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Preparing for Your Surgery • 43
Preparing for Your Surgery
Your History and Physical Exam
B
efore your operation, you may have an appointment for a “pre-opera- tive history and physical exam”. This appointment will take between 2-6 hours, depending on the tests you need. It may be helpful to bring a list of questions with you to the appointment. At this appointment you will meet with a Physician Assistant (PA) or Nurse Practitioner (NP) who:
- Reviews your medical history including allergies, current medications, and previous surgeries
- Performs a physical examination
- Reviews the results of your preoperative tests
- Answers your questions about the surgery
- Reviews the consent for surgery
- Reviews what your family can expect
- Explains what you can expect during your hosptal stay At this appointment you will meet with a Medical Assistant who:
- Provides you all of your pre-operative instructions
- Reviews all of your medications (Please bring a list of everything you take: prescription, over-the-counter, vitamins or herbal supplements)
- Shows you how to use an incentive spirometer (breathing machine) and gives you one so you can practice at home
- Reviews the tentative date/time of your surgery
- Explains where to go and when to arrive
- Explains where your family checks-in and waits while you are in surgery Medications: Please bring a list of everything you take: prescription, over-the-counter, vitamins or herbal supplements.
44 • Heart Surgery: A Guide for Patients and Their Families • Michigan Medicine
Staphylococcus Aureus
Infection Prevention before Cardiac Surgery
What is Staphylococcus aureus? Staphylococcus aureus or, “Staph”, is a germ that lives on the skin and in the noses of many healthy people. Staph germs do not cause any prob- lems for most people, but sometimes these germs can cause serious infections including surgical wound infections. To reduce the risk of Staph infections, you will need to bathe or shower with a special anti-bacterial soap called Chlorhexidine (CHG). The solu- tion will help remove germs from your skin. Wash with this soap for 5 days before your surgery. Use the soap from your neck down only. Do not use it on your face.
Use the Chlorhexidine soap only
from the neck down.
- Apply CHG onto a damp washcloth.
- Rub into a lather.
- Gently scrub your body from the neck down (front and back). - If showering: Move away from the shower stream when applying CGH to avoid rinsing it off too soon.
- Rinse thoroughly. Do not use in your face, eyes, ears, mouth, or nose.
46 • Heart Surgery: A Guide for Patients and Their Families • Michigan Medicine When is blood thinner medication stopped before surgery? You tend to bleed more easily when you take blood-thinning medica- tion. Your surgeon will give you specific directions for when to stop tak- ing your blood thinners before surgery. The following is a list of blood-thinning medications:
- Warfarin (Coumadin®)
- Enoxaparin (Lovenox®)
- Dabigatran (Pradaxa®)
- Apixaban (Eliquis®)
- Fondaparinux (Arixtra®)
- Rivaroxaban (Xarelto)
- Clopidogrel (Plavix®)
- Dipyridamole (Persantine®)
- Prasugrel (Effient®)
- Ticagrelor (Brilinta®) Review when to stop drinking alcohol before surgery Please do not drink any alcoholic beverages for 48 hours before your operation. If you are having an aor- tic aneurysm repair, we ask that you refrain from alcohol consumption for 30 days prior to surgery. Be sure your surgeon and anesthesiologist know your usual amount of alcohol intake. Do I need any vaccinations before surgery? Ask your surgeon or primary care provider about which vaccines you may need prior to your surgery. Set up a pre-surgery dental evaluation
- Please see a dentist prior to your operation. Your dentist will make sure your teeth and gums are in good condition before surgery. This is important to prevent any infection after surgery. If you are undergoing surgery for a heart valve, you will need to take an antibiotic one hour prior to your dental appointment.
- Please ask your dentist to sign and fax the provided dental clearance letter.
For any questions
about medicines, call
your surgeon’s office
(via the Call Center).
Call Center:
o o o o
Preparing for Your Surgery • 47 o You will receive a call 72 hours after discharge from one of the Medical Assistant Specialists. If you or your support coach have questions or concerns, they will be able to assist you.
