What to Expect after your Whipple Surgery
This packet will help you learn what to expect during your hospital stay when you come to F4/6. Read this ahead of time so you are prepared to learn what you need to do as a patient to move forward in your hospital stay and for your discharge. You may want to review this packet a few times.
The General Surgery Unit
Right after your surgery, you will go to the recovery room. Once your pain is under control and you are awake, you will be moved to F4/6. Here you will meet your nurse and nursing assistant (NA) and get settled in. Your family and friends are welcome to visit you in the room.
When you arrive, the nurse and NA will take your vital signs (blood pressure, temperature, oxygen levels, heart rate, and breathing rate). You may also have a sticker around one of your fingers or toes that is attached to a small machine to keep a constant reading of your oxygen level and heart rate. These vital signs will be taken often during the first few hours after you arrive in your room; then every 4 hours, even through the night. The nurse will listen to your heart, lungs, and abdomen, look at your incision, and ask about your pain level.
Another part of the process is a set of admission questions that you will be asked. It may be helpful to have a family member around who can also help answer questions, if you prefer. A nurse may have called you at home ahead of time to ask these questions. If that is the case, you will not need to answer them again.
The standard length of stay, without complications, is 4-6 days. We will work with you to help you meet all of your goals in order for you to go home in that time frame.
If at any point during your stay, your health care team feels that you need more intense care or treatment, you may be transferred to an ICU (Intensive Care Unit). Here the nurses and doctors will be able to keep a closer eye on you and give certain treatments if needed.
In the Hospital
You will have a private room with a private bathroom and shower. This is not an extra charge. You can adjust the temperature to your liking in the room as well. Your family and friends are welcome to visit you during your stay. If you’d like to learn more about visiting, as your nurse for the handout: Guidelines for Primary Supports and Visitors.
We provide hospital gowns for you during your stay, which we will ask you to wear. You will be given a new gown each day or at your request. If it is more comfortable for you, you may bring in loose fitting clothing from home and/or a bathrobe. Be aware that these may get dirty while you are in the hospital. We ask that when you are out of bed, you have something on your feet to prevent falls. We provide you with non-slip socks to wear when out of bed. You may bring in shoes or slippers if you prefer.
Your sheets and linens will be changed daily. We also provide you with soap, toothbrushes, toothpaste, shampoo, razors and shaving cream, deodorant and lotion, washcloths and towels. If you prefer to bring in your own items from home you may. You should try to do as much of your own hygiene as you are able. We will expect that you brush your teeth or do basic oral care at least twice daily. Hygiene is the best way to prevent infection and will become a part of your daily routine while you’re here. You may plan a time with the NA to help you with your bathing and oral care. Ask your nurse when you can shower. This will depend on what kind of wound you have and how many days it has been since surgery. You will not be able to take a tub bath or soak under water for at least two (2) weeks after surgery. Before you go home, you will be doing your daily cares on your own, or at the level you were able to before surgery.
Feel free to bring items from home that may make your stay here more comfortable but leave valuable items at home.
The Health Care Team
During your stay, your health care team will create a plan for you which we will update and change as needed. You are a vital member of the team. Input from you and your family is greatly considered in making your care plan. We know that your stay, even one that has been planned, can be stressful. Feel free to talk about any questions or concerns with any member of your health care team. Our goal is to help you get better and to be able to care for yourself at home.
Listed below are some of the team members you may meet.
- The Attending Surgeon is the doctor who directs all of your medical care.
- The Resident and Intern are doctors who work very closely with your attending surgeon and you. You can expect visits from your doctors each day to assess your progress. It is hard to predict when your doctors will visit and visits are often brief. Try to write down your questions to ask the doctors or let your nurse know so they may be answered.
- Medical Students are students who assist the doctors with your care as well as learn from you as a patient. These students may come to see you a number of times a day with or without the resident doctors.
- The Registered Nurse (RN) is the nurse you will see each shift. The nurse will assess your pain, incision, and other symptoms; give medicines; and create and follow your plan of care. The nurse will also teach you about your care plan and provide updates. The nursing staff will have the most contact with you during your stay and can help you in many ways. Feel free to ask the nurses any questions you may have. They are a great resource to you during your stay.
