St. Joseph Hospital of Orange
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Preparing for Home - Discharge Teaching

Recovery at home may create anxiety and fear for you and family members/caretakers. To help decrease this anxiety, we begin discharge education early in your hospital experience. Your Cardiac Services Nurse Practitioner will assist you throughout your hospitalization and will also provide a majority of the education on going home. The education will be given through various methods including videos, booklets, pamphlets and this website. If you have any concerns or questions during your recovery, please call the Cardiac Services Nurse Practitioner at (714) 771-8000 ext. 24052 or call your physician.

At Home

You can expect to wait six to eight weeks until you are able to return to your usual routine. Each person recovers differently so recovery time may be a little shorter or longer. Just remember to be patient and take care of yourself as you recover. If at anytime you have any questions regarding your at home care please call the Cardiac Services Nurse Practitioner with your questions at (714) 771-8000 ext. 24052.

If given any other guidelines by your physician upon discharge please follow those guidelines if they differ from the ones below.

Incisional Care

Once you return home it is safe to wash gently over your incisional areas. Do not place any oils, powders, or creams over the incisional areas. Check your incisional sites every day. During or after your shower is the best time. Notify your physician if you notice any of the following:

  • Increased tenderness over the incisional areas
  • Increased redness or swelling over the areas
  • A fever greater than 100 degrees Fahrenheit
  • Increased swelling and tenderness in your legs that reoccurs for several days
  • Any drainage from the surgical sites. If it is clear (it may be slightly red or yellow tinged), this is normal body fluid. Let it drain. If it is now thick and purulent, call your surgeon.

If you went home with gauze on any of your incisions (e,g., chest tube site or leg drain site), you may need to replace them with new gauze. A good rule of thumb is to check for wetness on the gauze when you remove them, which will indicate that the sites are still draining. If they are dry, you can use Band-Aids instead. Steri strips down your chest incision or leg incisions should be left alone to fall off on their own. If they start to peel off at the ends, you can trim them to avoid getting caught on your clothes.

Shower

The first thing many patients want to do when they return home is take a shower. Since you may be tired and fatigued from your first day at home, start taking showers your second day at home. Place a plastic chair or stool in the shower to sit on while you bathe. Make your showers short - between five and seven minutes. Have your clothes laid out and ready to put on to help with fatigue. This will help with any weakness or fatigue you may feel. Avoid tub baths until your physician says it’s okay.

With your back to the showerhead, use lukewarm water and gently wash your body and cleanse your surgical incisions. Use mild soap and avoid such soaps as Dial and Zest to avoid dry skin. Neutrogena, Dove, or soaps with moisturizers are a better alternative since they are not as harsh on your skin. This is a great time to look over all your incisional areas for signs of possible infection. If you have gauze on any of your incisions remove them prior to showering. This does not include steri strips, please leave them alone and let them fall off naturally.

Dress

Wear loose comfortable clothing that doesn’t place extra pressure on your surgical sites. For men, it is better to wear boxers instead of briefs especially if you have incisions down your leg

Walking

Walking is a very important part of the recovery process. You can follow the following guidelines unless instructed otherwise by your doctor:

  • On your first day at home, take four walks throughout the day, 5 minutes each. Then, increase your walk by 1 minute everyday until you reach your goal.
  • You can walk less frequently as you take longer walks. It is generally recommended that one 30-minute walk is good for everyone.
  • Walk inside the house for the first few days. Once you feel comfortable walking outdoors, walk on level ground and avoid hills.
  • Avoid using a treadmill or a stationary bike during your recovery period.
  • Walk slowly to avoid over-exertion on the heart. Two good rules of thumb:
    • Walk – talk test: You should be able to walk and talk without experiencing shortness of breath. Slow your pace accordingly.
    • Pulse check: Check your pulse at rest, then, check it again in the middle of your walk. You are allowed 20 to 30 beats above your resting heart rate, e.g. if your resting pulse is 80 beats per minute (bpm), you should be no higher than 100 – 110 bpm at the midpoint.
  • Keep your feet elevated when not walking to minimize swelling in your feet and ankles.

