Cardiovascular Surgery Discharge Instructions

At the time of your discharge from Good Samaritan Hospital, your recovery from heart surgery will be well underway, but not fully completed. The recuperation period at home is a very important step toward resuming your normal activities. This guide will help answer some questions you or your family may have in preparation for your discharge. If you have any other questions or concerns, please call the Cardiac Surgery Department at 630-663-1100.

A.  Medications
The doctor will write your prescriptions before you leave. You may have your prescriptions filled at the hospital before you leave if you desire (ask your nurse), or may have them filled at a pharmacy of your choice. It is important to ask your doctor about any medications you were taking before surgery as well as any over-the-counter medications. It is important that you take the medication exactly as they are prescribed. Keep your medication in the bottles provided by the pharmacist and keep a list of the medication names, dosages, and times to be taken in your wallet. Do not take other medications without consulting your doctor. Additional information on your medications will be provided by your nurse before you are discharged.

B.  Follow Up Doctor Appointments and Additional Lab Work

1. Your attending physician & cardiologist - Your attending physician and cardiologist usually like to see you the week after you get home. Call for an appointment and any additional instructions he or she may have about blood tests, X-rays, or other tests you are to have.
2. Cardiovascular surgeon - You should plan to see the cardiovascular surgeon and the clinical nurse specialist or physician assistant 2 to 3 weeks after you go home. Call 630-663-1100 for an appointment. Any questions regarding your incisions should also be directed to this office.
Bring a list of your medications to your doctor visits.
3. Follow-up on any additional blood tests, X-rays or other tests your doctor recommends.

C.  Caring For Your Incisions

1. Showers may be taken 7 days after surgery. Use mild perfume-free deodorant-free soap such as Ivory. Avoid vigorous scrubbing, soaking your incisions, and hot water. Rinse well. Tub baths may be taken when your incisions are completely healed, or with the permission of your physician.
2. The tapes (steristrips) across your incisions may begin to fall off once you start to shower. If they do not fall off, they will be removed during your office visit with the surgeons 2 to 3 weeks after surgery.
3. Do not apply any lotions, creams, oils, or powders on your incisions (unless prescribed by your doctor) until healing is complete and scabs have come off.
4. Check your incisions every day for signs of infection. Notify the surgeons if you notice any of the following:
   • Increased tenderness around the incision
   • Increased redness or swelling around the edges of the incision line
   • Any drainage from the incisions
   • If you have a constant elevated temperature

D.  Caring For Your Surgical Leg
If your surgery involved taking the vein from your leg the following guidelines should be followed:

1. Care for your leg incisions as described in the previous section.
2. Avoid crossing your legs. This may impair circulation.
3. Avoid sitting in one position or standing for prolonged periods of time.
4. Leg and ankle swelling - elevate your leg on a stool or coffee table when sitting. If swelling is persistent, elevate your legs above the level of your heart. Lay on the couch and put your feet on the arm of the couch or lay in bed with your feet up on 2 to 3 pillows. This should be done several times a day for 1-2 hours to reduce the swelling.

E.  Elastic Stockings

1. Continue to wear your elastic stockings daily until you no longer experience ankle swelling.
2. Remove the stockings at night.
3. Stockings may be washed with mild soap and water by hand or on a delicate machine cycle. Air dry only.

