After your heart surgery by pengxiang

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									                   Discharge Advice Following
                        Cardiac Surgery

   If you require a copy of this information sheet in
       Large Print please ask a member of staff.

 This information is not to replace the discharge chat with
 your nurse but to compliment it and to use as a reference
                    when you go home.

Discharge

When you have been told by the Doctor you are medically fit for discharge home the
following arrangements may need to be put in place before you can leave. This is to
ensure that you return home safely. These arrangements do not apply to all patients
and are adapted to individual needs.

You may require:

      To be provided with any necessary equipment, medicines and dressings and
       given instructions of use
      An appointment to attend the Anticoagulant Clinic (Warfarin)
      A District Nurse Referral
      Transport home if you are going home by ambulance
      Any other support services if necessary (e.g. social services or dietician input)
      Advice regarding the Discharge Advice Line and Cardiac Rehabilitation
      Follow up arrangements
      Sick note


Please note if you are told you are medically fit for discharge these arrangements
may take a number of hours. The nursing staff will ensure these are put in place as
soon as possible.


If you have any concerns about your discharge please inform the nursing staff
before leaving the ward.

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Leaving hospital

After leaving hospital you will need to follow the advice of your healthcare team so
that you can recover as quickly as possible. Everyone is individual and each person
will respond differently to having had surgery. Your recovery will also be an
individual process; however some generalisations can be made. The material
presented here is to be used as a guide and in conjunction with what your healthcare
team has advised. We hope you find it useful.

The first phase of your recover \y lasts about 6 – 8 weeks as this is how long it
generally takes for the breast bone to heal. Your scars should fade in approximately
6 months to a year. Tickling, itching and numbness are all normal sensations
associated with surgical wounds and will eventually disappear.


Resuming daily activities and taking regular exercise

Your aim over the next three months should be to increase your activity level day by
day. In order to achieve this, you will need to pace yourself. Regular activity is good
for you, but keep in mind that you have probably been less active for some time and
it will take a while to get back into a routine.

You should expect to feel tired when you are recovering from heart surgery. You
might find that a gradual return to physical activity will help you feel less tired.
However if you find you are exhausted after certain activities, it probably means you
are overdoing things and should cut back.

It is best to have someone with you at home for the first week or two. Your GP will
be sent a letter with details of your surgery and the medication that you are on. You
can always contact your GP for advice or support following your operation.


Everyone is different and these are general guidelines - please be guided by
your own body. The following describes how you may want to progress over the
forthcoming weeks. It is important to maintain and even increase your levels of
activity daily, to continue the progress and achievements you have made whilst in
hospital. It is up to you now to motivate yourself, and you will gradually feel the
benefit:

First two or three days at home

Each morning from the day you go home, it is important that you get up out of bed
and take your time having a wash. Get dressed and have a rest as even these
activities may make you feel tired. Initially, this is to be expected. Remember the
importance of having a breakfast, no matter how small, this is essential to help your
wounds heal.

Walk around as you did in hospital; set yourself two goals to achieve each day, such
as climbing the stairs once in the morning and once in the afternoon even if you don’t
need to. Make sure that you get plenty of rest and please don’t allow too many well
wishers to visit you if you are easily tired.
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Please put on appropriate outdoor clothes and take a short walk outside; this is an
excellent activity as it really exercises your lungs, which is so important after this
operation. You can take a short walk outside if you feel confident, maybe around
your garden at first, from the first day that you are home.

During the first one or two weeks at home

Walking is the best form of exercise at this stage and you should gradually increase
the distance you walk in these two weeks.

Activities like dressing, washing or shaving will be tiring at first. Gradually introduce
light tasks such as dusting, washing up and cooking light meals into your daily
routine.

At this point you can resume non-strenuous hobbies. Getting enough rest is as
important as exercise. It is a good idea to plan 30-60 minutes rest time each day
during the first weeks at home.

From three to eight weeks

Please begin to gradually introduce more demanding tasks such as ironing, making
beds, potting plants etc. You should also continue taking walks outside as this is
one of the best activities you can do.

From eight to twelve weeks

You may now introduce other tasks such as vacuuming, shopping, cleaning the car,
brushing the floor, light gardening.


After week twelve

You should now be able to do everything you were doing before you became ill.

Please remember that any activity which needs repetitive or sustained arm
movements puts an extra strain on your breastbone and makes your heart work
harder. It is a good idea to build up gradually to performing such activities.


Some general guidelines:

      Start slowly and introduce new activities gradually
      Set yourself realistic targets each week
      Slowly increase your level of activity each day
      Try and establish a balance between not doing anything and overdoing things
      Change an activity or rest if it makes you feel tired
      You should expect to feel a little short of breath while exercising but you
       should not become uncomfortably short of breath. A good estimate is the
       ‘walk and talk’ guide. This means you should still be able to hold a
       conversation while walking without gasping for breath.


