Cardiac Surgery

Transcripción

Cardiac Surgery

Cardiac Surgery
Patient & Family
Handbook
Our team of skilled
physicians, nurses
and technicians are
proud to provide
state-of-the-art
cardiac medicine
in Solano County.
Table of Contents
Your Personal Information and Contacts.................... 2
Welcome................................................................... 4
Understanding Your Heart......................................... 6
Your Surgery – The Healing Heart................................ 8
Your Hospital Stay................................................... 14
Incentive Spirometer and Lung Exercises................... 17
Telemetry Monitored Unit........................................22
Preparing to Go Home.............................................24
Sternal Precautions .................................................26
When to Call Your Doctor........................................ 27
Continuing Your Recovery at Home..........................28
Your Daily Routine at Home.....................................33
Cardiac Rehabilitation Program.............................. 44
For Those Taking Coumadin®...................................46
Diet and Nutrition...................................................50
Discharge Instructions Summary..............................54
Education Resources............................................... 57
NorthBay Heart & Vascular Center |
1
Personal Information & Contacts
Your Personal Information & Contacts
Our cardiac team – physicians, nurses, dietitians,
pharmacists, respiratory and physical therapists –
developed this booklet to help you during your recovery
and return to independence. Do not hesitate to contact
us if you have any questions or concerns or need
additional information.
Your Information
Name:
Date of Admission:
Date of Surgery:
Date of Discharge:
Surgical Procedure:
Type of Heart Valve (if applicable):
Robert Klingman, MD
2 | NorthBay Heart & Vascular Center
Contact Information
NorthBay Medical Center
1200 B. Gale Wilson Blvd.
Fairfield, CA 94533
(707) 646-5000
Surgeons: Dr. Robert Klingman and Dr. Sepehre Naficy
NorthBay Cardiac, Thoracic & Vascular Surgery
Address: 3443 Villa Lane, Suite 3; Napa, CA 94558
AND
1860 Pennsylvania Avenue, Suite 110; Fairfield, CA 94533
Phone number: (707) 254-9693
Surgeon: Dr. Ramzi Deeik and Dr. Sarah Minasyan
Northern California Minimally Invasive Cardiovascular Surgery
Address: 1261 Travis Blvd., Ste. 200; Fairfield, CA 94533
Phone number: (707) 576-7100
Nurse Practitioner: Amy B. Ziegler, ACNP-BC
Phone number: (707) 646-5300
Cardiologist:
Phone number:
Primary Care Physician:
Phone number:
Other Physician:
Phone number:
Cardiac Rehabilitation: (707) 646-5072
Diabetes Self Management Education: (707) 624-7999
Clinical Dietitian: (707) 646-5355
Home Health:
Phone number:
3
Welcome
We have assembled a dedicated
team at NorthBay Heart &
Vascular Center that puts you – the
patient – first. That’s our promise.
That’s our mission.
Kathy Richerson
Vice President/Chief Nursing Officer
Welcome
It is a privilege for each and every one of us associated
with the NorthBay Heart & Vascular Center to care for
you. We have carefully planned every step of your treatment,
and you alone will be the focus of our attention.
As you approach the day of your surgery or procedure, it is
understandable that you may become nervous or anxious.
That is quite normal. However, our compassionate team of
cardiac surgeons, cardiologists, nurses, technicians and
support staff strives to create an environment where you
will feel confident, secure and as relaxed as possible.
Rest assured that we have assembled these accomplished experts
to create the preferred place for your cardiac care. Our state-of-theart surgical suite makes the NorthBay Heart & Vascular Center
the premier provider of open heart surgery in Solano County.
Together, we will navigate the journey ahead and help you achieve
a successful and speedy recovery. You are in the best of hands.
You and your family have an important role in each step of your
treatment. We encourage and invite your involvement in the
decisions related to your care.
Please take the time to read the information presented in this
booklet. Let us know if you have any questions. And, thank you
again for allowing us to care for you.
Sincerely,
Deborah Sugiyama
President
NorthBay Healthcare Group
5
Understanding Your Heart
Understanding Your Heart
The heart is a muscle that pumps oxygen-rich blood
throughout your body. The heart’s rhythm and rate is controlled by an electrical pathway. The heart has four chambers
which are separated by valves. The tricuspid valve separates
the right atrium and ventricle. The pulmonic valve is located
between the right ventricle and the pulmonary system. The
mitral valve separates the left atrium and ventricle. The fourth
valve is the aortic valve which prevents blood from backing
into the left ventricle.
If you are having valve surgery, the valve will either be
repaired or replaced depending on your disease. If the valve
is replaced, there are two types of valves to choose from –
mechanical and bioprosthetic. The surgeon will discuss this
and the decision will be made before your surgery.
Pulmonic Valve
Aortic Valve
Heart’s Electrical
System
Left Atrium
Right Atrium
Mitral Valve
Tricuspid Valve
Right Ventricle
Kyle Kim
Director, Cardiopulmonary Services
Left Ventricle
The vessels which carry the blood to and from the heart are
called arteries and veins. The main arteries that supply the heart
with oxygen-rich blood are located on the surface of the heart.
The right coronary artery (RCA) supplies blood to the right
side, the bottom and the back of the heart muscle. There are
three arteries that supply the left side of the heart, as well as
the front and back of the heart: left main coronary artery, left
anterior descending (LAD) coronary artery and circumflex
coronary artery.
Pulmonary Artery
Aorta
Right Coronary Artery
Left Main
Coronary Artery
Circumflex
Coronary Artery
Left Anterior
Descending
Coronary Artery
Coronary Artery Bypass Surgery, or CABG, is a surgical
procedure to “bypass” the narrowings in the arteries which lie
on the surface of your heart. The surgeons will use arteries and
veins to bypass these areas. The most common type of bypasses
are the internal mammary artery (located in your chest wall)
and the saphenous vein (located in inner thighs). You may hear
the surgeons and staff refer to your surgery as “Off Pump,”
which means that the heart and lung machine will not be used
unless your surgeon feels it is necessary.
Diana Sullivan,
Director of Cardiovascular Service Line
7
Your Surgery – The Healing Heart
You are about to have open heart surgery at NorthBay Medical
Center, and we assure you that you will be well cared for during
your stay. As you approach the day of surgery, you may have
mixed emotions and be nervous about the journey ahead.
This is completely normal and to be expected. Experts in our
cardiovascular program have carefully planned every step of
your care to ensure a successful operation and speedy recovery.
Because we use a team approach to patient care, you are in
excellent hands every step of the way. Each team member is
specially trained to care for you and your family, and they
understand that your needs are unique.
The surgical team includes:
Ramzi Deeik, MD
•
The heart surgeon who will perform your surgery with help
from the operating room nurses and an assistant who will
perform the vein harvest.
•
The anesthesiologist who will meet with you and your family
before surgery to perform an assessment and discuss any
concerns that you may have. Your anesthesiologist and nurse
practitioner will also help you manage your post-operative pain.
•
The nurse practitioner, who specializes in cardiac care, will
work closely with your heart surgeon and nurses to follow
and manage your recovery process.
