Preparing for Home - Discharge Teaching
Recovery at home may create anxiety and fear for you and family members/caretakers.
To help decrease this anxiety, we begin discharge education early in your
hospital experience. Your cardiac liaison nurse will assist you throughout
your hospitalization and will also provide a majority of the education
on going home. The education will be given through various methods including
videos, booklets, pamphlets and this website. If you have any concerns
or questions during your recovery, please call your physician or our Cardiac
Liaison Nurse, Monday through Friday from 7 a.m. to 4 p.m. at (949) 364-1400
You can expect to wait six to eight weeks until you are able to return
to your usual routine. Each person recovers differently so recovery time
may be a little shorter or longer. Just remember to be patient and take
care of yourself as you recover. If at anytime you have any questions
regarding your at home care please call Nelo Siddiqui, your cardiac liaison
nurse. She will be happy to answer your questions over the phone.
If given any other guidelines by your physician upon discharge please follow
those guidelines if they differ from the ones below.
Once you return home, it is recommended to take daily showers. Use antibacterial
soap to wash gently over your incisional areas. Do not put any oils, powders
or creams over the incisional areas. You may have Dermabond, a topical
skin adhesive on your incisions. It will naturally fall off your skin
in 10 days or so. Do not peel or scratch it off. Check your incisional
sites every day. During or after your shower is the best time. Notify
your physician if you notice any of the following:
- Increased tenderness over the incisional areas
- Increased redness or swelling over the areas
- A fever greater than 100 degrees Fahrenheit
- Increased swelling and tenderness in your legs that reoccurs for several days
- Any drainage from the surgical sites. If it is clear (it may be slightly
red or yellow tinged), this is normal body fluid. Let it drain. If it
is now thick and purulent, call your surgeon.
If you went home with gauze on any of your incisions (e,g., chest tube
site or leg drain site), you may need to replace them with new gauze.
A good rule of thumb is to check for wetness on the gauze when you remove
them, which will indicate that the sites are still draining. If they are
dry, leave it open. Steri strips down your chest incision or leg incisions
should be left alone to fall off on their own. If they start to peel off
at the ends, you can trim them to avoid getting caught on your clothes.
The first thing many patients want to do when they return home is take
a shower. Since you may be tired and fatigued from your first day at home,
start taking showers your second day at home. Place a plastic chair or
stool in the shower to sit on while you bathe. Make your showers short
- between five and seven minutes. Have your clothes laid out and ready
to put on to help with fatigue. This will help with any weakness or fatigue
you may feel. Avoid tub baths until your physician says it’s okay.
With your back to the showerhead, use lukewarm water and gently wash your
body and cleanse your surgical incisions. Use liquid antibacterial soap
such as Dial. This is a great time to look over all your incisional areas
for signs of possible infection. If you have gauze on any of your incisions
remove them prior to showering. This does not include steri strips, please
leave them alone and let them fall off naturally.
Wear loose comfortable clothing that doesn’t place extra pressure
on your surgical sites. For men, it is better to wear boxers instead of
briefs especially if you have incisions down your leg
Walking is a very important part of the recovery process. You can follow
the following guidelines unless instructed otherwise by your doctor:
- On your first day at home, take three walks throughout the day, 8-10 minutes
each. Then, increase your walk by five minute each week.
- Walk inside the house for the first few days. Once you feel comfortable
walking outdoors, walk on level ground and avoid hills.
- Avoid using a treadmill or a stationary bike during your recovery period.
Walk slowly to avoid over-exertion on the heart. Two good rules of thumb:
- Walk – talk test: You should be able to walk and talk without experiencing
shortness of breath. Slow your pace accordingly.
- Pulse check: Check your pulse at rest, then, check it again in the middle
of your walk. You are allowed 20 to 30 beats above your resting heart
rate, e.g. if your resting pulse is 80 beats per minute (bpm), you should
be no higher than 100 – 110 bpm at the midpoint.
