Download Inova Heart and Vascular Institute

Inova
Heart and Vascular Institute
Patient Resource Handbook
Special Thanks
Inova Heart and Vascular Institute physicians, staff and administrators would like to
thank Barbara Wynne, whose generous contribution and ongoing support have
made this Patient Resource Handbook possible.
Table of Contents
Section I.
WELCOME TO INOVA HEART AND VASCULAR INSTITUTE
Letter from Administrative Team................................................... 1
Letter from Patient Care Directors................................................. 2
Location and Directions.............................................................3-4
Visitor Information.....................................................................5-6
Keeping Your Healthcare Safe and Effective............................ 7-10
Rapid Response Team................................................................... 10
Tips to Avoid a Fall...................................................................10-11
Heart Disease and Treatment Options................................... 11-14
Section II. PREPARING FOR SURGERY
Pre-surgical Instructions and Information.............................15-17
Thinking Ahead to Discharge.................................................17-18
Surgical Infection FAQs................................................................ 19
Welcome to the CVOR................................................................. 20
Welcome to the CVICU........................................................... 21-22
Welcome to the CVSDU..........................................................23-24
Section III. RECOVERING FROM SURGERY
Cardiac Surgery Plan of Care..................................................26-27
Sternal Precautions....................................................................... 28
Incision Care................................................................................. 29
Resuming Daily Activities.......................................................29-30
Medications............................................................................. 30-31
Scheduling Follow-up Appointment............................................31
Section IV. RETURNING HOME
Preparing in Advance................................................................... 32
What to Expect.........................................................................32-33
What to Do If…............................................................................ 33
Recovering Heart Home Plan...................................................... 34
When to Resume Your Usual Activities....................................... 35
Wellness Works Guidelines.......................................................... 36
Survival Skills...........................................................................37-38
Section V. LIVING A HEALTHY LIFESTYLE
Risk Factors for Heart Disease..................................................... 39
Healthy Lifestyle Changes....................................................... 39-41
Cardiac Rehabilitation............................................................ 41-44
How to Quit Smoking.................................................................. 45
Heart Healthy Nutrition.........................................................46-50
Section VI. OTHER RESOURCES
Inova Diabetes Center.............................................................52-53
Mended Hearts........................................................................54-55
Important Phone Numbers......................................................... 56
Web Resources.............................................................................. 56
Section VII. PATIENT NOTEBOOK
Section I: Welcome to Inova Heart and Vascular Institute
Dear Patient:
Welcome to Inova Heart and Vascular Institute at Inova Fairfax Hospital, the only facility in the
region dedicated exclusively to cardiac care. As a leader in cardiovascular services, we move beyond
the traditional role of “curing” heart disease, to focus on prevention, early detection and lifestyle
modification. Our world-class surgeons, nurses and healthcare professionals provide the full spectrum
of cardiac services, backed by state-of-the-art technology, to ensure the best possible outcomes.
We are pleased to provide you with this patient handbook, which includes general information and
guidelines about what to expect before, during and after your cardiac surgery. Please keep it with you
during your hospital stay, as your physicians, nurses and other members of your care team will refer to
its contents. The handbook provides space for you and your family members to take notes and write
down questions, as well as a convenient pocket folder to store your caregivers’ business cards and
contact information.
We hope you find this handbook helpful, but please remember it is intended only as a guide and
should never replace instructions or information from your physician.
Thank you for selecting Inova Heart and Vascular Institute for your heart surgery. Our physicians,
nurses, and staff have a commitment to provide excellent cardiac care. If you have any questions or
concerns or would like more information, please feel free to ask a member of your healthcare team.
Sincerely,
Patrick Christiansen, Ph.D.
Chief Operating Officer, Inova Fairfax Hospital
Senior Vice President, Inova Health System
Alan Speir, MD
Medical Director, Cardiac Surgery, Inova Health System
Patricia Knowles, BSN, RN, MS, CNOR
Administrator, Cardiovascular Services, Inova Heart and Vascular Institute
Maggie Perih, RN, MSN, NE-BC
Senior Director, Cardiovascular Services, Inova Heart and Vascular Institute
Staff of Cardiovascular Intensive Care Unit and Cardiovascular Stepdown Unit
1
Dear Patient:
Welcome to the Cardiovascular Operating Room (CVOR), Cardiovascular Intensive Care Unit
(CVICU) and Cardiovascular Stepdown Unit (CVSDU) at the Inova Heart and Vascular Institute at
Inova Fairfax Hospital.
Our team of dedicated and compassionate health professionals is committed to providing you with
excellent care and service, and making your patient experience as pleasant as possible.
During your stay with us, you and your family can expect courteous and professional treatment, a safe
and comfortable environment, frequent communication, outstanding teamwork among physicians,
nurses and staff, and personalized attention that meets your needs.
Here are three specific ways we accomplish these goals:
• P
atient safety is our top priority. We will frequently check your identification, including your
name and medical record number, to ensure your safety.
• Hourly rounding helps us anticipate and meet your needs. If you require anything we have not
provided, however, or you need us for any reason, please let us know by ringing your call bell.
• Our Rapid Response Team (RRT) is a tool our patients and their families can use when they
feel they need immediate attention beyond care being provided. If you or your loved one needs
to access our RRT service, please call ext. 4260.
• Patient representatives are always available and can address any special needs or concerns that
may arise. To reach a patient representative, call 703-776-3663, or ask a member of your care
team for assistance.
Members of your care team are always available to answer questions or discuss concerns. Please don’t
hesitate to ask! Additionally, you may contact us directly at the telephone numbers listed below.
It is our pleasure to provide you with excellent care and service during your stay. Thank you for
choosing Inova Heart and Vascular Institute.
Sincerely,
Maggie Perih, RN, MSN, NE-BC
Senior Director, Cardiovscular Services, Inova Heart and Vascular Institute
2
Location and Directions
to reach the main reception desk at Inova Heart
and Vascular Institute.
Inova Heart and Vascular Institute at Inova Fairfax
Hospital is located just off the Capital Beltway
(1-495) and Route 50 (Arlington Boulevard) on
Gallows Road in Falls Church, VA.
Parking
Patient and visitor parking is available in the
Gray Garage, which connects to the Inova
Heart and Vascular Institute. There is a nominal
parking fee, but special discounted parking
permits are available to visitors, patients and
senior citizens (60 and older). Ask the parking
attendant for more information.
Inova Heart and Vascular Institute
3300 Gallows Road
Falls Church, VA 22042
For step-by-step photographic directions to the
Inova Heart and Vascular Institute, visit our
Web site at www.inova.org/ifhmaps and click
on Building 1. You also may call 703-776-7064
Inova Fairfax Hospital Campus
(Arlington Blvd.) Route 50
8505
8503
8501
OUTPATIENT CENTER
8503 Arlington Blvd., Suite 200
GARAGE
CLAUDE
MOORE
CENTER
GE LAB
SUPPORT
SERVICES
IFH/IFHC
SURGERY
CENTER
MAIN OR
VALET
UNDER
CONSTRUCTION
UNDER CONSTRUCTION
3
Inova Heart and Vascular Institute Floor Plan
Second Floor
4
Visitor Information
Soda, juice and snack food vending machines
are located throughout the hospital.
Visiting Hours
Spiritual Support
• Visiting hours vary by unit, so check
with a member of the patient’s care
team for specific information.
We support the spiritual needs of our patients
and their family members. Care is available to
people of all faiths as well as those who have
no religious affiliation. Our volunteer staff is
made up of lay and clergy volunteers from every
major faith group. Trained chaplaincy volunteers
are available for spiritual support through
compassionate presence, conversation or, if
requested, prayer and sacrament. In addition, lay
and ordained chaplains are on-call to respond to
medical crises 24 hours a day, seven days a week.
• On most units, there is a limit of two
visitors per patient.
• On most critical care units, visitation is
limited to immediate family only.
• Many units restrict visits by children
under 12.
• Visitors may be required to check in for
a visitor’s pass prior to visiting the unit.
• Please DO NOT VISIT if you have
symptoms of a cold, flu or other
infectious disease.
Our hospital chapel is located on the first floor
of the Tower Building, adjacent to the lobby and
is open 24 hours a day, seven days a week for
patients, family, friends and staff.
At Inova Heart and Vascular Institute, our goal is to
provide a quiet environment that promotes rest and
healing. As such, all patient care areas are considered
“quiet zones.” When visiting, please respect the
needs of all our patients for rest and privacy.
For more information about our Chaplaincy
Services or to request a chaplain visit, please call
703-776-3767.
Gift Shops
Food and Beverages
A gift shop is located in the Inova Heart and
Vascular Institute lobby, featuring an array of
items including newspapers and magazines,
cards, fresh flowers, jewelry, apparel, toys,
snacks and personal care items. Gift shops are
also located in the Tower and Inova Fairfax
Hospital for Children lobbies.
Visitors to the Inova Heart and Vascular Institute
may eat in the Heart Healthy Cafe (first floor
IHVI), Skylight Café (basement level, Tower
Building), or Park Avenue Deli (Tower Building
Atrium). Take-out food is also available from
each of these venues. The Skylight Café is open
24 hours a day for soup, sandwiches, salads,
snacks, beverages and other light fare.
ATM
Automated teller machines (ATMs) are located
across from the gift shop in the Inova Heart
and Vascular Institute lobby, in the Tower and
Inova Fairfax Hospital for Children lobbies,
and outside the Skylight Café.
Coffee carts, offering a variety of gourmet
beverages and baked goods, are located in
the Inova Heart and Vascular Institute lobby,
the Tower Lobby, the Inova Fairfax Hospital
for Children lobby and the Emergency
Department waiting area.
5
Overnight Accommodations
More Patient and Visitor Information
We have negotiated special room rates and
services for patients and family members at
nearby hotels and motels. A complete listing
is available in the front pocket of this binder,
at the information desk in the Inova Heart
and Vascular Institute lobby, as well as other
information desks throughout the hospital.
Comprehensive patient and family information
is available on our Web site, www.inova.org.
Inova Heart and Vascular Institute
at a Glance
As the region’s only comprehensive cardiac
care facility, Inova Heart and Vascular Institute
combines innovation and state-of-the-art
technology with a healing environment to
provide for all patient needs under one roof.
The facility features:
Cell Phone Use
While inside the hospital, cell phones must be
off or kept more than five feet from medical
equipment. You may use your cell phone anywhere
outside the hospital (except in the Inova Fairfax
Hospital for Children pediatric courtyard/play area,
and the Inova Heart and Vascular Institute Healing
Garden), and in all lobbies, hallways, waiting areas,
cafeterias and administrative areas where there is no
medical equipment.
• 204 patient rooms, the majority of
which are private
• 42 intensive cardiac care beds
• six operating rooms, including an
uniquely designed hybrid room
that will allow cardiac surgeons,
electrophysiologists and cardiologists
to operate together on a patient.
When using your cell phone in the hospital,
please be mindful of others. Keep your
conversations as brief, and as quiet, as possible.
• six catheterization labs
For your convenience, pay telephones are
located on the Inova Heart and Vascular
Institute ground floor, across from the gift shop
and outside the family/visitor waiting rooms
on the first, second and third floors.
