Cardiac Stepdown Unit
Open Heart Surgery Handbook
As you progress, your condition will be upgraded to constant care and then step-down status.
Because your recovery is our primary goad, the following guidelines are in place:
- Family is welcome to visit when it is convenient for both the family and the patient keeping in mind that the patient needs to rest and heal and may not be up to entertaining a large number of people.
- We recognize the importance of family involvement in the healing process.
While you are considered step-down status your heart will be monitored by a telemetry unit, a small box about the size of a transistor radio, which will be attached to five small patches positioned on your chest. This unit will transmit your heart pattern to monitors located at your bedside and at the nursing station. The unit monitors your heart rate and rhythm, and should be worn at all times. Because the unit is used to alert the staff to any irregularities, it does activate an alarm. Occasionally, movements such as walking or changing position in bed can set off this alarm. If this occurs, a staff member will respond, but will also be able to differentiate between this and an actual alarm.
Dysrhythmias, or irregular heartbeats, can occur after surgery. If you feel your heart palpitating or racing, do not panic. Contact your nurse and explain the sensation. If necessary, any electrocardiogram will be performed and medication started to combat this problem.
Pacemaker wires, may have been placed at the time of your surgery and located under a dressing on your chest, may also be utilized to treat postoperative heart irregularities. These wires can be connected to an external pacemaker to regulate your heart rate during recovery. The pacemaker wires will be removed prior to your discharge.
The incisions in your chest and leg will be observed and cared for during each shift. These incisions are kept clean and dry and will not be covered with a dressing unless they are draining.
A buildup of secretions in your lungs is relatively common following surgery, due to anesthesia and decreased activity. Respiratory therapy including deep breathing, coughing, chest percussion, and use of the Inspirometer will be continued throughout your hospital stay.
It may hurt to take deep breaths and cough after surgery, but both are important to your smooth recovery. Coughing and deep breathing serve to “bring up” lung secretions that might otherwise lead to collapsed lungs or pneumonia, thus keeping your lungs clear. Some patients find that holding a pillow over their chest while coughing decreases discomfort. A small pillow will be provided for this purpose.
Your decrease in activity following surgery can also cause your blood circulation to slow down. Because this slowdown can lead to this formation of blood clots, it is important to take the following measures to promote good circulation:
- Leg exercises. You will be instructed on leg exercises which can be done easily in bed. These simple exercises consist of alternately pointing your toes toward and away from you as your legs lie flat on your bed.
- Activity. Activity promotes circulation. Your activity will gradually be increased as tolerated, beginning with short walks to the bathroom and hallway until you can handle at least six walks daily. In addition, you will be assisted to the chair at your bedside for meals.
Postoperative Pain and Discomfort
As mentioned previously, it is normal to experience some pain after your operation. It is important, however, to mention that the pain and discomfort you may feel is tolerable and can be controlled with oral pain medication within 24 hours after your surgery. Pain medication is ordered for all patients . Your nurse will question you about pain at regular intervals throughout your recovery.
Major surgery can have a major impact on your emotions. Often, the physical and emotional toll surgery can take (physical exertion, pain, lack of sleep, etc.) can lead to feelings of depression, boredom, fear, sadness and irritability. In addition, you will have a low red-cell blood count after surgery, which can affect the way you feel. Because red blood cells are responsible for carrying oxygen throughout the body, it is natural to feel tired until your red-cell blood count gradually rises. Some people experience a string of recurring bad dreams and may even experience lapses in memory and concentration, or blurred version. It is important to:
- Recognize these feelings as normal following open heart surgery
- Realize that they are temporary and
- Above all, to communicate your feelings to your family, friends, your nurse and hospital support personnel - all of whom can offer a sympathetic ear and help in coping with problems. While these mixed feelings and intensified emotions may continue after your return home, they normally subside within 4-6 weeks, as your recovery continues.
Patient / Family Pathway
The preparation and education of our patients and their families is an important part of our program. The patient and family pathway is a day-to-day guide of what to expect, when to expect it, and why. Your nurse will review the pathway with you at regular intervals to assess your progress and to set goals to keep you on the road to a speedy recovery. Your Patient/Family Pathway can be found here.
Removal of Pacemaker Wires and Sutures
Pacemaker wires will usually be removed by a surgical assistant prior to your discharge. Sutures will normally be removed after discharge. This removal will be scheduled prior to your discharge.
Please plan your discharge-day activities to include as much rest as possible. As you leave the Medical Center, you might consider asking for pain medication prior to your ride home. As always, you should wear your seatbelt and shoulder harness during the ride. Ask your driver to bring along a small pillow for you to place between the belt and your chest should you experience any discomfort during the ride home. Your driver might also bring along another pillow and a blanket to help make your ride a more comfortable one.
Arrangements for Discharge Needs
Clinical Care Coordinators are available daily on the nursing units to assist you and your family with discharge planning and any special needs. On daily morning rounds, your physician and the clinical care coordinator will discuss your progress toward discharge. The social worker is available to assist you with financial resource referrals and discharge arrangements, which may include home care or medical supplies. If you have transitional care needs, the social worker will work with you and your insurance company to fund your continued care in a rehabilitation center or skilled nursing facility. These facilities serve as a stepping stone between the hospital and your home. An advanced practice nurse works with the Cardiovascular team to assist with your special discharge needs.
During your initial recovery period, your body considers all activity as “work.” This means that routine activities such as shaving, bathing - even combing your hair - can be physically taxing. The reality of this situation is that you will now need more rest during the day. In fact, you should make a point to plan at least two 20 to 30 minute rest periods to avoid extreme fatigue. Try to get 8-10 hours of sleep each evening, and avoid staying up late thinking you can "catch up" on your sleep the following day. If you must stay up late, arrange to take a nap earlier in the evening in order to ensure that you are properly rested.
Wear Loose Clothing
During the initial stages of your recovery period, it is a particularly good idea to wear loose, comfortable, non-restrictive clothing. Tight clothing can cause discomfort in the area(s) of your incision(s).
Prior to the removal of your sutures, you will sponge-bathe only. You may (preferably) shower or tub bathe once your sutures are removed and when approved by your surgeon. You may feel weak the first few times you bathe, so have someone available to assist you if needed. You may wish to consider purchasing a non-skid stool for use in the shower stall until you feel stronger. Avoid very hot showers at first, because they may cause lightheadedness. Do not scrub incisions, blot your skin and let the water do its work. You should use a mild soap and avoid lotions, powders, creams, etc., all of which hinder healing and promote bacterial growth.