•
The intensivists and hospitalists, physicians who specialize
in the management of your medical care while you are in
the hospital, will work closely with your surgeon to help you
have a quick and safe recovery.
•
Your cardiologist or one of their partners will follow your
progress during your recovery in the hospital and work with
the cardiac surgery team to aid in your recovery.
•
The nurses, who have undergone specialized education and
training specific to the care of open heart surgery patients, will
manage your care at the bedside during your recovery process.
Each team member is specially trained to care for you and
your family, and they understand that your needs are unique.
•
The physical therapists who will assist you with any
additional needs you may have pertaining to physical
conditioning after surgery. Please be sure to tell them
if you have to climb any stairs at home so that they can
train with you while you are recovering at the hospital.
•
The dietitians who will meet with you to educate you
about a heart-healthy diet and assist you with any specific
dietary needs.
•
The case managers and social workers who will meet
with you to help with any discharge needs or obtain any additional resources/services you may need at home.
The NorthBay Medical Center
Perioperative Services team includes,
back row from left, Sonia de Guia,
RN; Amber Pitts, RN; Shannon
Wilkins, RN; Danny Drabeck, RN;
and Jo Apilado, anesthesia technician.
Front row from left, Cindy Swanson,
clinical manager; Daniel Hartley,
RNFA/NP; and Susan Gornall, director.
9
Preoperative Tests
Your condition may have allowed you some time to prepare
for your surgery. After visiting with your surgeon, you will
be scheduled to come to the hospital for additional testing,
which may include lab, urine sample, chest X-ray, ECG and
ECHO (heart tests), ultrasound and/or lung testing.
If you are already in the hospital, these will be done at your
bedside or in the specific departments. These tests are necessary
to provide quality safe care throughout your hospital stay. You
may have an option to donate your own blood before surgery
and this can be discussed with your surgeon and cardiologist.
Before Surgery
You will be instructed to eat nothing after
midnight on the day before your surgery.
You will also be given instructions on
how to prepare your skin and mouth for
surgery. Directions will be given on the
use of Chlorhexidine wipes (special cloths)
to prepare your skin prior to the surgery
and Chlorhexidine mouth wash to prevent
lung infection.
Same Day Center staff you may meet include, seated from
left, Sonia Tula, office assistant; Elsa Hatch, RN; and Lindy
Davis, patient access specialist. Standing from left, Diodita
Ong, CNA; Beverly Lewko, RN; Pat Suderow, RN; and
Hilda Castro, RN.
Please bring a complete list of your current
medications, including supplements and
herbals. Include the dosages and times
that you take your medications.
Certain medications are important to take
prior to surgery, but with just a sip of
water. These should be limited to your
heart medications and you will be given
instructions on which to take the morning prior to your surgery
with a sip of water. If you are not taking a specific class of
medication called Beta-blockers, you may be given a prescription
to start this medication before your surgery. Certain medications
should be discontinued in the days before surgery. You should
stop aspirin, Clopidogrel (Plavix™), Warfarin (Coumadin®) or
any other blood thinners at least 5 days prior to surgery, unless
instructed differently by your physician.
Advance medical directive is a document that allows you to
express your wishes when you can no longer care for yourself.
We recommend that all patients have this document regardless
if they are undergoing surgery. It is important for your healthcare providers to know what your end of life wishes are so that
those can be honored and respected. If you are interested in
completing this prior to your surgery, please let your nurse
know and one of our social workers will be happy to assist you
with this important document.
Please bring a
complete list of your
current medications,
including supplements
and herbals. Include
the dosages and times
that you take your
medications.
If your surgery is elective and planned, a registered nurse, the
cardiac nurse practitioner and an anesthesiologist will meet
with you several days before your surgery in the cardiac family
waiting room, located in the lobby of the hospital. We want to
be sure all of your care is well coordinated before your surgery,
during your hospital stay, and following your return home.
During this visit, you can become familiar with the hospital,
making it easier for you to find where you need to go on the
day of your surgery. You will also be able to meet many of the
nurses and staff members who will care for you. If you are
already admitted to the hospital for unplanned surgery, the
nurse practitioner and nurses will review the steps with you.
11
You and your family will learn about your surgery, your care
during recovery, and care when you return home. We have
developed a tool called a clinical pathway to help all members
of the team help care for you. It is a guide that defines daily
routines and goals, and your nurses will inform you of these
routines and goals each day.
Pre-registration
Your journey to
recovery begins
before surgery.
Your journey to recovery begins before your actual surgery.
You will receive a telephone call from our pre-registration staff
who will ask for the following information:
•
•
•
•
•
•
•
•
•
Name and current address
Marital status
Social security number
Insurance information
Employer information
Emergency contact number
List of medications, including vitamins, herbals,
and dietary supplements
Previous surgical procedures
Religious preference.
The Day of Your Surgery
After you change into a patient gown, your nurse will complete
a health assessment. The nurse will obtain your vital signs,
which include blood pressure, heart rate, oxygen saturation,
temperature, height and weight. The nurse will place an
intravenous (IV) catheter into a vein in your arm and start
an appropriate fluid drip in preparation for your surgery.
Later, the operating room nurse will come to meet you and
your family and then take you to surgery.
While in surgery, the operating room team will continuously
monitor your vital signs. Additional catheters and tubes will
be placed after you are asleep and you will be on a breathing
machine until you are able to breathe on your own. During
your surgery, you will receive pain medications continuously
through your IV catheter.
Your family will be asked to wait in the cardiac family waiting
room, located in the front lobby of the hospital. They should be
prepared to wait for several hours and the surgeon will speak
with them when your surgery is finished. Your family will
remain there until the Intensive Care Unit (ICU) notifies them
that you are ready for visitors.
After your surgery, you will go directly to the ICU, located on
the third floor of the hospital. After your family visits you, they
are welcome to stay in the ICU waiting room.
You and your family have an important role on our team.
We encourage and support your active involvement in
decisions related to your care. This information will help ensure
a successful surgery. Please review it, and let us know if you
have any questions.
Sonia DeGuia, RN
13
Your Hospital Stay
Your Hospital Stay
The Intensive Care Unit
Immediately following surgery, you will be moved to the ICU.
Because it is a busy place, you can expect bright lights and a
great deal of activity during the day.
As you wake up, you may notice several sensations. You will
probably feel very groggy. Anesthesia can also make you feel
nauseous, so your stomach may feel queasy. Many of the sounds
you will hear are made by monitors and different equipment.
Your medications, including those for pain control, or blood
transfusions (if needed) will be given through IV tubes at very
controlled rates using small machine pumps.
The nurses will closely watch your blood pressure and monitors
and be at your bedside continuously. A respiratory therapist
will also be caring for you,
focusing on your lungs and
your breathing. While providing quality care for you, we
will follow a daily routine of
shift changes occurring at
7 a.m. and 7 p.m.
Typically your stay in the
ICU will average 24 hours,
although everyone recovers
at a different rate. Your cardiac
team will decide the best
time for you to progress to
the next unit.
