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Before ...
Precautions & prerequisites
Prior
to Surgery
The average hospitalization after heart surgery is about 7 days.
Hospitalization can vary greatly depending on the type of operation
performed and the degree of disability before surgery. Home
recuperation continues over a period of eight to twelve weeks after
discharge. Before your operation ask your doctor about activities and
limitations during the convalescent period.
Blood
donation.
People who undergo heart surgery will need some blood transfusion
during and possibly till few days after surgery. The amount required
will vary depending upon the particular surgical procedure. However, 4
units of blood are kept ready in the blood bank before the surgery is
undertaken. In your interest, you must arrange for 4 donors within your
family and friends, preferably of your own blood group. The blood can
be donated in our blood bank on all working days, between 9.30 am and
4.00 pm excluding half an hour lunch break between 1.00 pm and 1.30 pm.
Please contact MSW or officer-in-charge blood bank for coordinating the
blood donation.
Scheduling
Your surgeon will tell you the day he expects to perform your
operation. Sometimes, though, surgery may be delayed or postponed due
to an emergency requiring the surgeon's immediate attention, or due to
unexpected findings from preoperative testing, or as a result of an
illness, such as cold and fever.The surgical team will make every
effort to perform your surgery on the scheduled day. If it cannot be
done on that day, you will be informed as soon as possible regarding
your rescheduled date.
Patient
Education Programme
Patients and their family members are invited to participate in-group
meetings conducted both prior to and after the surgical experience. For
more information regarding the group meetings, please contact medical
social workers.
Emotional
Preparation
Emotional preparation for surgery is as important as the physical
preparation. Both factors will play an important role in the ease and
speed of your recuperation. It is normal and natural to be anxious and
concerned about your heart surgery. The best thing you can do is to
discuss your concerns openly and frankly, with those who can assist
you, such as your family physician, the cardiac surgical team, the
nursing staff or Medical Social Worker. In the hospital, nurses,
physicians and MSWs are always available to explain what to expect
before, during and after surgery. They will explain to you the normal
routine during your hospitalization and after discharge. The important
thing to remember is that the overwhelming majority of patients who
have undergone heart surgery experience an improved quality of life.
Breathing
Exercises
While you are in the hospital awaiting your scheduled surgery, certain
preparations will take place before the operation. Preparation of the
lungs is one of the most important activities as lungs are vulnerable
to infection and other problems after major surgeries like open heart
surgery. This includes exercise like deep breathing and instruction for
coughing. To help with deep breathing and coughing, the patient will be
instructed by the hospital staff and will be encouraged to practice
preoperatively. Here are some more deep breathing exercises:
- In a sitting position,
place your hands over the upper region of our abdomen, just
between the two angles of your ribcage. Now take a deep breath
through your nose, then, let the air out slowly with your lips
pursed as though you were blowing out a candle (observe your ribs
moving down and your abdomen tightening when you are letting the
air out).
In performing this breathing exercise, your shoulders and upper
chest should remain essentially quiet, while your hand resting
between the angles of your ribs will rise on inhalation and fall
on exhalation. What you are feeling is, in fact, the full
expansion of your lungs, down to their bottom (basal) segments.
The process is then followed by a slow-pursed lip expiration.
- In order to cough and
expectorate secretions from the lungs, follow these instructions
- Take a deep breath as
you were just instructed; hold your breath; quickly tighten your
abdomen and cough the air out (instead of blowing it out as you
did before). Feel for the contraction of your stomach muscles
under your hands. The sensation of contraction tells you whether
you have coughed. Clearing your throat will not give you this
feedback.
- After surgery, patients
have found it helpful to "splint" their incision by
either hugging a pillow or placing their hands alongside the
incision while coughing. This makes coughing less uncomfortable.
- One of the most
important measures in preparation for surgery and as a lifelong
consideration is to STOP SMOKING, preferably a few weeks before
surgery.
Incentive
Spirometer
Learning and practicing deep breathing exercise before surgery will not
only keep your lungs in perfect condition-while you are awaiting
surgery, it will also make it easy to follow instructions for deep
breathing and coughing after surgery. Spirormeter will help you achieve
this. This exerciser measures the volume of air you inspire and shows
you how effectively you are filling your lungs with each
inhalation.Normally, you take many deep breaths each hour without being
aware of it. They are spontaneous and automatic and occur in the form
of sighs and yawns.
In
certain instances, however your normal breathing pattern can change
when you are experiencing pain following chest or abdominal surgery,
e.g. breathing tends to become shallow and deep breaths are suppressed
in an effort to minimize pain.
In
this instance, it is important that you strive to resume your normal
breathing pattern, despite any discomfort you may have. Taking the deep
breaths (you might ordinarily suppress), will help prevent the
possibility of respirator complications.
By
carefully following your physician's instructions you will begin
receiving the benefits of slow, deep breathing exercise. With the help
of this program, you can hasten your recovery and you should be well on
your way towards better breathing.