- After your heart valve or aortic surgery, you will need to take an antibiotic before any dental or invasive procedures. Please ask your nurse if you have any questions. Develop a plan for recovery To maximize support for your recovery, pick a friend or family member to be your personal support coach. Your support coach will be educated by your providers on how to support and encourage you during your re- covery. Your support coach will:
- Accompany you to your history and physical appointment.
- Accompany you to the hospital on the day of your surgery.
- Be the primary person to talk with your doctors and nurses. Your coach can then relay information back to your family and friends.
- Receive education from your health care team on how to provide the best care and support for you at home.
- Be present as you receive your discharge instructions at 9:30am on the day of discharge and drive you home.
- Stay with you for the first 7 days after you are discharged from the hospital; this includes at night, too.
- Be available to help you with certain tasks in your recovery after you leave the hospital:
- Help you monitor your temperature, blood pressure, heart rate, weight, and check your incisions
- Assist you with your medications
- Assist you with daily activities and exercise
- Accompany you to follow-up appointments and blood draws.
Preparing for Your Surgery • 49 o (^) Practice your pre-operation exercises We prefer the OMRON 700 or 900 series devices (“COMFIT” cuff) as they have been validated by independent societies to be accurate. These can be purchased at many stores or on the Omron website. For any home blood pressure device you purchase, make sure that it has been validated to be accurate (the manufacturer will attest that the device passed validation by the AAMI, BHS, or the AHA). Practicing your exercises before and after your operation is important and will allow you to take an active role in your recovery. Performing these exercises will play an important role in getting yourself well and home. See the section on Physical Therapy in this chapter. Purchase the necessary equipment:
- Oral thermometer
- Weight Scale
- Home Blood Pressure Cuff o
50 • Heart Surgery: A Guide for Patients and Their Families • Michigan Medicine The following breathing exercises are designed to assist in keeping your lungs fully expanded and clear of extra secretions so that you do not develop pneumonia. Remember, no one can breathe or cough for you. Be sure that you are comfortable, relaxed and able to concentrate before you begin a practice session. Place your hand on your stomach or ribs, so that you emphasize expansion of the correct area. Exercises for your lungs
Practice the following exercises several times each day:
Incentive spirometer piston yellow indicator coach indicator mouthpiece Incentive spirometer (breathing machine) Before your operation, you will receive an incentive spirometer. Staff will teach you how to use it properly. You should practice using your breath- ing machine (incentive spirometer) several times each day. Your breaths should be slow and deep.
- You should have your incentive spirometer at your bedside immediately after your operation so that you can use it as soon as you wake up. You should use your incentive spirometer 10 breaths every (1) hour while you are awake.
- Do not compare your results to those of other people.
- Many factors can change the volume a person can achieve when using this machine.
- Use your incentive spirometer when you go home to help keep your lungs clear while you recover. Continue to use it until you return to clinic.
52 • Heart Surgery: A Guide for Patients and Their Families • Michigan Medicine
- Hold your breath as long as possible. Then exhale slowly and allow the piston to fall to the bottom of the column.
- Rest for a few seconds and repeat steps one to five at least 10 times every hour.
- Position the yellow indicator on the side of the spirometer to show your best effort. Use the indicator as a goal to work toward during each slow deep breath.
- After each set of 10 deep breaths, cough to be sure your lungs are clear. If you have an incision, support your incision when coughing by placing a pillow firmly against it.
- Once you are able to get out of bed safely, take frequent walks and practice the cough. piston
Preparing for Your Surgery • 53 Deep breathing and coughing One of the most important factors that will speed your recovery is your ability to breathe deeply and cough effectively. Practice each step below several times each day.
- Take two deep breaths in through your nose and out through your mouth.
- On the third breath, breathe in deeply and then give two or three sharp coughs before taking another breath.
- You should feel your abdominal muscles tighten each time you cough. Be sure to spit out any mucus your cough produces.
