Admission information for surgery University
Issue date: September 2021
Review date: September 2023
Ref: C-470
PDF: Admission information for surgery final September 2021.pdf [pdf] 245KB
Day of Admission
Nil by Mouth instructions
• 7 am admission: Continue Liver reduction diet until 2:30 am, you can have water up until 6:30 am
• 11 am admission: Continue Liver reduction diet until 6.30 am, you can have water up until 10.30 am.
• Report to the ward stated on your admission letter.
Post-surgery
Following surgery, you will return to the ward. Depending on bed availability, the wards that specialises in Bariatric Surgery is Postbridge 23 hour Stay Unit and Wolf, if no beds are available then we may have to send you to another ward. This cannot be confirmed until the day of surgery.
Contact Numbers:
Wolf: 01752 439677/ 01752 439678
Postbridge: 23 hour stay unit 01752 432568
Items to bring into hospital: Please be mindful that there is limited storage on the wards.
• All regular medication
• Overnight clothes
• Personal hygiene items
• Mobile phone
• iPads/Tablets: (see note below)
• Slim Fast®/Fortified Milk Powder /Sugar Free Squash (The ward is unable to provide this for you)
You must be advised that expensive items such as iPads/tablets and mobile phones are brought in at your own risk. The hospital cannot take responsible for your personal belongings.
Discharge Information
• Driving: No driving for 2 weeks.
• Work: You are advised to take up to 6 weeks off work.
• Exercise: You are encouraged to go for short walks and walk around the house. This will help reduce the risks of clots in your legs and lungs. Exercise such as swimming /Gym need to be avoided for 6 weeks.
• Blood Clots: To help prevent this, ensure you wear your stockings for 1 week and continue your blood thinning injections once or twice a day (weight dependent) for 7 days.
• Constipation: If you are struggling with constipation post-surgery please contact the Bariatric Nurse Specialist for advice on 01752 431724.
• Disposal of sharps bins: Please contact your local council who will have a sharps bins disposal service.
• Wound care: keep clean and dry, observe for signs of infection, bleeding or wounds opening up. If you have any concerns seek advice from your GP Surgery.
• Medication: You will be discharged with 4 weeks supply of your lifelong vitamin and mineral supplements. Your GP will be informed that these will need to be added to your repeat prescription record.
Lifelong supplements and post-surgery medication
Medication
Clexane (Enoxaparin)
Dose
40mg
How often to take your medication and when
Once or twice a day depending on weight
Same time every day.
How long to take the medication for?
For 7 days
Medication
Omeprazole
Dose
40 mg
How often to take your medication and when
Once a day in the morning
How long to take the medication for?
3 months only
Medication
Multivitamin and Mineral A-Z Forceval Capsules
Dose
1 Capsule
How often to take your medication and when
Once a day lifelong in the morning
How long to take the medication for?
Lifelong
Medication
Iron Ferrous Sulphate
Dose
200 mg
How often to take your medication and when
Once a day: in the morning.
Menstruating Women: you may be advised to take this twice a day.
08:00 hrs
18:00 hrs
How long to take the medication for?
Lifelong
Medication
Vitamin D and Calcium: TheiCal D3
Dose
1 tablet
How often to take your medication and when
Lunch time
How long to take the medication for?
Lifelong
Medication
Paracetamol 1g
Dose
2 tablets
How often to take your medication and when
Up to 4 times a day.
4-6 hours apart
How long to take the medication for?
Until pain controlled post-surgery???????
Medication
Ibuprofen (if you are able to take) 400mg
Dose
1 tablet
How often to take your medication and when
3 times a day
8 hours apart
How long to take the medication for?
Up to 7 days only
Medication
Ondansetron
4-8 mg
Dose
1-2 tablets
How often to take your medication and when
Up to 3 times a day.
Each dose 8 hrs apart
How long to take the medication for?
Only if required
Medication
Prochlorperazine 3 mg
Dose
1 Buccal tablet: Dissolves in your mouth
How often to take your medication and when
1 tablet twice a day
How long to take the medication for?
Only if required
Vitamin B12 injections: Date due to start ………………………………
Your regular medication
Some medication has to stop before surgery. Please refer to the information below regarding your own regular medication.
Post-operative diet plan
Following bariatric surgery, it is important to follow the texture stages as recommended by your Bariatric Centre to avoid complications such as pain, discomfort, regurgitation or vomiting and to allow your new stomach to heal.
Liquid stage (Day 1 – Day 14 following surgery)
For the first two weeks you must consume liquids only. Aim to have a nourishing drink at each meal and snack time. Liquids must be no thicker than a meal replacement shake such as Slimfast®.
