Each individual person responds differently to their surgery and their recovery from surgery. This guideline will provide basic and general information of what your body is going through and what it needs to recover successfully from open heart surgery.
Activity
The following are guidelines to help increase your activity at a healthy pace. It is first important to know to stop any activity immediately if you feel short of breath, notice irregular heart beats, feel faint or dizzy, or if you have chest pain. Rest until these symptoms subside; if they do not after 20 minutes, notify your nurse or doctor.
Post-Op day 0-1:
After your breathing tube is removed, sitting on the side of the bed 2-3 times is expected. When able, breathing exercises using Incentive Spirometry (I.S.) should be initiated. By doing your breathing exercises every 1-2 hours, you will prevent various lung problems associated with inactivity after open heart surgery. Your respiratory therapist will help in instructing you on its use.
Post-Op day 2:
Post- Op day 3:
Post-Op day 4:
Post- Op day 5:
Important Activity Reminders:
Wound Care
Post- Op day 0-1:
Your incisions will be covered with bandages for the first day or so. Your nurse will perform the first dressing change to assess the incision. If the incision is dry, your sternal and arm incision will be open to air. If there is some drainage, spot dressings will be applied. If you have had an arm incision, keeping it elevated on a pillow will alleviate swelling and drainage. If you have had a vein removed from your leg, an ACE wrap will be on your leg to help circulation back to your heart. This ACE wrap will be removed and reapplied daily. The ACE wrap will stay on for 4 days before being completely removed.
Post- Op day 2-3:
By now, your sternal and or arm incision may be open to air. You may have had your chest tubes removed and an occlusive dressing applied. When the chest tube sites are not draining, those too will be left open to air to facilitate healing. Your incision sites will continue to be monitored by your nurse and physician and if needed dressed appropriately.
Post-op day 3- discharge:
By now, most of your incisions will be open to air. Proper cleaning of the incisions is now important to prevent infection and promote healing. To wash your incision, use a clean washcloth with mild soap and warm water and gently wash the incision. Avoid scrubbing any incision site. If needed, rinse with clean water and pat the incision dry. Showering is preferred (when all tubes and lines are removed) to keep the incisions clean; continuing to take showers daily at home is encouraged. If there are paper tapes on your incision, these will fall off on their own or, may be removed seven days after you are discharged. Always remember to never apply any lotions, creams, powders, or oils directly onto your incisions unless prescribed by your surgeon. These wound care guidelines should also be used at home to prevent infection.
If you have had a vein taken from your leg, you should also follow these guidelines:
Nausea and Appetite
Starting a diet is difficult after having open heart surgery. It is normal to not have an appetite, and it may take several weeks for it to return. You may also notice your sense of taste and/or smell is diminished; this will return in time, too. Nausea is also very common after surgery and is caused by a variety of reasons. Anti-nausea medications can be used to help prevent or treat nausea. Let your nurse or doctor know if nausea becomes a problem. By starting a light diet consisting of clear liquids, crackers, etc., this may help with nausea. When you are feeling better, your diet will be advanced. Even though you may not have an appetite, it is important to eat in order to take in calories that will aid in healing. Foods that are rich in iron and vitamin C may help you feel better. Iron rich foods may help stimulate red blood cell growth and make you feel less tired. Vitamin C will help your body use the iron and also aid in wound healing.
Some examples are:
High Iron foods: beef, potatoes, dried fruits, liver, beans
High Vitamin C foods: citrus fruits, tomatoes
It is important initially to take in whatever calories you can tolerate after surgery. However, when your appetite returns to normal, it is important to follow a low salt and low cholesterol diet. If you are diabetic, it is very important to follow a diabetic diet. Our dietician may be able to assist you in diet choices; let your nurse know if you would like to speak with them.
