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PATIENT GUIDEBOOK
CARDIOVASCULAR CARDIOTHORACIC SURGERY
MISSION
USING THIS GUIDEBOOK
IMPORTANT PHONE NUMBERS
Above all else, we are committed to the care and improvement of human life.
This book is an important part of your preparation for and recovery from surgery. Each section is designed to help you and your family understand the surgical process and the continuation of your cardiovascular care. Please bring this guidebook with you to the hospital. Refer to it often, and please ask questions.
Rose Medical Center Main Operator 303-320-2121 Pre-Registration Center 303-320-2798 Surgical Readiness Department 303-320-2802 Cardiac Unit (4th Floor Telemetry) 303-320-2475 Cardiac Rehabilitation 303-320-2996 Case Management 303-320-2922 Director of Heart and Vascular Care 303-320-2179 Physician Referral Center 303-320-ROSE (7673)
CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 1
INTRODUCTION Welcome to the Rose Heart & Vascular Care Program! This book is a comprehensive guide to open heart surgery at the Rose Medical Center and aims to ensure you are prepared for the days before and after your procedure. We know that well-informed patients feel more comfortable when they know what lies ahead, which can result in more success in recovery. Please consider this book your go-to resource and bring it with you to appointments with your surgeon, educational visits at the hospital, and on the day of your surgery.
Inside you will find lots of helpful information. We’ve included checklists and tips to help you prepare for your hospital stay, forms to help you keep track of your progress after surgery and a comprehensive educational section. We’ll explain what you can expect and offer guidance very step of the way. From procedural explanations to parking instructions, we have you covered. We will highlight every member of your care team’s roles and responsibilities to help you understand who is on your care team and how they’ll be contributing to your progress. This team of specially trained experts is here to make sure your operation is safe and successful, your recovery is guided and your experience is pleasant.
This guidebook also includes an overview of your upcoming surgical experience designed to put your mind at ease and give you an inside look at what will happen on the day of your surgery. We’ll explain healthy changes you can make in preparation for your surgery, precautions to take after your surgery to aid your recovery and nutrition tips that will help you maintain a healthy lifestyle. You’ll also find information on managing pain, achieving comfort, and getting back to feeling healthy after surgery.
Once you leave the hospital, we’ll help you navigate your first weeks at home and teach you how to decrease post-surgery risks so that you are in a position to recover quickly. This guide will help you plan ahead for the day you are discharged, teach you how to recover and offer tips and advice to loved ones participating in your care. We’ll also introduce you to cardiac rehabilitation, an important step in your journey towards a healthy lifestyle after surgery.
When you choose the Rose Heart and Vascular Care Program for your heart surgery, you are putting your trust in our surgeons, staff and facilities, and we take that trust very seriously. This guidebook is just one of the ways we want to show you that you’ve made the right decision.
It is our privilege to help you regain your heart health.
CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 3
CONTENTS PART ONE GETTING STARTED Directions and Maps 05
Information for Family and Friends 07 About the Facility and Nearby Resources 07
Hospital Dining Options 07
Hotel Accommodations 08
PART TWO YOUR SURGERY Before Surgery 09 Recommendations 09
Advance Directives 10
Risks of Open Heart Surgery 10
Preparation Checklists 11
The Night Before 12
The Morning Of 12
Your Care Team 13
After Surgery 14 Immediately Following Surgery 14
White Boards and Hourly Rounding 14
Pain Management 15
PART THREE YOUR RECOVERY In-Patient Cardiac Rehabilitation 17 Ambulation 17
Safety Precautions 17
Flutter Valve/Incentive Spirometry 23
Incisions and Wound Care 24
Cardiac Diet 24
PART THREE CONTINUED YOUR RECOVERY Care Path 25
Preparing for Discharge 26 Case Managers 26
Extended Care/Skilled Nursing/ Rehabilitation Facilities 26
Delays in Discharge 26
Instructions from Your Surgeon 26
Life at Home 27 Exercise and Activtity 27
Home Walking Program 28
Phase 2: Outpatient Cardiac Rehabilitation 29
Intimacy After Surgery 30
PART FOUR EDUCATION The Heart 31
What Affects Normal Functioning 32 Coronary Artery Disease 32
Valvular Disease 36
Heart Surgery 37
Medication 39
Heart-Healthy Nutrition 40 Lowering Blood Fats (Lipids) 41
Lowering Sodium and Foods to Avoid 41
Whole Grains and Fiber 42
FORMS
PART ONE GETTING STARTED
CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 5
DIRECTIONS AND MAPS PATIENT AND VISITOR PARKING:
Complimentary valet parking for patients, their families and friends is available at the Rose Medical Center Wolf Building entrance at:
4600 Hale Pkwy Denver, CO 80220
287
Color
ado B
lvd
Queb
ec St
Mon
aco P
kwy
12th Ave
Hale Pkwy 9th Ave 6th Ave
Colfax Ave
Havana St
Leetsdale Ave
70
25
25
225
225
Holly St
NORTH
Northfield Blvd
270 Wabash St
47th Ave
DIRECTIONS:
Driving from the North: Take I-25 South to I-70 East. Take I-70 East to Exit 276B Colorado Boulevard South. Proceed south to 12th Avenue and turn left; 12th Avenue will veer slightly right and become Hale Parkway. Just after the light at Clermont and Hale, proceed to 4600 Hale Parkway and turn right into the circle drive in front of the Wolf Building. The valet will park your car.
Driving from the South: Take I-25 North. Exit on Colorado Boulevard North (Exit 204) and continue on Colorado Boulevard. Proceed north to 12th Avenue and turn right; 12th
Avenue will veer slightly right and become Hale Parkway. Just after the light at Clermont and Hale, proceed to 4600 Hale Parkway and turn right into the circle drive in front of the Wolf Building. The valet will park your car.
Driving from the West: Take I-70 East and exit at Colorado Boulevard South (Exit 276B). Go south on Colorado Boulevard to 12th Avenue and turn left; 12th
Avenue will veer slightly right and become Hale Parkway. Just after the light at Clermont and Hale, proceed to 4600 Hale Parkway and turn right into the circle drive in front of the Wolf Building. The valet will park your car.
Driving from the East: Driving westbound on I-70, exit at Colorado Boulevard South (Exit 276). Go south on Colorado Boulevard to 12th Avenue and turn left; 12th Avenue will veer slightly right and become Hale Parkway. Just after the light at Clermont and Hale, proceed to 4600 Hale Parkway and turn right into the circle drive in front of the Wolf Building. The valet will park your car.
DAY OF SURGERY: Enter at Wolf Building FIRST FLOOR: Surgical Readiness Department SECOND FLOOR: Surgical Check-in Desk
6 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | DIRECTIONS & MAPS
On the day of your surgery, check in at the Wolf Building on the north side of campus (4600 E Hale Parkway). The Surgical Readiness Department (SRD) is located just inside the doors on the ground floor. The surgical check-in desk is located on the 2nd Floor just off of the elevators.
