DISCHARGE INSTRUCTIONS

YOUR SURGEON IS:_________________ PHONE:_________________


YOUR CARDIOLOGIST IS:_________________ PHONE:_________________


YOUR PRIMARY PHYSICIAN IS:______________PHONE:_______________


Refer to your "Let's Talk About Your Open Heart Surgery" for more detailed information about your first few weeks after surgery. The following are a few guidelines.

1. MEDICATIONS: Take your medications as prescribed. Fill out the medication card (found in the back of your surgery information booklet) and carry it with you in your wallet.

2. ACTIVITY: Gradually increase your activity at home, being sure to include appropriate rest periods (see page 32). It is important to pace yourself, ensuring that you rest between activities. Walking should be done either before a meal, or at least 30 minutes after eating. You may climb stairs, limiting trips to once or twice daily.

Do the prescribed arm/leg exercises (see page 26,27).

DO NOT SMOKE!!!!!

DO NOT DRIVE. You may go for short car rides with someone else driving. When in the car use the red pillow you were given in the hospital under the seatbelt to protect your chest incision.

DO NOT LIFT OBJECTS HEAVIER THAT TEN (10) POUNDS.

Short warm showers are permissible. Use a mild soap of your choice.

Due to sternal instability during the first one to three months, you may occasionally feel sternal movement (i.e., often described as "clicking," "popping," "shifting"). These movements should only occur infrequently and are often related to position changes.

Elevate your legs for 15 to 20 minutes at least twice a day to decrease swelling in the ankles and lower extremities. WEIGH yourself at the same time each day and record. Notify your physician or home nurse if you gain more than two pounds in a 24 hour period, or four or five pounds in a week.

3. MOOD SWINGS: Along with the healing process occurring in your body, you may experience mood swings during the first four to six weeks after surgery. This can be expected and is considered normal.

4. STRESS: "Don't hurry, don't worry and don't forget to smell the flowers." You may have visitors for short periods of time. Avoid situations that irritate you.

5. INCISIONAL CARE: Observe your incisions daily for any increase in redness, tenderness, swelling, or any new drainage from the wounds. (No need to paint your incisions with betadine or apply creams or ointments). Chest and leg incisions do not need to be covered unless instructed by your physician. Band aids may be applied to the chest tube drain sites at the base of your sternal incision.

6. RESPIRATORY CARE: Continue to do your deep breathing, coughing, pillow splinting exercises four times per day at home. Before meals and prior to going to bed are the best times. If you have been given an incentive spirometer for home use, use this as directed at time of discharge.

7. DISCOMFORT MANAGEMENT: Discomfort or aches from the incision(s) may persist for a while. Take your prescribed medication as necessary to minimize chest pain/discomfort. This will enable you to do the necessary activities to help promote a speedy recovery. It is beneficial to take your pain medication especially the first few days and before going to bed at night. Frequently pain stems from muscle soreness across the back and shoulders from doing routine tasks such as dressing and opening and closing the refrigerator. Taking a warm shower and letting the water hit your back may be beneficial.

8. DIETS: Do not add salt to your food. Eat an iron rich diet. (Food high in iron include cream of wheat, raisins, dried beans, legumes, green vegetables such as broccoli, spinach, whole grain cereals, etc.). Be sure to include an adequate source of Vitamin C to help with iron absorption. Eat slowly. Rest approximately one hour after meals. Eat 3-4 meals per day. Refer to the recipes in your packet.

9. SEXUAL ACTIVITY: From a surgical standpoint, most people can gradually return to their previous level of sexual activity. Please refer to page 34 in your heart booklet.

10. CALL THE SURGEON: If you have a fever of 100 degrees or above that continues for 24 hours or more and does not respond regular Tylenol, or Bufferin.

  • If you have new drainage from your chest or leg incisions.

  • If you have an increase in redness, tenderness of swelling of your leg or chest incisions.

  • If you have a sternal rocking or excessive sternal movement.

11. CALL THE CARDIOLOGIST: If you have chest pain/pressure, angina-like pain or generalized discomfort that increases when you take a deep breath or lie flat.

  • If you have shortness of breath at rest or with increased activity.

  • If you have an increased heart beat, greater that 120/minute at rest.

  • If you feel your heart skip or flutter.

  • If you notice a change in the color of your stools. (dark stools are expected if you are taking iron tablets).

12. Within a day of discharge from the hospital, call your surgeon's office to make an appointment for your first post- operative visit. This will ordinarily be 10-14 days after discharge. If you have staples in your chest or leg we will need to see you about one week from discharge. We will remove the staples in our office.

APPOINTMENT DATE_____________ TIME__________

13. Within a day of discharge from the hospital, also call your cardiologist's office for an appointment.

APPOINTMENT DATE_____________ TIME__________

14. If you have any other questions before your follow-up appointment, feel free to call and ask. The cardiac surgeon's office is open Monday through Friday (except holidays) from 9:00 a.m. to 5:00 p.m. A physician is on call 24 hours a day through the office exchange.

If you will be receiving any visits from home nursing, you will be contacted by them the day after your discharge from the hospital.

15. HELPFUL HINTS:

It may be helpful to post a "VISITING HOURS" sign outside your front door. It will also be beneficial to utilize an answering machine to screen phone calls, or voice mail system to record messages to alleviate repeating status reports to concerned friends and relatives.

Elicit the assistance of those who want to help by asking them to collect your mail while you are in the hospital, walk pets, pick up newspapers or run errands. If you have family and friends who live out of town develop a telephone tree to decrease the amount of long distance calls being made by both sides.

Utilize recuperation time to catch up on reading, correspondence, computer games, puzzles, or anything that helps to reduce stress and doesn't require heavy lifting.

REMEMBER, you had both good and bad days before your surgery and both will continue after surgery, periods of feeling weepy and mildly depressed are normal for short periods of time. If this persists however, notify your doctor.

A recliner is great when resting during the day. You may find yourself waking up frequently at night when first home, this is not unusual as this was common practice when in the hospital. Try to have some quiet time before retiring and avoid excessive liquid intake prior to going to bed.

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