My 39 y.o. step-son has just been diagnosed with an ascending aortic aneurysm and bicuspid aortic valve.
He is scheduled for surgical repair of both next week. The valve replacement will be mechanical.
Since he had just begun a new job and therefore has no insurance, he will be medicaid.
In our area getting home health coverage for a medicaid pt. is very difficult.
I am a hospice nurse and am trying to prepare other family members for what to expect after d/c. I do understand he will be anti-coaged for life and what that entails.
Can anyone share with me what the usual cardiac rehab course is like.
He is otherwise healthy and this has been quite a surprise. Ironically, the aneurysm was found during a total body scan because of a hit and run motorcycle accident last week end. Musta' been a God wink.
Thank you for your time.
Jun 5, '11
I speak from experience as a tele nurse. We are the nurses that get patients usually a day after surgery and discharge the patient home. Generally patients will stay about a day in the SICU to be monitored and weaned off of the drips. Tele floors usually have ACLS nurses, though, that are drip certified. I was drip certified, so in case of hemodynamic problems, they are still prepared. Cardiac rehab is difficult and depends on the patient for how long it will last. I have seen as few as 4 days to months, with the average being about a week. No matter what reason for opening the chest cavity, whether it be for a valve repair or to do an open heart bypass surgery, they will need to place chest tubes. This means the chest's negative pressure is lost, therefore they need a way to drain the draining blood while the chest heals. This has to be drained because otherwise it places pressure on the chest cavity and the lungs can collapse. The best way to get rid of the chest tubes is to do Incentive Spirometry RELIGIOUSLY!!!!! It will hurt to do the IS becaquse the chest tubes poke a little bit, but it is so important. One tip is to make a notpad so he can keep track of his own progress. It is a big motivater for them to put a simple x on a piece of paper. As we know in nursing, it is so important to give the patient autonomy and independance. IS is important bc prevents "atelectasis" which is a big problem. This can actually cause fluid to build up in the lungs just from the normal process of breathing, and when there is fluid in the lungs that shouldnt be there, bacteria like to live there. Thus begins the problem of pneumonia. Chest tubes are uncomfortable, even if their is minimal incisional pain, they poke when doing T/C/DB but it is so important to do I. But once they come out, recovery period is usually much more comfortable and smooth. Nurses will titrate your son off of pain meds only as he is ready. Just keep in mind that it can be difficult to find the right combination of pain medication that works. Mds are reluctant to keep people on strong opioids because it causes the decreased respiratory drive, therefor increasing the risk of atelectasis and pneumonia. There is some discomfort involved that can't be avoided, but the simple fact is he has a huge advantage in having you. My best advice, and the advice the doctors and nurses will tell him is to keep moving after surgery, even if it is just his toes. Keep moving, and make sure that he does get good rest (ie limit visitors even ones that sit in the waiting room bc it is emotionally draining for patients to have to worry about others). The big thing is to get the blood flowing again and prevent blood clots. While in the hospital, no matter if the patient is in for pneumonia or for open heart, they are anticoagualted. If the heart valve is mechanic, anticoagulation is also indicated. I am sure you have heard horror stories about people being on coumadin and having bad experiences, but it is really necessary because the problems of blood clots are fatal. The nurses will teach proper precautions before discharging your son about all of this stuff. I would be happy to answer any other questions. Good luck and may God protect your stepson in his surgery. I apolgize that this posting is somewhat muddled, my keyboard has keys that get stuck!
P.S. I should also say that the "usual" day in rehab involves therapies like physical therapy teaching him how to get out of bed using a heart pillow (he wil not be able to grab anything to pull himself up, one gets out of bed by holding a pillow to the chest and moving using body weight), occupational therapy, and of course nursing. A lof of the therapy involves doing "normal" stuff, like getting in and out of bed, walking, how to eat healthy. Our goal is always to get the patient to be self-motivated to walk on their own, etc. In the beginning nurses, therapists, and therapists assistants will be there to be cheerleaders and coaches. Positive attitude and good spirits are so important in nursing and in life
Last edit by emilyBABSNRN on Jun 5, '11
Jun 5, '11
Oh yeah we cardiac nurses take pooping VERY seriously
It is really common with all of the anesthesia meds, narcotics, and just general response of the body to get plugged up. The natural stress response causes blood to be shunted away from our guts and toward our vital organs (heart)...therefore things definitley slow down. Straining to poop causes as vasovagal reflex...which includes bradycardia and sometimes worse things. SInce the heart has just been manipulated, it is really touchy. Thinkof it like a cranky heart, it has to be treated with extra TLC and it gets its feelings hurt really easily
NO STRAINING!!! t always weirds the young ones out when the nurse asks incessently "are u passing gas?" Actually we do listen to bowel sounds, but current Evidence says that this does not matter and that the true GI integrity returns when tooting starts
It's also really really important he eat good protein and drink lots of water. If it doesnt eat, nothing can come out, and the repairs they just did will not take as well. Nothing ****** a cardiothoraic surgeon off the most as someone who know doesnt do IS, doesn't walk, and doesnt eat. Believe me, I have seen these surgeries...it is HARD WORK! About the diabetes, I have never in my 2 years of being on a tele floor had a young patient go home on insulin unless they were overweight and probably borderline diabetic before surgery and didn't know. And a few things that might be of some comfort...although it is not too common, I have had patient in the late 30s and 40s that have needed open heart surgery...some with freakishstrains of the parainfluenza infections that destroyed their heart and other young people that have the genetic predisposition for atherosclerosis and therefore needed bypass an pacemakers. Additionally, I was told by a cardiovascular sugeron that many many people walk around with disecting aortic aneurysm and never find out. They said it's not uncommon for you to "have a leak"
Thank God he found out this early
Last edit by emilyBABSNRN on Jun 5, '11