CORONARY ARTERY BYPASS GRAFT & HEART VALVE SURGERY www.cpmc.org/learning i learning about your health What to Expect During Your Hospital Stay 1
Our Team: Our cardiac surgery specialty team includes nurses, nurse practitioners, physicians, and therapists who are here 24/7 to ensure your safety. Your primary contact throughout your stay will be our nurse practitioners, who work closely with our surgeons, nurses and therapists to coordinate your care needs. Being in the hospital can be stressful. We have resources to help meet your emotional needs, including spiritual care services and the Institute for Health and Healing. Please let us know if you are interested in any of these services Throughout your stay, we will monitor your condition closely, and will keep you and your family informed. Please let us know if you have any questions or concerns about your progress. The Medical-Surgical Intensive Care Unit (MSICU): You will go directly to the MSICU, located on the 3rd floor of the main hospital, after your surgery is finished. Most patients stay here one night after their surgery. Your family may visit for short periods when you are in MSICU, but may be asked to leave the unit during medical rounds to maintain patient privacy. Your family may ask about your condition, any time of the day or night, by calling the main hospital number (415) 600-6000 and asking for the MSICU. Waking up After Surgery: You will wake up in the MSICU with a breathing tube in your mouth. This tube will be removed as soon as it is safe, usually within a few hours. You will not be able to speak while the tube is in place, but you will be able to communicate by nodding yes/no to our questions. Tubes & Lines: After the breathing tube is taken out, you will receive oxygen continuously by nose for several more days. Nurses will give fluids, medicines, draw blood tests, and monitor your heart function using an intravenous (IV) line in your neck, which usually remains for 4-5 days after surgery. Chest tubes drain fluids from the incision area. The nurse practitioner or physician usually removes these tubes 1-2 days after surgery. 2
A urinary catheter drains urine from your bladder after surgery. Your nurse removes this catheter on the 1 st or 2 nd day after your operation. Temporary pacemaker wires are placed during surgery and are used as needed to maintain the best possible heart rate. The doctor or nurse practitioner removes these when no longer needed, usually 3-4 days after surgery. The Cardiovascular Specialty Unit (4-South): Most patients go to the Cardiovascular Specialty Unit (4-south), located on the 4 th floor, on the first day after surgery. Your friends and family members may visit anytime on 4-south, provided they allow you time to rest. Your safety is our priority: our nursing team will be checking on you to evaluate your condition, pain level, and personal needs often, at least hourly during waking hours. Most patients go home on the 4 th or 5 th day following surgery, after several days of rehabilitation and monitoring. While most patients do not require any additional nursing care after discharge, some patients may need follow-up at home by a visiting nurse or therapist. A member of our case management team will meet with you to discuss and coordinate any ongoing needs after you are discharged. If your nursing care needs cannot be managed at home, our case managers will arrange for you to be transferred to one of CPMC s Post Acute Care Units, or a Skilled Nursing Facility (SNF) in the community. Please note that insurance companies vary in their coverage of these expenses, based on your plan and the amount of care you will need. We will discuss these arrangements with you before you leave the hospital. Activity After Surgery Nurses and physical therapists will help you get up, walk, and sit up for meals several times a day starting the day after surgery. Once our staff tells you it is safe to walk without help, you can take short walks on your own. You should try to gradually increase your walking each day to help regain your strength. This will help you recover from surgery more quickly. Most patients begin inpatient Cardiac Rehabilitation the day after surgery. You will receive information about outpatient Cardiac Rehabilitation programs at discharge. 3
Physical and occupational therapists will show you gentle exercises, start you on a daily walking program, and teach you how to resume your normal activities. If needed, they can also practice stair climbing with you before you go home. You will be taught Sternal Precautions, which are very important to your recovery and include avoiding pressure on the breastbone and not using your arms too much when lifting, pushing, or moving about. You will be able to do most of your personal hygiene. You can shower once the pacemaker wires are removed. Our occupational therapists can teach you how to shower safely and assist with showering, as needed. Understanding Your Medicines after Surgery Our nursing staff gives you your medicines while you are in the hospital. For your safety, do not take any medicine unless given to you by our nurses. Some heart surgery patients take blood-thinners, (anticoagulants) which are medicines that prevent clotting. Unless ordered by the doctor, patients taking blood thinners should avoid taking other medicines that affect blood clotting such as aspirin or Ibuprofen. Additional information will be provided to you if you will be remaining on these medicines. Even if you are not a diabetic, we will be monitoring and controlling your blood sugar levels closely to prevent infection. Many patients who never take insulin may temporarily need it during their hospital stay, but it is unlikely that they will remain on insulin therapy at home. If needed, diabetic medicines will be restarted gradually once you begin eating solid food. All patients gain fluid during their operation, which is noticeable as tissue swelling and weight gain. We will be treating you with diuretics, such as lasix (furosemide) to help promote fluid loss and return you to your pre-surgery weight before discharge. Electrolyte replacement of potassium and magnesium is typically needed while taking diuretics. These medicines are sometimes continued after discharge. As we adjust your diuretic medicines, we will speak with you about how much fluid is appropriate for you to drink during your recovery. Beta blocker medicines (ie, metoprolol, atenolol) are typically given to patients following cardiac surgery to prevent irregular heart rhythms (ie, atrial fibrillation). These medicines are usually continued after discharge to help your heart recover from the surgery. Our nurse practitioners and nursing staff will review all your medicines with you before you go home, provide you with written instructions, and give you prescriptions for any new medicines you will need. If you have any questions about your medicines, please ask us. This is important for your safety! 4