Your ICU nurses include, back row
from left, MaryLou Lucero, RN;
Kalsang Dorji, RN; Shirelle Dickinson,
RN; Anita Clifford, RN; and Tamara
Fletcher, RN. Front row, from left,
Laura Corson, RN; Wendy Volponi,
RN; and Carol Brower, RN.
Visitor Information
Because your recovery is our first priority, we encourage visits
by immediate family members while providing an appropriate
environment for you to heal.
Visiting hours are from 9 a.m. until 9 p.m. Only two visitors
are allowed in the room at a time. Due to infection concerns,
children under the age of 12 are not allowed in the ICU.
Once you are able to speak on the phone, the nurse will transfer
calls to your bedside so you may speak to callers personally.
Due to the specialized monitoring and technology used in the
ICU, cell phones are not allowed.
Your Comfort
It is normal to feel cold and to shiver for a short
while after you arrive in the ICU. Your nurse
will give you blankets to keep you warm. It is
also normal to experience some pain after your
operation, which you may notice as you awaken
from surgery. Pain control is an important
part of your recovery. Because everyone experiences pain differently, we will frequently ask
about your comfort level. Although it may not
be possible to eliminate all pain, we will reduce
your level of discomfort as best as we can.
Pain control is an important
part of your recovery period.
Because everyone experiences
pain differently, we will frequently
ask about your comfort level.
Communicating with Your Nurses
You will be on a breathing machine until you can breathe on
your own. While you are on the breathing machine, you will
not be able to talk because of the tube in your mouth. All you
need to do is nod or shake your head to answer questions.
15
Your Hospital Stay
0
0
1
2
2
3
4
5
4
6
6
7
8
9 10
8
10
Please point to the number that best describes your pain.
You can also point to a list of pictures to help you communicate
with your nurse. A pain rating scale, shown above, will also help
you describe your level of pain. You will learn about the pictures
before surgery, as this rating scale is another way for you to
communicate your pain. Once we have identified your level of
discomfort, we can determine the best course of pain relief for
you, or administer pain medication as ordered by your provider.
We encourage you to take the prescribed medication as it is
offered when you feel sore or pain. If you are feeling more
comfortable you will be better able to keep up with your planned
activities, which are important for your recovery. As you progress
and heal, the need for pain medication will decrease.
Breathing
A build-up of fluids in your lungs is relatively common following
surgery. While the breathing tube is in place, your nurse will clear
these secretions by using a suction catheter.
A respiratory therapist will remove the breathing tube when you
are awake and strong enough to breathe on your own. Once the
tube is removed, therapists will assist you in a series of coughing
and deep breathing exercises that will help remove secretions. You
will also be taught to use a device called an incentive spirometer.
Regular use of this device will help your lungs to become stronger
and prevent secretions from building up in your lungs.
Incentive Spirometer and Lung Exercises
After your surgery, it is very important to use your incentive
spirometer and perform lung exercises every one to two hours
while you are awake. These are important to prevent pneumonia
and other potential lung complications.
The respiratory therapists and nurses will teach you how to use
the device. Always have your heart pillow on your chest when
doing your exercises. Sit on the edge of the bed or chair or raise
the head of your bed before starting the exercises.
After using the incentive spirometer, you will need to take deep
breaths and attempt to cough. This exercise opens the airways in
the lungs and prevents the build-up of secretions. Again, make
sure your heart pillow is pressed firmly against your incision
with both hands, supporting the chest to reduce pain.
How To Use the Incentive Spirometer
1. Breathe out normally.
2. Place your lips tightly around the mouthpiece.
3. Breathe in slowly and as deeply as possible to raise the white
piston in the center chamber, keeping the coach indicator in
the “best” flow range.
4. Hold your breath as long as possible (at least 5 seconds).
Try to reach your designated goal (yellow indicator). Remove
the mouthpiece and allow the white piston to fall to the
bottom of the chamber.
5. Rest for a few seconds and repeat steps 1 through 4 at least
10 times every hour while you are awake.
17
Your Hospital Stay
The Purpose of All Your Tubes
While you are in the ICU, you will be attached to many tubes
and wires. Each of these plays a specific role in your recovery
and will be removed in varying stages as you recover and before
you leave the hospital.
Your tubes may include:
•
Endotracheal (breathing) tube: Connected to a respirator
(breathing machine), this tube helps you breathe until you
are fully awake and breathing normally. Once you are awake
and breathing normally, the respirator will be turned down
and you will start to breathe more on your own. The breathing
tube is usually removed 4 to 6 hours after the surgery.
•
Nasogastric (stomach) tube: Used to empty stomach fluids,
this will help to avoid stomach bloating, nausea and vomiting.
•
Chest tubes: Used to drain your chest cavity of fluid and
blood from normal post-surgical bleeding.
•
Intravenous (IV) lines: These are used to give you fluids,
medications, nutrition and blood when needed.
•
Heart monitoring lines: These are located in the side of your
neck and allow for monitoring of pressures inside your heart.
Medications can also be given through here.
•
Arterial line: This is usually located in your wrist and
continuously measures your blood pressure. This line
may also be used to draw blood samples for testing.
•
Epicardial (pacing) wires: You may have these wires if you
have had a valve surgery or a slow heart rate during the
surgery. These wires can be attached to a temporary pacemaker to assist your heart to beat properly.
•
Foley (urine) catheter: This is used to empty your bladder
and measure urinary output.
Caring for Your Incisions
Immediately after your surgery, your incisions will be covered
with bandages. Soon after surgery, we will remove the bandages
and begin teaching you to care properly for your incisions at home.
Activity
Medical evidence shows that
Medical evidence shows that the sooner a
patient gets out of bed and starts walking, the
sooner the healing process begins. It also
helps patients regain their independence
much sooner. In the first 12 to 24 hours after
surgery you will be helped to sit in a chair.
You will soon begin to move around to improve
your muscle strength and blood flow. Your
nurse or a physical therapist will help you when you first get up
and walk. You will also be taught range-of-motion exercises to
help stretch and strengthen your muscles as they heal.
the sooner a patient gets out of
bed and starts walking, the sooner
the healing process begins.
While lying in bed, moving and changing position will help
improve blood flow in your legs and remove secretions in your
lungs. You can move your feet, wiggle your toes and point your
19
Your Hospital Stay
toes up toward your head and then down toward the foot of
the bed. Your nurse will help you change positions by turning
you from one side to another.
In the first 24 hours after surgery, we will help you walk as
much as 20 feet once or twice per day. The distance and
frequency of your walks will increase daily.
Medications
After open heart surgery, you may be on medications
to help your heart’s performance. Some of these
medications will be stopped before you transfer out
of ICU. We will slowly add new oral medications and
resume your home medications as we feel it is safe to
do so. To help prevent infection, we will monitor
your blood sugars very closely. We may need to give
you insulin to help keep the sugars controlled.
There are common heart medications that you will likely be
started on if you are not already taking them. It is important to
take your medications as directed and to not stop them unless
ordered by your doctor. The most common heart medications
that you may be on for your heart disease are listed below.
We will go over these medications in greater detail before you
leave the hospital.