The
day before
You
will have many visitors from the hospital staff. The anesthesiologist
will come to visit you preoperatively to discuss how you will be put to
sleep, and how all your vital functions will be monitored during
surgery and for a time after surgery. He/she will ask for information
about your medical and surgical history, especially any allergies.
Members of the cardiology staff will also be coming to examine you and
they will be following you along with the cardiac surgical team during
your hospital stay. Members of the laboratory staff will be coming to
obtain numerous blood and urine samples so that abnormalities, if any,
may be detected.
Shaving
On the evening before surgery, hair over your body will be shaved. This
is to reduce the chance of any infection. In addition, you will be
asked to shower with a special cleansing soap to prepare your skin for
surgery.
Remember
to:
Hand-over
personal items, clothing and all valuables, including rings, to your
relations for taking them home. Slippers, dentures, glasses, toilet
articles, hearing aids etc. may also be taken back and can brought
again to you one or two days after the operation when the need arises.
Nil orally after midnight
You also may find that some of your cardiac medication may be adjusted
in the day immediately before surgery. After midnight, you will told
not to eat or drink anything except sips of water for some medications,
if need be. You will be given medication so you can sleep
well.CommunicationSince the operation is long, and visiting is
restricted, unnecessary crowding in the hospital is not encouraged.
After the operation, the doctor will contact the family waiting in the
lobby, through the receptionist. One of the attendants will be able to
visit the patient in the recovery room and talk to the surgeon about
the surgery.
Morning briefing
Daily briefing session is held every morning in the Medical Social
Worker's office on the ground floor, to brief your attendants about
your progress and future plan while you are recuperating in the
postoperative critical care areas.
Assistance
in the lobby
Assistance desk, manned by a Medical Social Worker and/or the lobby
manager provides help, assistance, guidance and information to the
patients and the attendants visiting the hospital.
Internet/SMS
Update on patient's condition will soon be available over the Internet
at www.ehirc.com and through SMS services on cellular phones. Contact
Information counter or go to "Track patient progress."
Family
visit
Two members of your family will be able to visit you on the day of your
surgery between 6.30 a.m. and 7.00 a.m.
Before
shifting to operating room
On the morning of surgery, you will be given medicines and injections.
These are prescribed by your anesthesiologist and are intended to make
you feel better, control anxiety and may make you somewhat drowsy. The
side-rails will be placed up so as to act as a subtle reminder not to
get out of bed without assistance. Shortly after receiving these
medications, you will be transported to the operating room. Those in
distant wards are not given the sedatives.
In
the Operating Room
Once in the operating room your anesthesiologist will begin intravenous
fluids and attach you to the electro-cardiogram monitor. Anesthesia
will then be administered.Most of the patients who undergo open-heart
surgery have their surgery performed through splitting of breastbone.
This means your incision will extend from where your breastbone begins
(slightly below your clavicles) to about where it ends. To close the
incision, the two edges of breastbone are wired together. These wires
remain in the bone permanently (the only time you will be able to see
the wires is if you have opportunity to see your chest X-ray). The skin
on the chest is closed with sutures. The entire procedure takes about
5-6 hrs.
Know
the wards you will be in after surgery
You
may be spending time in some or all of these units prior to your
discharge from the hospital.
- Recovery Room (RR)
When the operation is finished you will be taken to the Recovery
Room (RR) or Intensive Care Unit. These areas are designed
specifically to give you constant specialized care and monitoring.
Doctors, nurses and other highly skilled people work together with
you toward the goal of a smooth recovery. Most patients remain in
the Recovery Room for approximately 24 hrs. Some patients may have
to remain longer if deemed necessary. Since visiting is limited to
one person per patient and is very brief, it is recommended that
it be restricted to the immediate family.
- Intensive Care Unit
(ICU)
The Intensive Care Unit like RR, has been specially designed and
equipped to provide maximum nurse observation and care of patients
during the period of recovery. Much patient centered activity
occurs in both these areas. You may find the Intensive Care Unit a
bit strange. For one thing, it is hard to keep track of time in a
place where the lights are always on and there is a constant
bustle of activity. Under such conditions, it is possible that
your senses will mislead you and you will feel somewhat
disoriented and confused. It is as if there is no night. The
medication given to reduce pain also may also add to your sense of
confusion.
The temporary confusion that you may feel is just
that-"temporary". It is not serious, and it will resolve
within a day or two after you are transferred to quieter quarters.
Once you are able to catch up on your rest, you will be able to
think clearly again and return to your normal sleep
pattern.Visiting in ICU is also limited to one person at a time.
- Intensive Coronary Care
Unit (ICCU) Coronary Care Unit (CCU) Intermediate Care Ward (ICW)
These are the other step-down units where you stay for about 24/48
hrs. The monitoring and nursing care is just the same in these
units. As the visiting time increases and you become gradually
more ambulatory, you start feeling much better and are then
shifted to the postoperative ward.
Post operative floor
Once in a regular room you will be able to sleep for longer
undisturbed periods. You will continue to receive the necessary
medical and nursing care designed to return you to
"normal". You will be encouraged to take an active role
in the activities of daily living while being closely monitored by
the health-care team.
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