Wolf Building 4600 E. Hale Pkwy
Orthopedic& SpineCenter
Main Hospital Parking Garage
HALE PARKWAY
NINTH AVENUE
= VALET PARKING
CLER
MO
NT
STRE
ET
CHER
RY S
TREE
T
DA
HLI
A S
TREE
T
Founders Parking Garage Founders
Building 4700 E. Hale Pkwy
NORTH
MAINENTRANCEMAIN ENTRANCE
WOLFENTRANCEWOLF ENTRANCE
FOUNDERSENTRANCEFOUNDERS ENTRANCE
AMBULANCE ENTRANCE ONLY NO PUBLIC ACCESS
Physician Offices II
4500 E. 9th Ave
DAY OF SURGERY: Enter at Wolf Building FIRST FLOOR: Surgical Readiness Department SECOND FLOOR: Surgical Check-in Desk
PHYSICALMEDICINE &
REHABILITATIONENTRANCE
PHYSICAL MEDICINE &
REHABILITATION ENTRANCE
Main Hospital 4567 E. 9th Ave
Physician Offices I 4545 E. 9th Ave
EMERGENCY ENTRANCE
Colorado Blvd (6 blocks west)
CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 7
INFORMATION FOR FAMILY & FRIENDS ABOUT THE FACILITY AND NEARBY RESOURCES:
Visiting Hours: Rose Medical Center has open visitation where family and friends may visit at any time. During the hours of 8:00 p.m. - 6:00 a.m., guests must enter through the ER entrance and present a valid form of identification to enter the hospital.
Waiting Hours: Waiting areas are located on the 2nd Floor of the main hospital near the Central Elevators. Complimentary WiFi is available throughout the hospital; look for Rose Guest Network among the list of available networks.
Patient & Family-Centered Approach to Care: Rose Medical Center promotes and supports a patient and family-centered approach to care. The hospital uses a broad definition of “family” as defined by each patient. Families and other partners in care are welcome 24 hours a day, according to patient preference. Cots are available upon request for anyone wishing to stay with their loved one.
We know that waiting while your family member is in surgery is an especially anxious period. If at any time you need anything, please ask a staff member for assistance. Family will be allowed to see the patient approximately one hour after surgery. To promote energy conservation and recovery, it is helpful to keep visiting time short and to try to limit the number of family members in the room at one time.
Tobacco: Rose Medical Center is a tobacco-free campus. Nicotine use, including e-cigarettes and smokeless tobacco, is prohibited everywhere on campus.
DIRECTIONS:
Rose Garden Café: Located on the ground floor of the main hospital.
The Rose Garden Café offers a variety of hot food choices, deli items, a salad bar and takeaway options for breakfast and lunch. Daily breakfast and lunch specials are available.
Monday – Friday: 6:30 a.m. - 2:00 p.m. Saturday and Sunday: 6:30 a.m. - 2:00 p.m.
*Snacks and pre-made items are still available until 3:00 p.m. Monday – Friday*
Little Miss Latte: Located on the 1st floor of the main hospital near the central elevators.
Our coffee shop offers coffee drinks, soups, salads, pastries, deli options and hot meal entrees for breakfast, lunch and dinner.
Monday – Friday: 6:30 a.m. - 1:00 a.m. Saturday: 7:30 a.m. - 1:00 a.m. Sunday: 2:00 p.m. - 1:00 a.m.
At Your Request Room Dining Service: Guest meals are available by calling ext. 05444 to place your order. Payment accepted by cash or credit card.
8 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | INFORMATION FOR FAMILY & FRIENDS
HOTEL ACCOMMODATIONS:
If you require hotel accommodations while your family member or loved one is with us, the Rose Information Desk is available during the week from 8:00 a.m. - 6:00 p.m. and can be reached at 303-320-2396. When making your reservations, ask if there is a Rose Medical Center rate and shuttle service. Here is a short list of hotels near Rose Medical Center, in no particular order:
Hilton Garden Inn (Denver/Cherry Creek) 303-754-9800 600 S. Colorado Blvd, Denver, CO www.hiltongardeninn3.hilton.com/en/hotels/ colorado/hilton-garden-inn-denver-cherry-creekDENCKGI/index.html
Hampton Inn & Suites (Denver Cherry Creek) 303-692-1800 4150 E. Kentucky Ave, Denver CO www.hamptoninn3.hilton.com/en/hotels/colorado/hampton-inn-and-suites-denver-cherry-creekDENCCHX/index.html
Staybridge Suites (Denver-Cherry Creek) 303-321-5757 4220 E. Virginia Ave, Glendale, CO www.ihg.com/staybridge/hotels/us/en/glendale/ dench/hoteldetail
Doubletree Hotel 303-321-3333 3203 Quebec St, Denver, CO www.doubletree3.hilton.com/en/hotels/colora-do/doubletree-by-hilton-hotel-denver-RLDV-DT/ index.html
Holiday Inn (Denver Cherry Creek) 303-388-5561 455 S. Colorado Blvd, Denver, CO www.cherrycreekhoteldenver.com/
Extended Stay America (Cherry Creek) 303-388-3880 4444 Leetsdale Dr, Glendale, CO www.extendedstayamerica.com/hotels/co/denver/cherry-creek
Ramada Denver (Downtown) 303-831-7700 1150 E. Colfax Ave, Denver, CO www.ramada.com/hotels/colorado/denver/ramada-denver-downtown/rooms-rates
Fairfield Inn & Suites (Denver Cherry Creek) 303-691-2223 1680 S. Colorado Blvd, Denver, CO www.marriott.com/hotels/travel/denfi-fairfieldinn-and-suites-denver-cherry-creek/
La Quinta Inn 303-758-8886 1975 S. Colorado Blvd, Denver, CO www.laquintadenvercherrycreek.com/
PART TWO YOUR SURGERY
CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 9
BEFORE SURGERY RECOMMENDATIONS:
The following recommendations are just a few of the things you can do to prepare yourself for surgery and help speed up your recovery. We suggest that you start implementing these recommendations now.
• Stop smoking. Stop smoking. Being informed you need surgery may have convinced you to quit smoking. However, if it hasn’t, it is imperative for your health to quit now, as it is critically important you do not smoke after open-heart surgery. Smoking can increase heart rate, narrow blood vessels, raise blood pressure, cause spasms of the coronary arteries, and scar your lungs. Stopping smoking is one of the best things you can do for your heart and overall health, especially as you are healing from surgery. Here are some tips to help you not smoke:
• Ask family and friends not to smoke around you.
• Get rid of any cigarettes. Clean out ashtrays, or even throw them away!
• Take it one day at a time. Tell yourself out loud each day: “I will not smoke today.” Saying “I will never smoke again” has potential to set yourself up for failure and disappointment.
• Don’t think “just one cigarette won’t matter” because it will.
• Ask for help! Check with your doctor or nurse for stop smoking resources.
• If you have diabetes, keep your blood sugar in your target range.
• Follow your dietary recommendations.
• Maintain your activity level.
• Get adequate rest.
• Take your prescribed medications as scheduled.
• Seek support from your family members and significant others.
• Develop a plan for recovery (identify who will help you when you return home.)
• Practice taking deep breaths.
• Call your doctor if you experience increasing chest pain or shortness of breath.
• Call your doctor if you have any other concerns or questions.
Remember, your doctors and staff have successfully helped hundreds of patients and families through this experience. They are here for both you and your family. Please call your surgeon or cardiologist any time before your surgery if you or your family have any questions or concerns.
10 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | BEFORE SURGERY
ADVANCE DIRECTIVES:
Open-heart surgery is a serious event and a major operation. Though most everyone recovers and returns home, sometimes complications do occur. Your surgeon will be able to describe these to you.
Complications from stroke, respiratory failure or heart failure may leave you unable to make decisions regarding your health care. It is important that you have all of your affairs in order. This includes having a current will and appointing a Durable Power of Attorney for Health and Financial matters.
Official forms for Durable Power of Attorney can be acquired through the hospital or your doctor’s office.
RISKS OF OPEN HEART SURGERY:
As with any type of surgical procedure there are certain risks associated with heart surgery. Some risks include infection, reactions to anesthesia, fever, pain, blood clots and heart rhythm abnormalities.
Though complications are rare and extensive measures are taken to minimize these risks, it is important that you are aware of potential concerns.