• three electrophysiology labs
Smoking
• cardiac rehabilitation
To promote healthy living, Inova Health System
does not allow tobacco use in its buildings or
on its grounds. Inova is proud to support a
no smoking, tobacco-free setting and offers a
helpful program to those who want to stop using
tobacco. For more information on this program,
please ask your nurse or call Inova HealthSource
at 1-855-My-Inova (1-855-694-6682).
• patient and community wellness
programs
• one combination catheterization/
electrophysiology lab
• outpatient cardiac services
• noninvasive cardiac services
• education and conference rooms
• heart-healthy café
• rooftop garden for patients and staff
• a unique healing environment to
enhance emotional, psychological and
physical recovery
6
Keeping your Healthcare Safe and
Effective
• C
onsent to or decline participation in
research studies or media recordings
• Access information, request amendments
to, and receive an accounting of
disclosures of your health information
At Inova Heart and Vascular Institute, we consider
you an active partner in your hospital care. When
you are well-informed about treatment decisions,
and communicate openly with your physician
and healthcare team, you help make your care
as safe and effective as possible. Take a moment
prior to your surgical procedure to read the
following information concerning your rights,
responsibilities and care options while a patient
at Inova Heart and Vascular Institute.
• B
e free from unnecessary or
inappropriate restraints
• Be free from all forms of abuse or
harassment
• Receive hospital services without
discrimination on the basis of any
factor prohibited by applicable law
If you have questions or concerns, please
discuss these with any staff member or contact
the patient representative at 703-776-3663.
• Interpreter services at no cost
Patient Responsibilities
As a patient, you are responsible for the following:
Overview of Patient Rights
• Providing complete and accurate
information about your health,
including past illnesses, hospital stays,
use of medications and other matters
relating to your health
While you are in our hospital, you have certain
rights as a patient. You have the right to:
• Courteous, respectful care
• Effective communication
• Asking questions when you do not
understand what you have been told about
your care or what you are expected to do
• Information about your health and care
• Make informed decisions
• Participate in your care plan
• Telling your doctor if you believe you
cannot follow through with your treatment
recommendations, and understanding the
possible outcomes if you elect not to follow
the advised treatment plan
• Consent to or decline treatment
• A
ppropriate assessment and
management of pain
• K
now the names and titles of your
healthcare providers
• Being considerate of other patients, staff
and hospital property, and following
hospital rules and regulations (we ask
this of your visitors as well)
• Safety and privacy
• Confidentiality
• Contact the patient representative
• P
roviding necessary information for
insurance claims and for promptly
assuring that the financial obligations
of your healthcare are fulfilled
• Have a family member or
representative, and your physician,
notified of your admission
7
Rights and Services for Individuals with
Special Needs
Speak Up! Help Keep Your Healthcare Safe
At Inova Heart and Vascular Institute, patient
safety is our number one priority. Become a
more active, involved and informed member of
your healthcare team by:
When serving individuals with special needs,
Inova Heart and Vascular Institute continually
strives to meet the requirements of the Americans
with Disabilities Act and the Virginians with
Disabilities Act. If you or a visitor encounter any
physical or communication barrier during your
time at our hospital, or believe you have been
denied access to any of the hospital’s services
because of your disability or special need, we
encourage you to speak to members of your
healthcare team or their supervisor, or access our
Patient Relations Department at 703-776-3663.
S
P
Services for the Deaf and Hard of Hearing
To ensure effective communication with patients,
their family members, and companions who are
deaf or hard of hearing, we provide auxiliary aids
and services free of charge, such as:
E
• Sign language and oral interpreters
K
A
• Telecommunications typewriters for the
deaf or hearing impaired (TTY/TDD)
U
• Video remote interpreting (VRI) enabled
with point-to- point video calls (VRS),
text functionality (TTY), and access to
the national relay service (711)
P
• Written materials
electing, in partnership with your
physician, a hospital or healthcare
organization (such as Inova) that has
undergone a rigorous onsite evaluation
for established state-of-the-art quality
and safety standards, such as that
provided by The Joint Commission.
aying attention to the care you are
receiving and making sure you are getting
the correct treatments and medications.
ducating yourself about your
diagnosis, your medical tests and your
treatment plan.
sking a trusted family member or
friend to be your advocate.
nowing what medications you take
and why you take them.
nderstanding what is happening
to you and asking questions about
anything that is unclear.
articipating in all decisions about
your treatment.
• Telephone handset amplifiers
Remember, you are the center of your Inova Heart
and Vascular Institute healthcare team!
• Assistive listening devices (marketed as
Pocketalker)
Here are some specific ways you can help keep
your healthcare safe:
• Telephones compatible with hearing aids
• Always identify yourself. Each time you
receive any medications, treatments or
procedures, identify yourself. Make sure
your caregiver knows your full name
and checks your armband or chart to
double-check your identity.
• Open and closed captioning of most
hospital programs.
Please ask your nurse or other hospital personnel
for assistance, or contact 703-776-7641.
8
• Be safety conscious. If you are having surgery,
ask your physician to mark the area that is
to be operated on, so there is no confusion
in the operating room. If you have any
safety concerns, tell your physician, a nurse
or Inova Heart and Vascular Institute staff
member immediately.
• Choose an advocate. Ask a family member
or trusted friend who knows your care
preferences to be with you for important
medical decisions. This person can identify
you, ask questions you may not think of,
review medical consent forms, and convey
your wishes about resuscitation
• Be health conscious. Please help us doublecheck our processes to prevent the spread
of infection. Ask your caregivers if they have
washed their hands prior to giving you care,
and encourage the use of gloves.
• Encourage medication safety. Before taking
any medication, be sure your caregiver
knows you are the correct patient to receive
it. Be sure you know the name and potential
side effects of any medication before you
take it. If it is unfamiliar, ask what it is and
why you are getting it. Tell staff about any
allergies you have before taking medications.
If you are taking prescriptions home, be sure
they are legible. If you can’t read them, your
pharmacist probably can’t either.
• Know your caregivers. Ask the name
and title of any Inova Heart and Vascular
Institute staff member caring for you. Don’t
be shy about asking your physicians, nurses
and other caregivers about their specialized
training and experience.
• Know your hospital. Ask how frequently
Inova Heart and Vascular Institute
performs the procedure you need or treats
your type of illness, and what specialized
care is provided to help you get well.
Ethics Consultation
Today’s healthcare decisions can be very complex
and often must be made at a time when it is
difficult to communicate your wishes. Family
members who have responsibility for such
decisions may be confused about their effects.
• Ask questions. Healthcare procedures
are often complicated and difficult
to understand. If you are confused or
unclear about something, don’t be
afraid or embarrassed to ask questions
until you have the answers you need.
The Inova Heart and Vascular Institute Ethics
Committee can help you and your family deal
with these concerns. The committee offers
consultation services to assist patients, families
and hospital staff in formulating an appropriate
plan of care. Its role is advisory only, helping
to clarify issues and ease the decision-making
process. None of those involved is bound by the
suggestions discussed.
• Write it down. Ask for written information
you can keep about your condition,
the specialized care you receive, the
procedures you have and your care plan.
• Understand before you sign. Be sure you
understand and agree to any treatments
before signing medical consent forms.
Don’t be afraid to ask for a second opinion
before deciding what is best for you.
If you and your family would like to meet with
the Ethics Committee, ask your nurse or call
the hospital operator by dialing “0.”
9
Advance Directives
• The RRT should be called if your onduty nurse is not immediately available
when a medical change is noticed.
As an Inova Heart and Vascular Institute patient,
you have the right to create an advance directive,
which helps ensure that your healthcare choices
are followed in the event you are unable to
communicate those choices to your caregivers.
• The Rapid Response Team serves as
an additional resource for immediate
medical assessment and care. You can
call on them whenever you have a
concern with the patient’s condition or in
understanding what care is being offered.
A living will allows you to state the types of treatment
you do or do not wish to receive following the
diagnosis of a terminal condition. Your physician is
required to honor your directive within the limits of
the law. We encourage you to talk to your physician
about these issues prior to your surgery, so you can
make more informed decisions.
• Inova Fairfax Hospital is committed to
providing the highest quality of care. With
patient and family access to the Rapid
Response Team, patients can now actively
participate in their own medical care.
A durable power of attorney for healthcare lets you
legally appoint a relative or close friend to make
healthcare decisions for you if you are unable
to do so. These decisions could include making
anatomical gifts (organ and tissue donation).
To call the Rapid Response Team, dial
703-776-4250 and provide voicemail with your
details and the team will be immediately paged.
Tips to Avoid a Fall
To Our Patients and Families:
For more detailed information about advance
directives, ask your nurse for a copy of “Your
Right to Decide.”
Illness and/or medicines can affect your ability
to move and can put you at risk for falls. To
avoid a fall while in the hospital, please follow
these suggestions from our nursing staff.
Rapid Response Team (RRT)
• Our Rapid Response Team (RRT), staffed
by physicians, nurses and other clinicians,
provides immediate medical assessment
and care to patients experiencing a
noticeable change in their condition.
Always:
• Wear good fitting, non-skid footwear
and walk slowly.
• Wear your eyeglasses.
• Available 24 hours, the Rapid Response
Team is always accessible. The RRT nurse
can be at the patient’s bedside in less than
ten minutes for the initial assessment.
• Use your cane, walker or other personal
assistive devices.
• Plan regular trips to the toilet to avoid
the need to rush.
• Since 2005, Inova Fairfax Hospital clinicians
have called on the Rapid Response Team
to provide additional, immediate medical
assessments of patients. Now, patients and
their family members can request that same
team to their loved-ones’ bedside.
• Ask for help getting out of bed if you
feel weak, dizzy or light-headed.
• Ask to have your bedside table, telephone,
and call bell/light, within your reach.
10
• prompt, efficient treatment is key to
surviving a heart attack
• Use the call light in the bathroom if
you need help getting back to bed.
• Call the nursing staff if there is a spill
on the floor.
How Is a Heart Attack Diagnosed?
• electrocardiogram (EKG), to measure
electrical activity in the heart
• Keep the night light turned on in your room.
Remember: We are here to help you and we are only
a call away.
• blood tests, to measure level of cardiac
enzymes
Heart Disease and Treatment Options
• echocardiogram (ultrasound), to measure
heart size, pumping strength and damage
Heart disease can involve any and all parts
of the cardiovascular system, including the
myocardium (heart muscle), coronary arteries,
heart valves, conduction (electrical) system and
pericardium (sac surrounding heart). Treatments
range from traditional surgical methods to stateof-the-art minimally invasive techniques.
Heart Attack Warning Signs
Call 911 immediately if you experience any
combination of these symptoms. Do not delay!
Do not drive yourself to the hospital; do not
have a friend drive you. EMS has the emergency
medical equipment you need and can begin
treatment on the way to the emergency room.
How Does the Heart Work?
