What to Expect Before and After Surgery

Prior to surgery, a series of laboratory, x-ray, and breathing tests will be performed. These tests will give your doctors valuable information regarding your health. A cardiac surgeon will visit you before your scheduled day of surgery to discuss the procedure as well as both the benefits and risks involved.

The Day of Surgery:

On the evening before surgery, you should eat your usual meal. However, following dinner you must not eat anything until after the operation. Drinking water should be discontinued at midnight. If you feel that a sleeping pill will help you get a good night's sleep, please ask for one. A good rest will help prepare you for the next day's busy schedule. On the day of your operation, a surgical orderly will come and shave the hair off the chest and legs of all male patients. You will then be requested to take a shower using a special soap.

Approximately 30 minutes prior to being taken to the operating room, your nurse will give you several injections (shots). One is a narcotic to help you relax, another is an agent that will make your mouth extremely dry, and the third is an antibiotic to help prevent infection. Following these injections, you must stay in bed. Your immediate family should arrive one hour before your scheduled surgery. Your family may accompany you to the second floor. Here you will be taken into surgery, and your family members will be directed to the Surgical Waiting Room.

The Operating Room:

Once in the operating room, you will receive an intravenous medication that will put you to sleep. Once asleep, other tubes and monitoring equipment will be used to control and monitor all of your body functions during and after surgery. Surgery preparation takes approximately one hour; the surgical procedure take another two or three hours.

The function of the heart and lungs will be taken over by the Cardiopulmonary Bypass machine during surgery. Once your are taken off this machine and your heart and lungs resume their normal function, a staff member will come to the Surgical Waiting Room and inform your family of your condition.

Closure of the incisions take about 45 minutes to an hour. When this procedure is completed, you will be taken directly to the Surgical Intensive Care Unit.

Surgical Intensive Care:

After 30 to 60 minutes, your family will be allowed to see you. It generally takes about an hour, however, before you will begin to awaken from the anesthetic. When you awaken, you will be aware of a tube in your mouth. This tube is attached to a respirator which will assist with your breathing. Certain tests will be performed to determine when this tube can be removed safely.

The Intensive Care nurse is trained to anticipate your needs during this period. While in Intensive Care, you will notice several pieces of special equipment and much activity. This is normal and it should not alarm you. Once the breathing tube has been removed from your mouth, you will be able to speak.

At this point, you will begin breathing treatments, including coughing and deep breathing. Your nurse will also remind you to do you leg exercises. If you need medication for pain, please ask for it. During the first several hours after surgery, you vital signs (blood pressure, heart rate and rhythm, breathing rate, urine and chest tube drainage) will be checked frequently. Try to rest as much as possible.

You will remain in Intensive Care approximately 24 hours. During this time, you will have various tubes removed. Chest X-rays and blood tests will be performed.

Visiting Hours:

Visitors to the Intensive Care Unit are limited to members of your immediate family. One member of your family should be delegated the responsibility of SPOKESPERSON. He/She can call the hospital at any time of the day or night for a report on your condition. Other members of the family should call this spokesperson for a report. After your condition is stable, you will be transferred from the Intensive Care Unit to a cardiac surgical floor of the hospital. At this time, you will no longer need continuous attention. The nurses on this floor will observe your recovery, check your vital signs, care for your incisions, weigh you daily, and provide any assistance you may need. Blood tests, X-rays and other diagnostic tests will be done as needed. You will need to wear support hose during the daytime, and you legs should be elevated while you are sitting.

Activities:

Your activities will be increased daily. The Cardiac Rehabilitation staff will see you one to two days after surgery to start you on an exercise program. This inpatient (Phase I) program consists of exercises, progressive ambulation, risk factor modification and activity guidelines. These daily sessions continue until you are discharged from the hospital.

Incisions:

You will be instructed by your nurse about cleansing the incisions. Showering daily will replace your incisional care. Sutures will be removed from 10 to 14 days following surgery.

Medications:

You will receive various medications during recovery, some of which will be discontinued before you are discharged from the hospital. If you have any questions about your medication, ask your nurse or doctor for further information.

Pulse Taking:

Why?

You will be taught to take your pulse before you leave the hospital if you are taking certain heart medications or may be prone to develop a disturbance in the heart rhythm. This is an important skill to learn because your pulse rate will give you valuable information about your heart's health and rhythm.

How?

The pulse can be felt on the inner part of the wrist, below the base of the thumb. Press lightly until you feel the slight thumping with your fingertips.

When?

If you have been instructed to take your pulse daily, it should be done before you take your heart medication in the morning. Count your pulse for a full minute to determine heart rate.

  

Ready for Home 

Follow-up Care:

Every patient who has undergone open heart surgery will be seen by the Cardiovascular Nurse Practitioner after discharge from the hospital. The number of post-operative visits depends upon the patient's condition. This is part of your surgeon's surgical service.