Your surgeon will discuss these risks with you and answer any questions you may have. When you have discussed the operation thoroughly with your surgeon, you will be asked to sign a consent form. The purpose of the consent form is to confirm that you understand the risks and potential complications associated with heart surgery.
YOUR ROLE IN PREVENTING SURGICAL INFECTIONS:
Preparing skin before surgery can reduce the risk of infection at the surgical site. To make the process easier, we can provide you with (or you can purchase at your local pharmacy) a special antiseptic soap— Hibiclens/4% Chlorhexidine—designed to reduce the bacteria on your skin. If you are allergic to the Hibiclens/4% Chlorhexidine, use an antibacterial soap for your showers. Please review the forms section at the back of this guidebook, where you will find detailed instructions for skin preparation and a checklist for you to complete.
BEFORE SURGERY | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 11
PREPARATION CHECKLISTS:
When You Have Decided to Have Surgery:
[ ] Pre-register by calling 303-320-2798 or online at the MyHealthONE Portal RoseMed.com/MyHealthONE
[ ] Arrange a ride to the hospital
One Week Before:
[ ] Begin your pre-operative infection prevention bathing with chlorhexidine gluconate (CHG) (See Forms section)
Last Minute Checklist: The 24 hours before surgery will be busy. Please use this checklist to make sure you remember everything.
[ ] Do not eat or drink anything after the time instructed by the anesthesiologist, surgeon or hospital staff
[ ] Do not wear lipstick, makeup, perfumes, powders, deodorants, lotion or nail polish on the day of surgery
[ ] Bring a list of current medications: Be sure to include medication name, frequency and time of day taken (see Forms section)
Pack your hospital bag to include:
[ ] This patient guidebook
[ ] Toothbrush and toothpaste
[ ] Hearing aids and extra batteries
[ ] Glasses, contact lenses and solution
[ ] Comfortable shoes with backs, no heels and no laces (preferably slip-on)
[ ] Loose fitting shorts or athletic pants and a t-shirt
Bring the following items for family or friends to hold onto:
[ ] Government issued photo ID
[ ] Personal electronics if you wish; please note these cannot be locked in your room and should be held by your family or friends
[ ] Rose Medical Center recommends leaving valuables such as cash and jewelry at home
12 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | BEFORE SURGERY
THE NIGHT BEFORE:
• Follow the instructions from your surgeon or anesthesiologist regarding food and drink. Typically, you are instructed not to have food within eight (8) hours of your scheduled surgery time, and no food or liquids within three (3) hours of your surgery time.
• Your surgeon will tell you which medications to take and which to stop taking. • Carefully follow antibacterial skin prep and shower instructions. (see Forms section)
What Should I Bring to the Hospital?
Bring the essentials—your glasses, dentures and hearing aids. Be sure to label these items. When you leave for surgery, give them to your family to take to the Intensive Care Unit (ICU). The hospital cannot be responsible if these items get lost.
Leave all jewelry at home, including your wedding ring. Your fingers swell during surgery and rings may cut off the circulation. We will provide you with a hospital gown and non-skid socks.
THE MORNING OF: On the morning of your surgery, take only the medications that were directed by both your anesthesiologist and your surgeon. Take the medication with only small sips of water—do not eat or drink anything else.
Arrival: • Plan on arriving two hours before your surgery time. • Come to Rose’s Wolf Building at 4600 Hale Parkway (see Maps and Directions section). • Use our complimentary valet service. • Take the elevator to the second floor of the Wolf Building to get to the Surgical Check-in Desk.
Pre-Op: • An IV will be started. • Your medical history and home medications will be reviewed. • You will meet with your anesthesiologist to review your anesthesia plan and some medications may
be administered. • You will meet with your surgeon who will obtain final consent for the procedure and answer any remaining
questions you may have. • You will meet your operating room nurse, who will be with you throughout the surgery.
Operating Room: • Anesthesiologists administer anesthesia. Your anesthesiologist is typically assigned 24 hours prior to
surgery and will attempt to call you the night before surgery to discuss your medical history and the type of anesthesia he or she will provide.
• Anesthesia uses anesthetic gases and IV medications to put you to sleep. Your breathing, heart rate and blood pressure are continuously monitored.
• The surgeon will contact your loved ones when the procedure is finished.
BEFORE SURGERY | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 13
YOUR CARE TEAM:
Here are a few of the staff members that will be caring for you during your stay and a short description of their roles in the hospital. They are here to help make sure your experience is as safe and comfortable as possible, and you should ask them questions and share any concerns you may have.
Cardiac Rehabilitation Staff - RNs and clinical exercise physiologists who help you regain physical and emotional strength. They will also create your activity plan.
Case Manager - Either a nurse or a medical social worker who assists in the coordination of your care in the hospital. Also helps prepare you for discharge.
Certified Nursing Assistant (CNA) - Helps you with various activities like bathing and getting in and out of bed.
Hospitalist - In-house medical doctor who assists your surgeon with your care during your hospital stay.
Intensivist - In-house medical doctor specially trained to care for you during your time in the ICU.
Physical Therapist/Occupational Therapist (PT/OT) - Specialize in helping patients improve their strength, balance, movement and activities of daily living after surgery.
Registered Dietician (RD) - Creates a specialized nutrition plan for you.
Registered Nurse (RN) - Registered nurses provide your direct care (administering medication and caring for wounds, for example), teach you and your family about your care, help plan your care, set goals and supervise the CNAs.
Registered Respiratory Therapist (RRT) - Specialize in assessing and treating lung care needs.
Cardiothoracic Surgeon - Performs your surgery, oversees and directs your care. Also checks your progress at follow-up office appointments.
Anesthesiologist - Administers anesthesia to you in the operating room, monitors your condition during surgery and may direct your post-operative pain management.
Pharmacist - Coordinates your medications based on physician orders.
Cardiovascular Nurse Practitioner (NP) - Works closely with your cardiologist to plan and coordinate your care based on physician orders. Helps educate you and your family and assists with continuation of care.
Cardiovascular Physician Assistant (PA) - Works closely with your thoracic surgeon during your procedure and assists in coordinating and monitoring your care based on physician orders.
14 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY
AFTER SURGERY IMMEDIATELY FOLLOWING SURGERY:
After the surgery is finished, you will be transported to the ICU. You will still be asleep when you arrive. The nurses in the ICU are specially trained to care for post-surgery patients who are recovering from anesthesia.
When you wake up, you will be aware of a tube in your throat. This is a breathing tube attached to a ventilator. Your natural reaction will be to reach up and pull the tube out, but your hands will be gently restrained by soft cloths to prevent you from instinctively doing this.
You will not be able to talk when the tube is in your throat, so your nurse will communicate with you with simple “yes” and “no” questions. Your nurse will ask questions to determine your need for pain medication and instruct you to take deep breaths. Your medical care team will do their very best to ensure your pain is appropriately managed.
Once you have met the appropriate criteria and are properly breathing on your own, you will have the breathing tube removed from your throat (extubation) and the restraints removed from your
WHITE BOARDS & HOURLY ROUNDING:
White Boards: White boards are placed in each patient room to give staff a place to write important information for the patient and staff members. The purpose of the white boards is to enhance communication between patients and staff members. Your white board should list information such as:
• Name of your nurse, nurse’s aide, physician
• Phone numbers
• When medications were given
• Upcoming scheduled tests
hands. You may have a sore throat from the tube that was placed in your windpipe.
Following surgery, you will likely have two chest tubes attached below your ribs. The purpose of these tubes is to drain the excess fluid from your chest. The fluids drain into containers that are closely monitored by your care team. Your surgeon will determine when the chest tubes can be removed, which is usually after a few days.
