CARDIAC REHABILITATION Follow-up Options & Dismissal Instructions Open Heart Surgery

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1 CARDIAC REHABILITATION Follow-up Options & Dismissal Instructions Open Heart Surgery For patients of Jeffrey Kramer, MD As you re discharged from the hospital, you may have questions about your continuing recovery. Here are some answers to those questions and a description of your options. If you have more questions, please call us. We re looking forward to seeing you outside of your hospital room and working with you to continue your recovery. CALL YOUR HEALTH CARE CONTACT You ll receive your contact name and phone number before you leave the hospital. If you don t or have misplaced the information, call us at Your contact person: If you have an emergency, call 911 or your physician. Our hours are Monday through Friday, 7 a.m. to 3 p.m. If your contact is unable to take your call, please leave a message, and your contact will call you back as soon as possible. CARDIAC SUPPORT GROUP You know that trying to live a normal life with heart disease is tough. Sometimes you just need to talk to people who understand. People who will listen because they experience the same frustrations. Our active Cardiac Support Group includes a diverse mix of people who meet monthly to listen to a speaker, share information and just talk. We meet at 7 p.m. the third Tuesday of each month at The University of Kansas Hospital White Heart Learning and Resource Center Center for Advanced Heart Care 2 nd floor Conference Room. There s no fee for this service. For more information, call Cardiac Rehab Follow-up and Dismissal Open Heart 1

2 DISMISSAL INSTRUCTIONS 1. Check incisions / wounds daily for signs of infection: Increased redness Tenderness or pain Increased swelling Pus-like drainage Fever greater than Shower daily and clean your incisions or wounds with soap and water. Towel dry. Following your shower and at bedtime, use Kara-Clenz. Spray lightly. Do not wipe or rinse off. 3. Do NOT use powder, lotion or cream on your incisions or wounds. 4. Wash your incisions / wounds gently; DO NOT SCRUB. 5. If you notice signs of infection in your incisions or wounds, call your surgeon at Do NOT lift anything heavier than 10 to 15 pounds for three months. 7. Do NOT push or pull anything that resists movement for three months. 8. Do NOT do activities that cause discomfort to incisions or breastbone for three months. 9. Do NOT do activities that put strain on incisions or breastbone for three months. 10. Do NOT drive for two weeks. You may ride in a car. 11. You may use the stairs, but do not make repeated trips for the first couple of weeks. 12. You may resume sexual activity four to six weeks after surgery. For the first six to eight weeks of sexual activity, choose a position that does not require supporting your weight with your arms. Avoid positions that put stress on the healing chest. Recovery will not be the same for each person. 13. Weigh daily call your physician if you gain 3 pounds in a day or 5 pounds in a week. 14. To decrease swelling in your leg incisions, elevate and support leg while sitting. 15. You may experience a let down or depressed feeling. These feelings are normal after surgery and should get better in four to six weeks. If not, talk about these feelings with your physician. Cardiac Rehab Follow-up and Dismissal Open Heart 2

3 16. Continue your exercise program as prescribed by the Cardiac Rehab staff in the hospital. Wait at least one hour after eating before exercising. 17. It is normal to feel tired upon your return home from the hospital. This will improve as you follow your activity program. Alternate rest with activity during the day. You should rest 45 minutes to one hour twice a day for about the first three weeks after you return home. 18. The surgeon will let you know when you can return to work. This is normally four to six weeks following surgery. 19. Doctor appointments: The surgeon and cardiologist offices will contact you about the date and time of your follow-up appointment. You will need to make an appointment with your primary care physician yourself. Primary Care Physician one to two weeks after surgery Cardiologist approximately four weeks after surgery: Surgeon approximately four weeks after surgery Reasons to call the physician: Angina Shortness of breath that is not relieved with rest Lightheadedness / dizziness / feeling faint Weight gain of three pounds in a day or five pounds in a week Abnormal heart rate or heart rhythm Signs of infection: increased redness, pain, swelling, pus or fever Increased popping or clicking sound in the breastbone area Cardiac Rehab Follow-up and Dismissal Open Heart 3

