Admission
You will be admitted to the hospital 1-2 days prior to your scheduled operation. Occasionally, due to emergency situations, your scheduled ad mission or operation may require a change. PLEASE BRING A LIST OF YOUR CURRENT MEDICATIONS WITH THE NAMES, DOSAGES AND SCHEDULED TIMES, AS WELL AS THIS BOOKLET. A physical examination and history, blood tests, an electrocardiogram (EKG) and chest X-ray will be done as part of the routine preoperative preparation. You are asked to enter the hospital through the Admitting Center in the early morning on the admission day and are usually taken to your room between 11 a.m. and 12 noon. Lunch is served between 12:30 and 2 pm. PLEASE have your family check with one of the floor nurses BEFORE they leave you or leave for lunch.
Several members of the cardiac surgical team will meet with you and your family before the operation to provide you with information and answer any questions you may have.
Your surgeon will see you before surgery to discuss details of the operation with you. A member of the surgical team will meet with you to do a physical examination and medical history.
You and your family will also meet with one of the thoracic surgery clinical nurse specialists to discuss any questions you may have and to provide you with information about your hospital stay and the recovery period.
One of the Surgical Intensive Care Unit (SICU) nurses will visit you and your family to answer questions about your stay in the SICU. They will arrange to take you and your family on a tour of the SICU if you so choose. Visiting the SICU before your operation is encouraged to help you understand the various equipment used and decrease the anxiety associated with such new experiences.
The anesthesiologist will also see you the afternoon or evening prior to your operation to discuss his role in the operation and the anesthesia to be, used.
The nurses on the Thoracic Surger y Unit will take care of you before and after the operation following your stay in the SICU and ISCU (Intermediate Surgical Care Unit). They will be checking your weight, temperature, blood pressure, pulse and medication schedule on admission. They will also instruct you in the coughing, deep breathing and leg and arm exercises necessary for your recovery after your operation. See the insert included with this booklet.
Someone from pastoral services usually stops by before the operation to assist you and your family with any spiritual needs or concerns while you are hospitalized.
It is important that someone from your family plan to stay with you the day before your operation if possible. This enables all members of the health care team to meet them, provide them with specific information and answer questions they may have. This may require that your family stay into the evening hours in order to assure that all necessary personnel have adequate time to see them. If you are coming from out of town and your family is planning to stay at a motel in the Ann Arbor area, please make arrangements for the motel to hold your room until after 6 p.m. This allows your family to stay at the hospital and not be concerned about leaving to check in at the motel. The McAuley Inn is also available for lodging of patients and their families. It is located within the Catherine McAuley Health Center campus and provides close access to the hospital. Please contact the surgeon's office, or ask one of your nurses about further information and reservations. When your family goes home for the night, they may wish to take some of your belongings with them. It is advised that you pack lightly for admission and keep only your pajamas, robe, slippers and personal toilet articles with you the evening before your operation. The evening before the operation you will bathe with a special soap to decrease bacteria on the skin surface and lessen the possibility of infection. An enema may be ordered and you will be reminded not to eat or drink anything after midnight. If you feel a sleeping pill would be helpful to get a restful night's sleep, ask your nurse for one.
Day of Surgery
The
morning of your operation you will have your temperature, blood pressure,
pulse and respirations (vital signs) checked by your nurse. You will
also be asked to put on a hospital gown. All jewelry, rings, dentures,
wigs, glasses, contact lenses, hairpins, nail polish, etc. must be removed.
Approximately one-and-one-half hours prior to the operation you will be given medications ordered by your surgeon and anesthesiologist. These include antibiotics to help prevent infection and medications to help you relax and feel drowsy.
Shortly after this, you will be taken to the Preoperative Holding Area next to the Operating Room. Your anesthesiologist will meet you there and insert the IV's and monitoring lines he has discussed with you. These IV's will supply you with necessary fluids and. medications before, during and after your operation. The IV monitoring lines enable the surgical team to follow your blood pressure and also pressures within your heart and lungs. After this is completed, you will be taken into the operating room and be fully anesthetized. The operation usually requires 3-5 hours depending on the complexity of the procedure.