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      If you become too breathless you should rest for a short while until you
       recover before continuing to exercise at a slower pace. This breathlessness
       should improve as you recover, but if it continues you should talk to your GP.
      Please do not compare yourself to others
      Get into the habit of taking exercise regularly rather than in occasional bursts
       of activity.

Lifting

Please make sure that you do not lift, push or hold any objects that weigh more that
ten pounds (e.g. a full kettle of water) for six-eight weeks after your operation.

You should also avoid any sudden twisting movements. The reason for this is that
during the early stages of recovery your breastbone must not be put under any strain
or pressure. It takes time for the body to heal after surgery. Please remember not to
lift small children, babies or pets, nor to push or pull heavy objects. Therefore you
will need help to walk your dog, carry shopping or do the laundry.


Emotional adjustment

Immediately after your operation you may have days when you feel low. These
feelings are known as ‘post–op blues’ and many people experience them while
recovering from an operation. They are a natural reaction to all you have been
through. It is important for you to express your feelings and to talk to someone about
them.

At home, you may have these mood swings, feelings of irritability, anxiety or unable
to concentrate. You may also find that you suffer from loss of memory or blurred
vision. These symptoms will pass with time. Your family/carers will need to
understand this and be patient and supportive. It is a good idea to show them this
guidance.

Keeping yourself occupied and having a positive attitude will help you to overcome
these feelings. Getting back to your hobbies or taking up new ones, planning a
holiday, taking regular exercise with plenty of rest/relaxation in between, are all good
ways to keep busy.


Advice to your family/friends/carers

Your relative/friend who has undergone surgery will be independent on leaving
hospital and needs to be allowed to get back to normal activities gradually. It is
perfectly alright for them to be left alone during the day – while you go shopping, for
example. Please try not to be over- protective as this may not be beneficial.

Please give your relative/friend time to recover emotionally from the operation. This
is best done by being patient and supportive during any irritable or anxious
moments. Try to be encouraging and helpful if your relative is trying to lose weight
or give up smoking – perhaps by joining in. In the early stages please do not allow
too many friends or relatives to visit at one time, as this can be very tiring.



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You may also find that you too can become tense or anxious. These are all normal
feelings so please don’t worry. Some patients and their relatives find that joining
their local support group can help.

Medication

Your medication may have changed following your surgery. Your Consultant or
member of the medical team may have stopped medications like those used to
control symptoms of angina. The strength of some of your medicines may also have
been changed in hospital. You should continue to take your medication as you were
advised when you left the hospital, until you are told otherwise either by your GP or
by the doctor in the outpatient clinic.

Please dispose of any medication that you are no longer prescribed following your
surgery by taking it to your local chemist.

When you go home you will have been given a 14 day supply of medication. You
should contact your GP before you run out of this medication to arrange for a repeat
prescription.

Pain relief

Good pain control is essential for a speedy recovery and to enable you to return to
normal activities.

When you leave hospital you will have been given tablets for pain relief. You should
take these as instructed. Taking them regularly after your operation is the key to
successful pain control.

If you still have pain after taking the tablets you should contact your GP to have your
pain relieving medication reviewed.

When you are feeling more comfortable and can exercise without discomfort you
may gradually reduce the tablets you are taking for pain relief by leaving out a dose
or taking one tablet instead of two. You may experience a few aches and pains in
your chest and shoulders for a few months after your surgery. If there is any change
in the type and location of the pain, please contact your GP.

Wounds

Most people’s wound(s) are clean and dry when they are discharged from hospital.
If there is discharge from your wound ward staff will have arranged for you to be
followed up by the community nursing team.

You should check your wound(s) daily and look out for signs of infection, which are

      Redness
      Heat or swelling around the wound
      Change in wound pain
      Discharge from the wound
      An unpleasant smell
      Any opening or gaping of the wound

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Do not be afraid to get your wounds wet. Keeping them clean will encourage
healing. However you should only use water and pat dry with a clean towel. Do not
use any soap, flannel or sponge when cleaning your wounds as these may harbour
infection.

The scars may seem very noticeable at first but they will become less obvious over
the next few weeks. They may look bruised, be itchy, numb or sore. If you have had
a vein taken from you leg, you may notice that it swells up. This should go down
within six weeks of your surgery.

If you are concerned about your wound in any way you should contact your GP who
can telephone the Tissue Viability Nurse Specialist at the hospital who will make
arrangements for you to be seen in the Wound Clinic.

The Tissue Viability Nurse is available Monday – Friday 8 am – 5pm.

Should you require help outside these hours please contact your GP or attend your
nearest A&E Department.


Follow- up appointments

You will be seen by your consultant or a member of his/her team approximately 6-8
weeks following your surgery. This appointment will either be given to you before
you are discharged from hospital or sent to you in the post.