- The Nursing Assistant (NA) works with your RN to assist with your cares such as walking, using the bathroom, and bathing.
You can expect to be assigned 2-3 RNs and NAs in a 24 hour day. They will check on you about every hour during the day and every 2 hours at night. Use the white call light by your bed to let us know any other needs, questions, or concerns you may have.
- The Pharmacist will review the medicines that you take at home and teach you about any new medicines before you are sent home.
- The Case Management Staff is a team which consists of a Nurse Case Manager and a Social Worker. One of them will meet with you during your stay to help arrange the safest discharge plan for you. This plan may include getting special equipment, home health care, or arrange placement at a skilled nursing facility if needed.
- The Physical and Occupational Therapists will help you to become more mobile and help you to be safe and strong at home. Your doctor will decide if you need to see this team.
- The Registered Dietitian will meet with you to discuss your diet for home. This includes teaching you about foods that you will be able to eat and ones that you should avoid.
Primary Nurse
Most of the time, the nurse who admits you becomes your primary nurse. Your primary nurse is assigned to take care of you when he or she is working. This allows for one nurse to get to know you and your family; help devise a plan of care in the hospital; and manage your plan for discharge. All of the nursing staff can and will take very good care of you when your primary nurse is not working. We make every effort to keep the same nurses involved with your care.
Pain Medicine
You cannot expect to be completely pain free, but you should be comfortable enough to complete these main goals:
- Get some sleep.
- Do your deep breathing and coughing exercises.
- Get out of bed and either sit in the chair or walk in the hallways.
- Eat (when you are allowed).
You will likely meet with anesthesia doctors in the clinic before surgery to discuss your pain medicine options. There are three main ways that pain is treated after surgery, an Epidural (PCEA), a PCA, and pain pills.
- Epidural or PCEA (patient controlled epidural analgesia) – An epidural is placed right before surgery starts. A very small catheter is placed in your back (between your vertebrae or back bones) and will give you medicine at a constant rate to block the pain and numb the area around your wound. Often you can also give yourself more pain medicine through your epidural by pushing a button. This button helps to control your pain and cannot be overused. The machine will not let you. Anesthesia doctors will see you every day and check the medicine in the epidural to make sure it is working as it should. If your pain is still not in control, the anesthesia doctors will discuss ways to improve it. For the first 24 hours after you receive your epidural, the nurses will check on you every hour (even through the night). You will also have a urine catheter (Foley) until the epidural is removed.
- PCA (Patient Controlled Analgesia) – This type of pain medicine may also be called a “pain button.” This is a machine that contains pain medicine and a button to allow you to control how often you receive pain medicine. The machine will be programmed to allow only a certain amount that can be given in preset time frames. Your nurse will discuss this with you.
Neither the PCA nor Epidural (PCEA) machines will allow you to take too much pain medicine. Remember that you, the patient, are in charge of pushing the button. Family and friends should not push the button. This is for your safety and to prevent you from getting more than you really need.
- Pain Pills – Once you are able to eat or drink a liquid diet you may be offered pain pills instead of your epidural or PCA. We will talk to you about this when the time comes. Pain pills do not act the same as epidurals and PCAs. Most of the time they are given “as needed” so you must ask the nurse for pain pills when you want them. Also, the pain pills take about 30 minutes to start working, instead of within minutes like the epidural or PCA. The good news is that pain pills work for a longer time. Also, when your pain is controlled with pain pills you are one step closer to getting home! Before going home, your pain must be controlled with pain pills.
Let your doctors and nurses know soon if your pain is not being controlled. If your pain gets out of control, it can be much harder to get pain relief. Also, know that there are many types of medicine that can help get your pain under control. If one doesn’t work there are others to try. Remember, you are the only one who knows your level of pain. We will ask you often to rate your pain on the pain scale
Medicines
A pharmacist will visit with you to confirm the medicines you take at home. Nurses will give you medicines throughout the day. At first, many of them will be in a liquid form that will go through an intravenous catheter (IV) into your vein. Some of the doses you take at home in a pill form may be changed to the same dosage in the IV form. Once your bowels start to work, they will be changed to pills again.
