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After Cardiothoracic Surgery

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Incision Care

Please shower daily, using soap (any brand) and water on your incisions. It may be helpful to have your back facing the shower head as the force of the water may be too hard on your incision. Slowly, as you recover, the tenderness will lessen and you can turn around in the shower. Let the way you feel guide you. Pat your incisions dry; do not place any ointments, lotions, creams, or powders on your incisions for four weeks.

Women need to wear a bra to help support your breasts from pulling on the incision. A surgical bra should have been provided to you while you were in the hospital.

Your incisions may be numb, tight and sore for several months. This is perfectly normal; these symptoms will decrease as time passes. Itching is also common. You may notice swelling at the top of your chest incision, this also will decrease in time. Notify the surgeon or a cardiothoracic physician assistant if your incisions become red, hot, swollen, drain or begin to separate.

Inspect your chest tube incisions daily. You may cover them if they are draining; otherwise keep them exposed to air. It is not unusual to have a small amount of drainage from this incision. The site will heal within seven to ten days. Notify your cardiothoracic physician assistant if your incision becomes hot, swollen or you experience any signs of infection.

Sun exposure can permanently burn or darken the scar as your incisions do not have the full protective feature on uninjured skin. You need to use a sun block on your incisions with a minimum of SPF 30 for one year.

Your leg incision requires the same care as your chest incision. Inspect daily and call if you experience any redness, swelling, or pain. Sometimes the area becomes swollen and hard. Placing a warm cloth or towel on the area 4 times a day may feel soothing and help with the discomfort.

Learn more about what to expect after heart surgery from the Society of Thoracic Surgeons.


THE FIRST FOUR WEEKS AT HOME

No lifting more than 8 pounds (a gallon of milk) This includes: lifting children, pets, groceries, or laundry and moving furniture.

Avoid constipation. Drink 6-8 glasses of fluid a day and avoid straining. Do not hold your breath while trying to move your bowels. You may use a fiber stool softener, and it is important to have a bowel movement at least every other day; otherwise use a laxative.

Avoid alcohol.

Rest for 30 minutes, twice each day. Try not to sleep during the day because day sleep will interfere with your night sleep.

Weigh yourself daily, before breakfast. Log it into your booklet. Remember to contact the physician assistant if you gain more than 2 pounds overnight.

Check your temperature daily. Log your temperature reading onto your sheet. Call  your doctor if you have a fever of 101 degrees or higher. 

You may climb stairs. Take them slow and stop to rest if you need to do so. Use our legs not arms to pull yourself up the stairs.

Use your incentive spirometer every 2 hours while awake. Take 10 deep breaths.

Walk as directed by the cardiac rehab guidelines attached in the folder. If you are able to walk, further than stated. Remember to gradually increase the amount of walking you do daily. You may walk outside (use a scarf over your mouth if it is less than 30 degrees). You can walk in the malls. It is common to become short of breath after walking. After resting for periods your breathing should return to normal. If not, call 911.

Begin your walking program the day after you are discharged.

Take your pulse every morning and record it in our log sheet. A pulse rate less than 50 or above 120 warrants a phone call to your cardiologist.

Take your pulse before and after walking. If your rate is more than 30 beats above your resting pulse, decrease the exertion level the next time you walk. Remember to walk either before meals or wait at least one hour after meals. Wear good supportive shoes and comfortable clothing.

When sitting, elevate your legs to the level of your heart. A recliner makes this easier. Swelling at the ankle is very normal and elevation will help. Wear your elastic (ted) stockings.

Sexual activity is permissible when you feel comfortable.For many people this is about 2 to 4 weeks after discharge. Many medications may interfere with your sexual drive. If this occurs, discuss this with your cardiologist.

Driving is permissible 4 weeks after your surgical date or 2 weeks after your minimally invasive surgery. This time period is recommended to allow the discomfort in your breast bone to resolve. Also, your movements might be limited and slow the first 4 weeks. If your breast bone was not opened, you will be allowed to drive sooner. Always wear your seat belt. If you are in a car longer than 2 hours, pull aside and walk around for a few minutes.

Resuming Normal Activity

Keep in mind that when you resume normal activities you will become tired. When visitors come and your feeling tired, excuse yourself and lie down. Stop any exercise if you experience shortness of breath, unusual fatigue and/or chest pain. Notify your doctor if these symptoms persist.

The first 4 weeks, these activities are permissible:

  • Lifting up to 10 pounds
  • Light housekeeping; dusting, setting the table, washing dishes, folding clothes
  • Light gardening: potting plants, trimming flowers
  • Needlework
  • Reading, card playing, and board games
  • Cooking
  • Shopping
  • Restaurants, Movies and Church
  • Attending sports events
  • Shampooing your hair

The second and third month, these activities are permissible:

  • Lifting up to 15 pounds
  • Housekeeping: vacuuming, sweeping, laundry
  • Heavy gardening: raking leaves
  • Ironing
  • Traveling, driving, boating
  • Walking the dog
  • Cardiac Rehabilitation

After the third month

Continue the same activities throughout the third month. You will notice that you can tolerate more and get your life back to routine. Most patients will return to work as directed by their surgeon and cardiologist.

These activities are permissible:

  • Housework: scrubbing the floors
  • Shovel snow, digging
  • Soccer, football, tennis, golf, bowl, hunt, bike, lift weights/push-ups

PULSE ASSESSMENT

Monitoring your pulse rate helps to keep your activities within a safe heart range. Your pulse rate is the total number of heart beats per minute and measures how hard your heart is working to pump blood to the body. After some practice it is easy to take your pulse. Some medications such as: digoxin (lanoxin), inderal (propanolol), lopressor (metoprolol) or amiodarone (cardone) lower your pulse rate. You need to take your pulse prior to taking these medications. If your pulse is below 50 or above 120 beats a minute, do not take these medications and call your cardiologist for instructions.

To take pulse, place your index finger and middle fingers on the lower part of your thumb and then slide your fingers down to your wrist. If you do not feel the pulse, try moving your fingers over a little bit in the same area. Once you feel the pulse, count it for 15 seconds and multiply by 4. This will tell you how many times your heart your heart is beating in one minute. Practice makes perfect, tell your nurse or doctor if you are having difficulty taking your pulse.

Remember to take only those medications prescribed at the time of discharge. Before you leave the hospital review those medications you were taking at home with your nurse. They will bring any questions or concerns to the cardiothoracic team.

You should know the names of your medications, why you are on these medications and what they do for you. You should become familiar with the side effects. Ask your health team for this information before you leave.

Always keep a copy of your current medications with you. Every time you go to your doctor, they will request a list of medications.

Please check with us before taking any other prescription or non-prescription drugs such as mineral oil, antacids, arthritis medications and alcohol. They may interfere with the medications you are taking.

Your cardiologist will be responsible for managing and prescribing your medications after one month of your discharge from the hospital.

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