thi after surgery web
TRANSCRIPT
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Gds for Cardac Patts Aftr Srgry
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The following information is on recoery after open-heart
surgery, designed to prepare you and your loed ones for
discharge. Recoery is a family affair and you and your loed ones
are encouraged to read this information, along with attending
the discharge classes that are gien three times a wee. Our staff
is also aailable to answer any questions you may hae.
Recoering from open-heart surgery taes time. If you had
traditional open-heart surgery, where they brea the breastbone
and mae a large incision, it generally taes your body eight
wees to physically heal. In some cases, it can tae three to si
months to feel bac to your normal self. If you had MICS CABG
surgery, short for minimally inasie cardiac surgery/coronary
artery bypass grafting, it generally taes your body two to four
wees to heal but can tae up to two months to feel bac to your
normal self. MICS CABG patients typically heal faster, as there are
no broen bones and three small incisions to heal.
No matter what type of surgery you had, eerybody heals at a
different rate. So be patient, recoery will happen.
At home, it is important to get out of bed, shower and get
dressed for the day een if you are not going to be leaing your
home. Do this eeryday but plan rest periods between each
actiity, including showering, eating and waling. When getting
out of bed or up from a chair, do so slowly to aoid getting dizzy.
CARDIAC SURGERY DISCHARGE INSTRUCTIONS
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Dr. Joseph T. McGinn, Jr.
Medical Director, theheartinstitute
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INCISION CARE
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When you go home, your incisions will most liely be open to air
(no dressing). You may hae small steri-strips on your incisions.
These will start coming off in about a wee as you shower.
Caring for your incisions includes taing a shower eery eening
with warm water. Aoid hot water, as it can mae you feel dizzy
and wea. Aoid taing baths as getting out of the tub will put
too much strain on your upper body. Wash all of your incisionswith a mild soap such as Iory, Safeguard or Dial. Dry them
by gently patting the area. Aoid rubbing or scrubbing your
incisions.
Do not apply lotions or powders to your incisions until they hae
completely healed.
Inspect all of your incisions daily for signs of infection; these are: Redness, swelling, warmth around incision
Drainage that is white or yellowish and is foul smelling
Feer
NOTE: If you hae any of these symptoms, notify your
surgeon immediately.
Tae your temperature daily in the morning or at any point if you
feel hot or hae chills. After surgery, changes in temperature are
normal. Your temperature may een be slightly high (99F) as
your body heals. Notify your doctor if you hae a temperature of
100F for 24 hours, or if it is 101F at one time.
Your legs may swell slightly after surgery, especially if a ein was
taen for the surgery. You can help this by wearing your elastic(TED) stocings at home. Put them on in the morning and remoe
them at night. Wheneer you are sitting, you should eleate your
legs to help decrease the swelling. Call your doctor if you hae
ecessie swelling or drainage from your leg wounds.
Weigh yourself daily in the morning. If you notice you hae
gained a signicant amount of weight e pounds in two to
three days call your cardiologist right away. The weight gaincould be etra uid and you may need your medications adjusted.
To monitor your blood pressure at home, you can purchase an
automatic blood pressure machine. Record your readings once or
twice a day and bring them to your cardiologist.
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MEDICATION
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You will be discharged on medications prescribed by your doctor.
As you recoer, some medications may be stopped or the dose
changed. This will be done by your cardiologist or surgeon. The
nurse will instruct you on your medication before going home.
Some Tips For Taking Medication Include:
1. Tae medications around daily actiities such as mealtimeor bedtime.
2. Use reminders, such as a sign on your refrigerator, toremember to tae your medications.
3. Always tae the prescribed dose.
4. Neer tae anyone elses medication.
5. Neer gie your medication to someone else.
6. Neer sip a dose or double the dose.
7. Neer discontinue medication without permission ofyour doctor.
8. Chec with your doctor before taing oer-the-counter
medication, as they can interfere with your prescribedmedication.
9. Let your doctor now if you hae any unusual symptoms suchas omiting, diarrhea or a sin rash.
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INCISION PAIN ACTIvITY
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It is normal to hae incision pain for a while after discharge.
You may also eperience aches and pains in your bac, nec
and shoulders as you recoer and are more actie. You will be
discharged with a prescription for pain medication. Do not
hesitate to tae it if you need to, as pain medication can help you
with your recoery.
