Preparing For Heart Surgery HF#5307

     Date of Surgery: _________________

 

Your Surgery: ___________________

 

Surgeon: ________________________

 

Before your clinic visit, please:          Read this booklet        Fill out a Power of Attorney for Health Care form, if you wish.       Bring this booklet, your medicines, vitamins, and herbal supplements, any medical records that have been given to you, recent X-rays and test results to your pre-surgery clinic visit.

 

 

 

Highland Avenue

 

To go to the First Day Surgery Unit, enter at the hospital entrance.  Follow the gray path to the D elevator.  Take the D elevator to the 3^rd floor and turn left to the First Day Surgery Unit entrance.

 

 

 

 

Welcome to University of Wisconsin Hospital and Clinics

 

Knowing what to expect is an important part of getting ready for heart surgery.  This booklet helps you to learn about:

 

• Your Pre-Surgery Clinic Visit
• Getting Ready for Heart Surgery
• The Day of Surgery
• Recovering after Heart Surgery
• Important Phone Numbers

 

Your Pre-Surgery Clinic Visit

 

Members of the Cardiovascular Services team will meet with you to:

• Talk with you about having heart surgery.
• Learn more about your health history.
• Perform a physical exam.
• Complete any tests or procedures that are needed before your surgery.

 

This clinic visit may take 6 or more hours to complete.  A Patient Learning Center nurse will talk with you about what to expect before and after surgery.  Here you will learn how to prepare for surgery and what you can do to speed your recovery.

 

In the Heart and Vascular Clinic, a member of the heart team will ask you about your health history and perform a physical exam.  You will have a chance to ask questions about your specific heart surgery.

 

You can expect to have tests if they have not already been done.  If needed, you may have an ECG (electrocardiogram), a chest X-ray, and blood tests.  If you have not already met with your surgeon, you can plan to meet him at your clinic visit.  Your surgeon will explain the risks and benefits of your surgery.  You will be asked to sign a consent form indicating that you understand and wish to have to operation.  You will also meet with the Anesthesia staff and the Admissions staff.  It is helpful to verify your insurance and sign forms ahead of time.

 

By law, we are required to ask you if you would like to complete a Power of Attorney (POA) for Health Care or a Living Will.  This decision is up to you.  A POA allows you to name a health care agent who could speak for you if you were not able to do so.  More information about this can be found in this folder.   Some people wish to have a pastor, priest or rabbi visit while in the hospital.  If you would like a visit, let us know so that we can arrange for it or Call the Pastoral Care office at (608) 263-8574.

 

Getting Ready for Heart Surgery

 

The day before surgery (or on Friday for Monday surgery), a nurse from First Day Surgery will phone you to review your instructions, tell you what time to arrive at the hospital, and where to go the morning of surgery.  If you do not hear from First Day Surgery by 1:00 pm, please call (608) 265-8857 between 1:00and 4:00 pm.

 

If you have a cold, fever, or illness the day before surgery, please call your surgeon’s office between 8:00and 4:30 pm, Monday through Friday.  If you need to reach us after hours or on weekends, call the hospital operator (608) 262-0486 and ask to speak with the cardiac surgery resident on call.

 

Smoking Cessation

 

We strongly suggest you quit smoking before surgery.  Smoking will impair and delay healing time.  We also recommend avoiding second-hand smoke.  You should talk with your doctor or nurse if you need help to quit.  The Smoking Quit Line number is 1-800-QUITNOW (784-8669).

 

Psychosocial Aspects of Surgery

 

Your surgery may have an impact on you and your loved ones.  The impact may be both mental and physical.  Finding out what to expect, what is normal and what is not, provides a chance to adjust to the changes caused by surgery.  Patients with strong emotional support tend to recover more quickly.  It is best to talk with someone about your thoughts and feelings.

 

Setting goals and having a rehabilitation plan before surgery will give you sense of control.  You will be able to measure your progress.  Try to focus on positive thoughts.  Remind yourself the goal is improve your heart function and quality of life.  Our staff is here to support you during this time.  If you are having problems coping or need support, please talk with your doctor or nurse.