If you are unable to attend this appointment you should call the number on the letter
or appointment card to make alternative arrangements.


Cardiac Rehabilitation

Cardiac Rehabilitation is aimed at monitoring your progress and recovery and
restoring you to a full and active lifestyle. Many people find that attending a cardiac
rehabilitation programme can improve their overall quality of life and may reduce the
likelihood of further heart disease. It can also help you to regain your confidence by
knowing what you can do to help yourself and reduce the risk of further problems.
Attending a group will allow you to meet other people who have been through similar
experiences to yourself, which can be reassuring to you and your family / friends.

Most patients receive the first phase of Cardiac Rehabilitation either at pre admission
clinic or before they are discharged from this hospital. The next phase of
rehabilitation will be provided by your nearest hospital and involve participating in a
supervised exercise programme as well as information and advice on all aspects of
healthy living, relaxation, medication and management of stress. A member of the
cardiac rehabilitation team will contact you approximately 4-6 weeks after your
surgery and invite you to join the programme.




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Driving

You may recommence driving 4 weeks following your surgery. When driving a car or
travelling as a passenger, you are not exempt from wearing a seat belt. If you find it
uncomfortable, place a folded towel between your chest and the belt.

Other rules apply for holders of LGV and PSV license. Contact the DVLA helpline
for further information on relicensing rules following heart surgery 0870 600 0301.

Bathing

Take a shower or a bath daily; do not be afraid to get your wounds wet, showering or
bathing will keep your wounds clean and encourage them to heal. Do not add
anything to your bath, use water only. Do not get in or out of the bath on your own
for the first 2-3 weeks following surgery. Apart from the danger of slipping, you will
put too much pressure on your arms and therefore through to your breastbone. This
will not help with the healing process, and may cause damage. If possible use a
shower rather than a bath for the first five weeks, but if you do take a bath,
remember to:

    Empty the water before you get out
    Use a non-slip mat or a towel before attempting to stand up
    Get assistance to get out of the bath

Rest, Sleep and Relaxation

During the first few weeks at home you will find that you tire easily so adequate rest
and sleep are just as important for your recovery as exercising. Tell your friends and
relatives when you are planning to rest; this will help cut down the amount of
disturbance you get during this time. Try to get eight to ten hours sleep each night.
You may find it difficult for the first week after leaving hospital, as your usual sleep
pattern will have been disturbed. You may also find it uncomfortable. If you do,
make sure you are taking your painkillers. You may also be more aware of your
heartbeat at night, especially if you have had a mechanical valve replaced. You may
hear it as a ticking sound. You will get used to this over time and eventually not
notice it.


Alcohol
You may take alcohol after your surgery, but there are important notes to remember
first. You should avoid it whilst taking painkillers as it increases the potency of the
drug. You should limit the amount whilst taking Warfarin as it increases sensitivity
and will disrupt your clotting factor and affect the dosage you receive. Alcohol can
also irritate your stomach and this, along with a disrupted clotting factor in your blood
may cause stomach problems.

Heavy drinking or binge drinking is more harmful than small regular amounts.

It is recommended that alcohol intake should not exceed 21 units a week for men
and 14 for women.

1 pint = 2-3 units
1 short (pub measure) = 1 unit
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1 small glass of wine = 1 unit
1 medium glass of wine = 2-3 units


If you feel your intake is too high, or you would like help, than you can contact your
General Practitioner or Alcoholics Anonymous. The National help line number is
0845 7697555

The Merseyside, Lancashire and Cheshire Council for Alcoholism is situated on the
First floor, Fruit Exchange, Victoria Street, Liverpool L2 6QU
Telephone: 0151 707 1221 or 0151 707 1300 or 0151 263 0300
If you use the internet www.aa-uk.org.uk


Sexual Relations

Many patients that have undergone cardiac surgery experience anxiety about
resuming sexual relationships. It is quite safe to have sex after the operation.
However, we generally advise that you wait between 2 and 4 weeks, to give your
wounds a chance to heal. You may resume whenever you feel ready to do so but
don’t be too energetic. Some of the tablets you take may make you feel
disinterested in sex. These are known as beta-blockers. If the problem persists, you
should make an appointment with your G.P.

Do not expect too much of each other, take sensible measures and avoid putting any
strain on your arms.


Holidays and flying

You can holiday in this country whenever you feel well enough to travel.
If you are thinking of going abroad, we advise you to wait until after your outpatient
appointment.

If you are thinking of a long haul flight, then you should leave it longer, check with
your consultant at your follow up appointment.

If you are taking Warfarin, you need to let your anti-coagulant clinic know, as they
may need to adjust your dose.

Cover the scars with complete sun block when sunbathing in the first six months. It
is also important to clarify your holiday insurance.




Returning to work

You will need time to make a complete physical and emotional recovery before
returning to work.

