Before ... Precautions & prerequisites
Prior to Surgery
The average minimum 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. This booklet will give you a general guideline as to what you will and will not be able to do, although these activities often cannot be determined until after surgery. It is best to discuss your questions in the presence of your spouse or family; then everyone knows the guidelines and has a chance to have all questions answered.

Blood donation.
People who undergo heart surgery will need some blood transfusion during and possibly till several days after surgery. The amount required will vary depending upon the particular surgical procedure . However, 6 units of blood are kept ready in the blood bank before the surgery is undertaken. In your interest, you must arrange for 6 donors within your family and friends, preferably of your own blood group. The blood bank must be donated in our blood bank, between 9.30 am and 4.00 pm, with 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 unexpected results of preoperative testing, or for 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 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. This booklet is designed to complement the group 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, your nureses, physicians and MSWs are always available to explain what will happen to you before, during and after surgery.

They will explain to you the normal routine during your hospitalization and after dischage. The important thing to remember is that the overwhelming majority of patients who have undergone heart surgery experience an improved quality of life.
Begin to formulate your discharge plans before surgery. Use this time to the fullest to prepare yourself for what is ahead. It is in your best interest to discuss your concerns and work for a clear understanding of what is happening and what it means to you.

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 for infection and other problems after major surgeries like Open Heart Surgery. This includes exercise in deep breathing and instruction in 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 yur abdomen tightening you are letting the air out).
  
• In performing this breathing exercise, your shoulders and upper chest shuld remain essentially quiet, while your hand resting between the angles of your ribs will rise on inspiration and fall on expiration.
• 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 eigher 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 practising 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. Spiormeter 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 usually with 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. brething tends to become shallow and deep breaths are suppressed in an effort to minimize pain.

In these 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 bigin 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 yur way towards better breathing.

The Day before your cardiac care team
You will have many visitors from the hospital staff. The anesthesiologist will come to visit yu 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 aks 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 alongwith the cardiac surgical team during your hospital stay. Members of the laburatory 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, practically your entire bodywill 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.

To prepare your skin for surgery.
Hand-over personal items
Also, on the day before the operation, your clothing and all valuables, including rings, are to be taken home. Slippers,dentures,glasses, toilet articles, hearing aids etc. may also be taken back and can brought back 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 on the day of the surgery, you will receive nothing by mouth except for some medications. These restrictions include water. You will be given medication so you can sleep well.

Communication
Since 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 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
A morning briefing session is organised in the Medical Social Worker's offie on the ground floor, to brief your attendants about your progress and future plan while you are recuperating in the post operative critical care areas. Your family members will be able to talk to your caring surgeon across the table and hae their questions answered.

Assistance
Assistance Desk, manned by a Medical Social Worker and/or the lobby manager provides help, assistance, guidance and information to the patients and the attendents visiting the hoss\pital.

THE MORNING OF SURGERY
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 ansethesiologist 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.

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 a median sternotomy approach. This means your incision will extend from where your breastbone begins (slightly below your clavicles) to about where the sternum ends. To close the incision, the two edges of breast-bone 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 usually closed with sutures. The entire procedure takes about 5-6 hrs.

PATIENT CARE AREAS
You may be spending time in some or all of these units prior to your discharge from the hospital.
Recovery Room (RR)
Recovery Room (RR)
When the operation is finished you will be taken immediately 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. The patient may remain longer if deemed necessary. Since visiting is limited to one person and is very brief, it is recommended that it be restricted to the immediate family.

Intensive Care Unit (ICU)
The Intensive Care Unit just like RR, has been specially designed and equiped to provide maximum nurse observation and care of patients during the period of acute illness. Much patient centered activity occurs in both these areas. You may find the Intensive Care Unit a bit strange. For on ething, 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 nigh. The medication give to reduce pain also can increase 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 recovery 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 little ambulatory you start feeling much better and are then shifted to the post operative 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.