1. Aspirin helps reduce blood clots.
2. Beta-blockers help lower your blood pressure and heart rate,
reducing the work your heart performs with each beat.
3. ACE inhibitors lower your blood pressure and therefore
decrease the strain placed on your heart.
4. Lipid-lowering medications are important to control your
cholesterol and triglyceride levels.
Transferring out of the ICU
Your heart surgery team will determine the best time for
you to be transferred from the ICU to the Telemetry Care
Unit (TCU) or the Surgical Unit (1600). These two units are
monitored with portable remote sensors (telemetry) so
the nursing staff can continue to closely watch your heart rate
and rhythm while you continue to recover and increase your
activity. Some patients are transferred to one of these units
on the first day following surgery. If you remain in the ICU
longer than that, a member of your surgery team will explain
the reason for the delay. Extra time spent in ICU is often
a precaution, not an indication of any problem.
Most of your tubes and wires will be removed
before you leave the ICU. Continue to use your
incentive spirometer every hour while you are
awake, followed by your deep breathing and
coughing exercises. Hug your heart pillow whenever moving around, deep breathing or coughing.
Performing these lung exercises will allow the
nurses and respiratory therapists to slowly wean
your oxygen.
You will also be seen by the physical therapist.
You will be encouraged to get up to the chair in the
morning and start walking in the hallway in the
afternoon. You will start learning sternal precautions
and we want you to practice them at all times.
The telemetry care staff includes, left to right, Rebecca
Miller, RN; Jim Zhu, RN; Sheila Delos Reyes, RN;
Maria Rios, UC/MT; and Arlene Monsada, RN.
You will be given liquids, then solid food, and will sit in a chair
for each meal. It is important for your nurses to monitor your
oral intake and output so we will be measuring your urine
output and want to know when you have a bowel movement.
21
Telemetry Monitored Unit
Telemetry Monitored Unit
The average stay on the Telemetry Unit is 3 to 5 days. You will
continue to have the portable monitor until you go home. We will
watch your heart rate and rhythm closely throughout your stay.
Each morning the nurse will weigh you and check your oxygen
level. Continue to use your heart pillow when you cough and
deep breathe. Continue to use your incentive spirometer every
hour while you are awake. In the days following your surgery
the oxygen in your nose will be “weaned” off as long as your
oxygen level is greater than 92%.
It is important for your recovery that you increase your activity
and we will expect you to be in the chair for all meals and
snacks. We will continue teaching you sternal precautions and
assess that you can perform them. Strive to walk in the hallway
three times a day with your nurse or physical therapist. Before
you leave, the physical therapist will also teach you how to go up
and down stairs.
At this point your pain medicine will be in pill form, so please
let your nurse know when you need it and how well it is working.
Tell your nurse when you have a bowel movement or if you need
a stool softener. Constipation is very common after surgery and
is a common side effect of the pain medications. Do not strain
during a bowel movement.
If you have chest tubes or pacing wires, these will be removed
and then you can shower. Starting the morning after your surgery,
you will have knee-high TED stockings on both of your legs.
These are to help prevent blood clots and also control swelling.
Your TED stockings will be removed twice daily with the assistance of your nurse.
Carol Brower, RN
The Unit 1600 surgical specialty
nurses include, from left, Dorothy
Waweru, RN; Gretchen Polk, RN;
Eirena Oteyza, RN; Tanya Hightower,
RN; and Noraliza Yasay, RN.
Each day, the heart surgery team will adjust your medications.
Before you are released from the hospital, we will explain these
medications and provide a prescription for all new medications.
Several other important members of the team will visit you
while on the Telemetry Unit. A dietitian will speak with you
about a heart-healthy diet. The cardiac rehabilitation nurse will
enroll you in a rehabilitation program which you will start a few
weeks after you leave the hospital. A case manager has followed
you throughout your stay and will help you with discharge
planning. Our patients often have home health care to assist
with their recovery once they return home. Your case manager
will help you and your family determine if you need or want this
valuable service.
23
Preparing To Go Home
Preparing To Go Home
Early in your admission, you and/or your family will meet
with a case manager to:
•
Determine if you meet the guidelines for home health
care and organize this service for you.
•
Determine if you meet the guidelines for placement in a
skilled nursing facility. You and your family will participate
in this discussion with your case manager.
A case manager
will help you
•
Assist you and/or your family with any post-hospital needs
so you are ready to check out of the hospital by 11 a.m.
•
Arrange transportation by friends or family if you are going
home (this service is not provided by the hospital). If you are
going to a skilled nursing facility, the case manager will
arrange transportation for you. However, this transportation
may or may not be covered by your insurance.
•
Arrange to have someone stay with you at home for at least
one week after discharge. If no one is available to stay with
you, ask your case manager how to hire help. This help is not
covered by insurance.
•
If you or a family member is able, obtain a thermometer,
blood pressure machine and scale before your surgery or
before you are discharged.
plan for any posthospital needs.
Our goal is to prepare you for a safe transition. We use the
following checklist as a guide to determine when you can be
safely discharged. You can go home when you are able to:
•
Get in and out of bed using sternal precautions
•
Get up and down from the chair and toilet using
sternal precautions
•
Get dressed using an appropriate assistive device
•
Walk with/without assistance for 150 feet
•
Walk up and down a flight of stairs
•
Perform your cardiac home exercise program on your own
•
Explain and demonstrate your sternal precautions
with activities
•
Understand your medications and the potential side effects.
25
Sternal Precautions to Help You Heal
Sternal Precautions to Help You Heal
Sternal precautions are restrictions you will follow for
6 to 8 weeks after your surgery to allow your breast bone
to heal properly.
The surgeon closes the breast bone with multiple stainless
steel wires to help the bone edges heal. In most people, it takes
6 to 8 weeks for the bone to heal completely so it is important
to follow your sternal precautions to promote healing and
prevent problems.
Most important is to remember NOT to use your arms.
1. Cross your arms over your chest to get in or out of the chair.
2. Do NOT use your arms to sit down or stand up.
3. Do NOT lift more than 5 to 10 pounds. Do NOT push
or pull heavy objects.
4. Do NOT raise your arms higher than shoulder height for
an extended period of time. It is okay to perform activities
such as washing and brushing your hair.
5. You may climb stairs but only use the handrail for balance.
Do NOT pull yourself up the stairs with the handrail.
When to Call Your Doctor
When to Call Your Doctor
When you return home, call your doctor if you experience
any of the following:
•
Redness, bruising or drainage in or around the incision
•
Increased pain, swelling or warmth in or around the incision
•
Excessive fatigue or shortness of breath
•
Chest pain
•
An irregular heartbeat
•
Nausea and vomiting that lasts more than 24 hours
•
Weight gain (more than 2 or 3 pounds in one day
or more than 3 to 5 pounds in one week)
•
Fever greater than 101°F.
Jeffrey Breneisen, MD
27
Continuing Your Recovery at Home
Week Two Following Surgery
Gurinder Dhillon, MD
Activity
Monitor your weight and temperature daily.
Use incentive spirometer every hour while
awake. Start gentle stretches. Go outside for
walks when possible, but avoid hills and heat.