Medications
You may be started on new medications during your hospital stay and upon discharge. These may or may not be long term medication needs depending on your recovery. It is important to have a good understanding of what the medication is, the dosage, and when to take the medication when you are discharged from the hospital. When you see your doctor 4 weeks after you are discharged, they will assess your medications and determine if you need to continue taking certain medicines or whether they can be stopped. Always take your medicine as it is prescribed. Do not stop taking medicines unless told to do so by your doctor. So that you have a good understanding of why you are taking certain medications, information about your medications will be provided to you prior to your discharge from the hospital.
Common Problems after Open Heart Surgery
There are several common problems that many people with open heart surgery go through. They are:
Hopefully these guidelines will provide you with the information you need to have a successful and speedy recovery. Please ask your nurse or doctor if you have any questions. Also, refer to the "Get Well Network" educational videos on your television for added review.
Activity
The following are guidelines to help increase your activity at a healthy pace. It is first important to know to stop any activity immediately if you feel short of breath, notice irregular heart beats, feel faint or dizzy, or if you have chest pain. Rest until these symptoms subside; if they do not after 20 minutes, notify your nurse or doctor.
Post-Op day 0-1:
After your breathing tube is removed, sitting on the side of the bed 2-3 times is expected. When able, breathing exercises using Incentive Spirometry (I.S.) should be initiated. By doing your breathing exercises every 1-2 hours, you will prevent various lung problems associated with inactivity after open heart surgery. Your respiratory therapist will help in instructing you on its use.
Post-Op day 2:
- All meals should be provided with guest sitting in chair.
- Ambulate with staff 2-3 times/day; if unable because of chest tubes, walking in place is acceptable.
- AROM (active range of motion) exercises should be done two times/day (see AROM activity sheet).
- Incentive spirometry (IS) should be continued every 1- 2 hours while awake, for 10 repetitions.
Post- Op day 3:
- Up to chair three times/day, with assistance if needed.
- Ambulate 3-4 times/day with assistance from staff or family.
- Guest completes as much of bath as possible, with needed assistance from staff.
- AROM exercises 4 times/day prior to each walk.
- IS should be continued every 1- 2 hours while awake.
Post-Op day 4:
- Up to chair 3-5 times/day, with assistance if needed.
- Ambulate 3-4 times/day with assistance from staff or family.
- Guest is responsible for bath, with staff assisting with back and legs. Guest may shower if tubes and IV are removed.
- AROM exercises 4 times/day prior to each walk.
- IS exercises every 2 hours while awake.
Post- Op day 5:
- Up to chair 3-5 times/day, with assistance if needed.
- Ambulate 4 times/day on own, unless assistance needed from staff or family.
- AROM exercises 4 times/day prior to ambulating.
- Guest is responsible for complete bath, staff may assist if needed. Guest may shower if tubes and lines are removed.
- IS performed every 2 hours while awake.
Important Activity Reminders:
- Never strain or hold your breath with activities
- Space your activities throughout the day
- Stop and rest if you feel tired
- Rest 30 minutes after meals before exercising
- Avoid strenuous twisting, reaching, or lifting with arms for 4-6 weeks
Wound Care
Post- Op day 0-1:
Your incisions will be covered with bandages for the first day or so. Your nurse will perform the first dressing change to assess the incision. If the incision is dry, your sternal and arm incision will be open to air. If there is some drainage, spot dressings will be applied. If you have had an arm incision, keeping it elevated on a pillow will alleviate swelling and drainage. If you have had a vein removed from your leg, an ACE wrap will be on your leg to help circulation back to your heart. This ACE wrap will be removed and reapplied daily. The ACE wrap will stay on for 4 days before being completely removed.
Post- Op day 2-3:
By now, your sternal and or arm incision may be open to air. You may have had your chest tubes removed and an occlusive dressing applied. When the chest tube sites are not draining, those too will be left open to air to facilitate healing. Your incision sites will continue to be monitored by your nurse and physician and if needed dressed appropriately.