• intense and/or prolonged chest pain,
pressure or discomfort lasting more
than a few minutes
• the myocardium pumps blood to all
body tissues
• the right atrium receives blood from
the body for oxygenation
• discomfort radiating to the left or right
shoulder, left or right arm, neck, back,
jaw or ears
• the left ventricle pumps oxygenated
blood back into body
• four heart valves keep blood moving
in one direction, opening and closing
with each heartbeat
• prolonged upper abdominal pain
• the coronary arteries carry oxygen and
nutrients to the myocardium
• fainting or loss of consciousness
• pounding heart or palpitations
• shortness of breath
• nausea or vomiting
• the conduction system controls heart
beat, stimulating the heart to contract
and pump blood
• sweating
• abnormal skin color
• frequent angina not due to physical or
emotional exertion
What Is a Heart Attack?
• a heart attack occurs when oxygen-rich
blood can’t get to part of the heart muscle
• angina that is unrelieved after taking
three nitroglycerin tablets in 15 minutes
• results range from heart muscle injury
to permanent heart damage to death
11
What is Angina?
• non-surgical heart valve repair,
performed in the cardiac catheterization
laboratory, opens narrow valves
• temporary lack of oxygen and blood
flow to heart caused by blockages in
the coronary arteries
• surgical heart valve replacement is
performed when a diseased valve
cannot be repaired and must be
removed and replaced with a substitute
mechanical or biological valve
• symptoms include pressure or tightness
in the chest, with dull pain
• usually brought on by physical or
emotional stress, with symptoms easing or
disappearing when stressful activity stops
• minimally invasive surgery involves
a small chest wall incision to
accommodate special instruments
• stable angina recurs in a predictable
pattern; unstable angina is unpredictable
and requires prompt medical attention
Maze Procedure for Atrial Fibrillation
• treated with medication, angioplasty/stent to
widen coronary arteries, or bypass surgery
• Maze procedure treats atrial fibrillation,
an abnormal heart rhythm that is the
most common cardiac arrhythmia in
the United States today
Coronary Artery Bypass Surgery
• relieves the symptoms of angina and
other coronary artery blockages
• traditional surgery involves a series
of maze-like incisions in the heart’s
upper chambers to block the irregular
electrical impulses that cause atrial
fibrillation; patient receives a midline
chest incision over the breast bone and
is placed on a heart-lung machine
• uses a healthy blood vessel from
another part of the body to bypass the
blocked or narrowed artery and restore
blood flow to the heart
• traditional surgery involves midline chest
incision over the breastbone; patient is
either placed on heart-lung machine or,
in certain circumstances, receives heart
stabilization techniques “off pump”
• a minimally invasive version of
the Maze procedure, known as the
“Minimaze,” uses a smaller chest
incision or thoracotomy
Heart Valve Repair and Replacement
Aortic Aneurysm Repair
• corrects conditions in which heart
valves do not fully open or close
• an aneurysm forms when a part of the
thoracic or abdominal aorta weakens
and the wall stretches and expands like
a balloon, threatening to rupture
• surgical heart valve repair can be
performed on a valve that is too narrow
to allow sufficient blood to flow through
its opening or cannot close tightly
enough to prevent back flow of blood
• surgery involves removing and
replacing the aneurysm with a synthetic
tube and usually requires a chest or an
abdominal incision
12
Exterior View of the Heart
13
Interior View of the Heart
14
Section II: Preparing For Surgery
The following are guidelines to help you prepare
for your surgery at Inova Heart and Vascular
Institute. Your surgeon may give you additional
instructions and information. If you have any
questions about these pre-surgical procedures,
contact your surgeon.
• Shower or bathe with Exidine solution
the evening before surgery (specific
instructions follow) as well as the
morning of your surgery. Your surgeon’s
office will give you a prescription for this.
• Regardless of whether or not you have a
history of diabetes, you will be placed on
on IV insulin during your hospitalization.
Research demonstrates that tight control
of blood glucose levels improves healing
and outcomes following cardiac surgery.
Your Surgery Is Scheduled for:
Date:
Time:
Surgeon’s Name:
Exidine Shower/Bath Instructions
Please arrive by:
Shower or bathe with Exidine solution the
evening before and the morning of your surgery
(note to men: please shave before you shower).
Wash yourself with regular soap, shampoo your
hair and rinse off. Using the Exidine solution
and your hand, wash again from the neck down,
gently scrubbing your skin. Avoid getting the
solution in your eyes and mouth. Rinse off.
Dry yourself with a clean towel. Do not apply
lotions, powders, deodorant, colognes, perfumes
or hair care products. Sleep on clean sheets and
wear clean clothing following your showers.
Before Your Surgery
Food and Drink
• Do not eat anything, even gum or mints,
after midnight the night before surgery.
• Do not drink anything after midnight
(you may take a sip of water with
medications you are instructed to take
on the day of surgery).
• You may brush your teeth the morning
of surgery, but do not swallow.
Medications to Take the Night Before Surgery:
• It is recommended that you do not
smoke 24 hours prior to surgery.
Other Instructions
• Take Amiodarone, if ordered, as
instructed by your surgeon’s office.
Medications to Take the Morning of Surgery:
• Apply Bactroban nasal ointment
the night before and the morning of
surgery (apply to the inside of the
nostrils using a Q-Tip swab).
• Remove all jewelry (including rings),
nail polish and makeup.
15
On the Day of Your Surgery
Additional Special Instructions:
What to Wear
Please wear comfortable, loose-fitting clothes.
Do not wear any jewelry or make-up.
What to Bring
When you come to the hospital, please bring:
Directions To Surgery Location and Check-In
• containers for eyeglasses, hearing aids
and/or dentures (If you normally wear
contact lenses, leave them at home and
wear glasses to the hospital.)
On the day of your surgery, enter the hospital
complex through the Gray Entrance. Park in the
Gray Patient and Visitor Parking Garage, located
at the rear of the campus, next to Inova Heart and
Vascular Institute. Follow the signs for Inova Heart
and Vascular Institute (Refer to map on page 3).
• a robe, comfortable slippers,
nightgown/pajamas and toiletries (You
will not need these items until the day
after surgery.)
Once inside, report to the Lobby Information
Desk to check in. A volunteer will escort you
and two loved ones to the Cardiovascular
Operating Room (CVOR) pre-operative area
where you will change into a hospital gown
and give your clothes to your loved ones. After
you are taken into the operating room, your
loved ones will be taken to the CVOR/CVICU/
CVSDU waiting room. They will receive a pager
so that they can leave the waiting area for food,
relaxation or restroom use without fear of
missing any important information. However,
it’s important they stay within the hospital or
the pager will not work.
• a copy of your advance directive, living
will or durable power of attorney (See
Section 1 for more information.)
Do not bring any valuables or large sums of money to
the hospital.
Advice for Women
Women with long hair should have it braided
prior to surgery and tied with a rubber band
(do not use metal clips). Women who are
menstruating should use sanitary pads (not
tampons) the morning of surgery and pack
additional pads with their toiletry items for use
after surgery. It is not unusual for women to
experience a change in their normal menstrual
cycle following surgery, with periods coming
more frequently due to the body’s stress
response. This condition is temporary.
When your surgical procedure is complete, the
surgeon will meet with your loved ones in the
waiting area. Approximately one hour later, they
will be called to come see you in the CVICU.
On this first visit, they will meet with the nurse
to discuss your condition and provide contact
information. Please note that there is a limit
of two visitors per patient in the CVICU. This
ensures the safety and privacy of all patients who
are recovering from surgery.
Large-breasted women should bring a comfortable,
front clasping support bra to wear after surgery.
16
heart surgery because of the normal
swelling that occurs postoperatively.
For more information on what happens after your
surgery, see Section IV: Recovering from Surgery.
• Leave all valuables at home.
It is our mission to provide you with excellent
care and keep your family well-informed
throughout the entire surgical process.
• Pack a small bag containing clothes
for discharge. Have your family bring
the bag to the hospital the day or night
before discharge. Your clothes should
be loose-fitting; pants with an elastic
waist, a button down or zippered shirt,
and loose fitting shoes or slippers.
Women should bring a bra for support.
We know that waiting can be stressful and
we are committed to sharing information
with your loved ones as soon as possible
after your procedure.
Be sure to share the following schedule with
them so they know what to expect during
your surgery.
• Arrange for someone to help you
at home with showering, fixing
meals, grocery shopping, picking up
prescriptions, and transportation to
doctor appointments.
Thinking Ahead to Discharge
For most people, heart surgery is a new
experience. It is not unusual to feel tired and
weak after surgery. This usually lasts a number
of weeks and is considered normal. With this
in mind, your surgeons and healthcare team
recommend that each patient have someone
available to them, especially at night, for the
first couple of days at home. Please keep in
mind that you will need to have transportation
arranged and have someone assist you in filling
prescriptions when you do go home.
• Have someone who can stay with you
overnight for the first few nights after
you go home.
• You will not be able to drive for two
weeks after discharge.
• Think about the steps in your home.
You will be able to navigate steps;
however, you will want to plan your
day so that you are not constantly
going up and down the steps. The
recommendation is to limit step
climbing to one to two times a day for
the first two weeks.
Our average hospital stay following cardiac
surgery is three to four days. While this may
seem like a short period of time, most patients
heal better and feel better at home in their own
environment.
• Keep in mind you will not be able to
lift anything greater than five to ten
pounds for about six weeks following
surgery. You also may not push, pull,
or tug more than five to ten pounds.
You may need to think about everyday
activities such as walking the dog,
vacuuming, etc.
You may need to consider the following and
plan ahead before you are admitted:
• Remove all jewelry before surgery and
leave it at home. This includes your
wedding band. Rings are a hazard after
17
• Find out if your insurance covers
visiting nurses or home healthcare
after discharge if you were to need
this. Some insurance companies do
not have this benefit so this may be
important to know before you are
admitted.
• You will need to have a ride from the
hospital on day of discharge. Please
have someone available to take you
home around 11 a.m.
• We encourage you to limit visitors to
close family members during your
hospital stay. You will be tired! We
suggest you request that family and
extended family wait to visit until you
return home.
18
INOVA HEART AND VASCULAR INSTITUTE
Patient Resource Handbook
22
19
Welcome to the Cardiovascular
Operating Room (CVOR)
Pagers
After you are taken to the operating room, your
family will be given a pager so they can leave
the waiting area without fear of missing any
updates. The beginning of surgery is a good
time for them to have something to eat or drink,
if desired, but remember that their pager will
only work inside the hospital. When their pager
vibrates and flashes, they should return to the
family waiting area on the second floor of the
Inova Heart and Vascular Institute. When your
surgery is over, and you have been moved to the
CVICU, please have a family member return the
pager to the front desk.
It is our mission to provide you with excellent
care and keep your family well-informed
throughout the entire surgical process. We
know that waiting can be stressful and we
are committed to sharing information with
your loved ones as soon as possible after your
procedure. Be sure to share the following
schedule with them so they know what to
expect during your surgery.
Today’s Schedule
• Wait with your family in the preoperative holding area until it is time
for your surgery.
Visits from Loved Ones
Once you are in the CVICU, staff will notify
your family when they can come and visit you,
and a volunteer will lead them to the unit. Often
there is a delay of an hour or more between
the time your surgeon meets with your family
and the time they are allowed to visit you. This
is entirely normal and not a cause for concern.