You will likely get medicines in the hospital that you may or may not take at home.
- Anti-acids help reduce the amount of acid made in your stomach to prevent stomach irritation that can cause ulcers or heartburn. Common types are Zantac® (ranitidine) or Protonix® (pantoprazole).
- Stool softeners help prevent constipation caused by pain medicines.
- Heparin prevents blood clots from forming in your legs and traveling to your heart or lungs or brain. Heparin is given as an injection (shot) either in the back of the arm or in the belly 2 to 3 times a day.
Let your nurse or doctor know if you have any questions about the medicines you are taking.
Diet
After surgery, you will be given IV fluids to keep you hydrated. To keep your mouth moist, you can use swabs dipped in ice chips and water. After surgery, nurses and doctors will listen for sounds from your abdomen, ask if you are passing gas or stool, have any nausea or vomiting, and ask how your appetite is. All of this helps the health care team know if the bowel is starting to work or “wake up.”
You can expect that your bowel function will not return for a couple of days after surgery. The time it takes for the bowel to start working again varies and may take from 2 or 3 days to a week.
As you and the health care team feel comfortable, you will be allowed to eat. Starting slowly with clear liquids (juice, Jello, broth, popsicles, etc), you will then move to full liquids (milk, ice cream, pudding, creamed soups, etc), and then to “real food.”
When you start eating, go slowly and only eat what feels good and tastes good. If you begin to feel sick to your stomach or full, you should stop eating. A member from the health care team will let you know when your diet has been changed.
We have a “room service” option that allows you to order food for yourself that will be delivered at any time between 6:30am and 9:00pm. You can talk with your nurse about whether you would like to use room service or have a tray made and delivered for you at a set time each day. Let your nurse know if you have any questions about diet or how to order.
A dietitian will visit you before you go home to teach you about the diet you should follow at home. They can answer any special questions you may have about certain types of food or restrictions.
Before you leave you should be able to eat normal foods.
Blood Sugar Checks
Your pancreas makes insulin and controls your blood sugar. Because of the stress of the surgery and the fact that part of your pancreas was removed, your blood sugar will most likely be higher. As a result, we will check your blood sugar. While you are not eating or drinking, we will check your blood sugar every 6 hours. Once you begin to eat and drink, your blood sugar will be checked before meals and before bedtime.
If your blood sugar is quite high, or if you had diabetes before surgery, an insulin drip (IV medicine) may be started to better control your blood sugar. While an insulin drip is running, blood sugar is checked every one to two hours.
Blood sugar is checked by poking your finger with a small lancet. A small amount of blood is then placed on a strip in a machine that measures the amount of glucose (or sugar) in your blood.
If your blood sugar is high (greater than 150), we will need to inject you with insulin (a shot).
If the doctor decides that you need to check your blood sugar at home or give yourself insulin at home, a nurse from the Learning Center will teach you to manage your blood sugar at home.
If you have any other questions or concerns about this, feel free to ask any member of your health care team.
Catheter and Drains
After surgery, you may have a tube in your nose that goes down into your stomach. This is a nasogastric (NG) tube. It helps to prevent nausea and vomiting because it removes fluids from your stomach until your bowel begins working again. The NG tube will be removed before you start eating. You will not go home with it.
Sometimes after surgery you will have drains in your abdomen to allow extra fluid to be removed. If you have any drains from your abdomen, they will be emptied and measured every 8 hours, or more often if needed. Sometimes, patients go home with the drain in place. If this occurs, the nurse will teach you how to care for your drain at home. Most of the time, these drains will be removed by a doctor simply pulling them out before you go home.
