over. So there will be a lot of accumulation of secretion. So if we don't take out the secretion, it will become pneumonia. So, become pneumonia means infection of the lungs. Okay besides walking beside wearing compression stockings, besides elevate their legs, beside do the incentive spirometer. We can, I mean, encourage them to do coughing exercise because already do, once before after the spirometer, they do the exercise. Then after that, the ball will come out, so maybe we can do 10 times in every two hours. Then after that they will feel want to cough. The secretion, very big secretion will come up. So, ask them to cough up. But again, for example, if the wound is at the - our abdomine site or on the chest for example so it will be very painful to cough out. So, take a small pillow - a square pillow. Then, hold it on the chest or wherever the area of the wound. And then, and then cough.
Okay, but what if the wound is on the hip or, you know, near the - it can be anywhere, right. So, if -
The lower part, the lower limb, you need to - I mean you just hold.
Hold on the chest area. Okay, okay. I see.
Yes. Okay because we don't want like if it's the chest or the abdomen, of course when we cough, we are, you are using the diaphragm you know the chest muscle often also the abdomen muscle. They, they will feel pain. Okay?
Okay, okay. We move on to the third one is pain management.
Pain management. Okay.
So how do you care?
Pain management means that medication.
So medication in terms of what the doctor has prescribed?
Yes, correct. So means that without a good control of pain management. According to the doctor's prescription. Of course the elderly cannot do, I mean we cannot do dressing on the wound, because we just touch only they feel pain, you know. So, and also they cannot do exercise.
So, we need a very good pain management that means if the doctor already prescribed analgesic or maybe any painkillers. Sometimes they will give two types of painkiller. Please give it accordingly to the time and the dosage even. Because some of the elderly will say, oh, I don't feel pain I don't want. But actually they have to take it because once they feel pain when they want to wake up and do walk around, they feel pain. They will oh, I don't want to walk. I feel pain. So, pain if orally - the painkiller or anything analgesic for any type of analgesic must given at least three to four hours in advance, earlier before we want to do any dressing. And also before I want to do any exercise.
Because of course we want to cough for example but we don't have any painkiller. So that's why they will be reluctant to cough. I don't want to cough, it's very painful for me. So actually, why they - they didn't want to cough, they didn't want to - reluctant to do exercise, because they feel pain.That's why in the hospital, they have their own pain management team. So the same doctor will prescribe the, the suitable analgesic or painkiller according to the age of this patient. Not everybody can take because of the age. So according to the disease. If they have any heart disease, but they undergone an operation so there's certain painkiller that - that they cannot take. So they will have, there will be a special medication or painkiller for them.
I see. Okay. Okay. Great. Okay.
And maybe the last one is nutrition.
So number one just now wound management. After that, of course, exercise. And then pain management before want to do exercise before we want to do dressing, of course we have to give the painkiller first then we can proceed with this two. And of course to enhance the wound healing. So we need good nutrition.
I see. Okay.
That's very, very important. So sometimes, try to avoid any caffeine. Caffeine drink. Although I know that of course they love to take coffee.
Kopi O' is like a thing already. Yeah. So what would be a good substitute compared to Kopi O'?
Also for elderly they like - Pardon?
What would be a good substitute if that elderly take Kopi O' like everyday right? So what will be a good substitute then?
Even actually even tea also they have caffeine. But again, it's not easy for us to recommend like, you know, some nutrition drink like you know something like milk you know. It's not easy but I think with their understanding we tell them that this is not good for you during your recovery phase, I think, I think they will follow if they are, I mean they know it much, much earlier before the operation. You know they will understand rather than after they come back only you say okay, you cannot take this, you cannot take that. So before also is very important. And if they don't have any appetite, you know, let them eat small portion of meal, but frequent. And if still no appetite maybe you can, you know, in between you can introduce biscuit that they like or fruits. Most of them, because after the operation they will be having some sore throat, difficult to swallow then we can, you know something that they like like any juice, you know, or, or any foods that's soft fruits that they can swallow. So that is my tips for the post-operation care.
Okay, thank you so much. So, I think that was 5 points also right? Or 4 points? 4 points yeah.