If your job involves heavy manual work or is stressful, you will need 3 months to
recover before going back. When you first return to work you should try to avoid any
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strenuous physical tasks. It may be a good idea to resume your employment on a
part-time basis at first, working only a few hours each week.

How to protect your heart

How can I reduce my risk of further heart disease?

The major risk factors for heart disease which you can do something about are:

      Smoking
      High blood pressure
      High blood cholesterol
      Lack of physical activity
      Being overweight
      Drinking too much alcohol
      Excessive salt intake

Your risk of further heart disease will depend on how may of the above risk factors
you have, as well as your individual risk factors.

Knowing about risk factors can help you to deal with them and gain some control
over your heart disease.

Please ask staff for a copy of the leaflet ‘Cardiac Rehabilitation’ for more information
about reducing risk factors for heart disease.


Smoking – If you smoke now is the time to stop!
Stopping smoking is the single most effective step you can take to help yourself.
From the moment you stop smoking the risk of a heart attack is reduced and is
halved after 1 year of stopping. Within 24 hours of stopping, carbon monoxide is
eliminated from the body, the lungs start to clear out the build up of tar and taste and
smell is greatly improved. Within 2 – 12 weeks circulation improves and the lungs
have room for up to 10% more oxygen. If you would like help to stop smoking
contact our smoking cessation advisor on 0151 600 1455 or speak to your GP.

Healthy eating and weight – Following a sensible low fat eating plan and eating the
recommended daily intake of five portions of fruit and vegetables per day can help
you to remain healthy and stay at a sensible weight. Keeping close to the
recommended weight for your height can help to control your blood pressure and
reduce the amount of work your heart has to do. Eating a low fat diet will help to
control your cholesterol which is a fatty substance that can build up in your arteries
and cause them to narrow. It is important to remember however that you should wait
until your wounds have healed before considering weight loss and making any
changes to your eating pattern. While your wounds are healing (approximately 6-8
weeks after surgery) your body needs extra nutrients.

Exercise and physical activity –Exercise can help to reduce blood pressure and
cholesterol and help to maintain a healthy weight. (Please refer to the advice given
about resuming activity after your stay in hospital before beginning exercise).

Stress – Stress can have a negative impact on health, affecting us both physically
and mentally. Although it is not always possible to remove stress from our lives,
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there are many methods which can be used to aid relaxation, relieve stress and
promote a positive healthy recovery including:

      Finding ways to relax - it is important to unwind. Each person has their own
       way of relaxing including deep breathing, listening to music or reading a book.
       Make some time for yourself.
      Eating right - eating a sensible low fat diet can give you energy, aid wound
       healing and promote well being.
      Sleeping - getting enough sleep is an important part of your recovery.
      Get moving - Your body makes certain chemicals called endorphins during
       exercise. They can help to relieve stress and improve your mood.
      Talk to friends or get help from a professional - talking to friends can help
       you work through your problems or concerns. For more serious stress related
       disorders it may be helpful to talk to a health care professional. Speak to your
       GP for more information.

   It is not uncommon to feel a bit low following discharge from hospital. These
   feelings usually resolve as you recover.


Blood pressure – High blood pressure can increase the risk of heart attacks and
strokes. If you have high blood pressure it is important to have it checked regularly
and continue with any medication you may be on to control it. Avoiding salt in your
food can help to control blood pressure too.

Who do I contact if I have any problems after I go home?

The hospital has a Discharge Advice Line for patients, relatives and carers for
information and advice following discharge.

A member of the nursing team will either take your call, or call you back if you leave
a message with your name and telephone number. This service is available Monday
to Friday. We aim to return all calls the same or next day. Please note that calls will
not be returned after 4pm or at week-ends. For help out of these hours please
contact your GP or NHS Direct.

Discharge Advice Line – Telephone - 0151 600 1056

There is a Discharge Advice Line available at the hospital
Monday – Friday 8 am – 4pm (excluding bank holidays)

This advice line is available for patients, relatives and carers for information and
advice following discharge.




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The Discharge Advice Line can give advice on:

      Recovery after a procedure or operation
      Mobility and activity
      Wound care
      Medication
      Driving
      Stopping smoking
      Healthy Eating
      Alcohol Intake
      Relaxation & Stress Management

If you are in need of immediate help – for example are
having chest pain, breathlessness, palpitations, dizziness,
please do not hesitate to contact your GP for assessment
or go to an A&E department or ring 999.
We would like to take this opportunity to wish you well in your recovery.

For further information visit;
www.lhch.nhs.uk
www.nhsdirect.nhs.uk
www.bhf.org.uk
www.dipex.org

Or contact:

The British Heart Foundation information line on 0845 070 80 70




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If you require a copy of this information in any other format (eg. Large print) or
language please contact us on 0151 600 1517 quoting the name of the information
leaflet you require.


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