Waling is the best eercise after being discharged. Start your
waling program the day after you return home. It is important
to rest at least 15 minutes before and after you wal. Do not wal
outside if the temperature is less than 30F or greater than 90F.
In bad weather you can wal in enclosed areas such as a shopping
mall. Along with waling, you should continue to use your
incentie spirometer at home to help eep your lungs clear.
In the immediate recoery period you will hae some actiity
restrictions. These are only temporary and necessary to allow your
body to heal:
Restrictions for traditional open-heart surgery patients
1. Driving:You will not be permitted to drie for eight wees after
surgery in order to allow your breastbone to completely heal. Also,your reaction time and reees will be slower from the effects of
anesthesia and pain medication. You may be a passenger in a car
as long as you ride in the bacseat to aoid airbags and wear your
seat belt. If you are taing a trip oer one hour, stop and stretch
your legs periodically.Traditional open-heart surgery incision MICS CABG incision
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2. Lifting: Do not lift or pull anything heaier than 10 pounds for
at least three months after surgery in order to let the breastbone
heal. You also need to aoid any actiity that causes straining,
such as acuuming, raing leaes or lifting grocery bags.
3. Sexual Activity: In general you should be able to resume seual
actiity four to si wees after surgery. Use a position that is
least demanding on your body, such as lying at on your bac onthe bed, and do not place any weight on your arms. Be sure the
room temperature is comfortable and aoid the consumption
of alcoholic beerages. various medications may affect seual
drie and/or function. If this occurs, consult your physician. Neer
stop taing any prescribed medication without your physicians
approal.
4. Returning to Work: Depending on your job, you may be ableto return to wor in four to si wees. If your job includes any
heay lifting, you will hae to wait at least three months. As your
surgeon on your follow-up isit when you may return to wor.
Restrictions For MICS CABG Patients
If you had minimally inasie surgery, MICS CABG, there are few
limitations after surgery. The driing and lifting restrictions listed
on this page apply for two to three wees after surgery. Generally,
patients can return to wor after two wees. Its oay to return to
wor sooner if youre feeling well enough, as long as your job does
not cause physical strain on your body.
NOTE: No matter what type of surgery you had, neer drie under
the inuence of pain medication.
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DIET
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A low salt, low fat, low cholesterol diet is recommended for you.
If you are on a special diet (diabetic) you should continue this
also. Remember that its normal not to hae much of an appetite
when you go home. Howeer, it is important for you to eat
enough for your wounds to heal. Instead of three large meals,
it may be better to eat smaller meals e to si times a day. All
dietary recommendations will be discussed in the discharge class.
If you would lie to see a dietician while you are in the hospital,please let your nurse now.
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COMMON PROBLEMS
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Sleep
You may nd you hae difculty sleeping when you get home.
This is normal. Plan to tae two rest periods a day, each for about
30-40 minutes. Do not stay in bed and sleep all day, as you will
not be able to sleep at night. If you had traditional open-heart
surgery, aoid sleeping on your side, as this will put tension on
your breastbone.
Depression
It is common after open-heart surgery to feel anious, irritable,
depressed and eperience mood swings. As you catch up on your
sleep and increase your actiity leel, this will go away.
Regularity
Constipation is a common problem after surgery, a normal
reaction to haing anesthesia and being inactie. This can behelped by drining plenty of uids, trying to increase your daily
actiity and eating fresh fruit and egetables. Do not strain when
going to the bathroom, this can mae you dizzy and feel faint.
You can tae a stool softener or laatie to help you if you are
haing a problem.
Pericarditis
After cardiac surgery, it is common for patients to deelop
pericarditis, where the lining of the heart becomes inamed.
One of the symptoms of pericarditis is sharp chest pain, which
worsens when you lie down or breathe in and gets better when
you sit forward. It is frequently accompanied by a feer. Contact
your physician if you are eperiencing these symptoms. He or she
can prescribe medication for treatment.
NOTE: Call your surgeons ofce immediately if you eperience:
Feer of 101F or aboe
Sweating or chills
Any redness, swelling or drainage from your incisions
Shortness of breath
Any pain unrelieed by pain medication
Persistent coughing If you feel your heartbeat is irregular or too fast, follow up with
your cardiologist or go to the nearest emergency room
It is always better to call your doctors ofce with any questions.
If your surgeon is in the operating room, a nurse or physician
assistant will return your call.
