THI After Surgery Web

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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

www.BypassThOrdary.co | 1 888 Hart 78 1

Dr. Joseph T. McGinn, Jr.

Medical Director, theheartinstitute


3/23

INCISION CARE

2 Gds for Cardac Patts Aftr Srgry

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


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


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.


7/23

DIET


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.


8/23

COMMON PROBLEMS


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.


9/23

FOLLOW-UP APPOINTMENTS


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


10/23

CARDIAC REHABILITATION


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



Sitting eercises in chair 2/day Wal 150 feet with assistance, as tolerated, 2-4/day

Notes:__________________________________________


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CARDIAC REHABILITATION


STEP 3



Sitting/standing eercises 2/day

Wal 250 feet 4-6/day

Notes:__________________________________________

STEP 4

Incentie spirometry 10 eery 4 hours



Wal 400 feet 6/day

Stair climbing

Notes:__________________________________________

STEP 5

Continue incentie spirometry



Wal 400 feet 6/day

Stair climbing

Notes:__________________________________________


12/23

HOW TO ExERCISE


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


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


14/23

BEGINNING A WALkING PROGRAM


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.


15/23

PROGRESSIvE WALkING PROGRAM


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


16/23

GUIDELINES FOR WALkING


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.


17/23

STRESS AND HEART DISEASE


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.


18/23

TIPS TO CONSERvING YOUR ENERGY


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.


19/23

ACTIvITIES FOR RECOvERY


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


20/23

DO NOT TIPS


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!


21/23


DATe/Time DiSTAnCe WAlkeD minuTeS WAlkeD ReSTinG HeART RATe exeRCiSe HeART RATe POST HeART RATe WeiGHT TemP.

WALkING CHART


22/23

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.


23/23


NOTES

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