Preparing for Thoracic Surgery and Recovery

Division of Thoracic Surgery Preparing for Thoracic Surgery and Recovery A Guide for Patients and Families Brigham And Women s/faulkner Hospitals

Important Phone Numbers Important Phone Numbers BWH NUMBERS Main BWH number... 617-732-5500 Main BWH Toll Free Number... 800-722-5520 BWH Page Operator... 617-732-6660 Care Coordination... 617-732-6469 Chaplain Services... 617-732-7840 Center for Patients and Families... 617-732-6636 Thoracic Social Worker... 617-732-5500 Ext 3-2819 THORACIC SURGERY NUMBERS Thoracic Clinic Office... 617-732-6824 Thoracic Clinic Appointment Line... 617-732-7606 THORACIC NURSING CARE UNITS 11A Thoracic Intermediate Care... 617-732-7835 11B Thoracic Intermediate Care Unit-TICU... 617-732-7830 11C Thoracic Surgery Intensive Care Unit-ICU.. 617-732-7750 11D Thoracic Intermediate Care Unit-TICU... 617-732-7840

Table of Contents Table of Contents Welcome... 1 Preparing for Surgery and Recovery... 2 Pre-operative Evaluation... 6 The Day Before Your Surgery... 7 The Day of Your Surgery... 8 Going to the Operating Room... 9 The Post Anesthesia Care Unit... 12 Day Surgery Patients-Going Home... 13 Overnight Patients-Your Hospital Room... 14 Working Towards Recovery... 16 Preparing for Discharge... 21 Recovering at Home... 22 Notes... 23

Welcome Welcome At Brigham and Women s Hospital you are the most important member of the healthcare team. We believe that you can help yourself best by knowing what to expect and by letting us know how you feel during your care. We have made this booklet to help you prepare for your surgery. It has important information about what to do before your surgery and about what to expect after surgery both in the hospital and at home. There is a space for notes in the back. Use it to write down any questions you may have. Please share this booklet with your family and friends. On the day of discharge invite them to join us as we go over all of your discharge instructions. What is the Thoracic Surgery Team? The Thoracic Surgery Team includes your surgeon, anesthesiologists, nurses, surgical residents, Physician s Assistant (PA) staff, care coordinators, nutritionists, social workers, hospital chaplins, and respiratory therapists. In addition to our Thoracic Surgery Team, we have many other services to help you during your hospital stay and recovery. The telephone numbers for these services are listed on the inside of the front cover of this booklet. We re Here to Help... Many patients feel anxious before surgery. This is normal. Please discuss your feelings with your surgeon. You may also find it helpful to speak with a member of our Care Coordination Team or a member of the BWH Chaplaincy Services or the Center for Patients and Families. The Thoracic Clinic staff will be happy to help you contact these departments. Let us know what we can do to help you get ready to go home! Page 1

Preparing for Thoracic Surgery and Recovery What should I do to prepare for my surgery? You can do some things to prepare for your surgery right away. These things are the same whether you are staying in the hospital after surgery or having day surgery and going home. Stop Smoking If you smoke, stop! Not smoking will make your recovery much easier. Speak with your doctor about prescription medicines that can help you quit. Ask your family members to quit smoking Do not let other people smoke in your home or when they are around you. Join a quit smoking program. Stop Smoking Resources The Massachusetts Smokers Helpline The Helpline provides free coaching sessions and written information. Contact the Helpline at: 1-800-Try-To-Stop or 1-800-879-8678 TTY: 1-800-833-1477 Spanish-speaking 1-800-8-Dejalo or 1-800-833-5256 website: www.makesmokinghistory.org/ Quit Tips Line The Quit Tips Line offers a good tip on the phone each day. You can call the tip line 24 hours a day, every day at: 1-800-9-GETATIP or 1-800-943-8284 Page 2