Cardiac Rehabilitation Program:

Cardiac rehabilitation is an exercise and educational program that was developed for patients who have had open heart surgery, a heart attack, angioplasty or for patients who are highly prone to cardiovascular disease. The goals of the program are to increase muscular strength and flexibility, improve functioning of the heart, lung and circulatory system, and teach ways to help avoid future heart problems. The program is divided into two components: Inpatient (Phase I) and Outpatient (Phase II). The Phase II component is an outpatient exercise and educational program that generally begins one to three weeks following hospital discharge. This program consists of a supervised exercise program, group support, and education on diet management, and stress reduction. Phase II Cardiac Rehabilitation is tremendously helpful in restoring confidence and stamina, after heart surgery, and empowers individuals to take control of their heart health. The Cardiac Rehabilitation Staff will see you daily after your heart surgery.

"Come join us-- we're here to help you build a healthier future."

Surgical Follow-up:

During your visits to the Cardiovascular Nurse Practitioner, your temperature, weight, blood pressure, heart, lungs, and incisions will be checked. If any problems are detected, one of the staff cardiologists will be contacted or your physician will be notified.

Phone your personal physician when you get home to set up an appointment. He or she will supervise your health care, as usual, and will adjust any medications as necessary.

Personal Comfort

Pain relief:

Muscle and bone discomfort in the chest, back and shoulders is a common occurrence. The pain will diminish with time, and it can be eased by:

• Performing the exercises prescribed for you in the Cardiac Rehabilitation Program 
  
• Taking your pain medications every four to six hours, as needed. 
  
• Applying a heating pad-- set on low to medium heat-- to the sore areas. 
  
• Taking a warm shower. 
  
• Swelling (edema) of the leg

You probably will have some swelling in the leg from which the saphenous vein was removed. The discomfort and swelling can be kept to a minimum by wearing the elastic stockings you received in the hospital. Put them on in the morning and remove them before going to bed.

When sitting for long periods of time, keep your legs propped up on a chair or foot stool.

If your leg swells more than usual, lie on a sofa and prop your leg up on the back of the sofa for 30 minutes several times a day. By elevating your leg above the level of your heart, the fluid is able to drain away from the tissues by gravity. Leg exercises and walking will continue to improve circulation.

Skin Care:

Cleanse your incisions daily with soap and water. The chest incision should be cleaned from top to bottom. Continue to clean incisions as you were instructed. Should your doctor or nurse prescribe other wound care, follow those instructions explicitly.

Some clear yellow drainage from the incisions is common. If there is pus, tenderness, or redness of the incisions, please report this to your physician and/or nurse practitioner. Also, report any fevers of 101 degrees or higher.

Activities

Lifting:

It is best not to lift anything heavier than 10 or 15 pounds for the first three months after surgery. It takes about this long for the sternum (breast bone) to heal completely. During this healing period, you may notice a grating or popping feeling in your sternum. It is quite normal and need not cause you alarm. The stainless steel sutures are holding the breast bone together firmly.

Driving:

Most people resume driving their car four weeks following surgery. Before you start to drive, make sure you have full movement of your chest and arms. If you are too sore, you will not be a safe driver. If you are planning a long car trip, please contact your physician first. When traveling, stop every hour and walk around for at least five minutes. This will improve the circulation in your legs and prevent you from becoming stiff and sore. Always wear your seatbelt and shoulder harness.

Sexual Activity:

You may resume sexual activity when you feel physically comfortable in doing so. If you are tense and tired, wait until you feel better. Certain positions may cause discomfort to your chest and will need to be varied.

Work:

How soon you return to work will be decided upon by your physician. This will depend on your type of work, the demands of your job and how well you have responded to the postoperative rehabilitation program. In regards to housework, you should not resume total responsibility for household duties until four to six weeks after surgery. Light housework such as dusting, assisting with meal preparation, etc... may be attempted after you are home one to two weeks. Heavy housework such as vacuuming, moving furniture, or mopping should be avoided for the first three months-- until your breast bone has completely healed.

Mood Changes:

Patients sometimes notice uncontrollable mood changes after they go home. Feelings of depression or anxiety may be related to inactivity, stress, boredom, or any number of factors. These moods are usually temporary and should not cause alarm. To avoid feeling depressed, plan daily activities, pursue a favorite hobby, leave the house whenever possible and continue an active exercise program. If feelings of severe depression persist, notify your doctor or the CARE nurse.

Irregular Heartbeat:

Call your physician or go to the emergency room if an irregular heartbeat lasts more than 10 minutes. Your heart may still be irritated from the surgery and require some medication to get back into a regular rhythm.

"You and your cardiac team share one important goal... your rapid return to a healthy, active lifestyle."