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FOLLOW-UP APPOINTMENTS
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You will need to mae an appointment with your surgical
team two to three wees after your surgery and with your
cardiologist seen to ten days after surgery. We also recommend
that you mae a follow-up appointment with your primary care
physician within two wees after you are discharged from the
hospital. If you are taing Coumadin, you will be referred to the
Coumadin Clinic for regular blood tests. You will need to hae
your rst blood test three days after discharge. Please call theCardiothoracic Ofce the day after discharge to schedule your
follow-up appointment with your surgeon.
To mae your follow-up appointment, call:
(718) 226-6210
The ofce is located at:
HLS Building2nd oor, Suite 202
501 Seaiew Aenue
Staten Island, NY 10305
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CARDIAC REHABILITATION
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Phase One Recovery To A Healthy Heart
You are now in the recoery process from recent heart surgery.
A daily actie role on your part will help counteract the weaness
you may be eperiencing. Your participation begins here, in
the hospital!
Activity During Hospitalization
1. Incentie spirometry
2. Anle pumps
3. Sitting/standing eercises
4. Ambulation (waling)
Your physical therapist will address these actiities and proide
you with all the guidance needed to start you on a heart healthy
road. The actiities are grouped into STEPS. Each STEP will be
reiewed with you daily to indiidualize your treatment.
Cardiac Rehabilitation Activity Sheet
STEP 1
Incentie spirometry 10 eery hour
Anle pumps 10 eery hour
Sit in a chair for most of the day, as tolerated
Sitting eercises in bed or chair 2/day
Wal with assistance to the bathroom
Notes:__________________________________________
STEP 2
Incentie spirometry 10 eery hour
Sit in a chair for most of the day, as tolerated
Sitting eercises in chair 2/day Wal 150 feet with assistance, as tolerated, 2-4/day
Notes:__________________________________________
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CARDIAC REHABILITATION
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STEP 3
Incentie spirometry 10 eery hour
Sit in a chair for most of the day, as tolerated
Sitting/standing eercises 2/day
Wal 250 feet 4-6/day
Notes:__________________________________________
STEP 4
Incentie spirometry 10 eery 4 hours
Sit in a chair for most of the day, as tolerated
Sitting/standing eercises 2/day
Wal 400 feet 6/day
Stair climbing
Notes:__________________________________________
STEP 5
Continue incentie spirometry
Sit in a chair for most of the day, as tolerated
Sitting/standing eercises 2/day
Wal 400 feet 6/day
Stair climbing
Notes:__________________________________________
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HOW TO ExERCISE
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Following your discharge from the hospital, it is important to
continue your eercise program at home. Oer the net four to
si wees of your recoery, the intensity and frequency of your
eercise should be appropriate to ensure safety and benet. As
you progress and gain endurance, your eercise time will increase
while decreasing the frequency of daily wals. Your heart rate
(pulse) and how youre feeling oerall determine the pace of your
wal. Chec your heart rate before and at midpoint during yourwal. Your heart rate at midpoint should be less than the number
determined below. The Borg Rating of Perceied Eertion scale is
proided to help you to determine how hard you are woring.
Resting Heart Rate:
The pulse rate taen before waling has begun
Limit Heart Rate:[(220 age) (Resting HR]) 50% + Resting HR
Resting Heart Rate: ___________
Limit Heart Rate: _____________
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TAkING YOUR HEART RATE
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Taing your own heart rate is essential to a proper eercise
program. It proides you with information on how hard your
heart is woring and allows you to gauge the intensity of your
eercise program. For patients on medications that regulate
the heart beat, taing your pulse helps in effectie medication
administration. Learning to count your pulse rate is simple
and can be mastered with some time and practice. When rst
learning to count your pulse, it is a common mistae to presstoo hard. This will bloc the pulse, and you wont feel anything.
A light but rm pressure using the nger pads (not the tips/not
your thumb) will allow you to feel a pulse.
The wrist pulse is located at the base of either thumb. It can be
felt with two or three ngers of the opposite hand.
The carotid pulse is located on either side of the windpipe. It canbe found using the middle ngers of the right hand to the left
carotid, or ice ersa.
NOTE: DO NOT press or rub both carotid arteries at the same
time. This may cause you to faint. Chec only one at a time.
