With our revolving door syndrome where I work...The stress test is the pre exercise and the walk home is the post...Oh and you really don't want to eat the hospital food...really.
May 15, '02
Almost 60% of our cabgs are inpatient/post MI. They walk in the door, have a cath and go to surgery. There is very little screening done for nutrition or exercise pre procedure. At the time of hospitalization, it's probably not a priority. This is an issue of community ed. But, since no one thinks it will happen to them, they don't listen to the information that they have already. Unfortunately, that make this issue almost purely tertiary
Jun 14, '02
In our facility we concentrate mainly on ability post -op, cardiac rehab and the dieticians work with the patients pre and post op. All the post op open heart patients work with cardiac rehab, and 70% of the patients work with the dieticans if indicated. On the second day post op our patients are to exercise 5 times a day if able. It is part of our strict cardiac rehab program. It is of course a good idea to know what there pre-op ability is and that is part of the assessment and teaching also. Most of the patients leave by the 5th POD, with the exception of the 80yr olds.
Jul 8, '02
ALL post cabg pts have dietician and pt consults. Ambulation begins either same day or next day (if late) of extubation and then done QID or greater (portable suction machine allows ambulation with CT's) and a Dietician sees pt again before d/c for NAS diet instruction and many a patient attends cardiac rehab following d/c.
Aug 25, '02
There was research done in Scotland a couple of years ago into the care of patients on the waiting list for CABG. They showed that with a significant number of patients that dietary advice, help with reducing or quitting smoking and regular exercise classes that patients that were 'fitter' going in to their operation recovered more quickly. There were 2 patients in this research who had repeat angios pre-op who were found to have reversed their atherosclerosis to such an extent that they no longer required an operation.... pretty cool.
If you want the reference I should be able to find it in a couple of weeks..... waiting to move into a new house and everything is boxed-up and in storage apart from the computer!!
Sep 22, '02
We sit our patients on the side of the bed within 4 hours of extubation (usually day of surgery), then once or twice more (4 hrly) before getting in the chair the frist time on morning of day 1. We walk them 30 metres twice on day 1, increase that daily, and they do stairs on day 4, by which time they can walk as much as they want. Usually home on Day 5, with physio booklet for progressive ambulation. Physio usually sees them once a day while in hospital, more if necessary for bad chests, but most of the ambulation and physio is done by the nurses.
Nothing special nutrition-wise - progress from clear fluids to full diet as they tolerate. When eating normally, at home, they have instructions for low fat diet. Dietician consult for diabetics or special problems.
Sep 29, '03
Our facility has a wonderful in-patient cardiac rehab program. Patients are seen pre-operatively (if possible) and then again on the first post-op day. They are seen 2-3 times daily until discharge. On each visit, the patients walk with the rehab staff. They are also taught about exercise post-hospital, diet, smoking cessation, incision care, medications, and any other concerns. Patients are also seen by the dieticans post-op.