Preparing for Inpatient or "Overnight" Surgery:

A Guide for Teens

You are planning to have a procedure/operation. Preparing for surgery can seem overwhelming or scary if you don't know what to expect. You may have some unanswered questions and worries that make you feel this way. Sometimes surgery can be unexpected and you don't have time to prepare for it. Other times surgery can be planned in advance so you have some time to get your questions answered and find out what will happen before, during and after your surgery. Knowing what to expect will help you feel less nervous and more in control. The following information is a general guide that addresses the most commonly asked questions by teens about surgery. You should ask your doctor for more specific information about the surgery you will be having.

What is the difference between day surgery and inpatient surgery?

Day surgery is when someone comes to the hospital, usually in the morning for a minor surgical procedure, and leaves the same day. Inpatient surgery is when you stay in the hospital overnight, after your surgery. Sometimes people who are staying overnight will be admitted to the hospital the day before their surgery. In most cases people who are staying overnight will be admitted the morning of their surgery.

What should I do before my surgery?

This will be different depending on the type of surgical procedure, but usually your doctor will ask that you not have anything to eat or drink after midnight, the night before your procedure. This means that you can't have anything to eat or drink by mouth—no food or liquids of any kind, not even mints, candy, or chewing gum. An empty stomach decreases the risks of anesthesia. It is very important to follow this rule. You can brush your teeth in the morning but you cannot swallow the water. If you forget and eat or drink before your surgery, be sure to let the nurse or doctor know right away. Mostly likely your surgery will need to be rescheduled.

What will happen on the day of my procedure?

Depending on the hospital where you are having your surgery in, the order of these events may be different and some advice may not apply. The following information is general and may help you to get an idea of what you might expect to happen on the day of your surgery.

• Time to arrive—Your health care provider or someone from your doctor's office will tell you what time to arrive at the hospital. Usually, this is 1-2 hours before the procedure so you can get settled in. You and your parent(s) or guardian(s) will need to sign a consent form (a document that gives the doctor permission to do the surgery and for anesthesia—"going to sleep"). This sometimes is done before the day of your surgery.
• ID Bracelet—When you check into the hospital, you will be given a hospital bracelet that will have your name, and your hospital identification number on it.
• Pre-op Area—After you have checked in with the admissions department, you will probably go to the Pre-op Area, where you will be assigned a nurse who will take your blood pressure and ask you questions such as if you had anything to eat or drink before arriving at the hospital. He or she will probably ask you some private questions about your habits and lifestyle, such as whether or not there's a chance you may be pregnant, or if you use drugs or alcohol. You should answer these questions truthfully because the doctors, surgeons, and anesthesiologists need to know if there's anything they should look out for that may complicate your surgery.
• Urine Test—Many hospitals require women/teen girls to have a urine pregnancy test. This routine and mandatory test is done on everyone of childbearing age, even if you are not sexually active. If there is a chance you could be pregnant, it is VERY IMPORTANT to let your doctor know!
• Nail Polish—If you are wearing nail polish and haven't removed it yet, you will be given nail polish remover to take it off. This is done because the doctors/nurses need to be able to see your natural finger nail to check your circulation. Nail polish may also get in the way of the pulse monitor, which is the small machine that gently clips onto your finger to keep track of your pulse.
• Acrylic nails—Most hospitals require that you remove at least 2 acrylic nails (one on both hands) so that your finger pulse can be checked.
• Jewelry—All jewelry should be removed and left at home before you go to the hospital. By doing this ahead of time, you won't be worried about losing it. All jewelry will need to be removed, especially nose, lip, and belly button rings, before your surgery.
• Clothing—Your nurse will ask you to get undressed. While you are a patient in the hospital, your clothes will be placed in a bag with your name on it. You will be given a hospital gown to wear during the operation and while you are recovering. When you are ready to be discharged from the hospital, you will be able to wear your own clothes home.

Why does everyone keep on checking my name and ID bracelet? Don't they know who I am?

You name, date of birth and the planned procedure will be reviewed with you and your parents/guardians many times while you are in the day surgery area. The medical staff knows who you are, but these are safety checks to make sure that your doctor always does the right operation for the right person.