Family Instructions
Your family is welcome to see you before your operation. They should plan to be in your room before you receive your preoperative medications. Ask the Thoracic Surgery Unit nurses or thoracic surgery clinical nurse specialist what time they should arrive.
Your family will be asked to take your personal belongings with them at this time. You will not be returning to the same room after the operation, and the SICU has no place for storage of personal items. The nursing staff will ask your family to give your incentive spirometer (breathing exercise device), glasses and dentures to the SICU nurse when they visit you after surgery.
Critical Care Family Room
Once you are taken to the Holding Area your family should wait in the Critical Care Family Room on the 2nd floor. This is located across from the Coronary Care Unit (CCU), room 2482. The surgeon will come to talk to them in this room after the operation is completed. Your family is encouraged to visit the cafeteria while you are in the operating room, but please make sure they let the receptionist in the waiting room know where they are going.
After Surgery
About one hour after speaking with the doctor, your family will be
notified by the SICU nurse that they may come to visit you. This time
delay enables the physicians and nurses to evaluate your condition and
arrange the necessary monitoring equipment.
Due to the complexity of care given in the SICU, only your immediate
family is allowed to visit you for short periods of time. Visiting hours
are scheduled five times a day for ten minutes at the specified times
of 11 a.m., 1 p.m., 3 p.m., 5 p.m. and 7 p.m. Your family should receive
a SICU visitor's pamphlet from the SICU nurse to help further explain
the usual routines of the unit. They should leave a phone number where
they can be reached at all times with the SICU nurse. Visiting hours
will increase as you transfer from the SICU to the ISCU (Intermediate
Surgical Care Unit) and to the Thoracic Surgery Unit. ISCU visiting
hours are at the same time and intervals as the SICU, but family members
may stay up to 30 minutes depending on the patient's condition. You
will continue to need a great deal of rest after you leave the SICU
and your family and friends should remember this when they come to visit
you.
Postoperative Information
The SICU (Surgical Intensive Care Unit) is an area in the hospital designed for patients who require specialized nursing care and continuous observation and monitoring. The SICU nurses have been specifically educated to care for critically ill patients. The first 1-2 hours you are in Intensive Care you will be asleep from the effects of anesthesia. As you begin to wake up you will feel several tubes THAT WERE INSERTED WHILE YOU WERE ASLEEP. They are all necessary to help you recover. These include:
1. Endotracheal tube (breathing tube):
This tube is inserted through your mouth down into your windpipe to control your breathing during the operation and help you breathe easier afterward. It is connected to a ventilator (breathing machine) that provides oxygen as you breathe. You will not be able to talk while this tube is in place because it passes through your voice box into your windpipe. However, you will still be able to communicate with the nurses and doctors because they will ask you questions to which you can nod your head "yes" and "no". You can also write notes if you wish to tell them something. You cannot eat or drink while this tube is in place. There will be mucus in the breathing tube that the SICU nurses will suction out periodically. You will experience the urge to cough as they do this. The breathing tube is in place approximately 24 hours or until you are able to breathe adequately without its help. The length of time is variable and depends on your individual condition.
2. Nasogastric tube (stomach tube): This tube goes down one side of your nose into your stomach. It removes air from your stomach and prevents vomiting. It is usually removed the morning after the operation when the breathing tube is removed. After this, you will be able to slowly begin drinking some fluids.
3. Chest tubes:
Chest tubes are placed around the heart to drain bloody fluid that may
accumulate from the operation. They go to a bubbling container at the
side or foot of the bed. These are usually removed the second day after
the operation or when the drainage stops.
4. Foley catheter:
This tube is inserted into your bladder after you are asleep. It drains
the urine into a collection bag on the side of the bed. The purpose
of the catheter is to enable accurate measurement of your urine output
as an indicator of your heart and kidney function. You may still feel
the urge to urinate while the catheter is in place. It is usually removed
when you are able to walk to the bathroom with help.