Your surgeon is able to leave the OR long before
you are ready to be transferred. However, if your
loved ones have waited more than two hours
after speaking with your surgeon, they should
ask a volunteer to call the CIVCU. If a volunteer
is not available, they can use the phone in the
waiting area to call ext.2211 for an update.
• Surgery will begin approximately 45
minutes after you leave the holding area.
• Your surgeon will have given you an
estimated length of time for your
procedure – be sure your loved ones
know what this is.
• Near the end of your surgery, your
circulating nurse will call your family
to give them an update.
• Further updates may vary, depending
on your surgical procedure.
• When the procedure is over, your
surgeon will meet with your loved ones
to explain how things went and answer
their questions.
More information about the CVICU, its
visiting hours and policies is included in the
following section.
• You will be taken to the Cardiovascular
Intensive Care Unit (CVICU). Once
you are settled in, your family members
will be able to visit you. (See details
in the following section “Welcome to the
Cardiovascular Intensive Care Unit.”)
Questions or concerns?
Contact the CVOR patient care director at
703-776-8966.
20
Welcome to the Cardiovascular
Intensive Care Unit (CVICU)
• Children over the age of 12 may visit.
In special circumstances, younger
children may visit for a short time with
the nurse’s pre-approval.
Our team of healthcare providers has a shared
responsibility to make your stay as comfortable
and pleasant as possible. Compassion, respect,
dedication, innovation and trust serve as our
guide to provide excellent, quality care to our
patients and families.
Entering the CVICU
• The CVICU is a secured access unit.
Visitors must ring the gray doorbell
outside the entrance door to come in.
All patients will be given a pass code for their
loved ones to use to enter the CVICU and
receive telephone updates.
• Please ring the doorbell once. If no
one has answered after a short wait,
ring again.
Your pass code is:
• Visitors will be asked for patient name
and pass code before entering.
Your CVICU room number is:
• To protect patient privacy, we request
that visitors ring the doorbell EVERY
TIME they wish to enter the unit, even
if the doors are open.
Your nurse’s name is:
Visiting Hours
• Although the CVICU has 24-hour
visitation, we ask that your loved ones
refrain from visiting when the nursing
staff is changing shifts (see next bullet).
Other Important Information for Visitors
• Flowers and plants are not allowed in
the CVICU. They often harbor bacteria
that can harm patients recovering in
the unit.
• If possible, visitors should avoid the
hours of 6:30 – 8 a.m. and 6:30 – 8
p.m. to protect patient confidentiality
during change of shift.
• While inside the hospital, cell phones
must be off or kept more than five feet
from medical equipment. You may use
your cell phone outside the hospital
(except in the Inova Fairfax Hospital
for Children pediatric courtyard/play
area, and the Inova Heart and Vascular
Institute Healing Garden), and in
all lobbies, hallways, waiting areas,
cafeterias and administrative areas
where there is no medical equipment.
• Your nurse will decide when visitors
are allowed to see you based on your
recovery progress.
• Loved ones are encouraged to keep
their visits brief and return home each
night to rest.
Visitors in the CVICU
• Only immediate family members are
allowed in the CVICU.
• Bathrooms are located outside the
CVICU near the family waiting area.
• With the exception of the first visit,
only two visitors are allowed at a time.
21
Waiting Room Etiquette
• Please respect the privacy of other
families sharing the waiting area.
• Sleeping overnight is not allowed.
• Please help keep the waiting area
clean by discarding trash in the
proper receptacle.
• Please do not rearrange the furniture.
Family Phone Number: 703-776-2211
Please designate one family member as
“spokesperson” to call this number for
patient updates. Please avoid calling between
6:30 and 8 a.m. and 6:30 and 8 p.m.
(nursing shift change).
Questions or concerns?
Contact the CVICU patient care director at
703-776-7248
22
Welcome to the Cardiovascular
Stepdown Unit (CVSDU)
Telephone
• If you are in a private room, or semiprivate room bed by the door, your
phone number is: 703-776-7 + room
number.
Congratulations on making it one step closer
to home! Although your time in the CVSDU
may be brief, we want to make your stay as
pleasant and comfortable as possible. Our
team of healthcare professionals is committed
to providing you with excellent care in a
supportive and healing environment.
• If you are in a semi-private room bed
by the window, your phone number is:
703-776-8 + room number.
• All patient phones are turned off to
incoming calls at 9 p.m. every night to
ensure a restful environment. Patients
may call out at any time.
Visiting Hours
• Having your loved ones close during
recovery is important, therefore we
have an “open door” visitation policy
and you may have visitors at any time.
• For urgent matters after 9 p.m., family
members may call the CVSDU Main
Nurses Station at 703-776-3295.
• We recommend that you limit visitors
to two at a time to avoid becoming
too tired.
Your Healthcare Team
• Surgeons and Physician Assistants are
responsible for managing your care.
They make rounds each day and can
answer questions or address concerns.
Please note that the surgeon you see on
daily rounds may not be the same one
who performed your surgery.
Meals
• Breakfast is served between 7:30 and
8 a.m.
• Lunch is served between 11:30 a.m.
and noon.
• Dinner is served between 5 and 5:30 p.m.
• For your visitors, the Heart Healthy
Café is located on the first floor and is
open from 7 a.m. – 4 p.m.
• Registered Nurses (RNs) are
responsible for your direct patient care
and coordination of that care. Our
nurses wear navy blue scrubs.
• The Skylight Café, located in the
basement of Inova Fairfax Hospital,
is open 24 hours a day for soup,
sandwiches, salads, snacks, beverages
and other light fare.
• Clinical technicians start IVs, change
dressings, and help with your daily
activities such as getting in and out
of bed, baths and meals. Our clinical
techs wear green scrubs.
• A coffee cart, offering a variety of
gourmet beverages and baked goods, is
located in the lobby.
23
• Monitor technicians provide 24-hour
observation of your cardiac rhythms
from our centralized monitoring center.
• Secretaries keep our unit running
smoothly! They answer phones and
respond to your call lights.
Discharge
• Your discharge education begins the
moment you arrive in the CVSDU.
• Depending on the type of surgery,
patients are generally discharged two to
four days after surgery.
• Be sure to have the clothes you will
wear home and arrange a ride the day
before discharge to ensure a smooth
transition.
• Bring comfortable, loose-fitting clothes
and shoes/slippers to wear home. You
may have some swelling in your feet
after surgery.
• Discharge time is 11 a.m.
Questions or concerns?
Conctact the CVSDU patient care director at
703-776-7248 or call the Nurses Station at
703-776-3295.
24
Section III: Recovering From Surgery
For most people, heart surgery is a new experience. It is not unusual to feel tired and weak after surgery.
The average postoperative hospital stay is three to four days. We recommend you limit your visitors to
close family members only during your hospitalization. Ask extended family and friends to visit you after
you have had some time to recover at home.
The next two pages outlines what you can expect during your stay at Inova Heart and Vascular Institute.
Use this information as a guide; individual experience varies for each patient.
25
INOVA HEART AND VASCULAR INSTITUTE
Patient Resource Handbook
Cardiac Surgery Plan of Care
CARDIAC SURGERY PLAN OF CARE
The following is a day-by-day outline of what you can expect during your stay in the hospital. It is only a
The following is a day-by-day outline of what you can expect during your stay in the hospital. It is only a guide and
guide and is expected to vary for each individual.
is expected to vary for each individual.
DAY BEFORE SURGERY
Visits
•
•
•
•
•
Surgeon
Physician’s assistant/nurse practitioner
Anesthesiologist
Mended Hearts
Research nurse
Lines and Tubes
DAY OF SURGERY/
INTENSIVE CARE UNIT
•
•
•
•
Surgeon
Physician’s assistant
Anesthesiologist
Mended Hearts
•
•
•
•
•
•
•
Breathing tube
Tube for stomach
Catheter for urine
Chest tubes
IV lines
Pacer wires
Heart monitor
Treatments
• Exidine shower at bedtime and in the
morning (two showers)
• Breathing tube removed
• Tube for stomach removed
• IV lines capped
Medications
• Stop aspirin or non-steroidal
anti-inflammatory drugs, e.g.,
ibuprofen, 5 days prior to surgery
• Sleeping pill available if needed
• IV fluids
• Pain medication if needed
Nutrition
• Eat what you like for dinner, but
nothing by mouth after midnight
except medications
• Nothing by mouth
• Ice chips and sips of clear liquids if
breathing tube out
• Unrestricted activity
• Bed rest
• Wrists will be loosely restrained to
protect breathing tube
• IS every hour while awake if
breathing tube out
• Dangle legs on side of bed
• If breathing tube out and able to dangle
legs, transfer to Step-Down Unit
Activity/Safety
Discharge Planning
• Complete home needs assessment
Education
• Review this plan of care
• Review advance directives
• Breathing/coughing exercises and
IS (Incentive Spirometer)
• Sternal precautions
28
26
• Family orientation to ICU
• Nurse will update your family
• Education reinforced as needed
DAY 2
AFTER SU RGERY
DAY 1
AFTER SU RGERY
Visits
DAY 3
AFTER SU RGERY
DAY 4
AFTER SU RGERY
• Surgeon
• Physician’s assistant/nurse
practitioner
• Mended Hearts
• Surgeon
• Physician’s assistant/nurse
practitioner
• Mended Hearts
• Surgeon
• Physician’s assistant/nurse
practitioner
• Mended Hearts
• Surgeon
• Physician’s assistant/nurse
practitioner
• Mended Hearts
•
•
•
•
•
•
•
Breathing tube
Tube for stomach
Catheter for urine
Chest tubes
IV lines
Pacer wires
Heart monitor
•
•
•
•
• Heart monitor
• Pacer wires
• Capped IV
• Heart monitor
• Pacer wires
• Capped IV
Treatments
•
•
•
•
•
Breathing tube removed
Tube for stomach removed
Catheter for urine removed
Chest tubes removed
IV lines capped
• Remove chest tubes
• Remove bandages
• Wash incisions with Dial
soap and water
• Remove pacer wires
Medications
• Ask for pain medication
and sleeping pill if needed
• Valve patients begin
Coumadin
• Ask for pain medication
and sleeping pill
• Ask for pain medication and
sleeping pill
• Ask for laxative if needed
• Ask for pain medication
and sleeping pill
• Ask for laxative if needed
• Sips of liquid after
breathing tube out
• Solid foods when ready,
then healthy heart diet
• Healthy heart diet
• Healthy heart diet
• Healthy heart diet
• Sit on side of bed
• Up in chair 1 to 2 times
• Walk with assistance to
bathroom
• Feed self
• Daily weight and measure
urine
• IS every hour while awake
• Transfer to Step-Down Unit
• Up in chair
• Walk in hall 1 to 3 times,
100 to 200 ft.
• Daily weight and measure
urine
• Feed self
• Bathe at sink with
assistance
• IS every hour while awake
• Up in chair
• Walk in hall 3 to 4 times, 200
to 400 ft.
• Daily weight and measure
urine
• Feed self
• Bowel movement
• Shower
• IS every hour while awake
• Late morning discharge
• Up in chair
• Walk in hall 3 to 4 times,
200 to 400 ft.