Nourishing drinks include
• Meal replacement shakes, make up as directed on tin with skimmed milk. Drink as tolerated.
• Fortified Milk: Make up 1 x pint per day by adding 4 x dessert spoons of skimmed milk powder to 1 pint of skimmed milk.
• Make smooth soups thinner by adding some of your fortified milk and this will increase the protein content.
• You can use Horlicks Light® / Ovaltine Light® / Sugar free Crusha® / Options® / Highlights® hot chocolate with fortified milk for more variety.
Liquid stage example day
Breakfast: ½ Meal replacement shake (made up as per manufacturers’ instructions (7.5 g protein)
Mid-morning: 150 mls Fortified milk (11g protein)
Lunch time: Fortified thin, smooth soup (100 mls soup & 100 mls fortified milk = 10g protein)
Mid-afternoon: ½ meal replacement shake (7.5g protein)
Evening: Fortified thin, smooth soup (100mls soups & 100mls fortified milk = 10g protein)
Supper: Ovaltine® light with 150 mls fortified milk (15g protein)
Overall aim: to drink at least 1pint fortified milk per day and 1 meal replacement shake per day to provide (630 kcals & 55g protein).
Pureed stage (Week 2 – Week 4 following surgery)
This stage needs to be followed for two weeks. Puree must be the same consistency and texture of smooth yogurt with no bits or lumps.
Getting started
• Invest in a handheld blender if you do not already own a food processor.
• Plan ahead and cook in bulk. Use ice cube trays and small containers to freeze meals and defrost as needed.
• Add extra liquid e.g., gravy, stock, tinned tomatoes / passata, milk or low-fat white sauce to blend food to the desired consistency.
• Add extra vegetables into sauce then blend to increase fibre content.
• Use a ramekin dish to help control portions
• Use a teaspoon. You may find 4 – 5 spoonfuls will fill you up.
• Stop eating before you feel uncomfortable or pain in your chest. This is a sign your pouch is full.
• Soups, stews and casseroles containing meat and / or beans, pulses and lentils tend to blend down very well, are a good source of protein and very nutritious.
Puree stage example day
Breakfast: ½ Weetabix® or 15g Ready brek® made with semi skimmed milk
Mid-morning: High protein or natural strained Greek yogurt & stewed apple
Lunch: Scrambled egg (made with one egg and milk)
Mid-afternoon: Pureed tinned peaches and low fat, low sugar custard
Evening meal: Pureed chicken casserole
Overall Aim: Use a ramekin dish for each meal / snack. Eat five times a day. Only eat what you can comfortably manage.
Pureed meal ideas
Pureed breakfast ideas: Weetabix®, Ready brek®, scrambled egg / poached egg with pureed tinned tomatoes, pureed tinned mackerel in tomato sauce, pureed baked beans and grated cheese.
Pureed main meal ideas: Pureed chicken with gravy, pureed cod in parsley sauce, smooth mashed potato with grated cheese and gravy mixed well, pureed sweet potato with salmon with half fat crème fraiche and mint sauce, pureed cottage pie with gravy, pureed fish pie with extra milk, pureed beef, pork or lamb casserole, pureed chicken & vegetable stew, pureed bolognese with extra tinned tomatoes (no pasta), pureed vegetable & bean hotpot, pureed macaroni & cauliflower cheese with extra milk.
Pureed snack ideas: Tinned fruit in juice such as apricots, peaches, or prunes pureed with natural strained Greek yogurt / high protein yogurt, stewed apple with low fat, low sugar custard, pureed banana with high protein natural yoghurt. Flavoured Quark, pureed cottage cheese.
Four weeks onwards
You can now start a soft diet. This includes minced meat, soft fish, well cooked beans / pulses / lentils / vegetables & soft fruits (no skin initially). You can gradually introduce normal textures over the next two to three weeks. You should aim to eat a normal textured diet by around 8 weeks after your operation date.
Remember your eating techniques!
• Eat mindfully & follow the 20-20-20 rule
• Leave a 30-minute gap between eating and drinking
• Ramekin dish sized portions will still be normal at this point and for several / months / years thereafter
• If portions remain small, aim to eat three meals a day plus one to two healthy snacks in between
• Ensure that you drink plenty of fluid, aiming for at least 1500 mls per day. If you are struggling to achieve this, try drinking 100mls fluid per hour.
If you have any queries, please contact the Bariatric Dietitian or Nurse email address.
plh-tr.DerrifordBariatrics@nhs.net