Your family and friends will be allowed in the ICU. Your surgeon will be contacting the person you identified as a “primary contact” to inform them that your surgery is over, and family will be allowed to visit approximately one hour after surgery.
Your nurse will maintain close communication with your surgeon, cardiologist, and other members of your care team to make sure you receive the highest quality of care. Your length of stay in the ICU will vary depending on your unique circumstances. Patients typically spend 24 hours in the ICU before being moved to the Rose’s Cardiac Unit.
Hourly Rounding: You can expect to see a caregiver at least every hour unless discussed with your nurse in advance. At night, even as you sleep, your nurse will check on you and may have to awaken you for vital signs or other care. We are dedicated to providing a quiet and relaxing environment for your recovery.
Wong-Baker Faces® Pain Rating Scale
0 2 4 6 8 10
Hurts Little Bit
Hurts Little More
Hurts Even More
Hurts Whole Lot
Hurts Worst
No Hurt
©1983 Wong-Baker FACES Foundation. www.WongBaker.org Used with permission. Originally published in Whaley & Wong's Nursing Care of Infants and Children. ©Elsevier Inc.
PAIN MANAGEMENT | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 15
Managing Your Pain During Your Hospitalization
OUR GOAL is to keep you as comfortable as possible. Rose Medical Center is dedicated to providing you with the safest, most effective and highest quality care possible.
You will be asked to rate your pain on a “0” to “10” pain scale. You will also be asked to create an individual “pain goal.”
This “pain goal” is a number on the scale where you feel you will be able to move around, eat and breathe deeply—all critical steps in your recovery process.
Please Note: Pain medication may not completely eliminate your pain. Although we aim to make you as comfortable as possible, pain medication must be managed according to tolerance and side effects.
In addition to medication, there are many other effective methods of pain management. Some of these pain management techniques include:
• Heat/ice • Distraction (conversation, watching TV, reading a book) • Re-positioning • Relaxation (imagery, music, deep breathing
We are here to help you. Hourly Rounding – Our staff will check in with you each hour to see how you are doing and to ensure your pain is being managed appropriately. Don’t hesitate to call for help at any time in between visits if:
• Your pain is not well controlled with your current treatment • You are having side effects from the medication (nausea, vomiting, itching) • Your pain is getting worse
Thank you for trusting Rose Medical Center with your care.
PART THREE YOUR RECOVERY
CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 17
IN-PATIENT CARDIAC REHABILITATION Your rehabilitation will begin while you’re still in the hospital. A registered nurse will work with you to get you up and moving right after surgery:
• Monitor vital signs with activity
• Cardiovascular education
• Planning home activity for after discharge
SAFETY PRECAUTIONS:
Ambulation:
After surgery, it will be important for you to get out of bed for some movement. This will play a very important role in aiding and speeding up your recovery. Nurses will be there to assist you in getting up and walking, using the bathroom and showering when appropriate. Staff from cardiac rehabilitation, physical therapy and occupational therapy will assist in your exercise and activity while teaching you how to remain active when you return home.
Your goal after surgery will be to take 4 walks every day, resting for 1.5 - 2 hours in between each walk.
18 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | IN-PATIENT CARDIAC REHABILITATION
Sitting Down: Getting Out of a Chair:
1
Back up until your legs touch the edge of the chair.
1
Scoot your bottom to the edge of the chair by walking your feet out in front of you.
2 2
Place your hands on your legs. Place your hands on your legs to steady yourself.
3
Bend your knees and lower yourself into the chair without using your arms.
3
Widen your stance, lean forward and stand up out of the chair using your legs.
IN-PATIENT CARDIAC REHABILITATION | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 19
Getting Into Bed:
1
Back up until your legs touch the edge of the bed.
2
Place your hands on your legs. Bend your knees and lower yourself onto the bed without using your arms.
20 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | IN-PATIENT CARDIAC REHABILITATION
Getting Out of Bed:
1 4
Hug a pillow against your chest. Use your elbow and the momentum from your legs to sit up.
2 5
Roll on your side. Once you’re sitting up, put down the pillow. Scoot to the edge of the bed by walking your feet out in front of you.
3
Continue hugging the pillow as you slide your legs off the bed.
6
Place your hands on your legs. Widen your stance, lean forward and stand up out of the bed using your legs.
IN-PATIENT CARDIAC REHABILITATION | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 21
DO NOT:
Do not twist your body. Do not put strain on your chest by reaching out in front of you.
Do not use your arms to push yourself Do not put strain on your chest by out of a chair. reaching above your head.
22 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | IN-PATIENT CARDIAC REHABILITATION
DO NOT:
Do not twist your body. Do not put strain on your chest by using your arms to prop yourself up in bed.
Do not put strain on your chest by Do not use your arms to push yourself using your arm to push yourself up to a off the bed. sitting position.
IN-PATIENT CARDIAC REHABILITATION | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 23
FLUTTER VALVE/INCENTIVE SPIROMETRY:
Breathing exercises will be your second form of activity after surgery in addition to walking. Using your flutter valve and incentive spirometer after surgery will help you keep your lungs clear and will help keep your lungs active throughout the recovery process, as if you were performing your daily activities. Your goal will be to perform your breathing exercises 10 times every hour. A staff member will teach you how to use each device.
Flutter Valve
Incentive Spirometer
24 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | IN-PATIENT CARDIAC REHABILITATION
INCISIONS AND WOUND CARE:
You will have an incision on your chest. If you had bypass surgery, you may also have incisions on one or both legs. These incisions will have bandages over them for the first day. Dressings will be changed as necessary. After day one, if there is no drainage on your chest or legs, the dressings will be removed.
Bruising is normal and can be extensive, but it will fade over time. It also is normal to notice a small amount of blood-tinged drainage from incisions on legs. This too will lessen with time. It is common for leg incisions to ooze and need more frequent bandage changes. You may notice a lump or swelling above your chest incision. This will gradually decrease.
A nurse will inspect your incisions multiple times a day. As these incisions start to heal, you may experience itching or numbness at the sites, but it is very important to remember: Do not touch or scratch your incisions.
CARDIAC DIET:
It is common for patients to experience a loss of appetite after their surgery. However, maintaining a proper diet is essential to your recovery. Protein consumption promotes healing and is an important part of your diet. Do your best to consume protein during your recovery. Some of the high-protein foods available to you at the hospital include: yogurt, protein shakes, eggs, meat, cheese, beans and nuts.
CARE PATH:
IN-PATIEN
T CARDIAC REH
ABILITATION
| CARDIO
VASCULAR/CARDIOTHORACIC SURGERY |
PATIENT GUIDEBOO
K | 25
Post-Op OR Day
Post-Op Day 1 (ICU-Tele)
Post-Op Day 2
Post-Op Day 3
Post-Op Day 4
Post-Op Day 5
Discharge Outcomes & Goals
Nutrition
Diet begins with clear liquids.
Diet is advanced to cardiac diet as tolerated.
Cardiac diet continues.
Protein rich cardiac diet continues.
Protein rich cardiac diet continues.
Protein rich cardiac diet continues.
Patient tolerating nutritional, protein rich cardiac diet.
Activity & Safety
Patient is assisted in sitting up.
Patient is helped up out of bed and into chair for meals. Short walks with assistance from clinical staff may begin based on tolerance.
Four (4) walks per day in the hallway with assistance from clinical staff.
Patient sits up in chair for all meals and is assisted in walking four (4) times per day. Assisted showering begins once approved by clinical staff.
Patient sits up in chair for all meals and is assisted in walking four (4) times per day. Assisted showering begins once approved by clinical staff.