 

Steps for Getting Ready

 

1.  You will stop taking some or all of your medicines.

• Stop taking all vitamins, herbs, and diet supplements, for 10-14 days before and up to 7 days after surgery. 
• Stop taking all anti-platelet drugs, non-steroidal anti-inflammatory drugs and aspirin or aspirin-containing products, 7 days before and for 7 days after your surgery.  This includes Advil®, Motrin®, Nuprin®, Orudis®, and Aleve®.
• Stop taking Coumadin® 5 days before your surgery.  Do not restart this drug until told to do so by your doctor. 
• It is all right to use Tylenol®  (acetaminophen).

2.    The night before surgery, eat a light supper -- small amount of low fat foods.  Stop eating solid food, drinking milk or juices with pulp at 7:00 pm.  After 7:00 pmtake only clear liquids (apple juice, white soda, tea, broth, Jell-O^®, weak coffee, water) until midnight.  After midnight do not eat or drink anything.  This includes water, ice chips, gum, candy, and chewing tobacco.  This is important to prevent getting stomach contents into your lungs during surgery.

 

3.  Stop drinking alcohol 3 days before your surgery.  When mixed with anesthesia, it can have serious effects on your body.

 

4.  Stop smoking or at least cut back to reduce your risk.

 

5.  The evening before and the morning of surgery, you need to shower with an antibacterial soap called Hibiclens®.  You will get this soap during your clinic visit.  Scrub gently from your neck to your toes for 2 - 3 minutes.  Avoid scrubbing too hard.  You should not break the skin.  Rinse off, do not apply any lotions or powder to the skin.  Avoid getting Hibiclens® in your eyes or genitals.

 

6.  Please remove all make-up and fingernail polish.  This includes clear nail polish.

 

7.  Try your best to have a restful night before surgery.  If you are coming from out of town you may wish to stay in Madison.  A Housing/Hotel Accommodations Coordinator, (608) 263-0315, can provide you with a list of nearby motels and arrange for your stay at a discount rate.

 

8.  The morning of surgery, brush your teeth and rinse, but please do not swallow.

 

9.  Take your morning medicines that you’ve been told to take with a small sip of water.  Do not take potassium or vitamins since they may make you sick on an empty stomach.

 

If you have diabetes, you will be given special instructions about your insulin or oral medicines at your clinic visit.

 

10.  Please leave all jewelry, rings, large sums of money, and credit cards at home.

 

11.  Bring along any inhalers or CPAP equipment, your glasses, eye drops, hearing aids, dentures, prostheses, or other special equipment that you will need during recovery.  Be sure these items are labeled and in a case, if appropriate.

 

12.  Feel free to bring pajamas, a robe, non-skid slippers, and other personal items.  All rooms are private and TVs are provided at no charge.

 

 

13.   Bring a calling card or your cell phone if you wish to make long distance calls. You may bring in your laptop; all of the rooms have wireless internet access. Please leave your belongings in the trunk of your car the day you check in. Once your room is ready, your family can bring your things to you. The hospital is not responsible for lost or stolen items.

 

Plan to stay in the hospital 4-5 days.  When you leave the hospital, you will need to have someone drive you home and stay with you for at least the first 24 hours.  It is helpful to plan ahead.

  

 

Questions about Getting Ready

 

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The Day of Surgery

 

When you arrive In the First Day Surgery Unit, you will be taken to a room to prepare for surgery.  Your family members will be given a pager and directed to a waiting area.  A nurse will ask you questions about your health and help you get ready for surgery.  An anesthesiologist will meet with you and answer your questions.  You will have an IV (intravenous catheter) placed in a vein of your hand or arm.  An IV is used to give fluids and medicines.  You may be given medicine to help you relax.

 

Before you leave for the operating room (OR), we will page your family friends so you can meet with them again.  Then, your family and friends can go to the Surgical Waiting Area on the 2nd floor.  Here they will be given updates from the operating room.  They can also choose to get a pager if they would like to leave the Surgical Waiting Area.  If this waiting area is closed they may use the D4/5 waiting area.

 

In the Operating Room

 

Once you are in the OR, you will meet your nurse who will answer questions, make sure you are comfortable and explain what is happening.

