Heart & Aorta
Preoperative & Postoperative Informational Video
Heart Surgery – In Hospital Recovery
Following heart surgery, you are taken directly to the Critical Care Unit (ICU) on the second floor, you will not go to the “Recovery Room”. Various monitoring lines will be attached to you after you go to sleep with the anesthesia. When you first awake from anesthesia, there is usually a breathing tube in your throat. This will be removed as soon as you are awake from anesthesia and strong enough to breathe on your own. While the breathing tube is in place, you will not be able to talk. Your nurse will give you sedation and pain medication to keep you comfortable until the tube can be safely removed. There will also be monitoring lines attached to your wrist and through a big IV line in your neck or upper chest. There will also be tubes coming from the bottom of your chest to drain fluid. You will also have a tube in your bladder to drain urine. Typically the monitoring lines, urine catheter, and drainage tubes are removed in the first few days after surgery. Patients usually spend one to three days in intensive care before moving to the Cardiovascular Unit (CVU).
After leaving intensive care, you will spend three to five days on CVU progressing on a standard pathway. During this time, any remaining drainage tubes or monitoring lines will be removed. You will usually also have temporary pacing wires placed during surgery in case a pacemaker is needed after surgery. If a pacemaker is not necessary, these wires will also be removed on CVU. Removal of the drainage tubes is associated with brief pain, while removal of pacing wires and monitoring lines is generally not painful. On the first full day on CVU you will take a shower and begin to walk in the hall. You will eat all of your meals sitting in the chair. Walking will be initially done with a specialized walker to aid you in your balance. You should not try to walk alone at first but allow the nurses to assist you.
Patients who have traditional open-heart surgery through the breastbone have lifting restrictions for six weeks following surgery. These restrictions are in place to allow the breastbone to heal properly. To facilitate healing, we ask that you not lift anything greater than five to eight pounds during this time. It is also important not to push yourself up from a chair or do other movements that place stress on the breastbone. The nurses and therapists will teach you about these precautions and restrictions while you are in the hospital.
Your medications will be different following surgery than they were before surgery. Prior to discharge, our nurse practitioner will go over all of the medications that your surgeon wants you to be on at home. At discharge, you will be given a written list of these medications, dosages, when to take the medicine, and how long you are expected to be on each medicine. You will receive a prescription for any new medications. You should follow the written discharge medication instructions even if they are different from what you were taking before. You should not resume any of the medications that you were on previously unless you are told to do so.
Each patient’s home situation is unique. Our nurse practitioner will work with you, case management, and social work to assess your unique situation and what needs you may have when you get home. Everyone will require some assistance following heart surgery and there are numerous resources available to tailor a plan that meets your needs. Almost all patients will also go home on oxygen for several weeks. This is normal given that we are one of the highest altitude heart surgery programs in the world. At your post-operative appointment your oxygen level will be re-assessed and many patients are taken off oxygen at that time. Prior to going home, you will have a home care plan put together by our nurse practitioner which will include medication instructions, home health care, home oxygen, and outpatient cardiac rehab. The nurse practitioner will discuss this plan with you and your family to be sure there are no questions and that you understand the plan and your responsibilities.
Heart Surgery – Recovery at Home
Once at home, your recovery will continue. We will provide you with an activity log to chart your progress. We expect that you will continue to work just as hard at home as you did in the hospital. Regular walking and graduated activity are essential to your recovery and the discharge plan should be followed and your progress charted in your log. It is also important to follow your weight, blood pressure, pulse, and temperature at home daily and track these in your patient log. Patients with diabetes should also chart their blood sugar levels. Your patient log will be reviewed at your post-operative visit.
We recommend that you begin taking short outings after the first week at home. Make trips away from home short and to places you enjoy – go sightsee or get a treat. Gradually make longer trips and errands. If you have a traditional open-heart operation through the breastbone you may drive three weeks after surgery if you are not taking prescription pain medication. You should keep driving trips short at first and slowly work up to longer outings. Air travel is safe approximately three weeks after surgery but should be discussed with your surgeon.
Outpatient cardiac rehab is typically begun two weeks after leaving the hospital. Cardiac rehab is an outpatient program that you attend three times a weeks for approximately one hour. The program can continue up to 12 weeks depending on your needs. We highly recommend cardiac rehab for patients who had heart attacks, who had heart failure, or are over age 60. Cardiac Rehab is available at Penrose Hospital and St. Francis Medical Center in Colorado Springs, St. Mary Corwin Hospital in Pueblo, and St. Thomas Moore Hospital on Canon City. For patients who live too far to come to the hospital for rehab we will craft a home exercise program for you at the time of discharge.
Following surgery you may have a poor appetite and not enjoy foods that were once favorites. It is important that you continue to drink fluids and eat what you can. While you do need enough calories to heal and recover, you do not have to clean your plate when you get home. If you have a poor appetite, try favorite foods or whatever sounds good – even if they are not “healthy” choices. While proper diet is very important, you are already under a great deal of stress and you cannot make too many changes at once. Trying a radically different diet when you first come home from surgery is not likely to succeed. Instead, we recommend that you get through the first several weeks after surgery before making dramatic lifestyle changes. Once things have settled down, then make small changes in an incremental fashion. This will increase the odds that the changes will become a permanent lifestyle change for you. Healthy diet and lifestyle are important to you over the long term, not in the days and weeks immediately after surgery.
Returning to work after heart surgery is stressful. You will need to be honest about your progress and readiness to begin working again. Some people are ready to return to work sooner than others, and some jobs are easier to return to than others. If your work involves physical labor then you will need to be six weeks out from surgery in order for your lifting restrictions to be lifted before considering returning to work. If you can do some work by email
or phone, you may begin to start doing these things sooner on a limited basis. When you are ready, we recommend that you return to work on a part time basis at first. Ideally, this would be half days, three days a week initially. From this you can slowly increase the number of days and then the length of your days. It is important to recognize stressors that may cause you to want to return to work sooner such as financial pressure, supervisor pressure, or guilt over the burden placed on co-workers by your absence. It is important to identify these factors and consider how they may be affecting your decision to return to work. If you have paperwork necessary to be absent from work, or to return to work, please bring that paperwork to our office to be completed.
Many patients experience varying degrees of depression following heart surgery. This is especially true for patients who had heart attacks and/or needed urgent surgery. These feelings are common and should be discussed with your family and doctors. The stress of major surgery, the long recovery, and the shock of a new diagnosis of heart disease all play a role in feeling depressed. These feelings are often the strongest approximately two weeks after going home from the hospital. After being home for a week or more, progress is not as fast as the first week in the hospital and this frustrates many patients. One month after surgery, most patients are still experiencing some fatigue and have less endurance. These feelings should be discussed with your family, your doctors, and with the cardiac rehab staff. Other patients at cardiac rehab are also a good resource to help you realize that you are not alone in your feelings. The combination of time and open discussion is usually sufficient to work through the depression and frustration.
Many patients have questions about resuming intimacy and sexual activities. While it is important to emotionally reconnect with loved ones after a significant life event such as heart surgery, it is also important to remember that sexual activity is exercise. When you are walking regularly for more than 10 minutes without stopping you can consider resuming sex. It is also important to remember that lifting restrictions on your healing breastbone may preclude some positions. Avoid positions in which you have to hold yourself up with your arms as this places excessive stress on the healing breastbone until your lifting restrictions are over.
Lungs & Chest
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