Patient sits up in chair for all meals and is assisted in walking four (4) times per day. Patient is showering daily with assistance.
Patient is walking independently four (4) times per day. Clinical staff is comfortable with patient’s ability to perform activities of daily living.
Breathing Exercises
Begin guided breathing exercises with flutter valve or incentive spirometer 10 times every 1-2 hours while awake.
Guided breathing exercises with flutter valve or incentive spirometer 10 times every 1-2 hours while awake.
Guided breathing exercises with flutter valve or incentive spirometer 10 times every 1-2 hours while awake.
Independent breathing exercises with flutter valve or incentive spirometer encouraged, 10 times every 1-2 hours while awake.
Independent breathing exercises with flutter valve or incentive spirometer encouraged, 10 times every 1-2 hours while awake.
Independent breathing exercises with flutter valve or incentive spirometer encouraged, 10 times every 1-2 hours while awake.
Patient has clear understanding of how to use flutter valve or incentive spirometer. Breathing exercises continue 10 times every 1-2 hours while awake at home.
Pain Management
& Comfort
Intensive post-surgery pain management by physician and clinical team.
Intensive post-surgery pain management by physician and clinical team.
Customized pain management by physician and clinical team based on patient’s unique needs.
Customized pain management by physician and clinical team based on patient’s unique needs.
Customized pain management by physician and clinical team based on patient’s unique needs.
Customized pain management by physician and clinical team based on patient’s unique needs.
Patient observes decreasing pain/ discomfort, at-home pain management plan is discussed.
Teaching & Review of
Proper Body Mechanics
Patient is taught sternal precautions and breathing exercises.
Sternal precautions and breathing exercises reviewed.
Sternal precautions and breathing exercises reviewed.
Patient continues sternal precautions and breathing exercises. Patient is taught cardiac diet.
Patient continues sternal precautions and breathing exercises, cardiac diet is reinforced, patient is taught home exercise program.
Discharge instructions reviewed, sternal precautions, breathing exercises and cardiac diet are reinforced, home exercise program is reviewed.
Discharge instructions reviewed, patient has clear understanding of sternal precautions, breathing exercises, pain management plan, cardiac diet, activity at home and follow up care.
26 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY
PREPARING FOR DISCHARGE CASE MANAGERS:
At Rose, we have specialized case managers available to assist you and your family in preparing for discharge. A case manager will not make decisions for you and your family, but will provide information that will assist you to make the best decision about your care after discharge.
EXTENDED CARE/SKILLED NURSING/ REHABILITATION FACILITIES:
In some cases, you may be discharged to a rehab facility or skilled nursing facility. We understand that the decision to continue your rehabilitation in another facility may be difficult and we are here to help you with this process. Our goal is to make this transition smooth and comfortable. The case manager will provide you with information on available facilities that will help meet your requirements.
Placement in these facilities will be determined by the level of care you need, physician orders, bed availability and payment source. These facilities provide 24-hour care for patients. Because the time for selecting a facility can be very limited, it is important that you and your family discuss potential choices with the case manager as soon as possible.
Your case manager will also help assist you in finding transportation to the facility. Based on your care needs, you may be transported by family car, wheelchair van or stretcher ambulance.
DELAYS IN DISCHARGE:
Every patient is different. Depending on your unique circumstances, your discharge may be delayed to address any concerns your care team has.
INSTRUCTIONS FROM YOUR SURGEON:
Your discharge instructions will vary based on your surgical procedure and your surgeon’s personal preferences. Your unique instructions will be reviewed with you upon discharge. Please keep these instructions in the front pocket of this book and refer to them as needed.
CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 27
LIFE AT HOME There is life beyond heart disease. Many people diagnosed with heart disease or who have experienced a cardiac event are able to live long and healthy lives. The following guidance promotes a healthy lifestyle. Our goal is to help turn your lifestyle adjustments into enjoyable habits.
EXERCISE AND ACTIVITY:
It takes 4-6 weeks to recover from open-heart surgery, so please remember to be patient with the healing process. Exercise and movement helps improve your strength and stamina after surgery, speeding up your recovery time. Here are some tips to help you get started with some activity:
• Be active and exercise when you feel able.
• Warm-up before you exercise with 3-5 minutes of slow walking or a stationary bike.
• Cool down after exercise by walking/riding slowly for 3-5 minutes.
• Stop exercising right away if you experience chest pain, severe fatigue or shortness of breath.
• Be sure to avoid exercise in conditions above 80° and below 40°. Seek indoor alternatives for exercise.
Many more tips and recommendations will be given to you when you begin your formal Cardiac Rehabilitation program.
Limiting household chores or social activities will help you use your energy stores wisely. It is a good idea to take a break between your different activities or exercise. While movement and some light exercise will speed recovery and healing, too much activity can have a negative effect on your recovery and leave you feeling overly tired. Remember, your daily energy allotment is like currency, and once it is spent for the day, you won’t be able to pull additional energy from reserves.
Remember to conserve your energy. Use the “1:1 rule” to guide you as you recover—for every one minute of action, you need to take one minute of rest.
28 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | LIFE AT HOME
HOME WALKING PROGRAM:
Follow the walking program given to you by your cardiac rehabilitation nurse. If you feel short of breath, dizzy or faint, stop and rest. If these symptoms do not subside within 20 minutes, notify your cardiologist.
REMEMBER: It is important that you rest for 1.5 – 2 hours in between walks.
WEEK FREQUENCY DURARTION OF EACH WALK TOTAL WALK TIME/DAY
1 4 times per day 5 minutes 20 minutes
2 3 times per day 10 minutes 30 minutes
3 2 times per day 15 minutes 30 minutes
4 2 times per day 20 minutes 40 minutes
5 1 time per day 40 minutes 40 minutes
6 1 time per day 45 minutes 45 minutes
For weeks 6 and later, 45-60 minutes of walking per day is recommended. Instead of 60 straight minutes of walking, it is acceptable to divide this into two 30-minute periods or three 20-minute periods.
LIFE AT HOME | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 29
REST/SLEEP:
During the recovery process, your body treats every bit of activity or exercise as “work.” Your routine activities of daily living (ADLs) such as bathing, shaving, brushing your hair can be tiring. You might need to rest for a short time to recover from performing those daily living activities.
• Plan on two 20-30-minute rest times each day during the first week or two at home. This doesn’t mean you need to go to bed, but just sit with your feet up for some time.
• Resting between activities will keep you from getting too tired throughout the day.
• Aim for 8-10 hours of sleep each night.
• Again, take your recovery one day at a time. Don’t push yourself too hard and try to force recovery.
It is common to have some sleeping problems when you get home from the hospital. Trying to return to your normal sleeping routine and cycle will help with your recovery and healing.
PHASE 2: OUTPATIENT CARDIAC REHABILITATION:
Once you’re home from the hospital, you’ll have the opportunity to continue your rehabilitation on an outpatient basis. Clinical exercise physiologists and registered nurses will guide you through an exercise program to help you physically recover from surgery. They also educate you about decreasing your cardiovascular risk factors for heart disease. The team of professionals you will be working with will also include physicians, nurse practitioners, dieticians and pharmacists.
Our Cardiac Rehabilitation Program Provides:
• Guided and monitored exercise to improve health, fitness, and quality of life.
• Daily monitoring of EKG, blood pressure, heart rate, and blood glucose (if diabetic).
• Physician correspondence.
Benefits of the Cardiac Rehabilitation Program:
• Reduction in fatigue, shortness of breath, angina, depression.
• Improvements in quality of life and your ability to participate in everyday activities.
• Reduce risk of cardiovascular disease & event reoccurrence (even death).
