Discharged: Time to Go Home

Patients are discharged and ready to go home once the cardiologist gives their consent. Many parents are nervous about taking their child home. This is perfectly normal. The nurses and staff of H4A do a great job of giving home care instructions. Many times we have parents practice giving medication, CPR, home incision care and picking up their child. Adults and teenagers may have lifting and driving restrictions.

At Discharge

Upon discharge, a nurse or doctor will give you instructions about prescription medications and what to do if a fever or discomfort occur.

A member of the Heart Center staff will contact you about one week after being discharged from the hospital. In addition, you will have a follow-up appointment with the cardiologist, usually one to three weeks after you are sent home from the hospital. A member of the Cardiothoracic Surgery staff will evaluate the incision at this visit. You/Your child will be asked to send a picture of your/your child’s incision approximately 30 days after the surgery. Additional wound care instructions will be given at that time.

Wound Care

• For incisions covered with glue, wash incision with soap and water daily until glue falls off. For incisions covered with a bandage you will be given instructions on when to remove bandage.
• Keep the incision and chest tube sites clean and dry. A tub bath or shower may be permitted, but do not soak the wound in water until it is healed and scabs are gone.
• If Steri-strips are still present when you leave the hospital, you will need to remove them seven days after surgery. A clean band-aid may be placed over the chest tube site. Change it at least once a day.
• Protect the wound from direct sunlight. When outdoors, a T-shirt should be worn and use sun block with at least SPF 15 for six months to minimize scarring.
• Do not use creams or lotion on the wound.
• You will need to check the incision daily for signs of infection – redness, swelling, thick pus-like drainage, fever or increasing pain at the incision. Sometimes the incision or chest tube hole will drain a thin, clear to yellow liquid which will usually subside in a few days. If you aren’t sure about the drainage or possibility of infection, call the Cardiology triage line at (614) 722-2530 and one of the surgery NP’s will give you instructions.
• Avoid saunas and hot tubs for 6 weeks.

Activity

• Patients can be up and about whenever they feel ready. Plan some quiet activities and games when your child first arrives home. Kids may be uncoordinated or confused up to 24 hours following surgery and anesthesia, so ease them back into their usual activities.
• No swimming, driving, biking, riding or climbing toys are allowed until after your follow-up appointment with the cardiologist or surgeon. During your appointment, activities will be re-evaluated.
• Playing outdoors is fine, but large public areas with crowds should be avoided for six weeks.
• Adults who live alone should arrange for a family member or friend to stay for about a week to help you out with household activities, especially to help with meal preparation. Do not expect to take full responsibility for household activities for 6-8 weeks after your surgery. By 3-4 weeks after your surgery you can do light household duties (dusting, setting the table), but only if you feel strong enough. Heavy work like laundry, lawn mowing and vacuuming should be avoided for 6-8 weeks.
• Your child should not go back to school or childcare until after your follow-up appointment.
• Let siblings know that their brother or sister will need to take it easy when they first come home.
• A new book or toy can make coming home a celebration.
• Some infants are uncomfortable being picked up under their arms. Please check with your doctor for any special instructions on holding your child.
• Teenagers may have restrictions on weight limits of their school books or backpacks and in gym class.
• No heavy lifting: You should not lift anything heavier than 10-20 pounds for 6 weeks after your surgery. Heavy lifting will put a strain on your healing breastbone (sternum). This includes children and pushing heavy objects. You should not lift more than 50 pounds for 6 months after your surgery.
• Adults are not allowed to drive for 6 weeks after surgery.
• Recovery may take anywhere from 6-12 weeks depending on your age and how active and healthy you were before surgery.

Nutrition

A regular diet of heart-healthy foods is recommended. Foods high in sodium should be avoided.

Behavior Changes

Children of all ages may behave differently after surgery. Young children may need more attention and may act cranky and demanding. They may have nightmares, poor appetites and bathroom accidents. Older children may regress, test limits or become withdrawn or clingy. These changes are normal, especially for young children who have limited ability to understand and talk about their operation. For most children, behavioral changes after an operation are temporary, lasting a week or two at the most. However, if their behavior worries or concerns you, call your surgeon’s office.

Some days, older patients may feel more emotional than other days. Frequently patients may feel depressed after surgery. You may feel that you cry more easily and for no reason. Other patients state they felt more irritable, impatient and angry. These feelings may be directed to the people who are nearest you. These mood changes are all common. Also, you may experience changes in your sleep patterns, recurring dreams, difficulty concentrating and temporary forgetfulness. These common mood changes may be bothersome but should diminish as you recover.

Sometimes family members experience mood changes also. Your family members may have experienced a range of emotions including fear and anxiety related to your surgery and your recovery. Being honest and open with each other about your feelings may help both you and your family members.

Rest and Relaxation After Surgery

Even little every day activities are work for your body after major surgery. Take things slowly and one day at a time. Attempt to get a good eight hours of sleep a night and try to take a couple 30-60 minutes rest or naps per day especially the first week at home.

Once you are home try to follow a routine every day. As your strength increases you may enjoy going out to dinner or short shopping trips. Your body will tell you when you need to slow down or it’s ready for more exercise. We aren’t all the same, so remember, everyone recovers at a different speed.

Support Your Child’s Return to a Normal Routine

• Be understanding
• Set gentle limits
• Encourage independence
• Give them opportunities to play and talk about their operation