Open Heart – Post Surgery Instructions

Pay attention to the following instructions:

Temperature

You may be instructed to take your temperature daily for the first 10 days, to make sure that your body temperature does not exceed (37.5 °C).

Weight

You may be instructed to weigh yourself daily. The best time to weigh yourself is in the morning after emptying your bladder but before eating. Weight gain may mean you are retaining too much fluid. Call your healthcare providers if you gain more than 2.5kg in one week.

Heart rate (pulse)

Sometimes after surgery you may experience an irregular heart rate, or feel like your heart is racing. If your heart beats fast for a long time and you feel lightheaded and weak, call your healthcare provider.

Pain

It is normal to experience some pain and discomfort after the operation. You may have pain in your shoulders or upper back as well as around your wound; you may also feel a dull ache or numbness on the left side of your chest.

Be alert to any angina pain – this is not normal after heart surgery. Angina pain is often described as a smothering feeling or discomfort, pressure or pain in the chest, back, neck, jaw, shoulder, or arms.

Breathing

Use your spirometer three or four times a day for the first 10 days you are at home to keep your lungs healthy and expanding.

Medication

Your discharge medication is listed on your discharge instructions sheet.

• Listen carefully, ask questions, and take notes when your providers explain your medication
• Understand why you are taking each of your medications, as well as how and when to take
• Take only those medications prescribed by your healthcare providers
• Don’t stop taking any medication unless you are instructed to do so for example when you leave the hospital, you may receive an initial supply (usually 7 days) of medication from the hospital pharmacy
• Tell your health care provider about any side effect from your medication

If you are taking Warfarin

• You will be instructed to have regular blood tests (INR)
• Avoid drastic changes in your diet. It is especially important to be consistent in the amount of dark green, leafy vegetables (like spinach) you eat from day to day. These are high in vitamin K, which affects how warfarin works
• Do not eat grapefruit or drink grapefruit juice at the same time you take your warfarin: allow about four hours in between. Grapefruit can interfere with the absorption of warfarin
• Call your healthcare provider if you notice bleeding from your gums, and dark stool or red urine.

How to reduce wound pain

To help reduce pain when you move, cough or breathe deeply, you will need to take precautions and, perhaps learn how to splint your wound.

Precautions:

• Use bed side rails for support when you move and turn
• Move slowly and steadily. Do not move quickly. Whenever possible, wait to move until after your pain medication has taken effect
• Frequently move those parts of your body that were not affected by surgery to prevent them from becoming stiff and sore
• If you have difficulty moving by yourself, ask the nurse or a family member to help you

Splinting your wound

If you have had a chest or abdominal surgery, splinting the wound will help reduce pain when you cough or move. You can do this by placing one hand above and the other hand below your wound, then pressing gently and breathing normally when you move. Or you can place a small pillow over the wound. Hold it in place with your hands and arms. Press gently, breathe normally, and move to a sitting or standing position.

 Caring for your wound

You will need to care for your wound daily following these guidelines:

• Check your wound every day for signs of infection until it is fully healed. Slight itching, redness, numbness, or soreness is normal during the healing process. You may also have a lump at the top of wound, which will disappear with time
• Keep your wound clean and dry while it is healing
• Don’t put any lotion, cream or ointment on your wound until it is healed. This helps in the prevention of infection and irritation
• Protect your wound from the sun. Sun exposure increases pigmentation of scar tissue
• Depending on the surgery you had, the doctor may advise you to wear elastic stockings and a chest binder

 

Avoid demanding movements or activities

• Lifting, pushing, or pulling anything over 4.5kg
• Activities that require you to keep your arms over your head or behind your back for long periods of time (such as washing windows or painting the ceiling)
• Recreational activities that may place stress on your sternum (such as fishing, golfing and horseback riding)
• Climbing stairs too quickly
• Driving for three months

Recommendations post bypass surgery

Walking

30 minutes twice daily as recommended from six weeks after surgery.

Light household activities

Light household activities on discharge as recommended.

Full household activities

Full household activities at six to eight weeks after surgery as recommended.

Driving of motor vehicles

Patients are advised to refrain from driving until 12 weeks after surgery.

Light or office work

Patients are advised to recommence sedentary work at or after four to six weeks following surgery, after seeing their doctor.

Physical work

Patients are advised to recommence physical work at or after eight to 12 weeks following surgery after seeing their doctor.

Sporting activities

Walking immediately after discharge.

One hour per day of other sports will be recommenced after 12 weeks.

Smoking

Stop smoking completely including cigarettes, cigars and shisha.

When to seek medical attention

• Bleeding from your gums, or blood in your urine or stool
• Temperature over 37.5°c for three consecutive days
• Weight gain more than 1kg in one day, or more than 2.5kg in a week
• Excessive swelling in the hands or feet
• Racing or irregular heartbeat, especially if accompanied with lightheadedness or weakness
• Angina or a smothering feeling
• Pain that limits your daily activities
• Leg or sternum incisions that are red or hot to touch
• Increase in amount of drainage from incisions – or change in color of drainage (from clear yellow to cloudy white or yellow) possibly with a foul smell
• Increased swelling or soreness around incisions, especially with a fever
• Clicking or movement in your sternum after six to eight weeks
• Shortness of breath that awakens you at night or requires you to sleep propped up
• Episodes of dizziness, lightheadedness, or weakness
• Persistent nausea, vomiting, or diarrhea
• Feelings of depression that persists or interferes with daily activities and energy you need while you heal.

Guidelines for proper diet:

For the first two to four weeks, you may not have much of an appetite.

Your sense of taste may be diminished, and the smell of food may make you nauseated. Nevertheless, you need to keep eating to keep up your strength and speed your recovery. Here are a few guidelines for the first few weeks after your surgery: Eat whatever appeals to you. If you have no appetite, your healthcare provider may recommend nutritional drink supplements to help ensure you are getting the vitamins, minerals.

Remember, good nutrition fuels your recovery:

• Eat small, frequent meals. Large meals make the heart work harder
• Rest for an hour after each meal
• Cut down on caffeine. Caffeine makes the heart work harder and can cause skipped heartbeats. Ask your providers how much caffeine is safe for you
• After four to six weeks, follow a heart-healthy eating plan as recommended by your healthcare providers

Here are some basics:

• Use unsaturated fats and oils instead of saturated fats and oils
• Eat lots of fruits and vegetables
• Eat more whole grains and choose heart-healthy proteins such as fish, poultry, soy products, nuts and beans
• Select dairy products or dairy alternatives which are low in fat
• Limit your salt intake

Returning to work

After heart surgery, people are often anxious to resume work, if only for the comfort of a familiar routine. Here is what your health care providers will probably tell you about going back to work:

• Do not hurry to go back to work. It is important to give your heart a chance to heal before you try to do too much work
• Expect to wait at least six to eight weeks before your providers approve your return to work. The time frame for returning to work will depend on your individual condition, the type of work you do, and when you are able to drive
• If you can arrange it, ease back into work gradually. Try lighter-duty assignments and/or shorter days at first

Driving and travelling

You should not drive for at least the first 12 weeks. During this time, your reflexes and reaction time will be slower than normal due to weakness or pain medications.

You can travel as a passenger. However, when you are riding for long distances, do not travel for more than an hour or two at a time.