Walk two times a day, at a pace that allows you
to carry on a normal conversation. Start with
5-10 minutes and try to increase your total time
each week by 3-5 minutes. Some days you will
have more energy than others, and this is normal.
Balance activities with rest periods. Continue to
follow sternal precautions as instructed.
Nutrition
It is important to eat regularly. Plan for smaller,
more frequent meals because your body needs
nutrients such as calories and protein for
healing. Drink plenty of fluids unless instructed
differently by your provider. Avoid caffeinated
and alcoholic beverages.
Incisions
Monitor your incisions daily and contact your
surgeon if any redness or drainage is noted.
Do not use powders or lotions on incisions.
Remove any remaining paper tapes on incision.
Medications
Continue to take pain pills as needed. Remember,
pain pills can cause constipation and take stool
softeners as needed. Continue all medications
as prescribed by your provider.
Social,
Spiritual,
Emotional
May go out to lunch, bank, or store as a passenger.
You may feel depressed or irritable, be tearful
or cry, or have trouble concentrating. This is
normal and will gradually improve.
You may begin to conduct light business at home.
Business
Visits/Calls
You will see your cardiologist. Ask him/her
about Cardiac Rehabilitation. This is a good
time to discuss questions and concerns about
your surgery and recovery. Clarify your medications if you have any questions or concerns.
Week Three
Activity
If you are breathing well you can stop using
your incentive spirometer. May do light cooking
and housework. Continue to gradually increase
length of walks and walk two times a day. Do
not lift more than 5-10 pounds for 6-8 weeks.
Continue sternal precautions.
Nutrition
Plan your diet and lifestyle changes. It is
important for you to limit your sodium and
fat intake. Avoid processed foods with added
salt. Refer to the information provided for
heart-healthy choices. Drink plenty of fluids
unless instructed differently by your provider.
Avoid caffeinated and alcoholic beverages.
Patient Notes:
29
Incisions
Monitor for continued swelling. Wound redness
or drainage is abnormal. Please be sure to call
your surgeon’s office if this occurs.
Medications
Do not stop or change your medications unless
you talk with your physician first.
Social,
Spiritual,
Emotional
Some “down” days and tiredness may continue.
May attend place of worship.
Business
Continue conducting business as you feel able
and limit work-related stress.
Visits/Calls
You will follow up with your primary
care physician.
Week Four
Patient Notes:
Activity
Continue activity as in week three. You should
be walking at a comfortable pace two times per
day, but know that everyone recovers at a
different rate. When you can climb two flights
of stairs without shortness of breath or pain,
you should be ready to resume sexual activities
– check with your physician if you have any
questions or concerns. May start cardiac
rehabilitation program.
Nutrition
If you will not be attending Cardiac
Rehabilitation, ask for a dietitian referral.
Make sure you include high fiber foods like
fresh fruits, vegetables, whole grains and oats
in your daily diet.
Incisions
Your wound(s) should be completely healed.
Medications
Ask about over-the-counter pain medication,
if still needed. Continue heart medications
as ordered.
Social,
Spiritual,
Emotional
May go out for short trips (i.e. movies and
shopping as tolerated). Enjoy visiting with
family and friends.
Business
You may return to work part-time if your work
is not physical and your physician approves.
Visits/Calls
You will see your heart surgeon.
Week Five
Activity
Increase walking time to 30 minutes every
day. May resume driving if approved by your
heart surgeon.
Nutrition
Choose healthier fats and lean proteins.
Skinless chicken breast is a good lean protein
choice. Olive or canola oils are better choices
than margarine or butter.
Incisions
Complete healing has occurred. Your scar
will begin to fade.
Medications
Continue heart medications as ordered.
Social,
Spiritual,
Emotional
Business
Reflect on any changes you want to make
in your life. Remember, you are in charge!
Visits/Calls
Contact your physician if you are experiencing
anything abnormal.
Resume your business management as needed.
31
Week Six
Activity
Nutrition
Choose a variety of heart-healthy foods every
day. Limit refined and sugary foods. If you
would like to take a vitamin or herbal
supplement, ask your physician first.
Incisions
You may still have some leg swelling where veins
were removed. If so, elevate legs when sitting.
Medications
Some of your post-operative medications may
be stopped. Check with your physician before
making any changes.
Social,
Spiritual,
Emotional
You may travel. Make plans. Enjoy life
to the fullest!
Resume your business management as needed.
Business
Visits/Calls
Patient Notes:
Increase walking time to 30-40 minutes a day.
You can climb hills. You may take a bath. You may
also get in a pool – but no swimming, golf, or
tennis until three months after your procedure
or until approved by your heart surgeon.
Ask your physician about a cholesterol lipid
panel profile to evaluate effectiveness of your
diet and exercise program.
Your Daily Routine at Home
Our goal is for your safe transition home after surgery.
The following are recommendations regarding what you
need to do when you get home:
Getting Out of Bed
Step One:
•
Use your heart pillow to help when doing activity. To get
out of bed, lie on your back, bend both knees and put
your feet flat with your heels on the bed.
Step Two:
•
Log roll: Roll your entire body onto your side in one motion.
(Either right or left side, depending on your comfort and
where you are in the bed)
33
Step Three:
•
Turn your chest toward the bed and lightly push with your
arms while raising your torso and dropping your feet over
the side of the bed. Push up on your elbow while you hug
your pillow. Lower your legs to the side of the bed and use
your heels as an anchor. Remember: You are only allowed
to push or pull up to 10 pounds of weight!
Getting Into Bed
•
To get into bed, reverse the procedure by lying down on
your side and then log-rolling onto your back as you swing
your legs up to the edge of the bed. Remember, it is safer for
your back and chest to do this with your knees bent.
Getting In and Out of a Chair
•
While holding your heart pillow over your chest, scoot
your bottom to the edge of the chair. Keep feet firmly on the
ground. Keep your eyes forward and slowly rise up keeping
your nose over your feet. You will be using your leg and
stomach muscles. To sit in a chair, stand close to the chair
until you can feel the chair behind your legs. Slowly lower
your bottom to the chair, keeping your nose over your toes
and your heart pillow over your chest.
35
Sitting and Standing Exercises
You can perform the following exercises 2 to 3 times a day.
Complete each exercise 10 times.
Ankle Pumps
Raise toes, keeping heels on floor. Pump your ankles up and
down: toes up, heels down, then toes down and heels up.
Knee Extension and Flexion
Start with your feet on the floor. Straighten one leg as far as you
can, then return it to the floor. Repeat with the other leg.
Arm Curls
Sit with arm out in front, palm up. Slowly bend your elbow and
raise forearm toward shoulders. Relax arm. Repeat with other arm.
Knee Raises, March in Place
Using a chair for balance, march in place so that each leg
is lifted 10 times.
37
Shoulder Shrugs
Raise shoulders in an exaggerated manner, then drop them down.
Breathe in as you raise up and breathe out as you lower down.
Head Rotation
With head in a comfortable position and chin gently tucked in,
rotate head to the right and hold for 5 seconds. Repeat to the left
side. If you become dizzy, stop the exercise.