• Supervision by experienced and knowledgeable staff certified in both Advanced Cardiac Life Support (ACLS) and Cardiopulmonary Resuscitation (CPR).
For more information, contact Rose Cardiac Rehabilitation at 303-320-2996.
30 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | LIFE AT HOME
INTIMACY AFTER SURGERY:
Your surgeon may want you to wait several weeks before having sex. As a general rule, you may begin having sex after heart surgery when you:
• Feel physically and mentally ready
• Have a clear understanding of the precautions you should follow to protect your healing breastbone.
• Are free of cardiovascular related symptoms
• Can walk two blocks or up two flights of stairs without any cardiovascular related symptoms
Range of motion and comfort are the biggest concerns and you should avoid putting too much pressure on your breastbone. Take the same care getting out of a position as you did getting into it. Have towels or pillows nearby as they can be used for body support.
In Case of Severe Pain
If you have a sudden onset of pain, STOP and reposition yourself. If the pain continues, have your partner call your surgeon for further instruction.
Special Note for Partners
If your partner has had heart surgery:
• help your partner stay safe
• do not put all your weight on your partner’s chest
• control the amount and speed of movement during sex
• do not try any new or unusual positions
PART FOUR EDUCATION
CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 31
THE HEART The heart is a powerful muscle roughly the size of your fist. It is located under the breastbone on the left side of the center of the chest. The heart’s pumping mechanism is used in combination with its electrical rhythmic component to deliver a consistent flow of blood throughout the body. By maintaining a steady circulation of blood, the heart can supply the body with essential oxygen and nutrients.
There are four muscular chambers in the heart. The top two chambers are called atria and the bottom two chambers are called ventricles. The right and left sides of the heart perform different but equally important functions. The right side of the heart receives unoxygenated blood from the body and pumps this blood into the lungs where it picks up more oxygen. The left side of the heart receives this oxygenated blood from the lungs and pumps it out to the body.
CORONARY ARTERIES:
The coronary arteries are the blood vessels that supply blood to your heart. They branch off the aorta at its base. The right coronary artery, the left main coronary, the left anterior descending, and the left circumflex artery are the four major coronary arteries. Blockage of these arteries is a common cause of angina, heart disease, heart attacks and heart failure.
HEART VALVES:
There are four valves in the heart that open and close to direct the blood flow from the right side of the heart through the lungs into the left side of the heart and back out to the body.
Cut-away view of a coronary artery
32 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY
WHAT AFFECTS NORMAL FUNCTIONING? Problems that can interfere with the normal functioning of the heart include:
• Blockage of the coronary arteries (coronary artery disease)
• Damaged heart muscle
• Valves that do not open or close properly
• Natural or inherited abnormalities (congenital abnormalities)
CORONARY ARTERY DISEASE:
Coronary artery disease occurs when the coronary arteries (blood vessels) that deliver blood and oxygen to the heart itself become too narrow to supply the heart muscle with the oxygen-rich blood that it needs. Coronary arteries may become narrow due to the buildup of plaque in the artery walls, which can be the result of an increase of fats in the bloodstream. The narrower the arteries, the more difficult it is for the arteries to supply enough blood to the heart muscle.
When the heart muscle is deprived of oxygen and nutrients due to a lack of blood supply, it can cause chest pain, shortness of breath, profound fatigue and heart muscle damage. A heart attack, or myocardial infarction, can occur when a piece of plaque ruptures or breaks and causes a blood clot to form, completely blocking blood flow to a portion of the heart muscle.
MAJOR RISK FACTORS FOR CORONARY ARTERY DISEASE:
Tobacco use: The American Heart Association (AHA) names cigarette smoking as “the most important preventable cause of premature death in the United States.”
Smoking can increase blood pressure, increase the tendency for blood to clot, increase the risk of coronary artery disease and decrease your body’s ability to benefit from exercise. The risk of developing coronary artery disease is 2 to 4 times higher for smokers than it is for nonsmokers.
Cholesterol: There are three types of lipids, or blood fats three types of lipids are high-density lipids:
• High-density lipids (HDL) – often called “good” cholesterol
• Low-density lipids (LDL) – known as “bad” cholesterol
• Triglycerides
High levels of LDLs and triglycerides can contribute to artery disease. Cholesterol levels are affected by age, gender, heredity, activity, tobacco use and diet.
As an adult, it is important to know your cholesterol levels. Tests that measure your total cholesterol and triglycerides are helpful in determining your risk factors for heart disease. Your total cholesterol is calculated by using the following formula:
HDL (good) cholesterol + LDL (bad) cholesterol + 20% of your triglyceride level
Generally, lower total cholesterol is good. The following chart explains how cholesterol levels are interpreted. Your doctor may have different cholesterol guidelines for you depending on your personal medical history.
WHAT AFFECTS NORMAL FUNCTIONING? | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 33
Your Total Blood (or Seum) Cholesterol Level
TOTAL CHOLESTEROL LEVEL CATEGORY
Less than 200 mg/dL Desirable level that puts you at lower risk for coronary heart disease. A cholesterol level of 200 mg/dL or higher raises your risk.
200 to 239 mg/dL Border line high
240 mg/dL. and above High blood cholesterol. A person with this level has more than twice the risk of coronary heart diseease as someone whose cholesterol is below 200 mg/dL.
Your HDL (Good) Cholesterol Level
HDL CHOLESTEROL LEVEL CATEGORY
Less than 40 mg/dL Low HDL cholesterol. A major risk factor for heart disease. (for men) Less than 50 mg/DL(for women)
60 mg/dL and above High HDL cholesterol. An HDL of 60 mg/dL and above is considered protective against heart disease.
Your LDL (Bad) Cholesterol Level
LDL CHOLESTEROL LEVEL CATEGORY
Less than 100 mg/dL
100 to 129 mg/dL
130 to 159 mg/dL
160 to 189 mg/dL
190 mg/dL and above
Optimal
Near or above optimal
Borerline high
High
Very High
Your Triglyceride Level
TRIGLYCERIDE LEVEL
Less than 100 mg/dL
CATEGORY
Optimal
Less than 150 mg/dL Normal
150 to 199 mg/dL Borerline high
200 to 499 mg/dL High
500 mg/dL and above Very High
34 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | WHAT AFFECTS NORMAL FUNCTIONING?
Blood Pressure: High blood pressure (hypertension) increases the heart’s workload, causing the heart muscle to thicken and become stiffer over time. High blood pressure can increase your risk of stroke, heart attack, kidney failure and congestive heart failure (when the heart loses its ability to pump blood efficiently).
Blood pressure is typically written as a ratio like this:
118 mm Hg Read as “118 over 60 milimeters of mercury”
60
Systollic: The top number, which is also the higher of the two numbers, measures the pressure in the arteries when the heart beats (when the heart muscle contracts).
Diastolic: The bottom number, which is also the lower of the two numbers, measures the pressure in the arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood).
BLOOD PRESSURE CATEGORY SYSTOLIC MM HG (UPPER #) DIASTOLIC MM HG (LOWER #)
Normal Less than 120 and Less than 80
Prehypertension 120-139 or 80-89
High Blood Pressure 140-159 or 90-99 (Hypertension) Stage 1
High Blood Pressure 160 or higher or 100 or higher(Hypertension) Stage 2
Hypertensive Crisis Higher than 180 or Higher than 110 (Emergency care needed)
Your doctor should evaluate unusually low blood pressure readings.
WHAT AFFECTS NORMAL FUNCTIONING? | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 35
Lack of Physical Activity: Moderate physical activity most days of the week can help prevent heart and blood vessel disease. Regular moderate physical activities like walking, bike riding and gardening are both physically and emotionally beneficial. Exercise helps control cholesterol, blood pressure, diabetes and obesity. It also helps lower stress and makes it easier to quit smoking.