You may also have a urine catheter called a “Foley” placed during surgery. It will remain in place until you are able to walk to the bathroom or the epidural is removed (if you have one). Once the Foley is removed, you should call your nurse and they will help you to the bathroom. We must measure your urine output. Your nurse will show you how this is done, either with a urinal (males) or a “hat” in the toilet (females). Sometimes patients cannot pass urine when the Foley is removed and it will need to be put back in. Rarely, it is left in place when you go home. If this happens the nurse will talk to you about what you need to know.
Surgical Wound
You will either have a long abdominal wound that is stapled together or taped together with strips (steri-strips). The health care team will check the wound for signs of healing.
If you have staples they will be removed during your clinic visit about 2 weeks after you go home.
Most wound care involves gently cleaning the incisions with soap and water and letting them air dry, which you should keep doing after discharge.
Walking
Getting out of bed is a vital part of your recovery.
Starting on the day of your surgery, you should be able to sit at the edge of the bed or in a chair with help from the nursing staff.
The day after surgery you will begin to walk with help. You should walk and sit in a chair for about an hour three times each day.
Walking helps the bowel to begin moving and to pass gas and stool. Walking is also good for your lungs and body strength.
Call for the nursing staff to help you move until it is safe for you to walk by yourself.
Some patients have some pain during walking, so you should talk with your nurse about when to walk so you may receive pain medicine if needed before you get up.
Since you may not be moving as much as you would at home, SCDs (sequential compression devices) are often ordered by the doctor. These are sleeves that wrap around your legs. They tighten and loosen to maintain proper blood flow in your legs in an effort to prevent blood clots from forming in your legs. TEDs (compression stockings) are stockings placed on one or both legs to prevent blood clots, often used along with SCDs.
Before discharge you will be able to walk safely, either by yourself or with an assistive device (walker, cane, etc).
While you are in bed, be sure to keep moving; shift your hips, turn from side to side, and move your legs. You may feel like you are attached to a lot of machines and may find it hard to move around. Ask the nursing staff to help you. You should move every couple of hours to help prevent pressure ulcers (bed sores) from forming. A nurse or NA will come to help you with your turns until you are able to do them by yourself. If you’d like to learn more about preventing pressure sores, ask your nurse for the handout on Preventing Pressure Sores.
Smoking and Tobacco products
The decision to quit smoking or to stop using tobacco products is one of the single most important things you can do to improve your health and speed your recovery. Besides the effects that smoking has on your lungs, nicotine slows wound healing.
If you are a current smoker or tobacco user, there are many programs to help you quit. Nicotine patches, nicotine gum, and other medicines can be used to help reduce cravings and help ease the withdrawal symptoms. Ask your health care team about these programs and medicines.
UWHC is committed to improving your health. If you are a current smoker or tobacco user, you will receive a quit smoking packet from your nurse. UWHC is also smoke-free, both inside the building and on the grounds.
Discharge
There are 6 standards that must be met before you go home. These are:
- be able to eat a regular diet
- be able to walk by yourself or with an assistive device
- have your pain controlled with pain pills by mouth
- be able to pass urine
- be passing gas and stool (often loose stools)
- be able to safely take care of yourself at home
Once these standards are met, one of your doctors will write an order for you to be discharged. At that point the nurse and the pharmacist will review your discharge instructions. Your paperwork, prescriptions, and appointments will be made. All of this often takes a few hours.
The pharmacist will meet with you to review the medicines you will be taking at home.
The nurse will review your discharge instructions which include:
- activity orders
- lifting restrictions
- your diet at home
- wound care instructions
- follow up appointment
- any special instructions
- phone numbers if you have questions or concerns
You can help in your discharge process if you alert us early on to any special circumstances about your discharge, such as long rides home, limits to when you can be picked up, etc.
At the end of your stay, we ask that you complete the survey you will get on F4/6 (or at home and mail it in) so we are aware of those who have done a great job for you and make changes based on your feedback.
See you on F4/6!
We look forward to meeting you after your surgery and helping you to progress through your hospital stay so that you can return home. Our focus is on you, the patient. If there are things that we can do to make your stay a little better, let us know and we will try to help.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 12/14/2010
Copyright © 12/14/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6955
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