Post-op day 3- discharge:
By now, most of your incisions will be open to air. Proper cleaning of the incisions is now important to prevent infection and promote healing. To wash your incision, use a clean washcloth with mild soap and warm water and gently wash the incision. Avoid scrubbing any incision site. If needed, rinse with clean water and pat the incision dry. Showering is preferred (when all tubes and lines are removed) to keep the incisions clean; continuing to take showers daily at home is encouraged. If there are paper tapes on your incision, these will fall off on their own or, may be removed seven days after you are discharged. Always remember to never apply any lotions, creams, powders, or oils directly onto your incisions unless prescribed by your surgeon. These wound care guidelines should also be used at home to prevent infection.
If you have had a vein taken from your leg, you should also follow these guidelines:
- Care for the incision sites as described above.
- Avoid crossing your legs because it will impair circulation.
- Avoid sitting or standing in one position for prolonged periods of time.
- Elevate your leg when sitting. This will help reduce swelling. If you notice swelling becomes worse and is not alleviated by elevation, notify your surgeon.
Nausea and Appetite
Starting a diet is difficult after having open heart surgery. It is normal to not have an appetite, and it may take several weeks for it to return. You may also notice your sense of taste and/or smell is diminished; this will return in time, too. Nausea is also very common after surgery and is caused by a variety of reasons. Anti-nausea medications can be used to help prevent or treat nausea. Let your nurse or doctor know if nausea becomes a problem. By starting a light diet consisting of clear liquids, crackers, etc., this may help with nausea. When you are feeling better, your diet will be advanced. Even though you may not have an appetite, it is important to eat in order to take in calories that will aid in healing. Foods that are rich in iron and vitamin C may help you feel better. Iron rich foods may help stimulate red blood cell growth and make you feel less tired. Vitamin C will help your body use the iron and also aid in wound healing.
Some examples are:
High Iron foods: beef, potatoes, dried fruits, liver, beans
High Vitamin C foods: citrus fruits, tomatoes
It is important initially to take in whatever calories you can tolerate after surgery. However, when your appetite returns to normal, it is important to follow a low salt and low cholesterol diet. If you are diabetic, it is very important to follow a diabetic diet. Our dietician may be able to assist you in diet choices; let your nurse know if you would like to speak with them.
Medications
You may be started on new medications during your hospital stay and upon discharge. These may or may not be long term medication needs depending on your recovery. It is important to have a good understanding of what the medication is, the dosage, and when to take the medication when you are discharged from the hospital. When you see your doctor 4 weeks after you are discharged, they will assess your medications and determine if you need to continue taking certain medicines or whether they can be stopped. Always take your medicine as it is prescribed. Do not stop taking medicines unless told to do so by your doctor. So that you have a good understanding of why you are taking certain medications, information about your medications will be provided to you prior to your discharge from the hospital.
Common Problems after Open Heart Surgery
There are several common problems that many people with open heart surgery go through. They are:
- Fatigue: Feeling tired and weak during your recovery is normal. Although feeling fatigued may be discouraging, it will eventually subside. Increasing your activity can actually make you feel less tired as long as you allow yourself rest periods in between.
- Insomnia: Having difficulty sleeping is a common problem both while in the hospital and when returning home. Altered sleep patterns in the hospital, emotional stress, and pain control issues may all contribute to sleeping disturbances. Taking pain medicines right before going to bed, may aid in getting more sleep at night.
- Depression: It is common to feel down in the hospital and once you have returned home. Irritability and crying may come easily, but do not let this discourage you. This is part of the healing process and should get better in time. You may find that talking with family, a friend, or doctor may help. Exercise is also a healthy way to battle depression. If you feel, after time, that you are continuing to feel depressed, notify your doctor.
- Pain and numbness: Getting good pain control is an important part of healing and the recovery process. It is sometimes difficult getting adequate pain control without feeling tired and sleepy. In order to keep your activity level going, try alternating your prescribed pain medicine with Tylenol. It is also common to feel some numbness in your fingers, along the incisions, and over the left breast; this usually will resolve after several months.
Hopefully these guidelines will provide you with the information you need to have a successful and speedy recovery. Please ask your nurse or doctor if you have any questions. Also, refer to the "Get Well Network" educational videos on your television for added review.
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