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| PREPARING YOURSELF TO BE IN THE BEST POSSIBLE SHAPE BEFORE OPERATION |
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| It is very important for you to be in the best possible physical condition before your operation, because it will help you recover more easily and more quickly. If you are still smoking, you must stop before your operation. If you need help with stopping smoking, please tell your doctor. It is also helpful if you strengthen your muscles before surgery. The following guidelines will help. |
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| ARM EXERCISES: |
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You can stand or sit to do this exercise |
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Place your arms level with your shoulders, so that your arms are straight and parallel to the floor |
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When you breathe in: raise your arms above your head, clasp your hands together, and hold for 2 seconds |
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When you breathe out: lower your arms slowly, exhale through pursed (puckered) lips, and stop when your arms are parallel to the floor |
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repeat this exercise 10 times |
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You should sit in a chair to do this exercise |
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Lift one leg off the chair, tightening the muscles on top of your thigh, and then straighten your leg out; hold your leg out straight for 3 seconds |
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bend your knee and lower your leg slowly; relax, and then repeat 10 times |
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rdo this exercise 10 times a day |
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| Breathing exercises: |
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This exercise helps your diaphragm (a breathing muscle) |
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You should sit in a chair to do this exercise |
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Sniff twice, hold your breath for 2-3 seconds |
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Tighten your stomach muscles, and then blow out slowly |
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Repeat this exercise 10 times |
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Do this exercise 10 times a day |
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| Other exercises: |
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Walk 1 mile, twice daily, in less than 20 minutes |
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Climb 2 flights of stairs, quickly, 4 times a day |
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The evening before your operation you may eat a regular meal and may drink fluids up until midnight. Do not eat or drink anything after midnight. |
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Please remove any lipstick or nail polish on the day of your operation. |
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Please leave all valuables and jewelry at home or with a family member. |
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| YOUR ADMISSION FOR SURGERY |
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You will be asked to arrive at the admissions floor of The Hospital. You will be taken to the pre-operative area, where you will change into a hospital gown. You will meet with an anesthesiologist again and an intravenous (IV) line will be started. You may receive a medication which makes you sleepy. You will be taken to the operating room shortly after you are given this medicine.
When your operation is over the doctor will call and speak with family members by phone in the waiting area. You may occasionally asked to meet the doctor in the 3rd floor meeting room. Your doctor will tell you before your operation whether you will need to stay in the hospital after your operation. If you go home after your procedure or operation, you will go to the Recovery Room when your operation is over. There you will be monitored until you are fully awake.
If you are being admitted to the hospital, you will probably go to the admission Floor. You will stay there for several more days, depending on the type of operation you had. Your activities and care will focus on getting you ready to go home.
After your operation, you will be connected to several pieces of equipment, which will help the doctors and nurses watch your condition closely. Most of the tubes are removed one or two days after surgery. The following are brief descriptions of the tubes and equipment used during your hospital stay:
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Chest Tube
The chest tube is placed after your anesthetic and during your operation. This tube drains air and blood which have collected around your lung during the operation. It is connected to a special collection container at the side of your bed. The nurse will measure the amount of fluid that drains into the container. Your doctor will remove the tube when the lung has reexpanded and the air and fluid have stopped draining. The tube usually can be removed in 4 to 5 days. Your doctor will decide when the tube can be removed. |
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Cardiac Monitoring
electrode pads will be put on your chest and attached to a heart monitor. This machine monitors your heart rate and rhythm and has an alarm that sounds on occasion. It is so sensitive that it may make a sound even if the nurse touches you or if you move around in bed. Do not worry if you hear the alarm often. |
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Intravenous (IV)/Arterial Line
You may have several IV lines. These are important for giving you fluids and medicines. The arterial line gives important information about your blood pressure, pulse, and amount of oxygen in your blood. |
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Foley Catheter
This tube drains urine from your bladder. It is inserted after your anesthetic and before your operation. The nurse measures the amount of urine while you are in the ICU. It is usually removed several days after surgery. |
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Epidural Catheter
This tube is inserted by the anesthesiologist before your operation to help treat your pain after your operation. While it is in place, you should have very little or no pain. Please tell your nurse if you are having pain. We will ask you to rate your pain on a scale of 0 to 10 in order to measure how well your pain medicine is working. A score of 0 means that you have no pain at all. A score of 10 means you have the worst pain you have ever had. |
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Patient Controlled Analgesia (PCA)
This is a pain control method where the pain medicine is in an intravenous (iv) solution and you can push a special button to give yourself the pain medicine whenever you feel you need it. The doctor will prescribe certain limits so that you cannot receive too much. If your pain is not adequately relieved, please tell your nurse so that your doctor can adjust the amount you receive. |
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Sequential Compression Stockings
These plastic sleeves are wrapped around your legs and squeeze your legs while you are in bed. This helps your circulation and helps prevent blood clots. When you are able to walk in the hall several times a day, you will not need to use them anymore. |
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Vital Signs
The nurse will check your vital signs (blood pressure, pulse, breathing rate, and temperature) and your oxygen saturation (the percentage of oxygen in your blood) to make sure you are breathing well and recovering from your operation.
You will be weighed every day, usually before 6 a.m.
The nurse will measure how much fluid you take in (your intravenous fluid and what you drink) and how much fluid you put out (urine). So, it will be important for you to save your urine in the container given to you.
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Breathing
You will receive oxygen as needed. It is given to you through a small tube placed just inside your nose, or you may wear a mask. Notify the nurse immediately if you feel short of breath or "winded".