4 points. Actually 5 points. Number one is wound management. After that, is exercise -
To promote blood circulation, and then pain management. To get these two, I mean to check the wound, to do the dressing and to do - for them to do exercise, the pain management very important. So when pain management is, we put it under medication.
And also, nutrition. 4.
Great. So, what would you say to someone who is right now, caring for a family member, what would you say to them?
I believe from my experience, from my observation. I can see that at the early part pre, you know, before operation. They already, mentally, make them ready, you know, be be be with them understand their needs. So, I think during - once you bring them home, or you know when once you want to take care of them, it will be a very smooth journey. So for me, I guess are three - four things actually again four things that - four points that I can share. Number one is mentally supportive. So we, as family members or the one that's next-of-kin, you know, because, because this is our loved one of course we want them to have a very smooth journey for recovery. So what's the meaning of mentally, we need to mentally supportive of them means that from the early beginning means that as what I inform earlier. I mean, meeting the doctor, make the appointment for the surgery
To be there with them for the rest - for most of the stages, every stage -
Yes, until hospital, until you know discharge, you need to be there to give them moral support. That's most, most important and then type, try - if - encourage them to ask more question if they don't understand. And usually the earlier part if they don't understand sometimes they are just looking at us, you know, we understand but they don't understand what the doctor say. Why don't we go back and we try to draw. Okay. The doctor will do like this, after the operation you will become like this. Okay, you will come up with what, you will - there will be a wound in the area. There will be a line here, we call it the central line on your neck. So many wires there so don't be panic. So sometimes when they realise they open your eyes, they see where am I? Am I in heaven or what? You know, some of the elderly they say like that. We already, we call it a talk - we give them reassurance that once you open your eyes, it's mean your surgery is successful. That is very, very important. If not they will be aggressive.
So to prepare them before the surgery even started right?
Yes, very important. I mean the mentally supportive. We support that they are mentally so because if not they are feel like okay, I'm doing this because you want it, because my children want it, not because they want it you see.
What are the other points that you would probably want to share also?
Besides, mentally, of course, physically. You need to support them physically. means that besides just being with them to show that you are there, you need to. I mean, when you're talking to them, make eye contact, hold their hand, show that you care for them. And means that once it's successful, the first thing they open their eyes they want to see you next to them, you see, so be there. Always be there for them that is the - for me, I call it, it's a -
Yes, it's mentally supportive, emotionally supportive and, you know, always hold their hand and then be there, don't worry I'm here for you know, don't worry I will be here. And number three is, of course, physical. Physical means not only be there and just observe them but assist them in their recovery process. Assist them, hold them. Assist them in, in the all the tips that I've given. In their wound management, in their in the exercise, in their, you know, to make sure they're not in pain. And last but not least for me. After all this, that there's certain part that, you know, I think the viewer will feel that they are not very expertise or not very expertise in certain parts. So why don't you all consider to, you know, to engage the professional caregiver or professional support in this. Not the whole part, because, again, we want you to be there, emotionally, physically, and also, you know, mentally to be there. But also everyday that everytime you want to be there besides your loved one. There are certain times that you, you need to fulfil your, you know, you need to go to work, to look into your business or you know. That is why you need to bring the professional caregivers in certain, certain procedure or certain task that is not manageable by you.
To get respite la yeah, especially when you're juggling so many things in life then it's important to take time off and let someone help also.
Yes. Because there's certain things that we feel at the end we feel like oh, I feel burnt out already, you see. Because you need to be - I mean the whole thing mentally, physically, you know all your energy, and then also you need to - to prepare the food in order to make sure that the environment must be clean so you know there's a certain part you know that you know, we can engage the professional caregiver.
Okay. Thank you, Sally for sharing. I think it is very educational and very timely as well when we talk about post-operative care because there are a lot of families out there who even through COVID-19 and the pandemic are caring for their family members at home because you know they might not want to stay in a hospital for too long. So, yeah, so thank you Sally for your time, and just want to put out a disclaimer there that this health information is provided for general informational purposes so it is not a substitute for professional health advice so if you need medical attention or you need to seek out just advice, do go to the nearest institution or get assistance from your relevant doctors. So, yeah. Thank you, Sally for your time.
It's been a great time just learning and gleaning from you. So see you and have a good night.
Okay. See you. See you again. Bye bye.