4 HOME WALKING PROGRAM You should be exercising at around 3 on the Perceived Exertion Scale. Remember, Listen to your body. If you can t carry on a conversation while you re exercising, you need to slow down or stop for a moment. WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 5 WEEK 6 WEEK 7 WEEK 8 Start with walking three to five minutes, two to four times a day. Walk five to10 minutes, two to three times a day. If you re tolerating this well, add one minute each day. Walk 10 to 20 minutes one to three times a day. Walk 15 to 25 minutes one to two times a day. Walk 20 to 30 minutes one or two times a day. Walk 25 to 35 minutes one time a day. Walk 30 to 45 minutes one time a day. Walk 45 minutes one time a day. Once you reach your personal maximal level, continue to exercise in this manner at least five days a week. Be sure to allow a few days a week for rest. PERCEIVED EXERTION SCALE Perceived Exertion: The mental and physical judgment of the effort it takes to exercise or perform daily activities. 0 No effort 1 Extremely light 2 Very light 3 Light 4 Fairly light 5 6 Somewhat hard 7 Hard 8 Very hard 9 Extremely hard 10 Maximum effort Slow or stop exercise if your exercise effort is greater than 5 6 or somewhat hard. After you re recovered or rested, resume exercise at a lower exercise effort. It s ok to feel: - A mild stretching or pulling sensation in the working muscles and joints - An increased but comfortable rate of breathing that gradually returns to normal after exercise - Mild perspiration - Mild fatigue after exercising But if you must rest, then you ve pushed too hard. You want to feel a pleasant sense of exertion. COMMENTS: Cardiac Rehab Follow-up and Dismissal Open Heart 4

5 HOME ACTIVITY PROGRAM RECOMMENDATIONS Here are some guidelines for increasing your activity. Keep in mind that each person is different, so your progress may be faster or slower than someone else s. These tips are designed to keep you active before, during and after Outpatient Cardiac Rehab. They re not an alternative to the formal program. If you are unable or unwilling to participate in an outpatient cardiac rehab program, please talk with your cardiologist before beginning any formal activity. Guidelines It s normal to feel tired when you return home from the hospital. This will improve as you follow your activity program. Alternate rest with activity during the day. Rest 45 minutes to one hour twice a day for the first three weeks at home. Begin exercise the day following discharge. Wait at least one hour or more after eating before exercising. Walk on level surfaces. Avoid large hills and inclines. Avoid walking against strong winds or in soft sand or snow. Exercise outdoors only in moderate temperatures. - Not when the temperature is warmer than 80 degrees - Not when the humidity is greater than 70% - Not when the temperature is colder than 40 degrees If you re on a medication that prevents your heart rate from increasing in response to exercise, use the Perceived Exertion Scale on page 4 or walk at a pace that you can carry on a conversation. You may use stairs. Take one step at a time. Stop and rest as needed. Reasons to Stop Exercise and Call the Physician Change in coordination Nausea or vomiting Skipping heartbeats Shortness of breath (not relieved with rest) Dizziness / lightheadedness / feeling faint Palpitations Leg pain / swelling and/or tenderness in leg Fatigue (lasting longer than 24 hours after exercise) Angina (discomfort, heaviness, pressure, etc. in your arms, chest, back, neck, shoulder blades or jaw) Remember, Listen to your body. Rest when you re tired. If your fatigue is relieved, continue at a slower pace. If fatigue persists, rest and stop your exercise session. Notify your physician. Cardiac Rehab Follow-up and Dismissal Open Heart 5

6 PHASE II OUTPATIENT CARDIAC REHAB Outpatient Cardiac Rehab (OPCR) or Phase II builds on the exercise and education that you receive in Inpatient Cardiac Rehab or Phase I. The program provides a supportive environment to assist in your cardiac recovery. Phase II consists of EKG-monitored exercise sessions usually three times a week for six to 12 weeks. These exercise sessions are one way to evaluate your recovery progress. The monitoring also provides your physician with information to make adjustments in your medical treatment. The program is flexible, allowing you to follow an exercise plan tailored to your own capabilities and requirements. We ll Call You to Begin Our staff will discuss OPCR with you while you re in the hospital. After discharge, we ll call you to make arrangements. We also will contact your physician for authorization to begin OPCR. The program includes three sessions a week, so convenient access is important. We ll identify an OPCR location that is near your home or work. Many Insurance Companies Cover the Cost Many insurance companies cover most or all of the costs of OPCR. We ll contact your insurer to ask about your coverage before you join the program. We ll discuss this information with you before you begin. OPCR Benefits Increased understanding of heart disease Reduction or control of cardiac risk factors Improved cardiovascular fitness / increased overall activity tolerance Early identification of developing medical problems Improved confidence and psychological outlook Help with adjusting to living with heart disease Best of Luck in Your Recovery! Revised October 2012 Cardiac Rehab Follow-up and Dismissal Open Heart 6

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