- After your surgery, you will want to support your incision with your hands, a pillow, or a folded blanket when coughing. After your surgery, you will want to support your incision with your hands, a pillow, or a folded blanket when coughing.
Preparing for Your Surgery • 55 Leg kicks: Sitting with an upright posture in a chair or in the bed, kick your leg out straight and slowly. Hold for 3 seconds, and then repeat with the other leg. Seated marching: Sitting with upright posture in a chair or in the bed, lift your knee up towards the ceiling without leaning backwards. Repeat with the other leg.
56 • Heart Surgery: A Guide for Patients and Their Families • Michigan Medicine Tips to Ensure a Safe Hospital Stay Michigan Medicine faculty and staff are working with patients and fami- lies to become the safest hospital in the world. Please review the following safety tips. If you have voiced a concern to staff that your or your family member’s condition is rapidly getting worse, but feel it has not been adequately ad- dressed, pick up any hospital phone and and call FIRST by dialing 141- The Family Initiated Rapid Safety Team. Speak up if you have any questions or concerns. You have the right to question anyone who is involved with your care. Know who is in charge of your care. Many people may be involved in your care. Also, doctors can change dur- ing your stay. You can encourage your care providers to write their names and roles on the whiteboard in your inpatient room to help you under- stand who is on your care team. Ask about test results. Do not assume “no news is good news”; ask your doctor about your test results. Be informed of any invasive procedures, such as surgery. Make sure you and your doctors all agree on exactly what will be done. When you are unable to speak up (sedated or breathing tube prevents you from speaking), a trusted family member or friend can be your advocate. Identify that person before you are admitted to the hospital. Read more in the Advance Directive. Speak up! Be informed Dial 141 for FIRST = The Family Initiated Rapid Safety Team
58 • Heart Surgery: A Guide for Patients and Their Families • Michigan Medicine You will need to confirm the time of your surgery so that you know what time to arrive at the hospital. It is important for you to follow these steps: ❑ The day before your surgery, please call 866-983-9090 between 8:00am and 11:00am. ❑ If your surgery is on a Monday, please call the Friday before. ❑ Leave your name and phone number with the clerk or on the answering machine. ❑ A pre-op nurse will call you back between 1:00-4:00pm to confirm the time of your surgery and the time you should arrive on the day of your surgery. ❑ Be sure to give your surgeon a phone number where we can reach you the night before and the morning of surgery. It is important to know how to reach you. Confirming your arrival and surgery time
The day before your surgery, please call
866-983- The Day Before Your Surgery
Preparing for Your Surgery • 59 Who do I contact if I am not feeling well the day before my surgery? Report any symptoms of flu, cold or infections to your surgeon. It is im- portant that you be in your best possible health for surgery. ❑ Call (888) 287-1082, Monday-Friday before 4:30pm to report these symptoms. Ask to speak to the clinic nurse. Call (866) 983- 9090 after 4:30pm and leave a message. How should I prepare for my surgery? ❑ You will be asked to shower using the chlorhexidine (CHG) 4% antiseptic soap the night before and the morning of your surgery. This special soap reduces the amount of germs on your skin. ❑ Use the Chlorhexidine body wash from the neck down.
Use the Chlorhexidine
soap only from the
neck down.
Do not use it on your face, eyes, ears, nose or mouth ❑ Do not shave the hair on your chest, arms or legs! Shaving your skin with a razor blade can actually increase your risk of infection. We will prepare your skin by removing the hair with a special clipper the morning of surgery. ❑ Do not apply make-up, deodorant, lotions, sprays, gels, creams, ointments or powders after showering with the special body wash the night before and the morning of your surgery. ❑ Remove nail polish from your hands and feet. ❑ Do brush your teeth the morning of surgery. ❑ The day before surgery you should practice the coughing, deep breathing, and physical therapy exercises you have learned. You should also practice with your breathing machine (incentive spirometer) several times that day. ❑ Review this booklet