 

There will be ECG (electrocardiogram) patches on your chest, a blood pressure cuff on your arm, and a plastic clip on your finger to check your heartbeat and oxygen levels.  The anesthesiologist will ask you to breathe oxygen through a soft plastic mask and medicines will be given through your IV.  After you are asleep, a breathing tube (endotracheal or ET tube) will be placed in your windpipe to breathe for you.  Other lines and monitors will be added after you are asleep.

 

Sometime during the day, your family or friend may wish to take your parking pass to the main information desk to have it stamped and to get one pass to be used during your stay.

  

 

The Cardiothoracic Surgery and Transplant Unit (B4/5)

 

This nursing unit is unique because you stay in one room for all stages of care. This includes ICU care to discharge.  You will be admitted to this unit from the operating room.

 

When you first arrive to B4/5, you will have a breathing tube, IV lines, drains, and monitors.  You can expect to wake up shortly after getting to the unit.  Though you will likely feel drowsy, you may hear beeps, alarms, bubbling noises,  and voices.

 

Many patients who have had heart surgery tell us that they recall little of the first hours after surgery.  When you first wake up, the breathing tube may startle you and make you feel anxious.  The nurses will help you relax and be more comfortable while the tube is in place.  The important thing is to let the breathing machine (ventilator) work for you.  It will give you puffs of air until you are able to breathe on your own.  Since it is put through the mouth and windpipe, you are not able to talk, but you can nod, squeeze hands or use a notepad to communicate.  Nurses are nearby to help you and reassure you.  In 4-6 hours, the tube is often removed and you are able to talk and begin taking ice chips and fluids.

 

All patients will have their blood sugars checked during their hospital stay.  If you have diabetes, you can expect to receive insulin through your IV.  You may continue to receive insulin over the next couple of days as you recover. Some patients who have not needed insulin in the past will be given insulin if their blood sugars are high.

 

As you become more stable, many of the IV lines and monitors will be removed.  This is a sign that you are doing well.  As your condition improves, the nurses will watch you closely but they will not be at your bedside as often.  This is a good sign.  You are on the road to recovery.

 

A staff member will bring your family to a private area to be updated on your condition by the doctor after surgery.  It may take 1-2 hours for you to recover in yourr room.  Staff will tell your family and friends when all post-surgical tests are done and visiting is allowed.

 

A note to family and friends

 

Visitors are asked to access and enter the nursing unit from the D elevators. The B elevator entrance to the unit is for staff only.

 

 

 

 

 

 

 

 

 

Heart surgery patients may have flowers in the ICU.   For the safety of our transplant patients, they are not able to have flowers in the ICU.  Check with the nursing staff before bringing flowers for the transplant patient.

  

 

Rest and Activity

 

Rest is important for good healing.  At the same time, getting up and walking helps to speed recovery.  Most often, the day after surgery, you will be expected to walk 5 times a day and be up in a chair for meals.  You may be surprised how much better you feel each day.  As soon as you are able, you will be walking in the halls and going to Preventive Cardiology for exercise.

 

 

Coughing and Deep Breathing

 

Once the breathing tube is out, nurses will ask you to breathe deeply, cough, and use a breathing tool (Incentive Spirometer).  Good breathing helps you to get rid of the anesthesia and prevent pneumonia.

 

To cough and deep breathe:

 

• Place a pillow over your chest to lessen the pain while coughing.
• Breathe in deeply and slowly through your nose.  Hold it.
• Exhale slowly through the mouth.
• Repeat twice more.
• Breathe in again; hold it, and then cough. 

 

To use the Incentive Spirometer:

 

1.  Exhale and place your lips tightly around the mouthpiece.

 

2.  Take a deep breath.  Inhale enough air to slowly rise the Flow Rate Guide between the arrows.

 

3.  Hold the deep breath.  Continue to inhale, keeping the guide as high as you can for as long as you can, or as directed by your nurse or respiratory therapist.

 

4.  Exhale and relax.

 

5.  Repeat 10 times each hour while you are awake.

 

 

Pain Control

 

People used to think that severe pain was something you just had to put up with.  That’s no longer true.  Today, you can work with your nurses and doctors to prevent or relieve pain.  Good pain control helps you to:

 

• Enjoy greater comfort.
• Heal faster.
• Start walking, breathing and gaining strength quicker.
• Leave the hospital sooner.
• Have better results and avoid complications.