Preparing for Thoracic Surgery and Recovery Stay Active Staying active will help your recovery. Try to walk every day. Walking is a good form of exercise. It will help prevent problems and help you feel stronger and have more energy. Your surgeon will let you know if you need a special conditioning program before your surgery. Plan Now for Your Recovery You will not be able to drive right after surgery. Plan for a ride to and from the hospital. You will also need someone to help you at home during your recovery. It is a good idea to talk about this with family and friends now so that you can set up a plan for later. Planning for Care After Discharge Most patients are able to care for themselves at home after leaving the hospital. However, some will need additional care such as a short stay at a rehabilitation facility. Others may need community services such as a visiting nurse. Talk with your surgeon now about what your care needs may be after discharge. Care Coordination If you do need care after leaving the hospital, your Care Coordination Nurse will work with you, your family, doctors, nurses, and your insurance company to make these arrangements. Whether you are going home or to a facility, you will be given written discharge instructions. They will include information about what happened in the hospital, your progress, and the care and medicines that you will need after your hospital stay. Page 3

Preparing for Thoracic Surgery and Recovery Types of Care Here are some types of care you may have after discharge. Outpatient Pulmonary Rehabilitation Home Care Sub-Acute Rehabilitation and Skilled Nursing Acute Rehabilitation Outpatient Pulmonary Rehabilitation This program may be helpful if you are well enough to live at home without nursing or other services but need therapy to help regain your strength. The Outpatient Pulmonary Rehabilitation Program meets 2-to-3 times a week for 6-to-9 weeks. Each meeting includes a discussion about living with lung disease and an exercise program to help you improve your strength and endurance. Home Care If you go home after discharge, you may need IV medicines, a hospital bed, and respiratory equipment such as oxygen. You may also need physical or occupational therapy. If you do, your Care Coordination Nurse will tell you about the home care agencies and medical equipment companies in your area. Your nurse will arrange for the equipment you need and for a visiting nurse or therapist to come to your home to give you treatments or teaching. Most insurance companies must approve home care services and most policies say that you must be homebound. This means that you are unable to leave your home for care at a clinic or doctor s office. Page 4

Preparing for Thoracic Surgery and Recovery Sub-Acute Rehabilitation and Skilled Nursing This type of care is given in special units at nursing homes or hospitals. Care includes help with wound care, IV medicines, and physical, occupational, and speech therapy. Therapy sessions can last from 1-to-3 hours, and you will see a doctor once a week or more if needed. Your insurance company must approve this type of care. Acute Rehabilitation Hospital A rehabilitation hospital is for patients who are medically stable but may need complicated care to help them recover from surgery. For example, patients who go to this type of facility may need to be weaned from a breathing machine. At a rehabilitation hospital a doctor will visit every day. There will be 3 hours of rehabilitation each day by physical, speech, or occupational therapists. Your insurance company must approve a transfer to this type of facility. Remember! Prepare for Surgery and Recovery... Stop Smoking Stay Active Plan Now for Your Recovery Page 5

Pre-operative Evaluation Visiting the Weiner Center for Pre-operative Evaluation Please come to the Weiner Center for Pre-operative Evaluation at 45 Francis Street on the date and time of your appointment. At this visit, you will finish preparing for your surgery. Plan to spend 2 or more hours at this visit. Make sure you ask any questions that you or your family have. Bring a list with you of all medicines that you are taking. At this time, you will be given final instructions about when and where to check in on the day of surgery. During this visit: You will meet with a nurse who will ask you questions about your health history. You will have a brief physical exam and sign a consent form for surgery. You will meet with an anesthesiologist who will look over your health history. An anesthesiologist is a doctor who specializes in the medicines needed for surgery. Your anesthesiologist will tell you about the anesthesia that will be used. Anesthesia is medicine to put you to sleep. You may have tests ordered by your surgeon such as blood tests, ECG, chest x-ray, or a urine sample. Page 6