- Keep your feet elevated when not walking to minimize swelling in your feet
You can climb stairs once a day if you have a two-story complex or you
live on the upper level. Make sure to give yourself plenty of rest before
climbing stairs. If you have a landing on your stairway, placing a chair
there will allow you to sit and rest when needed.
Resting between activities is very important. Nap or rest for 20 to 30
minutes between each activity such as showering or taking a walk. When
you do sit down make sure to elevate your legs above hip level to help
decrease swelling. Do not cross your legs and avoid sitting or standing
in one position for too long.
Returning to Normal Activity
Remember your sternum (breastbone) takes approximately six to eight weeks to fuse.
- Until your physician says differently, do not lift anything heavier than
5-10 pounds. Start with five pounds and then increase as tolerated. For
example a gallon of milk is approximately 7.5-8 pounds.
- Use your pillow when you cough or sneeze to splint your chest to prevent
opening your incision or movement of your bone.
- Avoid any activity that requires you to push or pull something, such as
vacuuming, mowing the lawn or walking the dog. After two to three days,
if you feel well enough, you may do light housework, such as folding laundry
- Avoid uneven movements such as being pulled out of bed, chairs, or the
car by the arm, opening the refrigerator against suction, or opening cans or jars.
- Avoid placing all your weight on your arms for support when getting in
and out of a chair or car. Reposition yourself to the edge of the chair
to align your center of gravity with your legs. You can use your arms
to stabilize yourself but place your weight on your legs.
- Avoid sleeping on your stomach or your side. You can wedge a pillow on
one side to allow yourself to be turned slightly. You can use as many
pillows under your head as preferred.
Do not drive for eight weeks. This time period will allow your breastbone
and sternal area to heal. If you are a passenger in the car, sit in the
back seat and take your heart pillow or another pillow from your home
and place over your sternum and then put your seatbelt on. This will protect
the area in case you make any sudden stops. If you take a trip make a
stop about every two hours so you can relieve some of the pressure on
your sternal area.
You can resume sexual activity when you feel comfortable or when you can
walk two flights of stairs without any shortness of breath. This is around
the fifth week. Remember the sternum is still healing so avoid any position
which may put strain or pressure on your chest. Often it is the spouse
or partner of the patient that may feel uncomfortable about resuming sexual
activity in fear of hurting the patient. It is important to talk it over
with your partner and resume when you both feel comfortable and ready.
Depression or mood changes are a normal part of the recovery process. You
may have some good days and bad days. Do not get discouraged. The support
of your family members or caretakers will help you in the process. If
you feel that the depression or mood changes are not getting better, contact
your physician for additional help.
Limit your visitors the first couple of weeks while you are at home to
20 minutes one time per day. You need your rest and having too many visitors
can increase fatigue during recovery.
Returning Back to Work
The type of work you do will determine when you will be able to return
to work. Usually by the 3rd week, you can resume light workload. Talk
to your physician. Remember, you need time to heal so follow the physician’s advice.
Do not smoke!
All current or former smokers:
- Try to avoid situations that trigger you to smoke
- Use tips recommended in the “Smoking Cessation” patient education material
- Increase your chances of success by joining a support group
- All patients - avoid second hand smoke
Upon returning home you will need to modify your diet to avoid further
heart complications. We recommend a low-fat, low-cholesterol and low-sodium
diet. One of the best ways to help improve your diet is to start reading
labels on the back of food products.
