During this video we will discuss concepts that your health care team at the hospital has likely already touched on. As well, many of the slides coincide with pages in your heart surgery book. This presentation will guide you through your heart surgery book, please follow along with the pages identified on each slide. We will discuss: Arrangements Before you are Discharged Pain Protecting your Sternum Medications Cardiac Rehab Depressive Feelings Sleep Bowel Movements Incisional Care Activity Follow-up Appointments and the DOTS Sheet Arrangements to Make Before You are Discharged When your health care providers have determined that you are medically ready for discharge you should have the following arrangements in place to assist you when you are home. Be sure you have someone to stay with you for the first few days to help you get settled back into your home environment. This person should be able bodied and be prepared to assist with household tasks such as meal preparation, cleaning, and shopping. The transition from hospital to home may present challenges you may not have anticipated both physically and emotionally. Be sure you have someone to walk outside with you. It is important to continue your walking activities. Be sure you have someone who can be in your home while you shower, just in case you need help. It is important that you shower daily to keep your incisions clean. Follow up with your healthcare team after surgery. Is an important part of your recovery. Be sure you have someone who can help you get to your appointments and run errands for you. Since you cannot drive after you leave the hospital, you will need help to get to your appointments. Pain Pain is a different experience for each person. Continue to use the 0-10 scale to assess your pain after going home. 0 means you are pain free. 10 means you are experiencing the worst pain you can imagine. You want to keep your rating as a 3 or less out of 10. If you rate your pain greater than 3 you should use the pain medication that has been prescribed for you. Most people need some form of pain medication, whether it be Tylenol or a stronger pain medication, for a week or two after going home. Gage your pain using the pain scale and use your pain medication as you need it. If you are running low on your pain medication and continue to require it, contact your family doctor for a refill. Other strategies you may use for pain management include, re-positioning and for women, wearing a bra. Providing support to the muscles along the incision line of the chest can assist in pain management. Protecting your Sternum Your sternum is the large breast bone down the middle of your chest. If you have an incision here as part of your surgery, there are specific precautions you must follow to ensure that the breast bone under the incision heals well. The breast bone has been wired back together. These wires do not need to be removed but they are only so strong, they can break if you strain them. This incision and the bone will need 3 months to heal completely. Moving around puts a lot of strain and pressure on this area. You will need to protect this area area as it heals, by following the sternal precautions you see on this video and in the heart surgery book. You should not lift, push, or pull anything weighing more than 5-10 pounds for 6 weeks. Do not forget that this includes your own body. Do not use your arms to push off the arms of a chair or bed to get up. Do not use your arms to push or pull on the railing of the stairs, and do not push or pull to open heavy doors. Hug your chest with your pillow when coughing, laughing, or sneezing. If you have a sudden cough or sneeze and your pillow is not available, cross your arms over your chest to protect your sternum. You should not drive or sit in the front passenger seat if there is a front air bag until your surgeon tells you that you no longer need your red pillow. In the event that the air bag would deploy, your sternum is not strong enough to withstand the pressure in the first 6 weeks. Sit in the back seat and wear your seatbelt normally, it is the law. Getting out of Bed You should continue to the follow the instructions you received in hospital when getting in and out of bed or a chair. These instructions will ensure good sternal precautions! Hug your pillow to your chest. Move close to the edge of the bed. Bend your knees up and roll over onto your side. Bring your legs over the edge of the bed. Push very slightly with the elbow that is against the bed to help you sit up. Use your legs to help you – push them against the side of the bed as you sit up. Sit on the side of the bed and rest for at least 30 seconds to make sure that you are not dizzy. Stand up. Getting into Bed Hug your pillow to your chest. Stand squarely in front of the side of bed and make sure you can feel the bed with the back of your legs. Lean forward, take a small ‘bow’, and lower yourself slowly onto the bed. Sit on the edge of the bed lower your shoulder and head to the pillow while staying on your side. Lift 1 leg at a time onto the bed When both legs are on the bed, roll onto your back and position yourself straight in the bed. Getting Up from a Chair Hug your pillow to your chest. Wiggle yourself forward with your hips to sit closer to the edge of the chair Place your feet shoulder width apart with your knees bent before you stand. Rock forward 3 times, bringing your “nose over your toes” while counting to 3. Stand up using your legs on “3”. Sitting Down in a Chair Hug your pillow to your chest Stand squarely in front of the chair and make sure you can feel the chair with the back of your legs. Lean forward and take a small ‘bow’. Slowly lower yourself to sit on the chair. Medications Following your medication regimen is an important part of your ongoing recovery from heart surgery. On the morning of your discharge from the hospital, your nurse will review your medication prescriptions and provide you with an instruction sheet. Take these prescriptions and all of the medications you have at home, in their original containers, to your pharmacy. The pharmacist should only return the medications that are on the prescription. Do this on the day of your discharge so