The Day Before Your Surgery The Day Before Your Surgery The day before your surgery confirm the time. Call the Thoracic Surgery Clinic between 3 p.m. and 4 p.m. the last business day before your surgery. If your surgery is scheduled for a Monday or for the day after a holiday, call this number on the last business day before the weekend or holiday. The number to call is 617-732-6824. Pack Some Personal Items to Take to the Hospital For an overnight stay in the hospital bring your toiletries, slippers, comfortable walking shoes, and any other personal items that you may need such as eyeglasses. Some patients find that listening to music helps them to relax so you might want to bring a portable radio and headphones. Do not bring any jewelry with you, and do not bring more than $10 in cash. No Eating or Drinking After Midnight Do not eat or drink anything after midnight before your surgery. If you are told to take your usual medicines on the day of surgery, you may do so with a small sip of water. If you take pain medicine, you may bring an extra dose of the medicine with you on the day of surgery. Be sure to tell the Admitting Nurse that you have this medicine with you. Try to get a good night s sleep the night before surgery. Page 7

The Day of Your Surgery Checking In Arrive at the BWH Main Lobby at 75 Francis St. 2 1/2 hours before your surgery. Day Surgery Patients and Families Go directly to the Day Surgery Unit on L1. Patients Staying Overnight Go to the Admitting Office in the Main Lobby to fill out your admission paperwork. When you have finished, our staff will take you and your family to the Bretholtz Center for Patients and Families. This waiting area is where your surgeon will speak with your family after your surgery is over. The Bretholtz Center offers: Comfortable chairs and tables Coffee and tea A business center Leisure activities Private areas to meet with the healthcare team The Kessler Health Education Library When it is time for your surgery, a staff member will take you and your family to the Pre-op Holding area in the Surgical Area on L1. Page 8

Going to the Operating Room The Pre-op Holding Area When you get to the Preop Holding area, check in with a nurse. Next, you will go to a changing room to put on a hospital gown. After changing, your family may wait with you in the preoperative area until your anesthesiologist arrives. You will rest on a stretcher until you go into the Operating Room or OR. A member of the anesthesia team will place an Intravenous line or IV in your arm or hand. This may sting for a few seconds. An IV is a soft flexible tube. It allows you to receive any medicines and fluids that you may need before, during, and after surgery. The anesthesiologist may give you some medicine before you go into the OR. The medicine may make you relaxed and sleepy. While you are in the preop holding area, you will be watched closely by the nursing staff. Please let them know if you need anything. Page 9

Going to the Operating Room Going to the Operating Room When it is time for your operation, the staff will take you into the OR. The staff will help you onto the operating table which is quite firm. The lights will be bright, and the room temperature cool. Small paper electrodes will be placed on your chest so that your heart can be watched. A probe will be placed on your finger to check your oxygen level. Your anesthesiologist may ask you to take some slow deep breaths through a black rubber mask. This will help fill your lungs with oxygen before you go to sleep. Some patients may go to sleep by breathing anesthetic gas through the mask. Your anesthesiologist will use the safest anesthesia for you. When you wake up, your surgery will be over. Page 10

Going to the Operating Room Your Family Your family may wish to wait in the hospital while you are having your surgery. Your surgeon will speak with them after your surgery is over. Day Surgery families may check in and wait in the nearby Day Surgery waiting area. Families of overnight patients may check in and wait in the Bretholtz Center located near the Main Lobby. If your family would like the surgeon to call them after your surgery, please give us the name and number of the person to call. Page 11

The Post Anesthesia Care Unit The Post Anesthesia Care Unit or PACU When your surgery is over, the staff will take you to the PACU. You will stay in this large, open area until you have recovered from the anesthesia. This usually takes a few hours. Although you may be very sleepy, the staff will ask you to do things to help you recover safely and comfortably. The nurses and doctors will be watching you closely and checking your blood pressure and pulse. You will have an oxygen mask on. The staff will ask you to take deep breaths and cough to keep your lungs clear. You will also have a chest x-ray and an electrocardiogram or ECG soon after you arrive. The PACU staff will ask you questions to see how awake you are and to find out if you are having any pain. We want you to be as comfortable as possible. Let the staff know how you feel. Staff may ask you to describe your pain on a scale of 0-to-10. 0 means no pain and 10 means the most. This helps the staff decide on the type and amount of pain medicine you need. 0 1 2 3 4 5 6 7 8 9 10 If your family wishes to visit the PACU, the Family Liaison staff will arrange a brief visit. Page 12