5. Pacemaker wires:
These are small temporary wires connected to the heart. They come out
through the chest wall and are taped on the surface of the chest. They
can be connected to a small Pacemaker generator IF necessary to help
regulate the heart rate. These wires are removed before you go home.
6. IV's:
You usually have at least one IV in a vein in each arm to give you fluid
and medication. These are removed when you are able to eat and drink
adequately.
7. Heart monitor:
This will be attached to you for several days to provide a continuous record of your heart rate and rhythm.
8. Arterial line:
This catheter in an artery in your wrist provides a recording of your blood pressure on the heart monitor. It also allows blood samples to be removed without repeated needle sticks. This line is removed before you leave the ISCU.
You will be allowed to sleep and rest as much as possible while you are in SICU/ISCU and awakened only when necessary for specific procedures. Patients frequently notice they have difficulty keeping track of the time or day while they are in an intensive care unit. This is not unusual and probably results from the constant flow of activity and interruptions in sleep.
Transfers/Room Changes
Most patients will have brief stays in three separate units of the hospital during their recovery period. These three units are the Surgical Intensive Care Unit (SICU), the Intermediate Surgical Care Unit (ISCU) and the Thoracic Surgery Unit, all of which are located on the 2nd floor. Most patients spend 24-48 hours in the SICU, then 1-2 days in the ISCU and the remainder of their hospital stay on the Thoracic Surgery Unit.
Length of Stay
The AVERAGE hospital stay after a heart operation is 5-7 days. You should be able to walk up and down the hospital corridors without help before you leave. Every person heals at a slightly different rate, so these numbers depend on your individual condition and progress. The remainder of your recovery will be at home and usually takes another 4-6 weeks.
Blood Transfusions
Blood will be given through an IV during and/or after the operation ONLY IF IT IS FELT NECESSARY BY YOUR SURGEON. Many patients require little or no blood products during or after cardiac surgery. All blood products are obtained through the local American Red Cross and are carefully screened for both hepatitis and AIDS. If blood products are used it is not required that they be replaced. However, we strongly encourage your family and friends to donate at a nearby Red Cross Center. Without voluntary contributions of blood, heart operations would not be possible. Please remind your family and friends that it is NOT possible to acquire AIDS through donation of blood. Donations may be made at the Washtenaw County Red Cross in Ann Arbor or at any of the Red Cross chapters or blood drives held in local communities. Please call the Washtenaw County Chapter for more information on the dates and times of blood drives in the Ann Arbor and surrounding areas.
Certain patients who are stable may be able to donate their own blood and have it saved for their operation. It may also be possible to have designated friends or family members donate blood for your operation if their blood type is the same as yours. Both of these procedures have very specific rules and time constraints for your safety. You should discuss these options or any concerns you have regarding potential blood transfusions with your surgeon SEVERAL WEEKS prior to your operation date.
Incisions
The chest incision is located along the length of the breastbone (sternum). It is necessary to divide the sternum to expose the heart. The sternurn is permanently wired together after the operation. It is not uncommon to feel a slight clicking sensation in the breastbone when moving or turning in bed. The bone takes 8-12 weeks to heal, much like any other broken bone, and this clicking sensation will disappear as healing takes place. Some women may find it more comfortable to wear a loose-fitting bra 3-4 days after the operation for additional incision and sternum support.
Pain
It is normal and expected for you to experience soreness and muscle aching in your chest and leg after this operation. Your physician will order pain medication for you at prescribed intervals and you should take it as needed. While you are in S ICU, the nurses will closely monitor your need for pain medication and administer it when necessary, and as your condition allows. As you heal each day and become more independent, the nurses will remind you to take your pain medication, but it is your responsibility to request it. They will NOT AUTOMATICALLY bring it to you. The discomfort will improve each day as you heal.
Coughing and Deep Breathing
You will be expected to cough and breathe deeply every 1-2 hours for several days after the operation to clear your lungs of secretions and to expand your lungs fully. It will hurt to cough but it is EXTREMELY IMPORTANT for you to do so. Splinting your chest incision with a pillow or blanket will help to decrease the soreness. Coughing deeply WILL NOT HARM YOUR heart incision and the soreness will improve each day as you heal. You will also be expected to use your incentive spirometer (breathing exercise device) every 1-2 hours for several days after the operation. This device assists you to expand your lungs and breathe more deeply.