• Daily weight and measure
urine
• Shower
• IS every hour while awake
• Morning discharge
• Discuss discharge, social
and nutritional needs with
nurse
• Discuss discharge, social
and nutritional needs with
nurse
• Driver designated and clothes
for home at bedside
• Driver designated and
clothes for home at bedside
• Read and review discharge
instruction packet
• Review discharge
instruction packet
• Review discharge packet
• Review “survival skills” and
medications
• Receive prescriptions and appointment schedule
• Review discharge packet
• Review “survival skills”
and medications
• Receive prescriptions and
appointment schedule
Lines and Tubes
Nutrition
Activity/Safety
Discharge Planning
Education
Chest tubes
Heart monitor
Pacer wires
Capped IV
29
27
Sternal Precautions
1:07 PM
• W
hen lying in bed on your side, use
your legs and elbows to help you sit up.
Sternal precautions are important after a sternal
surgical approach to allow time for the sternum
(breast bone) to heal properly. Without the
proper healing, the sternum may separate.
Page 30
• When using a walker, use your legs to
bear weight.
• Avoid pulling on bed rails to roll over.
30
• A
void heavy work at home, such as
mopping or vacuuming.
Strict sternal precautions are to be followed for
at least six to eight weeks (six for the general
population, eight weeks for individuals with
INOVA HEART AND VASCULAR INSTITUTE
diabetes). Failure to follow sternal precautions
Patient Resource Handbook
INOVA HEART AND VASCULAR INSTITUTE
may cause wound re-opening or fracture and
Patient Resource Handbook
may result in additional surgery. Please be
sure to check with your doctor if you have any
questions regarding sternal precautions or
healing time.
cautions
s
1.
Signs of infection
• Increased soreness, tenderness or
redness along incision line.
• Warmth or discharge along incision line.
• C
licking or cracking may indicate an
unstable sternum.
Do not raise the elbows higher
than shoulder height.
1. Do not raise the elbows higher than
• height.
Always face the object you
shoulder
to raise the
.proach
Do not
elbows
higher
than
Always face
thetoobject
want to
want
workyou
with.
m shoulder
(breast
height.work with.
Always face the object
want
to wash your hair.
• you
You
may
thout
the
You may wash your hair.
mportant
work with.
2.notDo
not reach
behind
your back
You may wash
your
hair.
2. Do
reach
behind
your back
um may
(e.g., scratching
your back
or yawning).
(e.g., scratching
your
back or
. Do not reach behind
your back
When putting on a shirt, bring the armhole around front
yawning).
(e.g.,
scratching your
back of
or reaching
yawning).back to find it.
are
to be
instead
When putting on a shirt, bring the armhole around front
o eight
• to
When
on a shirt,
instead of reaching
back
find it.putting
3. Do not
lift greater
than five to 10 pounds
l populaarmhole around
(e.g., a full bring
bag of the
groceries).
. Do not lift greater than five to 10 pounds
viduals
front instead of reaching
back to find it.
(e.g., a full bag
4.of
Dogroceries).
not push or pull especially when getting in or out of bed.
follow
Avoid placing weight through your hands.
When lying in bed on your side, use your legs and elbows to
cause
. Do not push or pull especially when getting in or out of bed.
When standing, use your leg muscles to push yourself up.
3. Dothrough
not liftyour
greater
than five to 10 pounds
Avoid
hands.
ture
and placing weight
a full
bag of
groceries).
When standing, use (e.g.,
your leg
muscles
to push
yourself up.
urgery.
help you sit up.
When lying in bed on your side, use your legs and elbows to
with
your
When using a walker, use your legs to bear weight.
help you sit up.4. Do not push or pull especially when getting
Avoid pulling on bed rails to roll over.
in use
or out
bed.
When using a walker,
youroflegs
to bear weight.
Avoid heavy work at home, such as mopping or vacuuming.
ions
or
Avoid pulling on bed rails to roll over.
• Avoid placing weight through your hands.
Avoid heavy work at home, such as mopping or vacuuming.
estions
Signs of infection
• Wsoreness,
hen standing,
useoryour
legalong
muscles
to line.
Increased
tenderness
redness
incision
Warmth push
or discharge
along
yourself
up.incision line.
Increased soreness, tenderness or redness along incision line.
Clicking or cracking may indicate an unstable sternum.
Warmth or discharge along incision line.
Clicking or cracking may indicate an unstable sternum.
igns of infection
28
Incision Care
Check your incisions daily and notify your
physician immediately if you notice:
Following are general guidelines for caring
for your incision at home. Always follow your
physician’s specific instructions.
• increased tenderness of the incision
line
• Wash your incisions daily with mild
soap and warm water, using a clean
washcloth for each incision.
• increased redness or swelling around
the edges of the incision line
• Use a mild liquid soap, i.e., Dove for
Sensitive Skin, if possible. Bar soap is
not recommended.
• a persistent fever
• pus-like drainage from the incision line
• shaking chills
• Avoid vigorous scrubbing.
Resuming Daily Activities
• Dry your incision with a clean towel by
gently patting it dry.
When resuming daily activities, remember to
take it slow and give your body time to adjust.
Even if you are feeling better, you may not be
able to do all you want to do at once.
• Do not cover your incision unless it is
draining.
• Do not apply any lotions, creams, oils
or powders on your incisions, unless
your physician prescribes them.
Stop any activity immediately if you feel
short of breath, faint or dizzy, or experience
irregular heart beats or chest pain. Rest until
the symptoms subside. If they continue for
more than 20 minutes, or worsen, call your
physician.
• Incisions sunburn easily! Protect them
from overexposure to sunlight during
the first year following surgery.
• Bathing: You should take a daily shower.
Use mild soap. Avoid extremely hot
water. No tub baths until your incisions
are completely healed.
If your surgery involved a bypass graft from
your leg, follow these guidelines:
• Care for your leg incision as described
above.
• Dress: Wear comfortable, loose-fitting
clothes that do not put undue pressure
on your incisions. Women should wear
a comfortable bra for support.
• Avoid crossing your legs or sitting or
standing in one position for prolonged
periods of time.
• To reduce swelling, elevate your leg
on a stool or coffee table when sitting,
or on the arm of a couch when lying
down.
• Rest: A balance of rest and exercise
is critical for your recovery. Plan rest
periods between activities and take
short naps as necessary. Rest at least 30
minutes after meals before exercising.
• Check your leg daily for swelling. If it
worsens, call your physician.
29
Medications
• Walking: Walking increases circulation
throughout the body and to the heart
muscle, so it’s an excellent exercise
during recovery. Remember to pace
yourself and increase your activity level
gradually. In very hot or cold weather,
walk at a local shopping mall.
Depending on the type of heart surgery you
had, as well as your personal medical history,
your physician will prescribe some or all of the
following medications, post-operatively. Be sure
to follow package or prescription instructions
carefully and ask your physician or pharmacist
to explain anything you do not understand.
• Stairs: Unless your physician instructs
you otherwise, you can climb stairs.
Take it slow and stop and rest if you
become tired or breathless. Use your
legs and lower body to pull you up, not
your arms on the handrail.
Aspirin/Antiplatelet Agent:
• helps keep bypass grafts and/or arteries
open and unblocked in patients who have
had bypass or artery opening (angioplasty
and/or stent placement) surgery
• Sexual Activity: You can resume sexual
relations when you feel comfortable,
usually about two to four weeks
following surgery. However, you should
adhere to your sternal precautions
guidelines (see page 28).
• prevents blood clot formation
Beta-Blockers:
• treat high blood pressure and prevent
recurrent heart attacks by decreasing
the heart’s workload
• Driving: Avoid driving, biking or
motorcycling for six weeks after surgery
to allow your breastbone to heal
properly and to ensure your reflexes
are back to normal. You may ride as a
passenger in a car at any time, but be
sure to get out and walk around every
two hours on long trips. Avoid sitting
in the front seat due to the air bag.
• block nerve impulses that can cause an
irregular heartbeat
Ace Inhibitors:
• treat high blood pressure and prevent
future heart attacks
• reduce risk of heart attack for diabetes
patients
• Lifting: Avoid lifting, pushing, pulling or
dragging anything heavier than five to 10
pounds for six weeks after surgery. This
includes children, pets, groceries, suitcases
and furniture, as well as activities such as
mowing the lawn and vacuuming.
• relax blood vessels, lower blood pressure
and improve blood flow to the heart
Statins:
• lower LDL (“bad”) cholesterol levels,
reduce heart disease risk
• Work: You and your physician will
decide when it is safe for you to return
to work. Most patients begin light or
part-time work between four to 10
weeks after surgery.
• slow down the rate of cholesterol
production in the body and improve
your liver’s ability to remove LDL
cholesterol from the blood
30
Warfarin (Coumadin):
• anticoagulant: helps keep blood
flowing smoothly by decreasing the
amount of clotting proteins in your
blood; prevents blood clots from
forming
• It is important for your healthcare
provider to know that you are taking
Coumadin in case of an emergency.
Amiodarone:
• helps your heart maintain a regular
rhythm. It is only used for a short time
following heart surgery.
Scheduling Your Follow-Up
Appointment
Depending on your procedure, you will need
a follow-up appointment with your surgeon
seven to 14 days after discharge. We recommend
you make this appointment on the day you are
discharged.
You should also make appointments to see
your cardiologist and/or your primary care
physician when you get home.
31
Section IV: Returning Home
Preparing in Advance
• A case manager/social worker will
evaluate you after surgery for any home
care needs.
Although most patients heal and feel better at home
in their own environment, there are a number of
things you can have ready in advance to help ensure
your recovery progresses smoothly and successfully.
Consider the following and plan ahead:
What to Expect
Patients recovering from heart surgery
experience a wide range of post-operative
symptoms that can last for several weeks at
home. The following are considered normal
and should diminish over time:
• Be sure to arrange for someone to drive
you home from the hospital on your
day of discharge. Discharge is at 11 a.m.
• Enlist family members or close friends
to help you when you return home.
Arrange for someone to spend the
night with you the first few nights, help
with daily activities such as showering
and preparing meals, do your grocery
shopping and pick up prescriptions.
• Lack of appetite. A diminished sense of taste
or even nausea around food is normal. It
often takes several weeks for your appetite
to return to normal. Eat what you feel
like until your appetite returns - avoiding
added salt. When able, resume a low-fat,
low-cholesterol, low- sodium diet.
• You will not be able to drive for several
weeks following surgery. Ask a family
member or friend for transportation to
and from your follow-up appointments.
• Swelling. This is normal, especially
if you have an incision in your leg.
Elevating your legs can help.
• If you have young children, be sure to
arrange for help with their care and
transportation.
• Sleeping difficulties. This includes
trouble falling asleep or returning to
sleep after waking. Taking a pain pill
before bed can help.
• Although you will be able to navigate
steps, it’s best to avoid going up and
down stairs constantly. Limit stair
climbing to once or twice daily.
• Constipation. Taking a laxative, or
adding fruit, fiber and juice to your
diet, can help.
• Mood swings and depression. It’s very
common to have good days and bad
days following surgery. Try not to get
discouraged. This will improve.
• Lifting, pushing, pulling and tugging are
limited for about six weeks following
surgery. Hire a neighborhood teenager
to do light housework or walk the dog.