Look at sections on fat, cholesterol and sodium. Total fat intake should
be limited to a total of 30% of your overall fat intake. Cholesterol should
be limited to 300 milligrams per day. Restrict your salt intake to 2000
to 2500 mg a day. The reduction in salt will help decrease water retention
in your body and will also help decrease the swelling in your legs. Decreased
salt intake also aids in reducing your blood pressure and any further
The American Heart Association has some great tips on reducing your fat,
cholesterol and salt intake. They also provide recipes to help you in
your new healthy diet. Visit
Depending on the type of surgery and your physician, you may be placed
on a drug called Coumadin. If you are placed on this medicine you need
to watch your intake of Vitamin K. This drug does not work like it is
supposed to when you increase your intake of Vitamin K. Vitamin K is found
in many green leafy vegetables as well as a variety of other foods. Remember
you do not have to get rid of vitamin K in your diet you just need to
eat it in moderation. Below is a site that contains foods that are high
in Vitamin K as well as some information on Coumadin and how to take the
medication at home.
A journal (simple notebook will do) will become a necessary tool in your
recovery. The journal will be used to keep track of your:
- Blood Pressure
- Heart Rate
- Other information like lab/ test result, medications and dosages
An example of how to set up your journal.
You will be placed on some medications that will lower your blood pressure.
As your heart recovers, we may need to adjust these medications. A good
way for your physician to tell if the medicines need adjustment is by
monitoring your blood pressure at home. You can get a blood pressure cuff
at your local drugstore or Costco. Get one that goes over your upper arm
NOT YOUR WRIST and one that also takes your heart rate. Take your blood
pressure once in the morning before you take your medicine and once at
night before you take your medicine. The top number is your systolic number
and the bottom number is your diastolic.
- 100 = Systolic
- 60 = Diastolic
If your systolic blood pressure is <90 and you are light headed or dizzy
do not take your blood pressure medication. Wait an hour and retake your
blood pressure. If it is still <90 and you are light headed or dizzy
do not take your medication and call your physician. An adjustment in
your blood pressure medications may be needed. Make sure to write down
your blood pressure readings and the time you took it.
It will be important to take your heart rate once in the morning and once
at night when you take your blood pressure. This should be done while
you are resting. Monitor how fast your heart beats per minute. If you
feel heart palpitations or notice your heart rate goes up or down by 20
beats since you last took it call your physician.
You should also monitor your heart rate during activities like walking.
If your heart rate goes up or down by more than 20 beats per minute from
your resting heart rate, slow down or decrease your activity level. If
you continue to see an increase or decrease call your physician.
To take your pulse without a machine place your index and middle finger
- NOT YOUR THUMB - on the lower part of thumb where it meets your wrist.
Count the number of pulses you feel in a minute. Remember to write down
your heart rate in your journals and at what time you took them.
Take your temperature once a day when you first wake up. If your temp is
>100 degrees Fahrenheit call your physician and monitor your incisional
sites. An increase in temperature could be an indication of an infection
in your incisional sites or somewhere else in your body. Remember to write
down your temperature in your journal and the time you took it.
Every morning you need to weigh yourself when you first wake up. Write
your weight down in your journal and compare your weight to the previous
day. If you gain 3-5 pounds in 1-2 days and see increased swelling in
your extremities call your physician. You may need to reduce your fluid
and salt intake as well as be placed on some medication to help get rid
of excess water that may build up in your body.
If you are diabetic, it is highly recommended that you check your blood
sugars regularly for optimal control whether you are on oral medication
or insulin. Check your blood sugar as instructed and consult with your
primary care physician or endocrinologist for any concerns.
You can use your journal to keep track of other things such as lab and
test results. You may also want to use the journal to keep track of the
medications you are using and their dosages.
After your surgery you will probably be placed on some medications to help
your new heart. They do a variety of things including:
- Lower your blood pressure
- Regulate your heart rate
- Increase blood flow
- Decrease blood clots
- Lower cholesterol
- Reduce pain
Make sure you follow your physicians’ instructions and don’t
increase, decrease or stop your medications unless advised by your physician.
Keep a list of your medications and take it with you to every physician’s
Cardiac rehabilitation is a way for people who have had heart surgery to
get going again after surgery. You can begin the rehabilitation program
after the first six weeks at home or when your physician approves. For
further information, talk to your cardiologist.