Day Surgery Patients-Going Home Day Surgery Patients-Going Home When you are feeling more awake, the staff will wheel you in your stretcher from the PACU to the Day Surgery Recovery area. Here the staff will watch you closely and keep you comfortable until you are ready to go home. Before going home, your nurse will go over any special instructions that you should follow. If you have any questions about how you are feeling when you go home, please call us. Follow-up Appointment Be sure to call the Thoracic Clinic to make a follow-up appointment with your surgeon. During this appointment, your surgeon will talk with you about the results of any testing done during surgery. If you have any questions about how you are feeling when you go home, please call us. Page 13

Overnight Patients Your Hospital Room Overnight Patients Your Hospital Room The hospital room that you go to after surgery depends on the type of care that you need. The BWH Thoracic Surgery Department offers patients specialized care throughout their hospital stay. The following information tells about the Thoracic Surgery patient care areas. 11C Thoracic Surgery Intensive Care Unit or ICU Your surgeon will let you know if you will need intensive care after surgery. If you do, you will come to the ICU directly from the operating room. You will still be very sleepy. Some ICU patients need a breathing machine to help their breathing for a short time after surgery. You may hear a breathing machine called a ventilator. If you are on a breathing machine, you will have a tube in your mouth and will not be able to talk. Your nurses and doctors will let you know how you are doing. They will tell you what they are doing to help you recover. Your surgeon will let you know when you can transfer to the Thoracic Intermediate Care Unit or TICU. 11A, 11B & 11D Thoracic Intermediate Care Unit or TICU Most Thoracic Surgery patients go to the TICU when they leave the PACU. These patient care units provide specialized nursing care where you will be closely monitored and cared for. As you get close to discharge, your nurse will teach you about what to expect when you go home. Page 14

Overnight Patients Your Hospital Room Visiting Policy Brigham and Women s Hospital welcomes visits from family and friends that support patients and help them feel better. However, it is important that you get the rest you need. Because of this there may be times when the staff asks that your family and friends wait close by in the family waiting rooms. Flowers, Balloons, and Telephones Some patients may not have flowers. Because of this, flowers are not allowed in the ICU or TICU areas. In addition, latex balloons may cause allergic reactions and are not allowed in the hospital. It is probably a good idea to ask family and friends to send these items to you at your home. Patient telephones are available in the General Care rooms only. Page 15

Working Towards Recovery Working Towards Recovery During your recovery, you will be working closely with your health care team. The information below tells you what you can expect and explains some of the goals for your recovery. Your Goals for Recovery 1. Get the right amount of rest 2. Keep your lungs clear 3. Take care of your pain 4. Get out of bed and walk 5. Get your body working again Get the Right Amount of Rest It is important to get the right amount of rest after surgery. We know that this is not always easy in the hospital. There is a lot of activity, especially during the daytime. You will have equipment to watch your heart, blood pressure, and oxygen level. Some of your medicines will be given through pumps which may beep at times. Please know that your healthcare team will plan your care so that you can get as much rest as possible. Page 16

Working Towards Recovery Keep Your Lungs Clear It is important to keep your lungs clear after surgery. The staff will ask you to take deep breaths and to cough. You will also receive chest Physiotherapy, or chest PT. This is a gentle tapping over your lungs. Deep breathing, coughing, and chest PT will help loosen secretions so that you can cough them up. You may have chest tubes after surgery. Chest tubes drain old blood from where you had your surgery. They also help keep your lungs inflated. You will have a chest x-ray each day. This will check the progress of your lungs. It will also let your surgeon know when your chest tubes can be removed. Right after surgery, you will need oxygen. The oxygen will be given through a mask or through prongs that go in your nose. Most patients no longer need oxygen by the time they are ready to go home. Page 17