• Clicking sensation in chest. This may
occur in the days immediately
following surgery and decrease over
time. If it gets worse, call your surgeon.
• Since you will need to weigh yourself
and check your temperature after
surgery, you will need a working scale
and thermometer at home.
32
• Muscle pain or tightness. Normal,
especially in your shoulders and upper
back. This should gradually diminish;
pain medication can help.
• Temperature greater than 101 F twice in
24 hrs
• Persistent bleeding or oozing from
incisions
Remember, normal recovery time following
heart surgery is four to six weeks. If you are
not feeling better by then, or these symptoms
persist or worsen, talk to your doctor.
• Reddened, swollen and warm wounds
• Skin rash
• New onset of vomiting or diarrhea
• Extreme fatigue
What to do if…
• Acute gout flare-up
How do you know if your symptoms constitute
an emergency? Consult the information below
for guidance. If you are unsure, call your
physician’s office.
• Calf pain that worsens when pointing
toe up
Call 911
• General postoperative questions
• Urinary tract infection, burning or
urgent urination, bloody urine
• Angina-like chest pain
• Discharge instruction questions
• Heart rate ≥ 150 bpm with shortness of
breath and new irregular heartbeat
• Symptom management
• Shortness of breath not relieved by rest
• Incisional care
• Coughing up bright red blood
• Home healthcare
• Draining or reddened wounds
• Sudden numbness or weakness in arms
or legs
• Sudden, severe headache
• Fainting spells
• Severe abdominal pain
• Bright red stool
Call the Surgeon’s Office
• Weight gain >3 pounds/day or 5
pounds/week
• Worsening ankle swelling or leg pain
• Worsening shortness of breath
• Sharp pain when taking deep breath
• Chills or fever
33
INO VA HEART AND VASCU LAR INSTITU TE
Recovering Heart Home Plan
Patient Resource Handbook
RECOVERING HEART HOME PLAN
Weeks 1 & 2
Activity and
• Get dressed.
Exercise
• Climb stairs, 1-2 times a day.
• No driving; you may ride short distances.
• Rest twice daily, 20 minutes.
• Limit visitors.
• Walk, 4 times daily (see walking
program), no exercise equipment.
• Use heart pillow to splint chest
• No lifting, pulling or pushing over 5
to 10 lbs or upper body exercises.
Health
Self-Care
• Get dressed.
• Climb stairs, as tolerated.
• Drive only as directed by surgeon; you may
ride longer distances to movies, store, church.
• Rest once daily, 20 minutes.
• Walk twice daily, 15-20 minutes.
• Use heart pillow to splint chest
• No lifting, pulling or pushing over 5 to 10 lbs
or upper body exercises.
• Resume sexual activity when ready but no
pushing with arms or upper body.
Weeks 5 & 6
• Get dressed.
• Climb stairs as tolerated.
• Travel without restrictions.
• Rest as needed.
• Walk, 30 minutes, once a day.
• No lifting over 10 lbs or upper body exercise.
• Return to work as directed by physician.
Daily:
Daily:
Daily:
• Check your incision sites.
• Check your incision sites.
• Check your incision sites.
• Take your temperature by mouth.
• Take and record your pulse.
• Take and record your pulse.
• Take and record your pulse.
• Weigh yourself.
• Weigh yourself.
• Weigh yourself.
• Follow a prescribed diet as tolerated, with no
added salt.
• Follow a lowfat diet, with no added salt.
• Follow a prescribed diet as tolerated,
with no added salt.
M edication
Weeks 3 & 4
• Take scheduled medications as prescribed.
• Take scheduled medications as prescribed.
• Take scheduled medications as prescribed.
• Take prescription pain medication every
4 hours as needed.
• Take prescription pain meds or try Tylenol©.
• Take Tylenol© for discomfort.
• Keep your feet elevated above the level of
your heart when sitting.
• Keep your feet elevated above the level of
your heart when sitting.
• Shower daily, clean incision sites gently
with warm water and soap.
• Shower daily, clean incision sites gently.
• Keep your feet elevated above the level of
your heart when sitting.
• Practice reading food labels for fat,
cholesterol and salt.
• Use an incentive spirometer every
1-2 hours while awake.
• Women should wear a soft bra for comfort
and support.
• Practice reading food labels for fat, cholesterol and salt.
• Women should wear soft bra for support.
• Shower daily, clean incision sites gently.
• Incorporate heart healthy foods into daily
food choices.
• Women should wear soft bra for support.
• Make sure you have seen your surgeon, cardiologist and primary care physician.
• Follow up with cardiologist and primary
care physician as directed.
• Get referral for cardiac rehab from your cardiologist.
• Begin cardiac rehabilitation.
• Call the surgeon, cardiologist and primary
care physician for appointments.
Resources
• Review discharge materials.
• “Survival Skills”
Call your surgeon if:
your pulse is less than 60 or greater than
120 beats per minute
• Call your cardiologist or primary care physician for all health problems, except those
related to surgical incisions
your temperature is over 101 degrees by
mouth
you are experiencing shaking, chills
you are short of breath at rest
you gain over 3 lbs. in one day or 5 lbs.
in one week
you have chest pain, other than incisional
pain
your incision site is red, painful or draining
you have questions or concerns
37
34
• Call your cardiologist or primary care physician for all health problems, except those related to surgical incisions.
When to Resume your Usual
Activities
• Heavier housework: vacuuming,
sweeping, laundry, ironing
Weeks One – Six
• Heavier gardening: mowing lawn with
a self-propelled mower, raking leaves
• Light housekeeping: dusting, setting
table, washing dishes, folding laundry
• Business or recreational travel
• Light gardening: potting plants,
trimming flowers
• Walking a small dog on leash
• Light aerobics (no weights)
• Driving a car or small truck
• Needlework
• Reading
After Three Months
• Cooking meals
• Continue activities of previous months
(but you may be able to tolerate more)
• Climbing stairs
• Heavy housework: scrubbing floors
• Shopping (do not carry bags heavier
than five to 10 pounds.)
• Heavy yard work: shoveling snow,
digging
• Restaurants
• Sports: football, soccer, softball,
baseball, tennis, bowling, jogging,
bicycling, golfing, weight lifting,
motorcycle riding, pushups,
swimming, fishing, boating, water
skiing, skydiving
• Movies
• Church
• Attend sports events
• Passenger in car
• Walking
• Shampooing hair
• Playing cards/games
• Sexual Activity: You can resume sexual
relations when you feel comfortable,
usually about two to four weeks
following surgery. However, you should
adhere to your sternal precautions
guidelines (see page 28).
After Six Weeks
• Continue activities of previous weeks
(but you may be able to tolerate more)
• Return to work part-time, with
physician’s OK, if your job does not
require lifting
35
INO VA HEART AND VASCULAR INSTITUTE
Patient Resource Handbook
Wellness
Works!
Wellness
Works!
part —
do yours.
We did We
ourdid
partour
—now
younow
do you
yours.
Take a comprehensive
approach
risk reduction
and enhance
your health.
Take a comprehensive
approach
to riskto
reduction
and enhance
your health.
Risk Factors
Smoking
Hypertension
Diabetes
Goals/ Guidelines
Dos and Don’ts
Find a reputable smoking cessation program.
•Inova HealthSource’s "Personal Quit Coach,"
1-855-My-Inova (1-855-694-6682).
Do:
Ask your physician about the nicotine patch.
Keep your blood pressure under control (see your
Do:
Take your blood pressure medication as directed; watch your diet, especially salt and
alcohol; exercise regularly.
Don’t:
Think it is NOT a problem because you feel
OK.
Do:
Check your blood sugar as directed by your physician.
Follow a diabetic diet as directed by your physician.
Maintain a desirable weight.
Don’t:
Eat sweets and refined sugars.
Do:
Select a variety of foods from each food group.
Choose monounsaturated oils such as canola
and olive oil.
Don’t:
Choose animal products, hydrogenated oils/fats,
whole milk, cheese products, high fat desserts
(danish pastry, doughnuts).
Do:
Join a cardiac rehabilitation program.
Warm-up and cool-down.
Feel that you are at a “slightly breathless pace”
at which you can talk to someone walking next to
you but are not panting.
Don’t:
Exercise outdoors in extreme heat and cold.
Overexert yourself.
Do:
Avoid angry, hostile behavior.
Avoid high levels of anxiety.
Avoid social isolation.
physician for guidelines).
Keep your blood sugar under control (as defined by
your physician).
Find a reputable diabetes education class and keep
abreast of self-management techniques.
•Inova Diabetes Center, 703-698-2500
Elevated
Cholesterol,
Excess Weight
Maintain a desirable cholesterol level (<200 mg/dl
for total cholesterol) and a desirable weight.
Use fats/cholesterol sparingly and select lower saturated fat or monounsaturated fat foods.
Contact Inova HealthSource at
1-855-My-Inova (1-855-694-6682) to learn about
nutrition classes.
Sedentary
Lifestyle
Exercise at least 30 minutes 3 times a week.
Stay active with nontraditional activities (gardening, using the stairs, walking during coffee breaks).
Warning signs - call your physician or 911 if you
experience the following:
•chest pain or tightness
•dizziness, lightheadedness
•cold sweats, nausea
•shortness of breath
Stress
Determine how to effectively cope with professional and personal stress/negative emotions.
Sign up for a stress management course through
Inova HealthSource, 1-855-My-Inova (1-855-694-6682),
or another organization and set some mental
health goals.
39
36
Survival Skills
Incision Care
Return appointments
• Shower each day. Wash each incision
with a fresh, clean washcloth using
mild soap and warm water (ex: Dove
body wash). Avoid vigorous scrubbing.
Check incisions every day for signs
of infection such as: warm to touch,
redness, pus-like drainage or fever of
101 degrees.
• Surgeons’ office visit (CABG-2 weeks,
Valve-1 week with chest X-ray). Call to
make an appointment when you get
home.
• Cardiologist: call office for an
appointment when you get home.
• Primary Care Physician (PCP): call
office for an appointment when you
get home.
• NO tub baths until incisions are
completely healed.
• Leave incisions open to air. DO NOT
apply any oils, creams, lotions or
powder to incisions, unless prescribed
by your physician.
Medications
• Use medication schedule to determine
when to take medications.
• Use the medication information sheets
for details on your medications.
Self Care
• Keep legs elevated above the level of
your heart when resting.
• Take only medications prescribed on
Patient Discharge form.
• Use Incentive Spirometer every 1-2
hours while awake.
• Bring a copy of these medications
with you to all physician/surgeon
appointments; medications may be
changed over time.
• Take temperature daily: call the office if
it is above 101 degrees.
• Take and record weight daily: call if
greater than 3 pounds weight gain in
one day or 5 pounds in a week.
Exercise
• Get up and get dressed each day.
• Sternal precautions: DO NOT lift more
than 5-10 pounds and avoid any upper
body exercise for 8-12 weeks.
• Climb stairs 1-2 times a day.
• Rest twice daily for 20 minutes
• Walk four times per day, 7-8 minutes
each. Gradually build up to 30 minutes
a day.
• Resume sexual activity when ready
(when able to climb stairs without
shortness of breath).
