What to Expect During Your Hospitalization
Preparation for Surgery
At Morristown Medical Center, most patients come to the hospital the morning of their surgery.
So that all is ready when you arrive for surgery, it will be necessary for you to visit the hospital ahead of time for preoperative testing and education. This is done by appointment which will be arranged for you by the surgeon’s office. You may expect that at the appointment with your surgeon, he will discuss the indication for operation, the procedure he will be performing, and any associated risks. The education you receive at the hospital will focus more on the in-hospital experience and what you may expect as a cardiac surgery patient at Morristown Memorial Hospital.
Day of Surgery
Prior to surgery, all patients are given an antibacterial soap to shower with at home the night before surgery. The morning of surgery, you will have a preparation at the hospital that includes a shave of body hair and another shower using the antibacterial soap. After you shower, an IV will be inserted and you will be taken downstairs for your surgery.
Most patients report that they have no recollection of their time in the operating room. As soon as you arrive in the OR you will be given sedation through your IV. Your surgeon will have told you ahead of time approximately how long he expects your surgery to take . After the surgery is completed, the surgeon will meet with your family to discuss your condition.
Post-op, you are taken to the Open Heart Intensive Care Unit. Your family may visit you for a brief period after you are settled in. For most patients, the day of surgery is a lost day. Because of all the anesthesia and narcotics associated with surgery, you are relatively passive in your care. A fully trained critical care nurse will be by your side the entire day and night of surgery monitoring your condition. Usually, several hours after open heart surgery, you will begin to wake up and will be removed from the ventilator.
Post-Op Day One
Postoperative day one is the real start of your recovery. On the first morning after surgery, provided you are stable, most of the tubes and monitoring lines are removed and you are transferred to the post-op Cardiac Surgery Unit where you will remain for the rest of your hospitalization. On day one you will meet with the cardiac rehab nurses who will outline your course for the next few days. You will likely spend some time sitting in the chair but walking will be limited to trips to the bathroom with assistance.
Post-Op Day Two through Discharge
From the morning of day two after surgery until discharge, the focus of your care will revolve around rehabilitation and preparation for discharge. You will be encouraged to walk several times a day. Initially, you will require some assistance, but before you know it, you will be cruising the hallways independently. It is important to remember that once you come out of the Open Heart ICU, you must request your pain medication. The surgeons strongly recommend that patients use pain medication as needed so that they may be active in their rehabilitation. Another important aspect of recovery is the use of incentive spirometry. You will be instructed on this by a respiratory practitioner and encouraged frequently. One of the most common problems people encounter post-op is fever almost always related to incomplete expansion of the lungs. It’s natural that you will be nervous about coughing and deep breathing but you will be taught by the nurses to splint your incision using the heart pillow provided. It is certainly important to your recovery that you participate by coughing, deep breathing, using the incentive spirometer and walking.
Some noteworthy events in your hospitalization will be discussed now. Please keep in mind that these are general guidelines, and the timing of patient care is always dictated by the individual situation.
Usually, on postoperative day three, the temporary pacemaker wires inserted at the time of surgery will be removed at your bedside. Following this, you will go downstairs for a chest X-ray.
Usually, on postoperative day four, provided your heart has remained in a normal rhythm, your portable telemetry monitor will be discontinued. Often, by day four, people are ready to try going up stairs and may even be ready for discharge.
Usually, on postoperative day five, you are able to shower. Most consider this the highlight of their recovery period!
Previously, fever was mentioned as a possible problem after surgery. By now, the most common problem experienced post-op is an irregular heart rhythm called atrial fibrillation. This situation is easily treated by medications in most instances but may require extra time on the telemetry monitor.
During your hospitalization, you will also be meeting with a care manager. This is a nurse who will help determine whether there is a need for homecare arrangements such as a visiting nurse. She will also meet with your family to insure that the proper support system is in place at home to assist in your recovery.
Day of Discharge
On the day of discharge from the hospital, you will require clearance from the surgeon as well as your cardiologist, both of whom will have seen you every day during your recovery. You will be given written instructions and prescriptions including one for pain medication. It is important to review your medications carefully as they are frequently different than your pre-operative regimen.
Your discharge instructions are specific guidelines for your recovery. You can ride in a car at any time but may not drive for 4-6 weeks. You may not take a tub bath or swim until your skin incisions have healed. You should shower every day and wash your incisions with soap and water. Be sure to pat them dry rather than rub as you don’t want to disturb the absorbable sutures. You may not lift anything over 10lbs. for at least six weeks. It is important that your breastbone have a chance to heal.
Your follow-up will be with your cardiologist. You will not need to return to see your surgeon unless there is a problem with your incisions.