Managing Your Pain after Surgery Take action to control your pain as soon as the pain starts. It is more difficult to relieve pain once it has become severe. Reporting your pain: If you are in pain, please tell us! Each person experiences pain differently; we rely on you to rate your pain using the pain scale below. A 0 on the scale means no pain, and a 10 on the scale means the worst pain you can imagine. Treating your pain early and well is key to good pain control and important to your recovery. Take your pain medicine before doing something that may increase your level of discomfort such as getting out of bed to walk. 0-10 Numeric Pain Intensity Scale 5
Your Diet After Surgery We will be monitoring how much food and liquid you take in, as well as how much urine you put out. Please review all fluid intake and output with your nurse. The day after surgery, most patients are started on a liquid breakfast. You will be given solid food as soon as you are ready. You will be able to select foods you like by filling out a daily menu. A dietitian will talk with you about heart-healthy eating habits. Any food or drink brought from home should be reviewed with the nurse to ensure they are correct for your diet. If we are monitoring your blood sugar levels regularly, please check with the nurse before eating to ensure proper timing of these tests. Nausea sometimes occurs after surgery and medicine may be given to help control this. Take only small amounts of food or drink at a time, and always take pills with food. You should tell your nurse immediately if you are having difficulty swallowing, or feel as if you are gagging or coughing when you eat. Wearing a Telemetry Monitor after Surgery You will be wearing a portable EKG (telemetry monitor) around the clock until you are discharged home. This device allows us to closely monitor your heart rhythm. Atrial fibrillation (AF) is an irregular heart rhythm (arrhythmia) that occurs commonly after heart surgery, despite medicines to prevent it (ie beta blockers). AF is not life-threatening and is usually treated on 4-South with oral or IV medicines. If AF occurs while you are in the hospital, you may need to stay on medicines for 6-8 weeks after discharge to control it. Arrhythmia treatment varies among patients; some will require medicines after discharge, while others will not. We will let you know if we have any concerns about your heart rhythm. 6
Tips for Your Recovery Stop Smoking: If you smoke, now is the time to stop. Talk with your doctor and nurse for suggestions on how to quit smoking Prevent Complications: Take pain medicine as needed so you can breathe deeply and move about comfortably. Change your position, cough, and take 10 slow, deep breaths using your spirometer, every hour while you are awake. Check with your nurse or therapist if you have questions about proper use of the spirometer. Sit up in a chair for all of your meals. Get out of bed and move about your hospital room as much as you are able. Take naps and frequent rest periods during the day. Remember to practice sternal precautions: avoid pressure on the breastbone and do not put a lot of weight on your arms for lifting or moving about. Do not get out of bed without help, unless your nurse or therapist instructs you that it is safe to get up by yourself. Please ask for help at night, to prevent falls. Preparing For Discharge You are ready to go home when: You are walking several times a day with little or no assistance. Your heart rhythm and blood pressure are stable for your condition. Your pain is controlled by oral pain medicine. You are passing gas, have had a bowel movement and do not feel bloated. 7
Planning for Discharge: Beginning on the third day after surgery, discuss with the nurse practitioner your plans for going home. Let your family know about your plans. Most patients go home without additional help. RN Case Managers can help you with your plans to go home. They can arrange for care at home (visiting nurse) or admission to a Skilled Nursing Facility (SNF), if that is thought to be medically necessary. Be aware that insurance companies vary in their coverage of after hospital care, based on your skilled care needs and your health care plan. Our Nurse Practitioners will coordinate your discharge. They will provide you with written instructions for your continued care at home. Please let us know if you have any questions or concerns about your recovery after discharge. Transportation Home You cannot drive yourself home. You should be able to go home safely in the back seat of a friend s or family member s car. Ask to speak to an RN Case Manager if you have concerns about getting home or walking up stairs. Be aware that most insurance plans will not pay for transportation home. Medicines At Home Our nurses and nurse practitioners will carefully review your medicine instructions with you: you should know what medicines you will take, what they are for, and possible side effects. Please identify which pharmacy you want to use to get your medicine(s). Have someone fill your prescriptions, including pain medicine, preferably the day before discharge. This will ensure that your medicines are available when needed. Do not stop any medicine without speaking to your cardiologist first. If you are taking Coumadin (Warfarin), we will arrange for outpatient lab tests to monitor the PT/INR (Protime) and provide you with additional instructions to take this medicine safely. Part of your follow-up will be having Protime tests drawn regularly to monitor blood clotting. 8
Diet and Activity At Home You and your family should know about any dietary restrictions, or if you are on a special diet. Know your activity limitations, lifting restrictions, and when to resume usual activities at home. Our physical and occupational therapists will develop a home exercise program for you. Please review this information with any friends or family members who will support you after discharge, to promote a smooth transition to your outpatient activities. Follow-up Appointments Your cardiologist needs to see you in the office about 5-7 days after discharge. We can assist you in making this follow-up appointment before you go home. This appointment should be made at the time you are discharged; do not wait to call their office, as this may cause a delay in your first postoperative visit. If instructed, call your surgeon s office right away, to schedule an appointment for 30 days after discharge. You will receive contact and referral information about Cardiac Rehabilitation programs in your area. Note: This information is not meant to replace any information or personal medical advice which you get directly from your doctor(s). If you have any questions about this information, such as the risks or benefits of the treatment listed, please ask your doctor(s). Produced by the staff and physicians at California Pacific Medical Center in association with the Center for Patient and Community Education. Last updated: 12/11. 2011 California Pacific Medical Center 9