Eating
When the breathing tube and stomach tube are removed you can begin a liquid diet. The doctors will gradually advance your diet to regular-food as your condition allows. Your liquid intake will be limited for a few days after the operation until your body readjusts its fluid balance. The nurses will measure the amount of fluid you drink to monitor the balance.
It is common to lose your appetite for a few days after the operation. You may also find that food tastes different and unusual. These are only temporary changes and should improve within a few days. You should try to eat as much as you can. You need adequate nutrition to heal and gain strength. Because of the importance of meeting post operative nutrient needs and the difficulty you may have in doing so, dietary modifications during hospitalization may be kept to a minimum. Therefore, a low fat, low cholesterol diet may be postponed until you go home. It is hoped that this greater dietary freedom will encourage you to resume normal eating patterns more rapidly. It is permissible to have your family bring food from home if you feel this will help you regain your appetite. Any food brought in should be low in salt content. Your family also needs to let the nurse know they have brought food in for you.
Activity
Most
patients remain in bed while they are in the SICU. The nurses will help
you turn on your sides and sit up in bed when you are able. After you
are transferred to the ISCU you will begin getting up in a chair and
walking in your room as your con- dition permits. Getting out of bed
and using your leg muscles helps condition your muscles and improve
your strength. Activity also helps to expand your lungs fully and prevent
pneumonia. Once you return to the Thoracic Surgery Unit you will begin
walking in the halls. You should be able to walk in the halls without
help before you are ready for discharge.
Exercises
The nurses will remind you to begin doing your arm and leg exercises 2-3 days after your operation. These exercises should be done twice daily to improve your muscle tone and circulation. See the insert provided with this booklet.
Fatigue
It is very common to feel exhausted after your operation. Minor activities like eating breakfast or bathing will tire you. You may also feel depressed, irritable and grumpy. These feelings usually result from lack of sleep and from wanting to feel better faster. It takes time to gain your strength back after a major operation. and plenty of rest and patience is required.
Support Stockings
You will be measured for white support stockings on admission. These are worn to prevent the formation of blood clots. After your operation, do not cross your legs while you are lying in bed since this slows the flow of blood in your veins.
ADMISSION: Most patients are admitted to the hospital the same day as their scheduled heart surgery operation. Preoperative testing such as blood tests, electrocardiogram (EKG), X-ray and a physical exam have already been completed. A meeting with one of the thoracic clinical nurse specialists from your surgeon’s office reviewed the heart surgery booklet and answered any questions you and your family have had prior to your admission to the hospital.
On occasion, a heart operation is scheduled for patients that are already hospitalized. Preoperative testing is completed prior to your operation. Depending on the time that your operation is planned, you MAY or MAY NOT meet with one of the thoracic clinical nurse specialists prior to your operation. The Heart Surgery: Preparation and Recovery book that you receive will serve as a guide for you and your family. Please ask questions of the floor nurse if a thoracic clinical nurse is unable to meet with you prior to your operation. Several other members of the cardiac surgical team will see you before your operation to provide you with additional information.
The Surgical Intensive Care Unit (SICU) tour is now available on videotape for you and your family to view before your operation. This will show you what the SICU looks like and the various equipment. The SICU nurse caring for you after your operation will be at your bedside when your family visits to answer any additional questions.
Endotracheal tube (breathing tube): Some patients are able to have their breathing tube removed the night of their operation instead of the next morning. This time is variable and depends on your individual condition.
Transfers / Room changes. When you are ready to leave the SICU, you will be moved to a room on the 2100 Progressive Care Unit. This unit now represents a combination of the ISCU and thoracic surgery unit that the book describes. You will be discharged home from this unit when you are ready.
The above information is an addendum to the current heart surgery booklet. Please contact your nurse with any further questions.
Acknowledgements
Content: Jaelene K. Williams, RN, MS
Medical Illustrations: Kathleen Wagner
Illustrations: Catherine Gendron