Video discharge instruction script

Cardiology

The following information provided is to help your recovery following open heart surgery.

What will be arranged prior to going home?

• Tablets to take home
• GP letter
• Outpatients’ appointment
• Sick note (if required)
• NR clinic appointment (if required)
• A visit from the District Nurse or Practice Nurse (if required)
• Support services (if required. Not for cleaning or shopping)

You can safely ride in a car; you must continue to wear a seat belt. Having a folded towel available in the car to put between your chest and the seat belt can make the journey more comfortable.

Medication

Before you leave hospital, you will receive a supply of the tablets which you will need to continue to take at home.

The nurse will explain the side effects you need to be made aware of and when is suitable for you to take.

If you are unsure on what medication to take, please read your discharge letter as this states the list of your medications you have been prescribed.

There is a label on your medicine box that tells you how and when to take it. Please read these instructions carefully before taking your medicine. There are some medicines that have special instructions, such as whether to take them before or after food. These instructions will also be on the label.

Please take your discharge letter to your GP as soon as possible. They will update your records and issue you a prescription before you run out of the medicines you were given when you left the hospital.

You will probably be discharged home on different medications than you were on prior to surgery.

Anticoagulation therapy

Patients that have been fitted with a mechanical valve will need to take warfarin for the rest of their life. A warfarin advice booklet and a member of the pharmacy team will explain this with you before you leave hospital.

Other conditions that can develop following heart surgery like an irregular heartbeat called atrial fibrillation or flutter may require a different type of blood thinning medication. If this is required, the pharmacy staff will discuss this with you and provide you with information and a safety card to carry with you by our pharmacy staff.

Valve surgery

If you have a temperature or any sign of infection it is important to see a doctor and remind them that you have had a heart valve replaced. This is due to the small possibility of the infection being related to the valve.

Pain

For most heart operations the surgeon cuts through the breastbone and spreads the ribcage apart to access the heart and therefore will take a number of weeks to heal properly.

During this time (usually 8-12 weeks but in some cases longer). It is common to experience aches and pains in the chest, back and shoulders. Simple pain relief medication such paracetamol should be taken to relieve this and is usually effective when taken as prescribed.

You should be able to cough and hold yourself tall without too much discomfort. If you have any concerns or need stronger pain relief medication you need to see your GP.

Please be aware some pain relief medication can cause constipation. Remember to drink plenty of water and eat fresh fruit. If laxatives are required, please discuss with the ward nurse before leaving hospital or your GP.

Lifting

As your breastbone is healing, you must be careful not to put it under undue excessive strain.

Avoid:

• Lifting, pushing or pulling heavy objects – more than 8-10 pounds (approximately half a kettle of water) for 6 weeks.
• Reaching, over stretching or straining. This includes ironing, hoovering and carrying shopping.

Light activities are encouraged such as washing up and preparing simple meals. Use both hands and turn to face whatever you are trying to move. Stick to light household tasks and slowly build up gradually. 

Exercise

This will be discussed with you by a physiotherapist before you leave the hospital. Please refer to your physiotherapy booklet which provides a guide to an exercise program.

Exercise can help improve your recovery and help your heart become stronger if carried out carefully and sensibly.

Surgical wound

The surgeon may have carried out your heart surgery by making a cut in your skin where your breastbone lies or on the side of your chest. If a vein or artery graft was needed, you may also have a wound on your arm, leg or groin.

Keeping the wound clean and dry

• Shower daily

• Wash your wound with unperfumed soap and water

• Use a clean washcloth

Normal symptoms

• Black or blue skin around the wound

• Redness along the wound edges

• Tenderness and swelling along the wound

• Numbness or tingling along the wound which may last several months (This is because the nerves in your chest are recovering from the surgery)

• Small amount of clear or pinkish drainage from the wound

Signs and symptoms of infection

• Redness that spreads out more than one inch from the wound edges
• Increased warmth in the skin around the wound
• Sudden increased amount of drainage
• White, yellow or green drainage with an odour
• Increased swelling, tightness or pain around the wound
• Opening of the wound
• Fever or chills (a temperature of above 37.5C or below 36C)

Once the wound is healed the scar can be gently massaged. Begin with very gentle massages and then move on to gradually increasing the pressure, depending on how comfortable you are. The idea is to move the scar and tissue underneath around to soften it. The massage should not be painful.