Stairs

You can climb stairs once a day if you have a two-story complex or you live on the upper level. Make sure to give yourself plenty of rest before climbing stairs. If you have a landing on your stairway, placing a chair there will allow you to sit and rest when needed.

Rest

Resting between activities is very important. Nap or rest for 20 to 30 minutes between each activity such as showering or taking a walk. When you do sit down make sure to elevate your legs above hip level to help decrease swelling. Do not cross your legs and avoid sitting or standing in one position for too long.

Returning to Normal Activity

Remember your sternum (breastbone) takes approximately six to eight weeks to fuse.

  • Until your physician says differently, do not lift anything heavier than 5-10 pounds. Start with 5 pounds and then increase as tolerated. For example a gallon of milk is approximately 7.5-8 pounds.
  • Use your pillow when you cough or sneeze to splint your chest to prevent opening your incision or movement of your bone.
  • Avoid any activity that requires you to push or pull something, such as vacuuming, mowing the lawn or walking the dog. After two to three days, if you feel well enough, you may do light housework, such as folding laundry or dusting.
  • Avoid uneven movements such as being pulled out of bed, chairs, or the car by the arm, opening the refrigerator against suction, or opening cans or jars.
  • Avoid placing all your weight on your arms for support when getting in and out of a chair or car. Reposition yourself to the edge of the chair to align your center of gravity with your legs. You can use your arms to stabilize yourself but place your weight on your legs.
  • Avoid sleeping on your stomach or your side. You can wedge a pillow on one side to allow yourself to be turned slightly. You can use as many pillows under your head as preferred.

Driving

Do not drive for six weeks. This time period will allow your breastbone and sternal area to heal. If you are a passenger in the car take your heart pillow or another pillow from your home and place over your sternum and then put your seatbelt on. This will protect the area in case you make any sudden stops. If you take a trip make a stop about every two hours so you can relieve some of the pressure on your sternal area.

Sexual Activity

You can resume sexual activity when you feel comfortable or when you can walk two flights of stairs without any shortness of breath. This is around the fourth week. Remember the sternum is still healing so avoid any position which may put strain or pressure on your chest. Often it is the spouse or partner of the patient that may feel uncomfortable about resuming sexual activity in fear of hurting the patient. It is important to talk it over with your partner and resume when you both feel comfortable and ready.

Depression

Depression or mood changes are a normal part of the recovery process. You may have some good days and bad days. Do not get discouraged. The support of your family members or caretakers will help you in the process. If you feel that the depression or mood changes are not getting better, contact your physician for additional help.

Visitors

Limit your visitors the first couple of weeks while you are at home. You need your rest and having too many visitors can increase fatigue during recovery.

Returning Back to Work

The type of work you do will determine when you will be able to return to work. Talk to your physician. Remember, you need time to heal so follow the physician’s advice.

Smoking

Do not smoke!

All current or former smokers:

  • Try to avoid situations that trigger you to smoke
  • Use tips recommended in the “Smoking Cessation” patient education material
  • Increase your chances of success by joining a support group
  • All patients - avoid second hand smoke

Upon returning home you will need to modify your diet to avoid further heart complications. We
recommend a low-fat, low-cholesterol and low-sodium diet. One of the best ways to help improve your diet is to start reading labels on the back of food products.

Look at sections on fat, cholesterol and sodium. Total fat intake should be limited to a total of 30% of your overall fat intake. Cholesterol should be limited to 300 milligrams per day. Restrict your salt intake to 2000 to 2500 mg a day. The reduction in salt will help decrease water retention in your body and will also help decrease the swelling in your legs. Decreased salt intake also aids in reducing your blood pressure and any further heart complications.

The American Heart Association has some great tips on reducing your fat, cholesterol and salt intake. They also provide recipes to help you in your new healthy diet. Visit
http://www.deliciousdecisions.org/ee/wbd_easy_main.html.

