IN-HOME Nursing Care after Plastic Surgery
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printer-friendly version| by Phyllis Graves, RN and Daisy Hartsell, RN, BSN You have lost the weight, and now you would like to lose your excess skin. It is a very common experience for people who have lost a great deal of weight through diet and exercise or as a result of lifestyle changes after weight loss surgery. The only real solution to excess skin is surgical removal, requiring lengthy recovery and careful monitoring. Recovery after Plastic Surgery Not only are more people having cosmetic procedures after significant weight loss, but television shows airing cosmetic procedures have caused a dramatic increase in the number of plastic surgeries sought in general. While most people are aware that these surgeries are available, many do not know what to realistically expect during the recovery period. Procedures such as belt lipectomy, abdominoplasty (tummy tuck) and other plastic surgeries used to be done in a hospital setting and required two to three days of hospitalization. With the new ambulatory surgery centers, many surgeons are doing these same surgeries in outpatient settings. The increasing number of large, complicated surgeries without lengthy hospitalization has created a necessity for many patients, their families and surgeons to have registered nursing care at home the first day after surgery. There are many possible complications after cosmetic surgery?anesthesia reaction, belly button death, bleeding, hematoma (bleeding under the skin), infection, skin necrosis, suture rupture, blood clot formation, nausea or vomiting, reactions to medications?and a registered nurse can often identify symptoms of these problems and help the patient get the care they need. The first thing to consider after surgery is the number of hours the patient was under anesthesia, which can compromise blood pressure and heart rate, affect fluid volumes in the body, and result in post-op nausea and vomiting. Once these immediate post-op complications are resolved, it is time to watch for the possible complications that may arise after the patient leaves the hospital. Of major concern after tummy tuck or belt lipectomy surgeries are the large incisions closed by sutures that can break and cause bleeding if there is too much pulling on the sutures due to improper body movement. Post-op bleeding can result in a return trip to the operating room to replace the sutures. Proper body movement is essential after the surgery. A registered nurse can teach patients how to use proper body movement to decrease both the pain associated with the movement and the risk of suture breakage. The registered nurse can also assess post-op bleeding, manage and teach patients about drain care, assess vital signs, and administer pain and other post-op medications. The registered nurse gives you the same type of nursing care you receive in the hospital, except that with in-home care, you are the only patient. New Options in Aftercare Friends and family members who are responsible for the care of a loved one following surgery often end up anxious and tired. Until recently, it fell to friends and family to provide that care alone, to the best of their abilities, because aftercare choices have been limited. In-home nursing provides one-on-one care, individual attention, and medical expertise to help minimize your post-op discomfort, recognize possible complications, and reduce the strain and worry on your loved ones. Suzy Preston underwent a dramatic weight loss on NBC?s The Biggest Loser. Once she lost the weight, she was left with excessive skin around her torso that exercise would not alleviate, so she elected to undergo belt lipectomy surgery, which involved an extensive incision that almost encircled her entire midsection. Her excess skin was removed and her abdominal muscles were tightened. Positioning, movement, and pain control are key to a successful recovery. So, at the recommendation of her surgeon, Suzy used a registered nurse after surgery. The nurse monitored Suzy closely for complications and taught her family how to provide proper care for her. Vital RNs is a nursing service in the Seattle area that was founded by nurses who recognized a need for quality post-operative care. Their full registered nursing staff specializes in the care of cosmetic surgery patients in their own homes or hotel rooms. Vital RN's understands that plastic surgery is as serious as any other operation and your aftercare should be considered if you are thinking of undergoing a cosmetic procedure. How In-Home Nursing Works The process we follow at Vital RN's begins when you call before surgery. A registered nurse will get all of the pertinent information in that pre-op call. The information we request is a history and physical, which alerts us to any existing medical problems that might affect your aftercare needs. We will need to know where you will be staying after surgery. We often work with patients in hotel rooms, since people sometimes choose surgeons that are far enough away that they cannot return home immediately. The registered nurse will review pre-op instructions with you, including reminding you to hydrate your body a few days before surgery to diminish dizziness and nausea after surgery. We will also remind you to make sure you have your post-op prescriptions filled before surgery and recommend that you bring them to surgery with you just in case we need to administer them on the drive home. It is also important to wear comfortable clothing that is easy to put on. Dark colored clothes will help hide any bleeding or spotting. It is very important to follow your surgeon?s recommendations to stop certain medications, such as aspirin and other drugs that will affect clotting times during and after your surgery. Don?t forget to tell your surgeon about any vitamins and herbs you may be taking, as some can cause increased bleeding times. For example, vitamin E can decrease blood clotting ability (reduced platelet aggregation) and prolong bleeding time. Once we have all the information required from you, we will call your surgeon?s office to verify your type of surgery, the surgery start and finish times, and your estimated discharge time. Your registered nurse will call you the night before surgery just to review information with you and to get any last minute instructions or requests. On the day of surgery we will give your surgeon?s office a call to make sure the surgery started on time and that everything is going as expected. We give the office the phone numbers they will need to contact us. They will alert us 30 to 45 minutes before your discharge, and the nurse will be dispatched to the surgery center. Once at the surgery center, we will get any special reports we need directly from the surgeon or the recovery room registered nurse. When we have all the information regarding your surgery, you are escorted home or to your hotel of choice, and your recovery to your new self begins.  As Founders of Vital RN's, Daisy Hartsell, RN, BSN, (right) and Phyllis Graves, RN (left) have more than 25 years combined nursing experience. Their nursing backgrounds include critical care and post-anesthesia care for both outpatient and inpatient procedures ranging from plastic surgery to open heart surgery. |
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