What's the "pre-op holding area" and what happens there?

The "pre-op" holding area is where you stay before you go to the operating room. While you are waiting to go into the operating room, an anesthesiologist or nurse anesthetist will probably start an IV. This is a plastic tube that delivers certain solutions to your body throughout your surgery. It is inserted with a needle but then the needle is removed so only the plastic tube remains. The IV is usually placed in your hand. You will receive medicine through your IV to make you feel relaxed. If the anesthesiologist gives you a choice of which hand to put the IV in, choose the hand you don't write with.

What happens in the operating room?

You will be taken to the operating room and your name and your procedure will be reviewed again. The heart monitor attaches to about 4-6 small white circular patches that stick to a few areas on your chest, so your heartbeat can be seen on a small screen. These white sticky patches are usually removed before you wake up. You will be given more medicine through your IV that will make you feel very sleepy. You will drift off to sleep and you will stay asleep during your surgery. In what seems like a few minutes later, you will wake up in the recovery room, and the surgery will be over.

What exactly is anesthesia?

Anesthesia is the medicine that puts you to sleep and makes you feel no pain during your surgery. There are two different types of anesthesia, "local" and "general."

Local anesthesia is when you receive numbing medicine to the area of your body where you are having the procedure. You are awake during the procedure.

General anesthesia is when you are completely asleep during your procedure. Most people wake up feeling sleepy when the surgery is over. With both types of anesthesia, you won't feel any pain. The anesthesia will take a while to wear off. In the meantime, you will stay in the recovery room where you will be cared for until you are completely awake and alert.

What happens after the surgery?

After your surgery you will be taken to the Recovery Room. There, the nurse who is assigned to you will check on you often and take your blood pressure, temperature and pulse and give you any medicine that your doctor orders. It is common to feel cold or chilly after surgery. Don't be shy—ask your nurse for a warm blanket! If you're thirsty, and your doctor has said that it's okay to have something to drink, your nurse will offer you clear liquids such as ginger ale. Before you can go home, you will need to pass urine. Your nurse will offer you a bedpan or take you to the bathroom. In special cases, it's possible that you will have a temporary "catheter" in place. This is a tube that drains your bladder of urine. Your doctor will tell you in advance if he/she expects that you will have a catheter after surgery. After a little while, when you are fully awake and comfortable, your nurse will help you get ready to go to a regular hospital room.

Will I have a scar?

Whether you will have a small, medium, long or no scar at all depends on whether your doctor needs to make an incision (a cut in your skin). Some surgical procedures can be done without any cuts. Other types of surgeries require your doctor/surgeon to cut the skin to remove something. For example, an appendectomy requires a doctor to make a small size cut on your belly to remove your appendix. Sometimes the cuts and stitches are inside such as a tonsillectomy (removal of tonsils).

If I have an incision, how long will it take to heal?

Most incisions (where the skin was cut) appear red after the stitches are removed or dissolve (these kind of stitches get absorbed by your body and do not need to be removed) but fade over time. About 4-6 weeks after the surgery the scar from your incision should be much lighter than it was after the operation but it takes up to a year for it to heal totally. It is very important to keep the area where you had the surgery out of the sun, as direct sunlight may burn the area and cause a more noticeable scar over time. If you can't help being out in the sun, be sure to use a sunscreen with a high (30+) SPF (sun protection factor) on the healed incision area, to prevent burning. Most incisions heal well so the scar is hardly noticeable. Sometimes, people develop a thicker type of scar that has extra fibrous tissue-this is called a keloid scar.

What can I do to make sure my incision heals well?

The most important thing to remember if you have an incision is to keep it clean. If you have an incision with stitches, you will receive instructions when you are discharged. The instructions will be specific to the type of surgery that you had. In general, you should call your doctor if you have:

• a temperature of 101 or over
• any blood or drainage from your incision after the first 24 hours
• redness at the incision area
• a bad odor coming from the incision
• severe pain in or around the incision

What can or should I bring to the hospital with me?