Working Towards Recovery Take Care of Your Pain Being as comfortable as possible after surgery will help you do all of the things that are needed for recovery like coughing and walking. Any discomfort you have will most likely be near the incisions in your chest. Right after surgery, you may have a very small epidural catheter on your back. An epidural catheter is a way to receive continuous pain medicine. The catheter is a thin flexible tube. It is placed through the back into an area called the epidural space. The catheter is attached to a pump. Pain medicine is given through a syringe, which is attached to tubing and the pump. The amount and type of medicine given by the pump is ordered by the doctor. You will have a button that you can push when you feel like you need more medicine. The Pain Service Team will visit you each day to make sure you are comfortable. Once your chest tubes are removed, you will begin to take pain medicine in pill form. It is important that you take the pain meidcine as prescribed so that you will continue to feel comfortable Page 18

Working Towards Recovery Get Out of Bed and Walk Staying active will help you recover. The staff will help you get out of bed, sit in a chair, and walk as soon as possible. This is usually on the first day after surgery. To make walking easier, we have special walkers with wheels. When you are in bed, you will wear leg wraps. The leg wraps are attached to a device that applies and releases gentle pressure. The pressure helps prevent blood clots from forming. Your nurses will help you with your personal care needs after surgery. To speed your recovery, you will be asked to help as much as you are able. Get Your Body Working Again After surgery, your body will slowly start to work again the way it usually does. Diet At first, you will probably not have much of an appetite. Your nurses will tell you what and when to eat and drink. If you have special diet needs, a member of the Nutrition Services staff will meet with you. It is important to know that the amount of liquids you drink while you are in the hospital will be limited. This will help prevent breathing problems that can happen from drinking too much fluid. The staff will weigh you early every morning to be sure you are not holding fluid. Page 19

Working Towards Recovery Your Bowels It may take a few days for your bowels to start working the way they usually do. You will be given a stool softener to help prevent constipation. Your Bladder You will have a urinary catheter in your bladder for a few days after surgery. A urinary catheter is a soft, flexible tube that drains urine from your bladder and into a bag. While this tube is in place, you will not be able to use the bathroom to urinate. Page 20

Preparing for Discharge Preparing for Discharge After your surgery, your surgeon will speak with you about your discharge plan. You will be discharged from the hospital when: Your chest tubes have been removed You can take care of your pain with medicine taken by mouth You can move your bowels and bladder You are able to move and walk by yourself Your nurse will give you instructions on what to do at home. You will get information about: Restarting your normal activities Taking care of your pain and incision Your diet Preventing constipation Follow-up appointments with your surgeon. We know that it can be hard to remember all of this information. We will give you printed discharge instructions. Please read them after you get home. Always ask about anything you don t understand! The Day of Discharge On the day of discharge, your nurse will go over all instructions and answer any questions you may have. The usual time for discharge is 10 a.m. If you can t get a ride home in the morning, please speak to the Care Coordinator who may be able to help. Page 21

Recovering at Home Recovering at Home Many patients have questions when they get home. It is important to us that all of your questions are answered. Please call if you have any concerns about the way you are feeling or do not understand any of your instructions. Our phone numbers are on the inside front cover of this booklet. Shortly after you return home, we will call you. When we call, we will ask you a few questions about how you are feeling, your pain, and your activities. Remember to keep your follow-up appointment with your surgeon. At this visit, your surgeon will examine you and discuss your recovery. Let us know what we can do to help you get ready to go home! If you would like to speak directly to your surgeon at any time, feel free to contact your surgeon through the BWH Page Operator. Just call 617-732-6660, and ask the operator to page your surgeon. Page 22

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