If your breastbone shifts, cracks, pops or clicks when you move, it is important to contact the ward.

If you have a leg wound, you may also experience swelling of the foot and ankle of the affected leg. When you are still such as sitting and not walking around, it is important to sit with your leg up at least level with your body, preferably higher. You can support your leg with pillows or cushions for comfort.

Sleep, rest and relaxation

You will experience feeling weak and become tired quickly following your operation. Take care to build things up gradually with plenty of sleep, including an afternoon nap if needed. 

• Try to get a balance between activity and rest.
• You may need to limit the number of visitors you have when you first go home.
• Your sleep pattern may be disturbed after the operation. This is unpleasant but should disappear within the first few weeks
• In the first few weeks after your operation, it is recommended that you sleep on your back

Shortness of breath

Most patients experience mild shortness of breath on exertion after surgery, which is normal, and should improve as your recovery progresses. If this happens at rest or does not improve you should contact your GP. 

Emotions

Do not worry if you feel upset or emotional after your operation – this is a normal reaction. Symptoms of mood swings, including depression, fear, anxiety, loneliness, helplessness, and anger, may occur for the first few weeks after surgery.

Sexual activity

These may be resumed when you feel ready. You and, or your partner may feel apprehensive initially – this is perfectly normal.

Try and choose a comfortable position to begin with that does not put too much pressure on your chest – a less active role is preferred – and do not be afraid to discuss your fears with your partner.

Avoid intercourse soon after a heavy meal and try to find a time when you feel rested and relaxed. If you encounter any difficulties in this area, your medication may affect your libido. If in doubt consult your doctor.

Eyesight or vision

It is very common to experience visual disturbances for the first 6 weeks after your operation. Patients who wear spectacles may find their vision is variable and do not seem to work as well as they did before.

You will not need to have your spectacles changed in the first 6 weeks of having surgery. This is a temporary and your vision will return to normal.

Outpatients appointment

You will be contacted or seen by a member of the team approximately 6 weeks following your discharge. This appointment will be sent to you in the post.

Cardiac rehabilitation

Depending on your case, you should be invited for an assessment appointment at your local cardiac rehab programme approximately five to six weeks following your discharge. In the meantime, please continue to follow the physiotherapist discharge booklet.

In cardiac rehabilitation, exercise and, or lifestyle sessions are given to patients who have suffered a cardiac event or procedure. It helps patients recover physically and mentally after a cardiac event or procedure.

You can receive gym sessions, dietary advice, educational classes, and/or emotional support as part of this program.

Driving

If you drive a car, moped or motorcycle (group 1) and have had routine heart surgery without complications the DVLA state that you must not drive for 1 month. You do not need to inform the DVLA and you should have your doctor’s approval before starting to drive. Your insurance company may have different rules to the DVLA so let the company know you have had heart surgery.

If you have an HGV License you must not drive for 3 months. You must contact the DVLA and will require clearance from your cardiologist before recommencing driving.

Employment

The length of time needed off work varies from person to person. Generally, you can go back to work in about 6 weeks if you are recovering well and do not have a physically demanding job. In some cases, you may require more time off, especially if your job requires a great deal of standing and lifting.

Flying and holidays abroad

If you are planning a holiday abroad, check with your consultant as to when they are happy for you to fly. The cardiac rehabilitation nurses have information on insurance, which they will give you when you attend the program.

If you have a pacemaker, report to someone at the airport to avoid the archway metal detectors as it may trigger off the alarms.

The amount of metal contained in a heart valve or the stainless-steel wires in your chest on their own will not trigger the alarms. However, these combined with other metal items you may carry may be enough to activate the alarm system.

How can I reduce my risk of developing further heart problems in the future?

After your surgery, it’s important to maintain a healthy lifestyle to lower your risk of future cardiac problems.

You may need to:

• Stop smoking if you smoke
• Eat a healthy, balanced diet
• Lose weight if your overweight or obese
• Moderate your alcohol intake. It’s recommended to drink no more than 14 units of alcohol a week, spread across 3 days or more
• Exercise regularly

Patient experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.

T: 01642 835964
E: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850

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