• Do not drive until directed by
surgeon (generally after follow-up
appointment).
37
Things to Expect:
• Loss of appetite is normal. Eat what
you feel like until your appetite
returns, avoiding added salt. When
able, resume prescribed low fat, low
cholesterol, low salt diet.
• Chest tube sites may ooze pink or clear
drainage for a few days.
• Difficulty sleeping, odd dreams and
getting comfortable in bed are common
complaints. Taking pain medication
before going to bed may help.
38
Section V: Living a Healthy Lifestyle
Risk Factors for Heart Disease
Diabetes
Certain risk factors increase your chances of
having heart disease. Some of them, such as
age and family history, cannot be changed.
Others, such as diet, exercise and smoking,
can. Consult the information below to learn
more about the risk factors you can control,
and consult the following section, “Healthy
Lifestyle Changes” for tips on how to succeed.
Diabetes is a disease that prevents your body
from using sugar (glucose) correctly. Over time,
it can damage arteries and increase your risk of
heart attack, stroke and kidney disease.
Stress
Stressful feelings and events can raise the level
of cortisol in your blood, elevating heart rate
and blood pressure, and eventually damaging
your arteries and heart.
High Blood Cholesterol
Cholesterol is a fatty substance in your blood that
can build up on artery walls and block blood
flow to the heart and brain. Fatty and processed
foods, trans fats, and full-fat dairy products can
raise cholesterol levels in your blood.
Healthy Lifestyle Changes
As a heart surgery patient, it is imperative that
you take action to prevent future heart disease by
making lifestyle changes that control or reduce
your risk factors. Consult the information below
for guidance, and review the following section,
“Wellness Programs,” for resources and help.
High Blood Pressure
High blood pressure causes your heart to work
extra hard to pump blood through the body.
Over time, artery walls become damaged and
threaten the heart, brain, kidneys and other
organs.
Quit Smoking
Quitting smoking is beneficial to all smokers,
no matter what their age or health condition.
Join a smoking cessation class or online
program for help in kicking the habit.
Smoking
Smoking damages your arteries, reducing
blood flow to your heart and brain. It greatly
increases your risk of heart disease, stroke, lung
disease and cancer. Smoking after a heart attack
doubles your risk of a second attack.
Short-term benefits include:
• within 20 minutes, blood pressure
returns to pre-smoking levels
• within eight hours, oxygen level in
blood increases to normal
Excess Weight and Lack of Exercise
Your heart is a muscle and needs regular
exercise to stay strong. Staying active reduces
the risk of heart disease and stroke. It can also
help you manage stress and lose weight. Being
overweight further taxes the heart and makes it
more difficult to stay active.
• within two days, sense of smell and
taste improve
• within three days, lung capacity
increases
39
Exercise
Long-term benefits include:
Exercise can help you prevent or recover
from disease, lose weight, reduce stress and
improve feelings of well-being. Always consult
your physician before beginning an exercise
program. Here are some ways to get started:
• within one to nine months, coughing,
sinus congestion and shortness of
breath decrease
• your risk of having a heart attack,
stroke or cancer drops
• Exercise options are numerous,
including walking, dancing, gardening,
biking or doing household chores.
• you and the people you live with will
be healthier
• you will have extra money to spend on
something other than cigarettes
• For heart health, the American Heart
Association recommends at least 30
minutes of moderate-intensity physical
activity, such as walking, on most days
of the week.
Eat a Heart-Healthy Diet
Making small dietary changes can reap big
health rewards. Try these:
• Maintain a well-balanced diet with
plenty of whole grains, fruits and
vegetables.
• Even small, daily increments of
physical activity can help you lose
weight and feel better.
• Choose lean meats, skinless poultry
and fish.
• Try building more activity into your
daily routine by walking instead of
driving, taking the stairs instead of the
elevator, or playing outside with your
kids or pet.
• Limit egg yolks to no more than three
per week.
• Remove the salt shaker from the table
and use salt sparingly during cooking;
season foods with herbs and spices
instead.
• Consistency is key! Pick an activity you
enjoy so you’re more likely to stick with it.
Reduce Stress
Stress is a fact of life for most people. The trick is
how you manage it. Here are some ideas to try:
• Marinate poultry, fish and meat in
lemon or lime juice, herbs and low-fat
salad dressing.
• Take good care of yourself by eating
well and getting plenty of rest.
• Avoid processed and convenience
foods, which can be high in sodium
and trans fats.
• Exercise regularly.
• Eliminate fried foods.
• Let your feelings out. Talk, laugh, cry
and express anger when you need to.
• When eating out, ask for sauces and
dressings on the side and use the “fork
dip” method to control the amount
you consume.
• A hobby can help you relax. Volunteer
work or work that helps others is often
a great stress reliever.
40
Who Can Participate?
• Relax with meditation, imagery
exercises, or listening to calming music.
You can participate in our program if you have
or have had one of the following:
• Don’t be afraid to ask for help with
stress reduction – from family, friends
or the medical profession.
• heart attack
• coronary bypass surgery angioplasty or
artherectomy or stent
Cardiac Rehabilitation at Inova
Heart and Vascular Institute
• heart valve replacement or repair
• stable angina
At the Inova Heart and Vascular Institute, we
are committed to working with patients to
create permanent, positive change in their lives.
Part of this commitment means providing
programs to help our patients return to or
maintain a healthy lifestyle.
• heart transplant
• heart failure
• serious risk of developing coronary
artery disease
• ICD/pacemaker
The Cardiac Rehabilitation Program helps
people with heart disease achieve their highest
possible level of wellness. Located at the Inova
Heart and Vascular Institute on the Inova
Fairfax Hospital campus, our EKG monitored
cardiovascular exercise and education programs
help people make positive lifestyle changes.
• other cardiovascular procedures
Your physician will be contacted to approve
your participation in the program.
Heart Enhancement Program
The Heart Enhancement Program is designed
to help people develop and maintain a heart
healthy exercise routine outside the hospital
setting. Sessions meet twice a week for 24
weeks. After completing the program, more
than 85 percent of our participants continue
exercising at a fitness facility or in their homes.
What is Cardiac Rehabilitation?
Cardiac rehabilitation is a comprehensive
exercise and risk factor management program
through which our staff will:
• teach you how your heart works
• educate you about your specific cardiac
risk factors and how to manage them
in your daily life
Before beginning the program, participants are
given a nursing assessment and a physiological
baseline fitness exam. Each participant then
receives a customized exercise plan best suited
to his or her personal goals, needs and medical
limitations.
• develop your exercise and basic
strength training program
• provide stress management counseling
The exercise program encompasses all
aspects of fitness, including cardiovascular
conditioning, strength training and flexibility.
• help you develop an appropriate
dietary plan
41
In addition to fitness, the Heart Enhancement
Program includes:
• nutrition counseling
The following are some of the cardiac
rehabilitation programs currently offered in the
metropolitan Washington area:
• stress management counseling
Virginia
• healthy lifestyle management
Falls Church
• risk factor modification
Inova Fairfax Hospital
Cardiac Rehabilitation
3300 Gallows Road
Falls Church, VA 22042
703-776-3635
The Heart Enhancement Program Team
Healthcare professionals work as a team with
each participant and include:
• cardiac nurses certified in Advanced
Cardiac Life Support (ACLS)
Alexandria
Inova Alexandria Hospital
Cardiopulmonary Rehabilitation
4320 Seminary Road
Alexandria, VA 22304
703-504-3398
• exercise physiologists
• registered dietician
For more information about our Cardiac
Rehabilitation Program, call 703-776-3635.
Inova Mount Vernon Hospital
Cardiovascular Health & Rehabilitation
2501 Parkers Lane
Alexandria, VA 22306
703-664-8034
Wellness Programs
Cardiac Rehabilitation
Cardiac rehabilitation is a comprehensive
exercise and risk factor management program
designed to help those diagnosed with, or
at risk for, heart disease achieve their highest
possible level of wellness. Participants
progressively increase their physical endurance
levels through exercise, while learning to make
healthy lifestyle choices and manage their own
risk factors.
Leesburg
Inova Loudoun Hospital
Cardiac/Pulmonary Rehabilitation
44045 Riverside Parkway
Leesburg, VA 20176
703-858-6674
Arlington
Virginia Hospital Center
1701 N. George Mason Drive
Arlington, VA 22205
703-558-6271
42
Chesapeake
Warrenton
Chesapeake General Hospital
Cardiopulmonary Rehabilitation
800 Battlefield Blvd.
Chesapeake, VA 22320
1-757-312-6132
Fauquier Health System
419 Holiday Court, Suite 200
Warrenton, VA 22186
1-540-316-2651
Culpeper
Winchester Medical Center
1840 Amherst St.
Winchester, VA 22601
1-540-536-8188
Winchester
Culpeper Regional Hospital
501 Sunset Lane
Culpepper, VA 22701
1-540-829-4126
Woodstock
Fredericksburg
Shenandoah Memorial Hospital
759 South Main Street
Woodstock, VA 22664
1-540-459-1148
Mary Washington Hospital
Cardiopulmonary Health & Fitness
1001 Same Perry Blvd.
Fredericksburg, VA 22401
1-540-741-1347
Maryland
Baltimore
Luray
Page County Memorial Hospital
200 Memorial Drive
Luray, VA 22835
1-540-843-4577
Johns Hopkins Bayview Medical Center
Heart Health/Cardiac Rehabilitation
4940 Eastern Ave.
Baltimore, MD 21224
1-410-550-0860
Prince William County
Bethesda
Prince William Hospital
Cardiac Rehabilitation
8700 Sudley Road
Manassas, VA 22110
703-369-8474
Suburban Hospital
Cardiovascular Rehabilitation
8600 Old Georgetown Road
Bethesda, MD 20814
301-896-2096
Potomac Hospital
Cardiac Rehabilitation
2296 Opitz Blvd., Suite 520
Woodbridge, VA 22191
703-670-1881
Cheverly
Prince George’s Hospital Center
3001 Hospital Drive
Cheverly, MD 20785
301-618-2449
43
Clinton
Takoma Park
Southern Maryland Hospital Center
7503 Surratts Road
Clinton, MD 20735
301-877-7370
Washington Adventist Hospital
7620 Carroll Ave.
Takoma Park, MD 20912
301-891-6016
Easton
Waldorf
Easton Memorial Hospital
Cardiopulmonary Fitness & Wellness
219 South Washington St.
Easton, MD 21601
1-410-822-1000 ext. 5208
Rehab Center of Southern Maryland
2 St. Patrick’s Drive, Suite 401
Waldorf, MD 20603
301-870-7366
Frederick
Lewes
Frederick Memorial Hospital
1000 North Market Street
Frederick, MD 21701
301-620-1250
Beebe Memorial Hospital
424 Savannah Road
Lewes, DE 19958
1-302-645-3300
Hagerstown
You can find additional cardiac rehabilitation
programs listed on the American Heart
Association’s Web site, www.americanheart.org,
or by calling your local hospital.
