Cardiac Surgery Patient/Family Care Path

The plan in this page is called a Care Path. The doctors and nurses, who will be caring for you before, during and after your surgery, designed this Care Path.

This plan has been designed to provide you with information about average surgical care for our cardiac surgery patients.

Variations in this plan may occur to meet your individual needs, however, the basic plan will occur during the course of your hospital stay.

Before Surgery	Monitoring Your Condition	Activity	Diet
	Nurses will check your height, weight, blood pressure, heart rate and rhythm, blood tests	Up at home or in hospital room as you are able, per your doctor’s orders	Nothing to eat or drink after midnight the night before surgery An IV will be inserted
	Therapies	Education	Pain Control
	Special shower the night before surgery Special shave the morning of surgery Special shower after shave Breathing exercise taught by nursing staff: practice both pillow and breathing exerciser (Incentive spirometer)	Watch Before-Surgery movie Nurse will review with you and your family what to expect on the day of surgery Ask any questions you have	Notify doctor (if at home) or nurses if chest pain occurs Instructed on pain scale

Surgery Day	Monitoring Your Condition	Activity	Diet
	Blood pressure, heart rate and rhythm continuously monitored	Bedrest. The nurses will turn you from side to side and raise the head of your bed for you Sit on side of bed in evening	Ice chips once breathing tube removed Diet will progress to clear liquids or food as tolerated
	Therapies	Education	Pain Control
	Breathing tube in place until you are awake enough to breath on your own Suctioning of secretions as needed Begin breathing exercises 10 times every hour when tube out You may feel pressure or as if you need to urinate. A urine drainage tube will take care of urinating for you	Teaching on breathing with tube Pain management Breathing exercises after tube removed Progress of care	Rate pain on scale from 0-10 Pain medication given in your IV Ask for pain medication early, before you are uncomfortable

Day 1 After Surgery	Monitoring Your Condition	Activity	Diet
	Heart rate and rhythm continuously monitored Blood pressure monitored every 2- 4 hours	Up in chair to eat Bedside exercises Protect breastbone with activity	Regular diet as tolerated, limited fat/salt Fluids measured, may be limited
	Therapies	Education	Pain Control
	Oxygen given by nasal cannula Breathing exercises 10 times every hour when awake — have family members remind you when they visit if you lose track of time Urine drainage tube may be removed this day You will get up to a commode or the bathroom as needed	Breathing exercises Pain management Watch educational videos with your family Protecting your breastbone	Rate pain on scale from 0-10 Pain medication given in your IV or by pill Ask for pain medication early, before you are uncomfortable

Day 2 After Surgery	Monitoring Your Condition	Activity	Diet
	Heart rate and rhythm continuously monitored Blood pressure monitored every 2 - 4 hours	Up in chair to eat Walking in room or hall, checking pulse before and during walk Protect breastbone with activity	Regular diet as tolerated, limited fat/salt Fluids measured, may be limited
	Therapies	Education	Pain Control
	Oxygen usually off Breathing exercises 10 times every hour when awake — have family members remind you when they visit if you lose track of time Use pillow to support chest when you cough Up to bathroom as needed	Pain management Attend wellness classes Watch “Going-Home” video with your family How to protect your breastbone	Learn to check your pulse Rate pain on scale from 0-10 Pain medication given by pill Ask for pain medication early, before you are uncomfortable

Day 3 After Surgery	Monitoring Your Condition	Activity	Diet
	Blood pressure, pulse and temperature checked every 4 hours Some patients may still need heart rhythm monitored	Up in chair to eat Walking in hallway, with physical therapy at least two times Protect breastbone with activity	Regular diet as tolerated, limited fat/salt Appetite may still not be back to normal
	Therapies	Education	Pain Control
	Breathing exercises 10 times every hour when awake Use pillow to support chest when you cough Up to bathroom as needed. Tell your nurse if you have not had bowel movement yet	Breathing exercises Attend wellness classes Watch educational videos Practice taking your pulse	Rate pain on scale from 0-10 Pain medication given by pill Discomfort should be less by this day and you will probably need less medication

Day 4 After Surgery	Monitoring Your Condition	Activity	Diet
	Blood pressure, pulse and temperature checked every 4 hours Many patients go home on Day 4 after surgery	Up in chair to eat Walking in hallway alone two to three times (or more) if tolerated Protect breastbone with activity	Regular diet as tolerated, limited fat/salt Appetite may still not be back to normal — eating is needed for wound healing
	Therapies	Education	Pain Control
	Breathing exercises 10 times every 2 - 4 hours when awake at home Use pillow to support chest when coughing Shower prior to going home You need to have a bowel movement to be discharged. You may need a stool softener due to pain medication — notify doctor if constipated	Home care instruction—activity, showering, wound care, protecting your breast bone, pain control Discharge medications Follow-up care with doctors, health nurse or physical therapist after discharge	Pain medication will be prescribed for at home; use may increase the first couple of days at home because you are more active Remember to use pain medication at bedtime to avoid waking up due to discomfort

Frequently Asked Questions

How long does the surgery take?

The actual surgery generally takes between two and three hours. However, when you first go into the operating room, the anesthesiologist and the nursing staff need time to prepare you before the actual surgery starts. Most people are in the operating room between three and four hours.

How much pain will I have?

The experience of pain is different for everyone. All patients experience some degree of pain after cardiac surgery. Some patients may complain that their chest incision is uncomfortable while others say that their legs are more uncomfortable. We want you to be comfortable. It is important to your recovery process that you are able to deep breathe, cough and walk. If pain is interfering with your ability to do this, talk with the nursing staff so that they can work with you and your doctor to make sure you are comfortable.

How soon will I be getting out of bed?

Most of our patients sit on the side of their bed on the evening of surgery. The following morning, you will be assisted up to a chair. Beginning the day after surgery, you will sit up in a chair for all meals and begin walking. Early activity of this type helps to decrease complications after surgery. Moving helps your lungs to inflate better and improve your appetite.

When will I be able to start eating?

Once the breathing tube is removed (generally three to four hours after surgery), we can begin to give you some ice chips and sips of water. As soon as your stomach begins working (generally the morning after surgery) we will begin feeding you a liquid diet and progress that to regular food as soon as you are able. Many patients have a decreased appetite after surgery but it is important that you eat so your body has the calories it needs to heal.

How soon will I go home?

Many patients go home on Day 4 after surgery. Upon being discharged from the hospital, it is very important that patients have had all of their questions answered regarding their home care. On occasion, a Home Health Care nurse will make a follow up visit to patients the day after their discharge from the hospital. The nursing staff can answer questions about home care, and patients are given their own Cardiac binder to use for home reference. At home, if patients have question(s) the visiting nurse cannot answer, patients are urged to call the Cardiac Program Coordinator at Salinas Valley Memorial Healthcare System at 759-1965. Patients need to call their doctors — either the cardiac surgeon or cardiologist — with questions about medication(s).

When do I see my doctor after I go home?

Generally speaking, your cardiologist will want to see you in the office one to two weeks after you leave the hospital. The cardiac surgeon will see you four weeks after surgery. If you have problems, contact the doctor’s office and they will see you sooner.

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