Gastroc Stretch
Gently holding on to a chair, place one foot in front of the other.
Front knee slightly bent, back knee straight. Hold for 5 seconds
and repeat on opposite side.
Showering
You may take brief showers but no baths before you are six
weeks past surgery.
•
Keep showers short (5 to 7 minutes) to avoid exhaustion.
•
Shower water should be warm. Remember, no hot showers!
•
If you feel weak or unsteady, sit down on a shower chair.
•
Avoid bending to wash or dry your feet. Use the shower
chair and cross your foot over your opposite leg/knee while
performing this activity or get a long-handled brush to help
with this activity.
•
When shampooing, keep your chin tucked and your arms
close to your head to minimize use of your arms.
•
Allow the water to gently run over the incision. For women,
also be sure to gently wash underneath your breasts to
decrease the risk of infection of your surgical site.
•
Use an oversized bath towel or robe to dry off. Avoid
unnecessary twisting and use of your arms to reduce stress
on your incision.
•
Gently pat the incisions dry with a clean towel and allow
them to air dry before putting on any clothing.
39
Caring for Your Incisions
•
We encourage you to inspect and wash your incisions daily.
It is OK to touch your incision after proper hand washing.
•
Please report any unusual redness, warmth, openings and/
or odor of your incision to your surgeon immediately.
We encourage you to inspect
•
Gently wash your incision with mild soap
and warm water daily when you shower.
•
Two weeks after your surgery, you may
remove the paper tapes across your incision.
•
To prevent infection, please do not use
lotions, ointments, creams, sunscreen,
Vitamin E, or powder near your incision
until it has closed or healed completely,
at least 6 weeks after your surgery.
and wash your incisions daily.
It is OK to touch your incision
after proper hand washing.
•
To prevent infection, do not use hot tubs or saunas for 2
months after your surgery.
•
It is normal for occasional small amounts of clear or pink
fluid to drain from your incision. Inform your doctor if
there is a significant increase in drainage or if the drainage
changes color.
Getting Dressed
•
Do not reach overhead to lift heavy clothing or other
items from the closet or shelves.
•
Avoid bending over when putting on your socks and shoes
by crossing your legs or propping your foot on a footstool.
•
If your therapist recommends it, use long-handled gear
such as a reacher, shoehorn, or sock aide for dressing.
•
For women, wear a support bra to protect the incision area.
TED Stockings
•
TED stockings help prevent blood clots and swelling
in your legs.
•
Wear the TED stockings during the day for 1 to 2 weeks
after surgery.
•
You may remove the TED stockings at night.
•
Wash your TED stockings by hand and let them air
dry overnight.
•
Because of the weight restrictions on your arms, you will
need the assistance of others when putting on or taking
off the TED stockings.
Rest
•
Take rest periods throughout the day.
•
You do not have to go to bed to rest;
simply sit quietly with your feet up.
•
While resting, make an effort to elevate
your legs to prevent swelling.
•
Limit visitors and avoid crowds for the
first 2 weeks after discharge.
•
Rest 1 hour after each meal and 20 to
30 minutes after self-care activities.
41
Sleep
•
Limit napping during the day to no more than 45 minutes
to avoid problems sleeping at night.
•
Your exercise program should help you sleep at night.
•
You may find it helpful to take a pain pill at bedtime.
•
It is normal for your sleep patterns to become disrupted.
If it becomes troublesome, notify your physician as you
may benefit from a sleeping pill.
Relaxation
Nervous tension and anxiety use energy and can cause muscle
tension, headache, backache, and put stress on your heart.
•
Identify and recognize stress in your life and
have a plan to manage it.
•
Plan ahead. Leave enough time to rest after finishing tasks.
•
Listen to relaxing music.
Pain Medication
•
You will continue to feel pain upon discharge
from the hospital.
•
You will receive a prescription for pain medication to help with your comfort.
•
Take the prescribed medication as directed.
•
Monitor frequency of bowel movements as most
pain medications cause constipation. You may
take over-the-counter stool softeners and laxatives as needed. Be sure to drink plenty of water.
Guidelines for Sexual Activity
•
It is normal for most people who have had open heart
surgery (and their partners) to worry about having sex.
However, you should be able to resume your previous level
of sexual activity.
•
For most people, it takes 4 weeks of recovery to enable the
heart muscle to handle the demands of sex.
•
Avoid sex after eating a heavy meal or drinking alcohol since
these may put additional stress on your heart. Wait at least
three hours after a meal.
•
Wait at least 1 hour after taking a bath, shower, or exercising
before you have sex.
•
Avoid bearing weight on your arms. Sometimes it is
recommended that the non-cardiac partner assume the
top, more active role. Alternatively, try other positions
such as having both of you lie on your sides (toward each
other or one behind the other) or sitting, facing each other.
•
Start out slowly and give yourself time to feel ready. Try
hugging, kissing, touching, or caressing at first. They help
you both feel close and wanted.
•
Choose a quiet, relaxed place to be intimate. Keep the
temperature in the room comfortable.
•
Choose a time when you both feel rested. Try when you
wake up in the morning or after taking a nap.
•
If your doctor has prescribed medication to be taken
before sex, take it as directed.
•
Discuss any concerns with your physician.
43
Cardiac Rehabilitation Program
Cardiac Rehabilitation Program
Cardiac Rehabilitation
is Essential to Your Recovery
Recovery from heart surgery begins the moment you enter
the hospital. Our Cardiac Rehabilitation Program helps patients
recover from their heart event by exercising in a medically
supervised setting.
Our mission is to help you make positive
changes in your life that will help you reach
your optimal physical and emotional health
and stop the progression of heart disease.
Referral
A referral is the starting point for admission
to the Cardiac Rehabilitation Program. You
may begin participating between 2 and 8 weeks
following your discharge from the hospital.
The Cardiac Rehabilitation
Program Components
team is eager to help you recover
Phase I – Hospital Recovery
from heart surgery. They are,
from left, Debbie Gordon, RN,
and clinical manager; Karen
Lowe, RN; Sonya Grant, office
assistant; Jo Kevan, RN; and
Lailanie Revelo, RN.
Your first encounter with Cardiac Rehabilitation will be in
the hospital and begins a few days after your surgery. A staff
member will visit you and your family to offer you the first few
steps in education and encouragement toward independence
and recovery.
Before leaving the hospital, home activities will be discussed,
including starting a home walking exercise program. Written
materials and discussions with your nurse and your physical
therapist will help guide you during your early recovery.
Phase II – Early Outpatient Recovery Program
After being home a few weeks, a Cardiac Rehabilitation nurse
will call you at home and see how you are doing. At that time,
questions can be answered, and you will receive your follow-up
appointment schedules with Cardiac Rehabilitation and the
dietitian, if needed.
Phase II occurs within the first weeks after your heart event.
During the next 4 to 6 weeks, you will come in to the Cardiac
Rehabilitation department, sit down with a nurse and discuss
your progress. Your goals will be established and a therapy start
date agreed upon.