that your prescriptions will be filled right away. All prescription refills should be requested through your family doctor. If you plan to take any herbal or naturopathic medications or vitamins, speak with your community pharmacist before doing so. The pharmacist will be able to identify the safety of taking these over the counter medications with your prescription medications. Additionally, your community pharmacist is a good resource after you have left the hospital, should you have any questions related to your medications. Medications Schedule Your medication schedule will tell you what time of day to take your medications. The schedule is set up with columns for “Breakfast”, “Noon”, “Supper”, and “Bedtime”. If you are released from the hospital in the morning, you will have already taken your “Breakfast” medications. Get your prescriptions filled on your way home, so that you have your “noon”, “supper” and “bedtime” medications for that day. Take your medications as they have been prescribed. Do not stop or change any of your medications without first consulting with your family doctor. Cardiac Rehab The Cardiac Rehab program can help you achieve and maintain a heart-healthy lifestyle through exercise, education and counselling. Cardiac rehab is recommended after heart surgery, and for people who are known to have heart disease or have had a heart attack. Although there may be some variation between cardiac rehab programs, they generally provide medical assessment, physical activity, lifestyle education and psychosocial support. You will be referred to your local cardiac rehab program. Your nurse will provide you with information about this program on your appointment card, which will be discussed later in the video. If you have not heard from your local cardiac rehab program in the first three weeks you are home, be sure to call them to get enrolled. You may begin working with them approximately one month after your surgery. Depressive Feelings After your heart surgery, you may feel down or have depressive feelings at times. You may also have difficulty concentrating. Feelings of sadness, irritability, fear or anxiety, can be normal, and may come and go. Be sure to communicate these feelings with your family and health care team, they will be able to help you cope with them. If these feelings last longer than 6-8 weeks, or if they interfere with your relationships or your ability to do your daily activities, speak with your family doctor. Sleep If you did not normally sleep on your back before the surgery, you may find it difficult to sleep on your back now. To help your sternum recover you must sleep on your back for 6 weeks. If this position is difficult for you, you may use pillows or rolled up blankets to help get you in a comfortable position, or you may sleep in a recliner chair. The important thing is that you are not sleeping on your side or your stomach. Most people do not need a sleeping pill at home if they were not taking one before surgery. If you are having trouble sleeping, despite repositioning, then speak with your family doctor to see if a sleeping pill might be appropriate. Bowel Movements Bowel regularity is important to prevent straining during your bowel movements. Poor appetite in the early part of your recovery, not being as physically active as normal, and taking pain medications, can all contribute to constipation. You may be prescribed stool softeners when discharged from the hospital. If you do not have a stool softener already available or what you are using is not effective, speak with your community pharmacist to see what over the counter options are available to you. Incisional care It is important to monitor your incisions to ensure that there are no signs of infection. Although infection is not common, you should monitor your incisions for one month after your surgery. Your best defense against an incisional infection is to shower each day. As you were instructed in the hospital, you should: Shower using unscented soap. Do not scrub your incisions directly or use a face cloth over the incisions. Allow the shampoo, soap and water to flow over the incisions. When you are showering, look at your incisions to ensure that there is no redness developing around the incision and that there is no new drainage. Pat your incisions dry after your shower but do not apply any creams, lotions, or ointments to your incisions. When you see your family doctor about a week after you go home, they will look at your incisions to ensure they are healing well. If you have any concerns about your incisions before or after this appointment, call your family doctor to be assessed. My Incisions It is normal that your incisions may be: • Slightly red and sore • Uneven or bumpy • Itchy • Bruised or slightly puffy • Numb or tingly in some areas • Draining a small amount of clear, yellow fluid Contact your family doctor if: • Your incision becomes warm to touch, • It is more swollen or reddened, • If it is draining more than usual or draining anything other than clear yellow fluid • If you have a temperature higher than 38 degrees C or 100 degrees F, twice in a 24 hour period. Contact your Surgeon if: • You have a new or widening gap from the edges of your incisions • If you hear or feel a clicking sound in your chest when you move your arms, cough, or sneeze. • If your family doctor prescribes an antibiotic for an infected incision. Activity Patients’ activity or energy levels vary before and after surgery. Your energy level may fluctuate from day to day, and every day may not feel better than the last. Overall your energy level should increase from one week to the next. Use the Four P’s to help manage your energy level. Plan your day, your week, and your activities. Remember to schedule in rest breaks between your activities fo r balance. Be realistic about your energy level. Stair Climbing is an active form of exercise, plan your day to reduce how often you need to climb the stairs. If you live on the main floor of your home but your only bathroom is upstairs, you may need to rent a commode chair or purchasea urinal to reduce stair climbing when you first go home. Pace yourself. You should be able to talk and breathe comfortably during