F.  Activity

1. Your breastbone (sternum) is a broken bone and must be treated that way. It takes 2 to 3 months to heal completely.
2. Lifting — Avoid putting too much strain on your sternum while it is healing. Avoid lifting more than 5-10 pounds for three months after your surgery. This includes carrying children, pets, groceries, suitcases, etc.
3. Dress in comfortable loose clothes that do not put undue pressure on your incisions.
4. Rest — A balance of rest and exercise is necessary to your recovery. Plan to rest in between activities and to take short naps as necessary. Resting may also include sitting quietly for 20 to 30 minutes.
5. Walking is one of the best forms of exercise as it increases circulation throughout the body and to the heart muscle. It is important to increase your activity gradually. Walk at your own pace on flat surfaces. If you get tired, stop and rest. Continue to follow the Progressive Cardiac Exercises (PCE's) that you began in the hospital. The cardiac rehabilitation nurses will provide you with a plan for exercise before you are discharged. It is important to pace your activities throughout the day. Do not try to do too many things at one time. Avoid the extremes of temperature outdoors. In poor weather you may utilize indoor shopping malls for walking. Wait 1 hour after meals before exercising.
6. Stop any activity immediately if you feel short of breath, experience palpitations, feel faint or dizzy, experience chest pain, or profuse perspiration. Rest until the symptoms subside. If they do not subside within 20 minutes, notify your doctor.
7. Climbing Stairs — Try to limit your trips up and down stairs to only 2-3 times per day until you're feeling stronger. Climb the stairs at a slow pace, stop and rest after every five steps if needed.
8. Sexual Relations — May be resumed when you feel physically comfortable (usually about 2 to 4 weeks after discharge) unless instructed differently by your doctor. Affectionate displays are important after being separated from the people you love. It is important to find comfortable positions for your chest and leg incisions.
9. Communication is now especially important. It is also important to plan sexual activity, as you would any other activity, for when you are well rested, unstressed, and more than one hour after a meal. For the first 2-3 months, do not support all of your body weight on your arms.
10. Housework — Light housework only, for about 3 months, such as dusting, dishes, folding laundry, cooking. No yard work, gardening, carpentry, mowing the lawn or vacuuming for 2-3 months after surgery.
11. Recreation — You may participate in card games, board games, arts & crafts as soon as you go home but avoid bowling, fishing, golfing, tennis for 3 months after surgery. Check with your surgeon as to the timing of more intensive recreation.
12. Driving — You may ride as a passenger in a car at any time. Wear both the seat belt and shoulder harness to protect your breastbone (sternum) from injury. Avoid driving for 6 weeks after surgery. Your movements may be limited and your reaction time slower prior to this time. This waiting period will allow your breastbone to heal. If going for longer car rides, stop every hour and a half to get out of the car and stretch your legs.
13. Returning to work - Check with your surgeon regarding returning to work.

G.   Diet

1. The dietitian will instruct you on your diet before going home.
2. Low Cholesterol - If you have had bypass surgery it will probably be recommended that you follow a low fat, low cholesterol diet. Generally, you should limit red meats (beef, lamb, pork), shellfish, butter, whole or 2% milk, and cheeses made with whole milk. These foods all contain animal fats which should be avoided. Also, avoid fried foods. Consume more skim milk, margarine, chicken (cooked without the skin), fish, whole grain products, fresh fruits, and vegetables. Avoid eating more than 3 eggs per week. You may use egg substitutes, or extra egg whites (discarding the yolks).
3. If you have high blood pressure, your doctor may recommend a low sodium diet. Further information regarding diets can be obtained by calling the dietary department at 630-275-1280 and asking to speak to a dietitian.

H.  Insomnia
Some people continue to have difficulty sleeping after going home from the hospital. Because of the stress of surgery, the frequent monitoring in the hospital of vital signs at night, and the anxiety surrounding the surgery itself, you may have trouble falling asleep after you go home.

Helpful hints for difficulty sleeping - Get out of bed when you cannot sleep. Read a book or watch a movie but do not become overstimulated. Have a small snack before bed. If you nap in the afternoon, you may need to stop.

I.  Aches and Pains
It is important for you to keep moving and exercising. Aches and pains should lessen day by day. If you overdo it, you will notice it, especially the next day. You will also tend to notice the aches and pains more in the quiet hours of nighttime. Check with your doctor regarding what to take for minor aches and pains.

J.  Signs and Symptoms to Immediately Notify Your Doctor of

1. A sudden change in your heart rhythm, palpitations, dizziness, faintness, or breaking out in a cold sweat
2. Sudden shortness of breath
3. Chest pain unrelated to the surgery (like the angina you may have had before surgery)
4. Increased swelling of your feet or ankles
5. Tenderness, swelling, redness, or drainage from your incisions
6. Pain or swelling of your calf or thigh
7. Fever of 100 degrees Fahrenheit or more
8. Weight gain of more than 2 pounds in 1 day

This guide will hopefully answer some of your questions regarding your care at home after open heart surgery.