HEART RATE CHART
8 6 = 48
9 6 = 56
10 6 = 60
11 6 = 66
12 6 = 72
13 6 = 78
14 6 = 84
15 6 = 90
16 6 = 96
17 6 = 102
18 6 = 108
19 6 = 114
20 6 = 120
21 6 = 126
22 6 = 132
23 6 = 138
24 6 = 144
25 6 = 150
26 6 = 156
27 6 = 162
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BEGINNING A WALkING PROGRAM
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As you begin your waling program, understanding your goal
is ery important. You will begin waling short distances a few
times a day. With daily practice, your goal of waling 30 minutes
continuously may be achieed in about si wees! Waling for
this length of time will require some body adjustment. When you
are able to wal for 20 minutes, your body will require a warm up
and a cool down for your eercise session.
Warm up: slow waling for e minutes
Eercise phase: bris waling for 20 minutes
Cool down: slow waling for e minutes
Consult with your physician four to si wees after discharge
to determine the indiidual progression best for you. At this
time your doctor may as to see your waling sills by taing
a stress test and may suggest you enter an outpatient cardiacrehabilitation program.
NOTE: Always chec with your physician before starting any
eercise program.
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PROGRESSIvE WALkING PROGRAM
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Remember to tae your Resting Heart Rate, monitor your heart
rate during your eercise and use the Borg Scale (RPE) to gauge
your effort.
Wee 1 Wal 3 5 minutes Total of 12-20 minutes
three to four times daily a day
Wee 2 Wal 7 10 minutes Total of 21-20 minutestwo to three times daily a day
Wee 3 Wal 10 15 minutes Total of 20-30 minutes
two times daily a day
Wee 4-6* Wal 15 20 minutes Total of 30 minutes
one/two times daily a day
*warm up/cool down
Remember, when you achiee a total of 20 minutes, add a e
minute warm up and a e minute cool down. If your Eercise
Heart Rate eceeds your Limit Heart Rate, do not stop waling.
Just slow down to bring your pulse rate down.
Listen To Your Body
If you should eperience ecessie shortness of breath, muscle
cramps or pain, etreme fatigue, or lightheadedness/dizziness,
follow the steps below to modify your program.
1. Stop and rest until these symptoms subside
2. Return home at a slower pace and tae a short-cut
3. Oer the net seeral days, wal more slowly or for a shorterdistance, then gradually increase your distance and pace
NOTE: If you should eperience any of the following symptoms,
contact your cardiologist immediately and discontinue actiity:
1. Chest pain/tightness
2. Palpitations
3. Nausea/omiting
4. Unresoled indigestion
5. Pain traeling to your jaw, arms, nec, teeth, ears or bac
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GUIDELINES FOR WALkING
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Carry ID name, address, physician, contact person and
medications you are taing.
Do not wal outdoors in etremes of temperature or humidity.
Wal indoors, such as at the mall, on inclement days.
In winter, wal in the late morning or early afternoon the
warmest part of the day.
In summer, wal in the early morning or the eening when
its cool. Aoid waling against the wind.
Wear a light scarf around your nose and mouth. While waling
in windy and ery cold weather, wear a est or scarf to coer
your chest wall.
Wal on leel ground. Aoid hills, ramps and inclines.
Wal when you feel rested.
Wait one hour after light meals and two hours after heay
meals before waling. Waling should be continual, rhythmic and at a pace that
is comfortable.
When you hae reached the stage when you are waling brisly
for 20 minutes in your waling program, always warm up and
cool down with a slow wal.
keeping trac with your diary is a good way to monitor
progression for yourself, your doctor and your therapist.
Walking Program Diary
Use the diary to record your actiity.
Under comments, write any changes in the way you felt during
or after your wal.
Tae this record with you when isiting your physician and to
your rst outpatient cardiac rehabilitation isit.
If you hae questions about your waling program, call the
cardiac rehab staff. If you deelop medical problems, call your physician.
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STRESS AND HEART DISEASE
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Stress in itself is not unhealthy. It is your bodys natural response
to any physical or emotional demand. But too much unrelieed
stress can lower your bodys resistance to disease, contribute to
disorders such as stomach ailments and insomnia, and cause
changes in the bodys chemistry that can directly affect your
hearts health.