 

Drug and non-drug treatments can help prevent and control pain.  Don’t worry about getting “hooked” or “addicted” to pain medicines.  Studies show that this is very rare unless you already have a problem with drug abuse.

 

Many patients tell us they don’t feel as much pain with heart surgery as they’ve had with other abdominal surgeries.  Some patients have more pain in the shoulders and back due to the chest tubes.

 

For best results:

 

1.  Discuss your options with your doctor and nurses.  At first, you’ll receive pain medicine in your IV.  Once you are able to take sips of water, you will switch to oral pain medicine. 

 

Ask for pain relief drugs when pain first begins.  Do not wait until your pain becomes severe. This limits the effectiveness of the medicine.  Pain pills take 20-30 minutes to work. 

 

2.  The nurses will ask you if the drugs are helping your pain. You will be asked to rate your pain using the following scale.

 

                                   0-10 Number Pain Intensity Scale

 

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  1        2      3        4        5        6        7        8        9                    10

No         Mild                   Moderate              Severe                       Worst Pain                                                                                             Pain

                                                                                                   Possible

 

 

3.  The goal should be a level that will allow you to do your deep breathing exercise, walk, and sleep with little pain.  Rating your pain helps us to know how well your pain medicines are working.

 

4.  Tell the nurse or doctor about any pain that won’t go away.  Don’t worry about being a “bother”.  Pain can sometimes be a sign of problems.

 

Pain medicine may cause you to become drowsy, dizzy or lightheaded.  Do not drive, use machines or drink alcohol while taking pain pills.

 

Narcotics can cause constipation.  When you go home, be sure to increase your daily water or juice intake to 6-8 (8-ounce) glasses.  Increase the fiber in your diet as well.

 

Healthy Eating after Surgery

 

After surgery, you may feel sick to your stomach.  This is due to the anesthesia. You will slowly advance from drinking liquids to eating soft foods.  Some people lose their appetite and find that they have a taste like metal in their mouths.  Though you may not feel like eating it is important to eat healthy to allow your breastbone (sternum) to heal.  It is not uncommon for heart surgery patients to lose 15-30 pounds.  While you may wish to diet later, now is not the time.

 

While in the hospital, your nurses will be keeping track of the water and other fluids that you drink.  Extra water in the body causes your heart and lungs to work harder.  To prevent this, you may be taking a water pill (diuretic) to rid the body of excess water.  While in the hospital, you will be asked to limit the amount of water and fluids you take in.

 

If you have a special diet (low salt, diabetes, etc.) a nutritionist will talk with you about a plan for learning more about your diet.  You may be asked to visit the Nutrition Clinic after you leave the hospital.

 

 

Going Home

 

You can expect to stay in the hospital 4-5 days.  Before you leave, you will learn how to care for yourself at home.  A friend or family member should be present the day of discharge to hear instructions.  You will receive prescriptions for medicines.  Please bring your insurance card if you plan to fill your prescriptions at the UWHC Pharmacy.

 

Plan to leave the hospital by noon.  A responsible person needs to drive you home and stay with you for 24 hours.  In fact, it may be helpful to have someone stay with you for the first week or two after you go home.  The cardiac case manager will help to arrange for special needs like Home Health, a nursing home stay or Meals on Wheels.

 

Questions about Going Home

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Important Phone Numbers

 

Admissions

To verify insurance ............................................................ (608) 263-9172

To speak with a financial counselor...................................... (608) 263-8770

 

Hospital Paging Operator.................................................... (608) 262-0486

Toll Free Number............................................................... 1-800-323-8942

 

Housing Accommodations.................................................. (608) 263-0315

 

First Day Surgery Unit......................................................... (608) 265-8857

Fax                                                                                     (608) 265-8858

 

Patient Information (for room number)................................. (608) 263-6400

 

Outpatient Pharmacy (E5/236)............................................. (608) 263-1280

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 03/07/2011

Copyright © 07/20/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5307

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