Depending on the type of surgery and your physician, you may be placed on a drug called Coumadin. If you are placed on this medicine you need to watch your intake of Vitamin K. This drug does not work like it is supposed to when you increase your intake of Vitamin K. Vitamin K is found in many green leafy vegetables as well as a variety of other foods. Remember you do not have to get rid of vitamin K in your diet you just need to eat it in moderation. Below is a site that contains foods that are high in Vitamin K as well as some information on Coumadin and how to take the medication at home. http://www.coumadin.com

A journal (simple notebook will do) will become a necessary tool in your recovery. The journal will be used to keep track of your:

  • Blood Pressure
  • Heart Rate
  • Temperature
  • Weight
  • Other information like lab/ test result, medications and dosages
Date Time Weight Temperature Blood Pressure Heart Rate Lab Results/Other

An example of how to set up your journal

Blood Pressure

You will be placed on some medications that will lower your blood pressure. As your heart recovers, we may need to adjust these medications. A good way for your physician to tell if the medicines need adjustment is by monitoring your blood pressure at home. You can get a blood pressure cuff at your local drugstore or Costco. Get one that goes over your upper arm NOT YOUR WRIST and one that also takes your heart rate. Take your blood pressure once in the morning before you take your medicine and once at night before you take your medicine. The top number is your systolic number and the bottom number is your diastolic.

  • 100 = Systolic
  • 60 = Diastolic

If your systolic blood pressure is <90 and you are light headed or dizzy do not take your blood pressure medication. Wait an hour and retake your blood pressure. If it is still <90 and you are light headed or dizzy do not take your medication and call your physician. An adjustment in your blood pressure medications may be needed. Make sure to write down your blood pressure readings and the time you took it.

Heart Rate

It will be important to take your heart rate once in the morning and once at night when you take your blood pressure. This should be done while you are resting. Monitor how fast your heart beats per minute. If you feel heart palpitations or notice your heart rate goes up or down by 20 beats since you last took it call your physician.

You should also monitor your heart rate during activities like walking. If your heart rate goes up or down by more than 20 beats per minute from your resting heart rate, slow down or decrease your activity level. If you continue to see an increase or decrease call your physician.

To take your pulse without a machine place your index and middle finger - NOT YOUR THUMB - on the lower part of thumb where it meets your wrist. Count the number of pulses you feel in a minute. Remember to write down your heart rate in your journals and at what time you took them.

Temperature

Take your temperature once a day when you first wake up. If your temp is >100 degrees Fahrenheit call your physician and monitor your incisional sites. An increase in temperature could be an indication of an infection in your incisional sites or somewhere else in your body. Remember to write down your temperature in your journal and the time you took it.

Weight

Every morning you need to weigh yourself when you first wake up. Write your weight down in your journal and compare your weight to the previous day. If you gain 2 pounds in one day or 4 pounds over a four-day period and see increased swelling in your extremities call your physician. You may need to reduce your fluid and salt intake as well as be placed on some medication to help get rid of excess water that may build up in your body.

Blood Sugar

If you are diabetic, it is highly recommended that you check your blood sugars regularly for optimal control whether you are on oral medication or insulin. Check your blood pressure as instructed and consult with your primary care physician or endocrinologist for any concerns

Other

You can use your journal to keep track of other things such as lab and test results. You may also want to use the journal to keep track of the medications you are using and their dosages.

After your surgery you will probably be placed on some medications to help your new heart. They do a variety of things including:

  • Lower your blood pressure
  • Regulate your heart rate
  • Increase blood flow
  • Decrease blood clots
  • Lower cholesterol
  • Reduce pain

Make sure you follow your physicians’ instructions and don’t increase, decrease or stop your medications unless advised by your physician. Keep a list of your medications and take it with you to every physician’s appointment.

Cardiac Rehabilitation

Cardiac rehabilitation is a way for people who have had heart surgery to get going again after surgery. You can begin the rehabilitation program after the first six weeks at home or when your physician approves. For further information, talk to your physician, call (714) 771-8727 or click here.