It is very important for you to help get rid of the secretions (mucus) in your lungs after your operation. You can help by using your incentive spirometer (a breathing exerciser) and coughing and deep breathing 10 times every one to two hours while you are awake. Small, throaty coughs will not clear the mucus. To cough well, place a pillow over your incision. Take a deep breath in through your nose. As you get ready to cough, hug the pillow, then cough twice. Repeat these steps until your chest feels clear. Your nurse will show you how to use your incentive spirometer.
Being physically active will exercise your lungs and help with your breathing and oxygenation. After your operation you may feel tired, but your lungs will improve more rapidly the more you sit up in a chair and take frequent walks in the hall. |
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Pain Medication
In order to be able to deep breathe and cough, it is important that you take the pain medicine that your doctor orders. It makes coughing, deep breathing, and walking more comfortable. Please tell your nurse if your pain medicine is not keeping you comfortable, especially when you are doing your deep breaths and coughing. |
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Physical Activity
It is very important that you resume normal physical activity as soon as possible after your operation. This helps to clear your lungs and helps the circulation in your legs. You will begin by sitting up in a chair next to your bed. Once you are out of the ICU, you will begin walking. Your nurse will show you how to support your incision to help decrease the discomfort with coughing and other physical activities (such as getting in and out of bed). Your nurse may help you walk for the first few days. You will need to walk in the hall at least 3 times a day. You should use both arms as you normally would.
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Nutrition
It is normal to lose your appetite for several days after an operation. However, good nutrition is important to help your body recover. Even if you are not hungry, try to eat at least half of each meal or small portions six times a day. The following section "Your Recovery at Home" covers information about activity, diet, medicines, wound care, and when to call your doctor. The nurses and doctors are available to answer any questions you or your family may have about your recovery.
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DISCHARGE
Most patients go home from the hospital about three to seven days after their operation. This section will give you some general guidelines to follow once you are home. Your nurse and/or doctor will review this information with you. They can answer any questions you might have. If you have questions, let your nurse know and he/she will get more information for you.
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Here are some general guidelines: |
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Get up and get dressed each morning. |
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Regular activity is an important part of your recovery. Use both arms as you normally would. Walking also helps your recovery. Begin with short walks, gradually increasing your distance every day. Space your activities throughout the day. Avoid rushing and stop and rest if you feel tired. |
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To help your incision heal, do not lift object weighing more than ten pounds (for example, children, heavy bags of groceries) for 4 to 6 weeks after surgery. |
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You make take a shower at home. The Steristrips (paper stitches) will fall off by themselves in a few weeks. |
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Here are some specific guidelines: |
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Breathing exercises |
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Why? Deep breathing exercise should be continued at home so that your lungs will stay clear. You should continue with the deep breathing exercises until your cough does not produce mucus (sputum). The deep breathing exercises usually are most effective when you are sitting in a chair with your back well supported. |
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How? Place both hands over the lower front part of your rib cage. Take a deep breath in through your nose and blow out slowly through your mouth with pursed (puckered) lips. With each deep breath, try to expand your rib cage as much as possible. Take four deep breaths in a row and then rest. After 10 minutes of deep breathing, take one deep breath in, support your incision with a pillow and cough. This exercise should be done at least twice a day if you continue to cough up mucus. |
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Shoulder range of motion exercises |
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Why? Your shoulder on the side of your operation may become stiff. Therefore, range of motion exercises should be done 2 to 3 times a day until your shoulder is not stiff anymore. These exercises are best done in front of a mirror so that you can watch your posture. |
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How? |
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With both hands clasped together, lift your arms straight up over your head and then lower to the starting position. Repeat 5 times. |
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With both hands clasped together, lift your arms up over your head and touch the back of your neck. Then lower your hands to the starting position and repeat the exercise 5 times. |
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Place one hand behind your back and with the tip of your thumb, try to touch your shoulder blade. Lower your hand to the starting position, and repeat 5 times. |
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Posture |
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Keeping your back straight (keeping a good posture) is important after your operation, so that your lungs can expand properly. Therefore, keep your shoulders level and your back straight when you sit, stand, and walk. |
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Diet |
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It is important to eat a well-balanced diet to promote healing of your incision.
Your appetite should return to near normal after a few weeks, especially as your activity increases. If your appetite is poor, try to eat high calorie and high protein foods. Small meals, 4 to 6 times a day, may be easier to eat. If you are not eating enough, a vitamin supplement can be used.
Constipation is a common problem after surgery, usually caused by the pain medicines. Drinking plenty of fluids and eating fresh fruit or bran will help prevent this problem. A stool softener may be ordered for you by your doctor. Please tell your doctor if this becomes a problem. |
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Medications |
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It is not unusual to have increased pain the first few days you are home due to increased activity. Your doctor may order pain medicine for your to use at home. Your pain will slowly decrease as healing occurs, but you may be stiff or achy for up to three months after surgery, especially on cold or wet days.
You may have pain in your incision for several weeks after your operation, and you will be given pain medicine to take at home. Do NOT take pain medicine before driving or with alcohol.
By 6 to 8 weeks after your operation, most of the pain in your incisions will be gone. You will also notice that the "bump" along the incision will have gone down. It is normal for the area around your incision to feel numb for many months, and this will improve with time. This numbness may be worse on cold or damp days.
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Wound Care |
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Tightness, itching, numbness or tingling around the incision area are often normal. These feelings may last for about 6 to 12 weeks, or longer. |
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Call your surgeon if you have any of the following signs or symptoms:
A large increase in mucus coughed up from your lungs.
A change in the color of the mucus (for example, yellow, green, bright red).
Difficulty breathing or new shortness of breath.
A fever of 101.5 for more than 24 hours.
Your incision becomes red or more painful.
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