If you are an overnight patient, it's a good idea to bring your own pillow, a book to read, a tape or CD player, something to write in, like a diary or journal and movies to watch (if you have a VCR in your room). Having a personal item from home, such as your pillow or a stuffed animal, can be a huge comfort while you're away from home. If you want to bring electrical things, such as a blow-dryer or laptop computer, it is important to ask your doctor or nurse if this is okay. Hospitals have very confusing electrical systems, and you may need a special adapter to have your items work. Also, most hospitals require their Safety Department to check all small appliances before you can use them. Cell phones and pagers may not be allowed in hospital rooms, as they can cause problems with the communication system in the hospital.

What if I get bored while I'm in the hospital?

Since you will be staying overnight, there may be times that you could get bored. The good news is that in most pediatric and adolescent hospitals there are activity rooms that have computers, board games, crafts to make and other things that will make the time go by.

What should I do about all the schoolwork I will be missing?

Helpful Tips:

• If your surgery is not an emergency and your doctor is available, you may find it possible to schedule your surgery during a school vacation week or during the summer. That way you won't be worried about the schoolwork you will be missing.
• If your surgery needs to be scheduled during school time and you will be staying overnight, you might want to bring some light schoolwork along with you, in case you feel up to doing it later.
• Once your surgery is planned, try to get your school assignments from your eachers in advance. You will be less stressed out if you get as much of your work done as possible before your surgery. Teachers usually will understand your situation if you take the time to explain that you will be in the hospital.
• If your surgery is an emergency, ask a parent or friend to get your work for you. Many teachers will give you some extra time to make up the work. You're in the hospital to get better, not to worry about schoolwork. If a teacher seems too demanding, speak with your guidance counselor or principal when you return to school.
• If you will be in the hospital for a long period of time or if you will be at home recovering from your surgery for longer than a couple of weeks, ask about having a tutor (someone to help with school work).
• Ask your doctor or someone in your doctor's office for a note to excuse your school absences for your surgery and recovery time at home.

What if I have my period while I'm in the hospital?

It's okay if you have your period the day of your surgery or while you are in the hospital. This will not cause your surgery to be moved to another date.

Most likely you will not be allowed to wear a tampon while in surgery, especially if you are having any type of procedure that requires your doctor to do a pelvic exam (checking your vagina, cervix and ovaries). Instead, you will be given pads to wear. The nurse in the operating room will change your pad while you are sleeping if necessary. If you will be staying in the hospital overnight, it may be possible for you to shower and wear tampons instead of pads.

How will I be able to stay clean?

Depending on whether you have an IV, cast or you are connected to any other equipment, you may need to take sponge baths (washing up with a bowl of water and soap while you are in bed) until your doctor says it's okay to take a shower. Taking a shower in the hospital is a bit harder than at home especially because you may not be feeling well. When your doctor gives you permission to shower, your nurse will help you until you can manage on your own. Hospital bathrooms and showers have special lights like the kind by your hospital bed that you can "turn on" if you need a nurse or help right away.

What if I don't like the hospital food?

Usually you will be given a menu that has different food choices for the day. You may be asked to circle the foods you would like for breakfast, lunch, and dinner. This menu will be returned to the dietary department (where they prepare food for patients) and your meal choices will be brought to your room. The dietary department can prepare special meals, for example, if you are a vegetarian or eat only kosher foods. If you are not on a special diet for health reasons and your doctor says that you can eat anything, it may be possible for you to receive food packages from your parents or friends, but be sure to ask your nurse first! The hospital may have certain rules regarding outside food, and you may have certain food restrictions.

What if I'm still nervous on the day of my surgery?

It is completely normal to feel a bit nervous, especially if it is your first operation, but knowing what to expect will make you feel less afraid. Try not to worry too much, your doctors and nurses are there to answer any questions you have, and they will take good care of you and keep you comfortable while you are in the hospital. If possible, try to talk with another teen who has had the same procedure that you're going to have. This may be a friend, relative, or someone your doctor or nurse arranges for you to talk to.

Written by the Center for Young Women's Health Staff

Updated 5/19/2005

Related Information:

• Preparing for Outpatient or "Day" Surgery: A Guide for Teens
• Related Links