Obesity and Overweight: Excess body fat— especially at the waist—can be a risk factor for developing heart disease and stroke, even if a person has no other risk factors. Excess weight makes the heart work harder. It raises blood pressure, cholesterol and triglyceride levels, and it lowers “good” HDL cholesterol levels. It also can increase the risk of developing diabetes. Though many obese and overweight people may have difficulty losing weight, losing even as few as 10 pounds can lower the risk of heart disease.
Diabetes: Diabetes significantly increases the risk of developing vascular disease. Diabetes increases the risk of heart disease and stroke even when glucose levels are under control, but the risks are even greater if blood sugar is not well controlled. If you have diabetes, it is extremely important to work with your health care provider to manage it and control any other risk factors possible.
Diabetes also can impair wound healing. People with diabetes are more likely to have poor circulation, nerve damage, weakened immune systems, and skin problems. These can slow wound healing and increase risk for infection.
After surgery, it will be important for you to maintain blood sugar within normal limits in order to promote healing and recovery. Considerations will be taken on an individual basis to ensure your diabetes is well managed after your surgery.
Stress: Depending on one’s response to stressful situations, stress may be a contributing factor to decreased heart health. Some scientists have noted a relationship between coronary artery disease risk and the stress in a person’s life. Stress has been linked to inflammation in the arteries and increases in heart rate and blood pressure. There is still much to discover about the effects of stress on the heart.
Alcohol: Drinking too much alcohol can raise blood pressure, cause heart failure and lead to stroke. It also can produce irregular heartbeats and contribute to high triglycerides, obesity, cancer and other diseases.
Age: Studies have found that plaque buildup in the coronary arteries begins at a relatively young age. As you age and as plaque continues to build up, your risk for developing coronary artery disease increases.
Gender: Men have a greater risk of heart disease at a younger age than women do. After menopause, the risk of heart disease increases significantly for women.
Heredity: Children of parents with heart disease are more likely to develop it themselves. Most people with a strong family history of heart disease have one or more other risk factors. Because factors like family history are beyond your control, it is even more important to treat and control any other risk factors you may have.
36 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | WHAT AFFECTS NORMAL FUNCTIONING?
VALVULAR DISEASE:
The function of a heart valve is to regulate the flow of blood as it moves along a one-way path through the heart. Therefore, a damaged heart valve can be disruptive to the proper flow of blood. Heart valve damage can cause blood to back up, which can cause congestion in the lungs and other parts of the body. This condition can lead to low energy levels and feelings of weakness, fatigue and shortness of breath.
There are several different ways a heart valve can become damaged, including:
• Normal aging: Valves can wear out as you get older—valve replacement is more common after the age of 65.
• Infection: Infection of the valve is known as endocarditis.
• Rheumatic heart disease: If a streptococcal infection somewhere else in your body is left untreated, it may travel to a valve and cause damage.
• Congenital defect: Someone may be born with an abnormal valve.
CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 37
HEART SURGERY Any procedure used to treat the heart muscle, heart valves or coronary arteries is classified as a heart surgery, sometimes called cardiac surgery. Open-heart surgery describes a type of cardiac surgery that involves opening the chest, not the heart itself. Some procedures can be performed using minimally invasive techniques that use a smaller incision on the side of the chest. Your surgeon will determine which option is best for you.
Two of the most common types of cardiac surgery are coronary artery bypass surgery and heart valve surgery. Coronary artery bypass surgery focuses on the arteries that supply blood to the heart itself, while heart valve surgery focuses on repairing or replacing the valves that control blood flow within the heart.
CORONARY ARTERY BYPASS SURGERY:
Coronary artery bypass surgery (also called heart bypass surgery, coronary artery bypass graft, and/or CABG) is a procedure that treats clogged coronary arteries by creating new pathways for blood and oxygen to flow to your heart muscle using grafts.
Grafts are healthier arteries or veins taken from elsewhere in your body. Surgeons use them to reroute blood around the clogged artery. Grafts may be taken from the leg or chest.
The saphenous vein runs from the ankle to the groin on the inside of your leg, and with several small incisions, it can be removed without harming the leg. The internal mammary artery is located inside the rib cage. Surgeons can attach the lower end of this artery to a coronary artery below the blockage.
After accessing the heart, the surgeon can place grafts and the mammary artery, if it is being used, in the necessary areas of your coronary arteries in order to provide blood flow and bypass the blockages. When the grafting is completed, the surgeon closes the incisions. The entire operation usually takes 3 to 6 hours.
Cut-away views of natural and
prosthetic valves of the heart
38 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | HEART SURGERY
HEART VALVE SURGERY:
Heart valve surgery is used to repair or replace damaged or malfunctioning heart valves. There are two types of replacement heart valves— biological (natural) and mechanical (artificial). Biological valves come from human, cow or pig donors. Mechanical valves are made of durable metal, carbon, ceramics and plastics. Mechanical valves last longer than biological valves. Your surgeon will decide which type of valve is best for you.
After accessing the heart, the surgeon then makes an incision in the heart or the aorta (the main artery that carries blood from the heart to the body) to reach the valve. Once the valve is exposed, the surgeon can determine whether to repair or replace it. When the surgeon is finished repairing or replacing the valve, the incisions are closed. The entire operation usually takes 3 to 6 hours.
Heart-Lung Machine & Off-Pump Technique During your surgery, it is important that blood continues to pump throughout your body. To ensure this happens, you may be connected to a heart-lung machine while the surgeon operates. Another technique allows the surgeon to operate on the beating heart, called off-pump coronary artery bypass.
CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 39
MEDICATION When it comes to your medications, please make sure that you know these facts about the medications prescribed to you:
• The name of the medicine (brand name and generic name)
• The purpose of the medicine
• How much to take
• When and how to take it
• Possible side effects
• When a refill is needed
As always, follow the instructions your doctor gives you. Do not increase, decrease or stop your medicine without first discussing it with your doctor. If you forget a dose of your medicine, do not take two (2) doses next time to make up for it. Never let anyone else take your medication.
Remember: Only take the medication prescribed to you at the time you leave the hospital. Don’t continue taking any medication you took before your surgery without discussing it with your doctor first. Your doctor will provide you with new prescriptions when you leave. Remember to have these filled before you go home, and ask the pharmacist if you have any additional questions.
A nurse will review home medications with you upon discharge from the hospital. Be sure to bring your medication list from the hospital with you to your follow-up visits.
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HEART-HEALTHY NUTRITION Eating a heart-healthy diet means eating whole, unprocessed foods. You will likely find these foods on the outer portion of the supermarket. This includes ample vegetables, lean meats, nuts and seeds, some fruit, starch, and no sugar. Below are some key points regarding heart healthy nutrition:
• Vegetables should be the staple of any diet
• Consume whole grains with fiber to ensure healthy blood sugar levels
• Limit saturated and trans fats
• Saturated Fats are solid at room temperature. Less than 6% of daily calories should come from saturated fats, according to the American Heart Association.
• Trans fats include margarines, hydrogenated and partially hydrogenated vegetable oils (e.g., hydrogenated soybean oil). Read the ingredients for these terms.
• Eat poultry, fish and lean cuts of meats. Aim to eat wild caught fish 2 times a week
• Select lean, unprocessed form of meats
• For example, avoid pepperoni, sausage, hot dogs, bacon, smoked meat and sandwich meat, which are all processed.
• Bake, boil, grill, poach or steam your food
• Decrease sodium. Aim for less than 1500mg per day with the upper limit at 2300mg.