The stress response is your bodys physical reaction to astressful situation. It is commonly called the ght or ight
response. The physical changes that occur are designed to help
your body to ght, or to ee from danger. When your body reacts
to stress it produces more adrenaline which acts as a stimulant
to increase your heart and respiratory rate as well as your blood
pressure. Fatty acids and cholesterol are emptied into the blood
stream and the blood becomes thicer. Muscles tense and
prepare for action. When the stressful situation is relieed, yourbody relaes and these processes reerse.
The ey to reducing stress is not in eliminating all stress,
but rather in learning to manage your response to
stressful situations.
Consider how you will handle a potentially stressful situation
before it happens. Often, stress results from fear of the
unnown. By rehearsing your response, you can help yourself
deal with the situation and lessen your stress.
Practice deep breathing wheneer you feel stressed out. Inhale
deeply through your nose, hold for a count of e and then
ehale slowly through pursed lips. Repeat three or four timesuntil you feel more relaed.
Tae time to rela. Go to a moie, tae a warm bath, wal
around the par, listen to soothing music, read a noel, put your
feet up and close your eyes or tae up a relaing hobby.
When you learn to manage stress youll be happier and your
heart will be healthier. If you need help in learning to managestress, spea with any of your healthcare proiders.
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TIPS TO CONSERvING YOUR ENERGY
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Energy conseration allows you to use your time and energy
more efciently during your daily routines. By utilizing the
following suggestions, you can maimize your wor and not feel
as tired.
All actions should be slow, smooth and rhythmical.
Use proper breathing techniques: inhale before eertion, and
ehale during eertion. Allow yourself plenty of rest breas during your daily routines.
Rushing will only fatigue you!
Plan ahead and organize your day and wee. Spread out heay
and light tass, and allow for scheduled rest breas.
Sit wheneer possible for actiities (dressing, ironing,
preparing foods).
Let your feet rest on the oor or footstool while sitting, dont let
them dangle. Plan your wor areas within normal reach to aoid etra
bending, reaching or stooping.
Hae duplicate items at different worstations
(cleaning supplies in the itchen and bathroom).
Aoid lifting wheneer possible. Use a utility cart and a
shopping cart, and slide objects along countertops instead of
carrying them.
Remember, a full recoery can tae up to si months depending
on the type of surgery you had. So if you feel depressed or
irritable, it is perfectly normal.
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ACTIvITIES FOR RECOvERY
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The following actiities are safe to resume immediately:
Playing cards/board games
Waling
Washing dishes
Cooing
Light lifting (less than 10 pounds)
Riding in a car Light dusting
Showering
Going to the store
Eating out
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DO NOT TIPS
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If you had traditional bypass surgery the following restrictions
apply for four to eight wees after surgery. All preious actiities
are resumed at three months after surgery as tolerated and
discussed with your doctor.
Patients who underwent MICS CABG should aoid the following
for two wees. Always remember to listen to your body when
doing actiities, especially when lifting or eerting energy.
1. Do not cross your legs or sit for long periods of time. Gieyourself a brea by standing and waling around.
2. Do not lift, push or pull anything oer 10 pounds. Thisincludes lifting groceries, grandchildren or garbage 10 pounds
or greater; dog waling, acuuming, bed linen changing and
opening acuum sealed jars.
3. Do not drie. Sit in the passenger seat with a seatbelt. If thereis a safety air bag in the passenger seat, sit in the bacseat.
4. Do not aoid stairs, howeer do not go up and down withouta rest.
5. Do not tae a bath. Shower with the water hitting your bac.
6. DO NOT SMOkE and aoid second hand smoe.
7. Do not oereert yourself. Tae two rest periods daily for 30-40minutes each.
8. Do not place both arms oer your head or behind your bac atthe same time. One arm at a time is ne. (Does not apply to
MICS CABG patients)
9. Do not sleep on your side or stomach for the net si wees.(Does not apply to MICS CABG patients)
Congratulations. You are on the road to a healthy heart.
Keep up the good work!
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20 Gds for Cardac Patts Aftr Srgry
DATe/Time DiSTAnCe WAlkeD minuTeS WAlkeD ReSTinG HeART RATe exeRCiSe HeART RATe POST HeART RATe WeiGHT TemP.
WALkING CHART
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theheartinstitute
475 Seaview Avenue
Staten Island, NY 10305
Telephone 1 888 432 7878
www.BypassThOrdary.co | 1 888 Hart 78
theheartinstitute is a joint venture
between Richmond University Medical Center
and Staten Island University Hospital.
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NOTES