Once your therapy has started, you will be guided in an individualized exercise program, based on your own abilities. While
exercising, a Cardiac Rehabilitation nurse will closely monitor
your heart rate, rhythm, blood pressure and response to exercise.
Lifestyle Change
Your lifestyle choices have a significant impact on your recovery.
That is why education for you and your family is an important
part of the NorthBay Cardiac Rehabilitation Program. Needs
for lifestyle changes will be discussed with you and support will
be provided as you address them. These will include:
•
Smoking cessation
• Heart-healthy nutrition choices
• Diabetic counseling (if needed)
•Medications
• Stress management
•Exercise.
Your lifestyle
choices will have a
significant impact
on your recovery.
Upon finishing your cardiac rehabilitation program, you will
have the knowledge and skills to continue a lifetime of recovery.
The NorthBay Cardiac Rehabilitation team will work hard with
you to help you succeed.
45
For Those Taking Coumadin®
For Those Taking Coumadin,
Please Be Aware of the Following:
®
Nutrition is Important
Warfarin (Coumadin®) helps keep your blood from clotting
and Vitamin K helps your blood to clot. Eating foods high
in Vitamin K can affect the way your medication works.
It is important to remember that you do NOT have to avoid
foods that are high in Vitamin K. Make sure your intake of
Vitamin K foods stays the same from week to week. If you
change your diet for any reason, such as illness or to lose
weight, be sure to tell your healthcare provider.
The foods listed below are high in Vitamin K. For your
medicine to work best, remember to keep the total amount
of these foods that you eat the same each week.
•
Greens: kale, collards, spinach, turnip, beet,
dandelion, mustard
• Spring onions or scallions
• Brussels Sprouts
•Broccoli
•
Green Tea.
For more information on the Vitamin K content
of foods, you can access the USDA food database:
http://www.ars.usda.gov/ba/bhnrc/ndl
Alcohol can also affect the way Warfarin (Coumadin®) works in
your body, so limit beer, wine, and hard liquor to no more than
2 drinks per day.
•
1 drink = 5 ounces wine, 12 ounces beer, or 1½ ounces
hard liquor
Nutrition Supplements
and Herbal Remedies
•
Much is unknown about over-the-counter nutritional/herbal
supplements. The safest policy is for you to avoid all of these
supplements or herbal remedies unless your healthcare
provider approves.
•
Be sure to inform your healthcare provider if you plan
to take any vitamin or mineral supplements.
Safety Tips
Because Warfarin (Coumadin®) thins your blood, you may
bleed or bruise more easily. Take extra care with activities such
as the following:
•
Caution when using knives, scissors and sharp tools
•
Use an electric razor instead of a sharp blade and use
a soft toothbrush
•
Avoid activities and sports that can easily hurt you
•
Don’t climb on ladders – keep both feet on the ground
•
Wear shoes or non-skid slippers in the house.
47
Helpful Hints:
•
Medications have both a brand name (Coumadin®) and
a generic name (Warfarin). Do not take both “Warfarin”
and “Coumadin®” because they are the same medication.
•
Take Warfarin (Coumadin®) at the same time every day.
If you miss a dose, do not make it up. Take the next dose
at the normal time. Never take a double dose.
•
Have your blood tested (Protime/INR) as directed. This
is the only way to check if your dosage is right. Be sure
to follow up to get your results.
•
Tell all of your healthcare providers that you take
Warfarin (Coumadin®).
•
Do not take NSAIDs, such as ibuprofen (Motrin/Advil) or
naproxen (Aleve/Naprosyn), unless your healthcare provider
has told you to.
•
Check with your healthcare provider when making
changes in your medications. This includes adding a new
medication, changing a dose of a current medication,
or discontinuing a current medication.
Have your blood tested (Protime/INR) as directed.
This is the only way to check if your dosage is right.
Be sure to follow up to get your results.
•
Most antibiotics can interfere with Warfarin (Coumadin®).
Check with your healthcare provider to see if you need
to have your blood tested sooner than regularly scheduled.
•
Always question a change in the color of your Warfarin
(Coumadin®) tablets.
•
If you are a woman of child-bearing age, use effective birth
control while taking Warfarin (Coumadin®) since this
medication is known to cause birth defects in unborn babies.
•
Wear a medical alert bracelet.
When to Call Your Health Care Provider:
•
Chest pain or trouble breathing
•
A serious fall or blow to the head
•
Dizziness or weakness
•
Severe pain, such as a headache or stomachache
•
Dark urine or black stools
•
Bright red blood in the urine or stools
•
Sudden appearance of bruises for no reason
•
Bleeding that does not stop in 10 minutes
•
Coughing up or vomiting blood
•
Heavier than normal periods or bleeding between periods
•
Skin changes/discoloration or purple fingers or toes.
49
Diet and Nutrition
During Your Hospital Stay
•
After your surgery, and when you are off the breathing
machine, you will begin eating.
•
Your hospital diet will start with liquids and progress
to solid foods. In the first weeks after surgery, it is best
to have small, frequent meals. Your hospital nutrition
team will send you smaller meals and between-meal
snacks to help your appetite return to normal.
•
Once you are on solid foods, Nutrition Services will send
you a menu for the next day. Circle the items you would
like and have the menu ready as early as you can.
•
If you would like an item that is not on the menu, please
write it on the menu or let your nurse know. She will
inform Nutrition Services.
•
A representative from Nutrition Services will visit you to
talk about your preferences. Please let them know if you
have any food allergies, intolerances or special requests.
•
Before you go home from the hospital, one of our registered
dietitians will visit you to review some nutrition basics and
make sure you are on the right track. They are experts and
will help you meet your nutrition needs during recovery.
Your hospital diet will start with
liquids and progress to solid foods.
James Allen, MD
When You Go Home
•
When you first go home (first or second week after surgery),
do not worry about making significant nutrition changes.
•
The important thing is to eat regularly so your body can heal.
Not only will you will feel better, but you have an increased
need for energy, protein, vitamins and minerals as you heal.
•
Continue to eat smaller and more frequent meals.
•
Consider the lifestyle and diet changes you plan to make to
stay as healthy as possible. Use this information and use the
additional material listed in the resource page to help you
follow a heart-healthy lifestyle.
Eating Heart-Healthy
Here are some guidelines for making healthy choices:
•
Choose healthier fats. Instead of butter or margarine,
choose canola oil or olive oil. It is important to limit your
total fat consumption, so look for foods that are “trans
fat free” and have very little or no saturated fat. Try to
reduce or eliminate fried foods and high-fat salad dressings
or spreads.
•
Choose lean proteins and use leaner cuts of meat. Use
skinless poultry and cut away visible fat. Also, use lowor non-fat dairy products such as skim milk or low-fat
cheeses. This will help lower your intake of artery-clogging
saturated fats.
•
Don’t forget your fiber. High-fiber foods include fresh fruits
and vegetables, whole grains, oats, beans and legumes.
Eating a diet high in fiber helps prevent constipation.
51
•
Eat your colors. Make sure to include fruits and vegetables
with the deepest and richest colors. Melons, oranges, broccoli,
spinach and peppers are examples of nutrient-rich foods.