• The largest contributor to added sodium is processed foods such as soups, dressings, sauces, packaged meals and microwaveable dinners.
• Limit added sugar sources such as sugar-sweetened beverages, baked items, ice cream and candy
• Choose low-fat dairy products
HEART-HEALTHY NUTRITION | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 41
LOWERING BLOOD FATS (LIPIDS):
Consumption of saturated fats, trans fats, and refined or added sugars add to the fat and cholesterol made by the body. Lipids can be measured in a Lipid Profile, a blood test for total cholesterol, HDL, LDL, and triglycerides.
Ways to increase HDL:
• Decrease simple sugar consumption
• Lose weight
• Aerobic exercise
• Increase dietary fiber
• Eliminate trans fats from diet
• Eat whole grains
• Eat olive oil, avocados, nuts and seeds which are healthy fats
LDL (low-density lipoprotein), frequently termed the “bad cholesterol,” poses a risk when it invades the lining of your arteries.
Ways to decrease LDL:
• Decrease saturated fat
• Increase dietary fiber (vegetables, fruits, beans and oats)
• Lose weight/body fat
• Avoid refined sugars and grains
• Decrease stress
• Exercise regularly
LOWERING SODIUM AND FOODS TO AVOID:
Most Americans consume too much sodium. Aim for 1500mg/day. Here are the top contributors to added sodium in our diet:
• Bread and rolls
• Cold cuts/cured meats
• Pizza
• Soups
• Processed meat dishes
• Cheese
• Pasta dishes
• Packaged snack foods
Become aware of the serving size and how much sodium is in each serving. A product may claim to be lower sodium, but the serving size may be smaller than you normally would eat.
Other foods that are highly processed that you should generally be alert to:
• Tomato sauce
• Frozen dinners
• Pre-packaged vegetables, rice and potatoes with sauces
42 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | HEART-HEALTHY NUTRITION
Ways to limit sodium intake:
Start by avoiding salt during cooking and at the table:
• Select fresh or plain vegetables and meats instead of canned products
• Season foods using fresh or dry herbs
• Watch out for various forms of sodium (e.g., table salt, MSG, sodium hydroxide, sodium sulfite, sodium citrate, disodium phosphate)
• Avoid high sodium spices such as teriyaki or soy sauce
• Make your own sauces and salad dressing. e.g., olive oil and balsamic vinegar mix
• When you eat out, request no salt be added to your meal.
• Avoid soups, appetizers, or casseroles
• Ask for sauce and dressings on the side
WHOLE GRAINS AND FIBER: Any food made from wheat, rice, oats, corn, or another cereal is a grain product. Bread, pasta, oatmeal and grits are all grain products. There are two main types of grain products: whole grains and refined grains. Eating whole grains provides important health benefits.
• Whole grains are generally good sources of dietary fiber; most refined (processed) grains contain little fiber.
• Dietary fiber from whole grains, as part of an overall healthy diet, helps reduce blood cholesterol levels and may lower risk of heart disease.
• Fiber-containing foods such as whole grains help provide a feeling of fullness with fewer calories and so may help with weight management.
American Heart Association
ADDITIONAL RESOURCES:
Maintaining a Healthy Diet: www.dashdiet.org
FREE Heart Health Assessment: https://apps.evaliahealth.com/v2/affd09074937-4e3b-b173-8c48317d8cb2
FORMS
FORM
S | CARDIO
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MEDICATION TRACKER:
Name of Medicine
Color What’s it For? Dose How Often & What Time
Prescribing Doctor
Pharmacy Phone No.
Special Instructions
Refill Date
Aspirin White Blood thinner 1 P il l Once daily at night Dr. Jones 303-555-1234 Take with food 9/1/17
NOTES:
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FO
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ACTIVITY LOG:
Date Type of Activity Total
Minutes How I Felt Personal Goals
FORMS | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | PATIENT GUIDEBOOK | 45
YOUR ROLE IN PREVENTING SURGICAL INFECTIONS Preparing skin before surgery can reduce the risk of infection at the surgical site. To make the process easier, we can provide you (or you can purchase at your local pharmacy) with a special antiseptic soap (Hibiclens®/4% Chlorhexidine) designed to reduce the bacteria on your skin. If you are allergic to the Hibiclens/4% Chlorhexidine, use an antibacterial soap for your showers. Please fill out the checklist on the following page.
ALL PATIENTS: Beginning five (5) days before your surgical date (or when you are told to start this process), shower with 4% chlorhexidine gluconate (e.g., Hibiclens) liquid at least one time a day. [Note: You do not have to shower at the same time every day.]
When showering with Hibiclens®/4% chlorhexidine gluconate (CHG) liquid soap, please:
• Get in the shower and get completely wet, then turn the water off.
• Apply the soap FROM YOUR CHIN DOWN and MOVE DOWN using a clean washcloth.
• DO NOT get the CHG liquid soap in your ears or eyes.
• DO NOT use the washcloth you used on the lower body to apply CHG to an upper body part. If you missed a part earlier, get a new clean washcloth to return to lather a missed area.
• When you lather up with the soap, paying special attention to:
• Area where your surgery will be performed
• Underarms (armpits) and groin
• Under any skin folds, such as breasts, abdominal or buttock folds
• Clean any tubing thoroughly
• Wash shallow wounds. The CHG liquid is safe to use on shallow wounds. Please contact your surgeon’s nurse if you don’t know whether you can use the CHG liquid on a skin area.
• Keep the liquid soap on for at least two (2) minutes.
• Turn the water back on and rinse the CHG liquid soap off well
• DO NOT shave parts of the body where your surgery will occur
• Dry your skin with a freshly washed towel
• Put on freshly washed clothes
On the morning of surgery, please:
• Shower with the CHG liquid soap using the steps above
• Do not apply any lotions, perfumes, powders or deodorant on your skin the day of surgery
If instructed by your surgeon’s office or the Surgical Readiness Department nursing staff: Beginning no sooner than six (6) days before your surgery, apply Mupirocin ointment 2% (e.g., Bactroban) ointment in your nostrils twice a day.
How to apply Mupirocin ointment 2%:
• Squeeze prescribed amount (about the size of a small pea) into one (1) nostril and the other half into the other nostril two (2) times a day (morning and evening) for five days for a total of 10 applications
• Next, pinch your nostrils together and then let go. Pinch and let go of the sides of your nose for 1 minute to spread the ointment onto the skin surfaces in your nose
Bring used Mupirocin tube with you on day of surgery.
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46 | PATIENT GUIDEBOOK | CARDIOVASCULAR/CARDIOTHORACIC SURGERY | FORMS
PRE-SURGERY DECOLONIZATION PATIENT CHECKLIST
Patient Name Date
Surgeon’s Name
Location of Pre-Surgical Visit Date of Pre-Surgical Visit
Location Where Surgery Taking Place
Surgery to be Performed Date of Surgery:
Please complete this checklist and bring it and the used Mupirocin tube (if prescribed) with you to the hospital on the day of your surgery.
ALL PATIENTS MORNING NASAL EVENING NASAL SHOWER WITH 4% CHLORHEXIDINE OINTMENT OINTMENT
DATE GLUCONATE LIQUID (IF PRESCRIBED) (IF PRESCRIBED) (PLEASE FILL IN) (CHECK WHEN DONE) (CHECK WHEN DONE) (CHECK WHEN DONE)
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6 • Shower with 4% chlorhexidine gluconate liquid soap. Surgery Day • Bring used tube of mupirocin and this completed checklist with you to surgery check-in
• Do not put any lotions, perfumes, powders or deodorant on your skin the day of surgery • Do not shave parts of the body where your surgery will occur