your activities. Do not rush. Pace your activities by taking rest breaks in between. Make yourself and your activities a priority so that you can heal and recover. Decide what is important for you and your recovery. Continuing your walking activities is very important, as lying or sitting down all day can put you at risk for blood clots in your legs. Position your body in the most comfortable posture during an activity. This will reduce the amount of energy you burn up. For example, if you can sit on a bath chair rather than standing while taking a shower, you will be less tired when you are finished. The energy you save can be used for another task. STOP Activities When: Stop any activity, including your exercises, if you develop: Chest pain that is similar to what you felt before surgery. If you develop a racing or fluttering heart beat with shortness of breath or you are feeling unwell. Or if you have difficulty breathing that does not get better with rest. If you hear or feel a “clicking” sound in your chest. If you experience any of these, refer to your “Symptoms After Heart Surgery” Connect the DOTS sheet Exercises at Home When doing the following exercises, you should be sitting in a comfortable chair, with your feet resting on the floor: 1. Neck Tilts While looking straight ahead, slowly side-bend your neck so that your left ear moves toward your left shoulder. Repeat this movement on your right side. 2. Neck Rotation Turn your head slowly and look over your left shoulder. Repeat this on your right side. 3. Elbow Circles Touch your right shoulder with your right hand. Raise your elbow to shoulder level. Draw a large circle slowly with your elbow, first forwards and then backwards. Do not extend your elbow to far backwards. Repeat with your left elbow. For these exercises, you should be sitting or standing with your feet shoulder width apart: 4. Forward Arm Lifts Raise your right arm forward and above your head, then bring it back down to your side. Repeat the same movement using your left arm. 5. Sideways Arm Lifts Raise your right arm out to your side with your palm facing up. Then raise it above your head. Breathe in as you raise your arm and breathe out as your lower your arm. Repeat the same movement using your left arm. 6. Trunk Side Bends Place your feet shoulder width apart. Slowly slide your right hand down towards the floor, keeping your back straight. Return to your starting position and repeat this movement, bending towards your left. 7. Hand Behind Back Reach with your left hand behind your back at your waist level. Reach your hand up towards your shoulder blades. Repeat this movement with your right hand. Home Activity Guidelines. When you leave the hospital it is important that you continue participating in everyday activities. As your body heals and recovers after your surgery, you can expect that you will be able to gradually complete more tasks. Important points to remember: Avoid lifting greater than 5-10 pounds, driving, or traveling out of the country until you receive permission fromyour cardiac surgeon. This is typically 6 weeks. Returning to work depends on the type of job you have. Discuss this at your follow up appointment with your surgeon. During the first 4 weeks you should avoid strenuous household activities that involve using your arms, such as vacuuming, mowing the lawn, mopping the floor, or ironing. You should only do light duties such as dusting, setting the table or simple meal preparation. At 5-6 weeks, if cleared by your cardiac surgeon, you may gradually resume all household activities however, continue to avoid lifting more than 20 pounds for 3 months. Continue your exercises and gradually increase the amount of walking you do during your recovery. Remember to listen to your body and stay safe by walking with someone. During bad weather you should walk in a shopping mall or on an indoor track. Do not use a treadmill until assessed at cardiac rehab. Prior to engaging in sexual activity, you should be able to comfortably climb two flights of stairs. That is 24-30 steps. While some of you may be eager to achieve this goal, please do not practice the stairs on your own or push yourself to complete this task too quickly. Report any symptoms of chest pain or palpitations during sexual activities. If your heart is racing or you are short of breath for 15 minutes after intercourse, please notify your family doctor right away. Avoid these activities if tired or tense, and avoid putting strain on your upper body for 3 months. Diet Following a proper diet is important for your ongoing health. Patients who have had heart surgery are recommended to follow a healthy heart diet to assist in their recovery and keep their hearts healthy. The most important point to remember is to limit the amount of salt you eat to no more than 2.3 grams each day. Remember, salt is already in most foods you buy, read the nutritional labels. After you are discharged, you will receive further information about this recommended diet when you go to cardiac rehab. Follow-Up Appointments No matter what type of heart surgery you have had, it is important to remember that you still have heart disease. Following up with your health care team is crucial. When you get home schedule follow up appointments with your family doctor, your heart surgeon, and your cardiologist. Your nurse will provide you with an appointment card before you leave the hospital. DOTS Sheet You have been provided with the Connect the DOTS sheet titled “Symptoms after Heart Surgery”. Please put it up on your fridge, or somewhere that you will see it frequently. This sheet will help you to identify if something is happening that is not an expected part of your recovery, and who to contact for further assistance. Your nurse will review this sheet with you prior to discharge. The nurse may have provided you with additional education information to aid in your recovery. It is important to keep this information in a location where you can continue to review it. Thank You! Please ask your nurse or another staff member if you have questions related to anything you have heard or seen on this video. The St.Mary’s cardiac surgery team wishes you the best with your continued recovery.