•
Eat a variety of foods. If you eat the same foods every day
you get the same nutrients every day. Not every nutrient
has been discovered yet, so don’t short-change yourself.
•
Refined flour products, such as white bread and baked
goods, generally add little or no fiber to your diet. Limit
refined and sugary snacks, which are also often high in fat.
Watch out for sodas and juices that are sweetened.
•
Don’t forget your calcium. It is important for healing and
for healthy bones and teeth. Best choices are non-fat dairy
products, black beans, soy beans and cereals or orange juices
fortified with calcium.
•
Make sure you drink several glasses of fluid every day unless
your physician, dietitian, or nurse has told you not to. Avoid
sugary drinks that have little nutritional value, but a lot of
calories. Water is best! You can use lemon juice, True Lemon®,
or Crystal Light® to flavor your water.
•
Use a variety of spices and herbs in place of salt to flavor
your food. Mrs. Dash® or McCormick’s® have a wide variety
of salt-free options from which to choose. Eating foods high
in salt can cause your body to retain too much fluid, which
can affect your blood pressure. Ask your doctor or dietitian
before using salt substitutes made with potassium chloride.
Choose low-sodium broth-based soups instead of creamy
soups. This is an easy way to increase your vegetable intake
and decrease your fat intake.
•
Choose low-sodium broth-based soups instead of creamy
soups. This is an easy way to increase your vegetable intake
and decrease your fat intake.
•
Reduce your intake of cream sauce and gravy. For example,
for pasta sauce, choose marinara over Alfredo or pesto.
53
Cardiac Surgery Discharge Instructions Summary
Cardiac Surgery Discharge
Instructions Summary
Each individual patient responds to surgery differently.
Remember, you are unique in who you are. Your complete
recovery after surgery is most important. Please contact your
heart surgeon’s office if you have any questions not covered
in this handbook. We recommend that patients have an
available family member or friend at home with them for
the first week after discharge from the hospital.
Medications
•
Take all medications as prescribed by the cardiac team.
Do not add or stop taking any medication unless instructed
to do so.
Diet
•
Your dietitian will discuss your nutrition plan with you
prior to discharge. Follow the plan carefully. Certain foods
and alcohol can affect the way your body uses medicine.
Activity
•
Gradually increase activity as tolerated. Remember to
strictly follow your sternal precautions for 6 to 8 weeks.
•
Avoid driving for 6 to 8 weeks or sitting behind an active
air bag in a passenger seat.
•
Sexual activity may be resumed when you feel comfortable.
For many people this is about 4 weeks after discharge.
Remember to follow your sternal precautions.
•
Stop any exercise if you experience shortness of breath,
dizziness, leg cramping, unusual fatigue, and/or chest pain.
Notify your healthcare provider if these symptoms continue.
Self Evaluation
•
A daily assessment of body temperature, weight, and
pulse rate should be performed at the same time each day.
•
All incisions should be inspected for redness, tenderness
or drainage. If anything abnormal is noted, please contact
your physician immediately.
Smoking
•
Stop smoking before surgery, if possible, but certainly
once you have been discharged to home. Your heart and
wound healing depend on oxygen and blood flow, which
is definitely affected by smoking.
Stop smoking before surgery, if possible. It’s most critical
o nce you have been discharged to home. Your heart and
w
ound healing depend on oxygen and blood flow, which
is seriously affected by smoking.
55
Cardiac Surgery Discharge Instructions Summary
Dental and Surgical Procedures
•
If your surgery requires you to have any type of prosthetic
material (such as a valve), you may need to take antibiotics
before undergoing future dental work. Be sure to inform
your dentist and doctors that you have had heart surgery.
•
It is important to wait at least 3 months after heart
surgery before having any dental or surgical procedures.
If an emergency procedure is necessary, please be sure
to inform the health professional that you have had
heart surgery.
Other
•
It is not uncommon following your surgery to have
appetite and sleep pattern changes. This will eventually
return to normal.
•
It is not uncommon to experience some depression
following surgery. You will have good days and bad days.
If this does not gradually settle, please discuss this with
your healthcare provider.
Education Resources
Education Resources
Heart Information Websites
American Association of Cardiovascular
and Pulmonary Rehabilitation
www.aacvpr.org
American College of Cardiology
www.cardiosmart.org
American Heart Association
www.americanheart.org
Complimentary Heart Health Resource
www.yourheartmadesimple.com
Heart Anatomy and News about Heart Disease
www.fi.edu/learn/heart/index.html
Heart Failure Society of America
www.hfsa.org/hf_modules.asp
Mayo Clinic
www.mayoclinic.org
WomenHeart: The National Coalition
for Women with Heart Disease
www.womenheart.org (202) 728-7199
Nutrition Information Websites
DASH Diet
www.dashforhealth.com
DASH Diet Action Plan
www.dashdiet.org
Fast Food Explorer
http://www.fatcalories.com
Lance Gough, MD
57
Education Resources
Fat Information
www.canolainfo.org
Fruit and Veggies More Matters
www.fruitsandveggiesmorematters.org
My Pyramid (formerly Food Guide Pyramid)
www.mypyramid.gov
Nutrition Action Healthletter
www.cspinet.org/nah
USDA Food Database
http://www.ars.usda.gov/ba/bhnrc/ndl
Resources for Patients with Diabetes
American Diabetes Association
www.diabetes.org
American Dietetic Association
www.eatright.org
American Heart Association Heart of Diabetes Program
www.americanheart.org/diabetes
Centers for Disease Control www.cdc.gov
National Diabetes Education Program
www.ndep.nih.gov
National Institute of Diabetes, Digestive, and Kidney Disease
www.diabetes.niddk.nih.gov
National Institutes of Health Medline Patient Education
www.nlm.nih.gov/medlineplus/tutorial.html
The Joslin Diabetes Center
www.joslin.org
Books
The American Dietetic Association’s Complete Food
and Nutrition Guide
by the American Dietetic Association
Living with Coronary Heart Disease: A Guide for Patients
and Families (A Johns Hopkins Press Health Book)
by Jerome E. Granato
Mayo Clinic on Managing Diabetes
by M. Collazo-Clavell, MD
The Volumetrics Eating Plan: Techniques and Recipes
for Feeling Full on Fewer Calories
by Barbara J. Rolls
Cookbooks
American Heart Association Meals in Minutes Cookbook:
Over 200 All-New Quick and Easy Low-Fat Recipes
by the American Heart Association
Everyday Healthy Meals
by the California Champions for Change
available on www.cachampionsforchange.net/en/Resources.php
Month of Meals
by the American Diabetes Association
Quick & Easy Diabetic Menus
by Betty Wedman-St. Louis
Websites In Spanish
http://diabetes.niddk.nih.gov/spanish/index.asp
http://www.healthfinder.gov/
http://library.med.utah.edu/24languages/
http://www.noah-health.org/
This is not a complete list and
does not imply any endorsement.
59
Notes
Notes
NorthBay Medical Center
1200 B. Gale Wilson Blvd.
Fairfield, CA 94533
(707) 646-5000

Cardiac Surgery

Transcripción

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