DELAWARE
Washington County Hospital
251 Antietam St.
Hagerstown, MD 21740
301-790-8940
Rockville
Shady Grove Adventist Hospital
Cardiac Rehabilitation
9715 Medical Center Drive, Suite 130
Rockville, MD 20855
240-826-6662
Salisbury
Peninsula Regional Medical Center
Cardiac and Pulmonary Rehabilitation
100 East Carroll St.
Salisbury, MD 21801
1-410-543-7026
44
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INOVA HEART AND VASCULAR INSTITUTE
Patient Resource Handbook
A Guide for Heart Healthy Nutrition
Hints to Get Started
♥ Maintain a well-balanced diet with plenty of whole grains and
fresh fruits & vegetables. Aim for 5 cups of fruits and vegetables per
day.
Choose foods higher in fiber such as whole wheat, rye, brown rice, wild rice,
buckwheat, triticale, bulgar, millet, quinoa, and sorghum.
♥ Choose lean meats, poultry, and fish. Reduce fat intake by cutting
off any visible fat from meat and removing the skin from poultry
before cooking.
Include more foods with omega 3-fatty acids. Good sources of omega-3’s are:
mackerel, albacore tuna, salmon. Aim to eat fish 2 times per week. Other
sources are: walnuts, canola & soybean oils, flaxseed.
♥ Review cookbooks for low-fat cooking tips and low-fat recipes. Limit
cholesterol to 300 mg/day.
♥ Egg yolks are high in cholesterol. Use egg yolks in moderation. Use egg
whites & egg substitutes freely.
♥ Remove the salt shaker from the table. Use salt sparingly during
cooking. Reduce total sodium intake to 2 grams of sodium per day.
♥ Read labels carefully and avoid processed and convenience foods
to lower sodium intake. (70% of salt intake is from foods & not salt shaker.)
Limit intake of trans fats (note ingredient: partially hydrogenated vegetable oil).
These are found in snack crackers, commercially baked goods and margarine.
Replace solid fats (butter & margarine) with vegetable oils when possible. Use
Vegetable oils with liquid vegetable oil as 1st listed ingredient & no more than 2
grams of sat. fat per day.
♥ When dining out, ask for sauces and dressings on the side and use
these sparingly--use the fork dip method. Keep in mind that foods
cooked at home are almost always lower in sodium.
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INOVA HEART AND VASCULAR INSTITUTE
Patient Resource Handbook
♥ Eliminate fried foods. Bake, Broil, and Grill your foods.
♥ Marinate poultry, fish, and meats in lemon or lime juice, herbs, and
low fat dressings.
♥ Season foods with herbs and spices.
♥ Check with your doctor before using a salt substitute as these
contain potassium.
Aim for a healthy body weight. Balance caloric intake with physical activity.
Also, minimize intake of beverages and foods with added sugars.
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INOVA HEART AND VASCULAR INSTITUTE
Patient Resource Handbook
Heart Healthy Nutrition
FOOD GROUPS
ALLOW
AVOID
MILK & DAIRY
PRODUCTS
♥ Skim milk, 1% milk, low fat
buttermilk
♥ Nonfat or low fat yogurt
♥ Evaporated skim milk
♥ 93% low fat or fat-free cheese
♥ 93% low fat or fat-free sour
cream and cream cheese
Whole milk, 2 % milk, condensed
milk, chocolate milk
Half & half cream, whipping
cream, eggnog
High fat yogurt, milkshakes,
regular ice cream
Regular cheeses
Cheese spreads
BREADS,
CEREALS, AND
STARCHES
♥ High fiber and whole grain
breads, cereals, rolls, buns,
bagels, and pita bread
♥ Plain baked potatoes, rice,
pasta
♥ Baked tortillas
♥ Plain lima beans, peas, corn,
and yams
♥ Unsalted pretzels
♥ Air popped popcorn
Egg or cheese breads, butter
rolls, croissants, egg bagels,
sweet rolls
Granola-type cereals
Pasta, rice or potatoes prepared
with cream or cheese sauces
Potato chips, corn chips, and
cheese puffs
High fat snack crackers
Fried noodles
French fries, hash browns, and
home fries
♥ All fresh, frozen, or canned
fruits and fruit juices
coconut
FRUITS
VEGETABLES
FATS & OILS
(USE
SPARINGLY)
♥ All fresh and frozen vegetables Regular tomato juice, V-8 juice
Olives, sauerkraut, pickles
Fried vegetables
Vegetables prepared with cream
or cheese sauces
♥ Tub margarine, vegetable oils
(i.e. safflower oil, corn oil,
soybean oil, olive oil)
Flaxseed, Canola, or soybean
oils (high in omega 3-fatty acids)
♥ Low fat or fat-free mayonnaise
♥ Vegetable sprays (i.e. Pam)
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Butter, coconut oil, palm kernel
oil, lard, fat-back, and hardened
shortenings (i.e. Crisco)
Regular mayonnaise
Gravy
Cream based salad dressings
INO VA HEART AND VASCULAR INSTITUTE
Patient Resource Handbook
Heart Healthy Nutrition
FOOD GROUPS
MEATS, EGGS,
POULTRY AND
FISH
ALLOW
AVOID
♥ POULTRY & GAME (white
meat): chicken, turkey,
Cornish hen, & venison
Duck and goose
Dark meat and skin from chicken
or turkey
♥ FISH: Fresh, frozen, or water
packed fish. Aim for 2 servings
per week esp. of fish high in
omega 3-fatty acids such as :
salmon, tuna & mackerel.
Fried, salted or dried smoked fish
Fish canned in brine or oil
(MODERATE
3 OZ. SERVINGS)
Limit red meat
To 3 servings
♥ BEEF: Choose low fat cuts
per week
and trim excess fat – round,
top loin, tenderloin, sirloin cuts
Extra-lean ground beef
♥ VEAL: All well trimmed cuts
♥ LAMB: Choose lean cuts such
as leg, loin, or shoulder
♥ PORK: Tenderloin, boneless
loin chop, leg
♥ EGGS: Egg whites and egg
substitutes/Eggbeaters
♥ BEANS & PEAS: Prepared
with low fat recipes
♥ LOW SALT LOW FAT
LUNCHEON MEAT
♥ NUTS & PEANUT BUTTER:
Allow in moderation
♥ TOFU AND MEAT
SUBSTITUTES: Without
added fat or sodium
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Heavily marbled and fatty meats
such as ground beef, corned beef,
ribs, and hot dogs
Fast foods
Ground lamb, mutton
Bacon, sausage, scrapple,
chitterlings
More than 3 egg yolks per week
Fried eggs
Peas or beans prepared with fat or
high-fat meat
Canned peas and beans
Avoid regular luncheon meat
INOVA HEART AND VASCULAR INSTITUTE
Patient Resource Handbook
Heart Healthy Nutrition
FOOD GROUPS
SOUPS
ALLOW
AVOID
♥ Homemade or low sodium
canned soups
♥ Low sodium broth
♥ Low sodium “cream” soups
made with skim milk
Regular canned soups
High fat cream soups
DESSERTS
♥ Popsicles, sherbet , gelatin
♥ Low fat or fat-free frozen
yogurt, ice milk, or pudding
♥ Angel food cake
♥ Low fat candy or hard candy
♥ Vanilla wafers, Fig Newtons,
ginger snaps, animal crackers,
and graham crackers
High fat desserts such as
custards, puddings, cake and
cookies made with large amounts
of eggs, fat, cream, or cheese
Coconut, chocolate, cashews,
macadamia nuts
CONDIMENTS
♥ Herbs & spices, vinegar, and
lemon (Mrs. DASH)
♥ Sauces and gravies made
from low salt broth and without
animal fat
Relish, meat tenderizers, soy
sauce, sea-salt, onion salt, garlic
salt, Worcestershire sauce,
teriyaki sauce, and steak sauce
Kim-chee
America’s Favorite Herb Blend Recipe
5 tsp. Onion powder
½ tsp. White pepper
½ tsp. Celery seeds
1 Tbsp. Paprika
1 tsp. Thyme
1 Tbsp. Dry mustard
1 Tbsp. Garlic powder
Combine the above ingredients and enjoy a low sodium seasoning blend!
Resources for Additional Information
Your doctor has recommended a heart healthy diet for you. This is an important
part of your treatment once you are home. Visiting a Registered Dietitian at
Inova HealthSource is strongly encouraged to complete your education
process. To make an appointment, please call the number listed below.
Inova HealthSource
703-698-2400
www.inova.org
American Heart Association
1-800-AHA-USA1
www.americanheart.org
American Dietetic Association
1-800-366-1655
www.eatright.org
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INOVA HEART AND VASCULAR INSTITUTE
Patient Resource Handbook
Create a Positive
Change inYour Life...
www.inova.org/heart
Visit the Inova Heart and Vascular Institute Web site and help create a positive change in your life.
Access complete information about heart and vascular disease, treatment and prevention.Take an
online health assessment, receive prescription and test information personalized for you, locate
cardiac specialists, sign up for heart healthy classes and more. Visit www.inova.org/heart.
Wellness and Prevention • Diagnostics • Interventions • Surgery • Rehabilitation • Recovery
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Section VI: Other Resources
Inova Diabetes Center
Starting Insulin Program
The Inova Diabetes Center believes in the
team management approach to diabetes. The
center, a recipient of the prestigious certificate
of recognition from the American Diabetes
Association, provides educational and clinical
services.
In this class you learn the basics of taking
insulin, monitoring your blood glucose and
planning your meals and snacks. There are a
minimum of two to three consultation visits
with additional visits based on your individual
needs.
In-depth Education
Our staff of nurses and dietitians are certified
diabetes educators. We offer services at four
outpatient offices. Our clients not only learn
about diabetes, they learn to make the lifestyle
changes necessary to improve their health and
quality of life – now and for the future.
Our team of nurses and dietitians work with
you and your physician to help you learn
more about fitting diabetes into your life
and improve your blood glucose control. An
individualized diabetes management plan is
developed just for you.
Basic Education
Insulin Intensification Program
At the Inova Diabetes Center, we understand
the uncertainty many people feel when they
are diagnosed with diabetes. With this in mind,
our basic programs are designed for those
who are recently diagnosed or who are new
to diabetes self-management. These programs
focus on the essential information and skills
for managing diabetes. Group seminars and
individual consultations are available with our
clinical team of certified nurse and nutrition
diabetes educators.
This program is designed to help you achieve
tighter blood glucose control through an
intensified management regimen. The
emotional and technical skills of self-managing
your diet, exercise and insulin are discussed.
For those who are interested, our experts
can provide support regarding the skills and
knowledge related to pump therapy.
Continuing Education
Individual Consultation
Type 2 Diabetes Basics Class
You or your doctor may request individual
consultations with a nurse and/or dietitian.
You will receive personalized instruction and
care to fit your needs and lifestyle. Examples
of topics include: carbohydrate counting,
calculating carbohydrate/insulin ratios, travel
guidelines, exercise guidelines and prepregnancy planning.
This class is designed for those with type 2
diabetes. The basics of controlling blood
glucose through good nutrition, moderate
activity and blood glucose monitoring are
taught. The class works together for four visits
during a four-month period.
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Additional Services
Diabetes Community Services
A variety of programs provide information on
many aspects of living with diabetes and an
open forum for discussion. They are held at
several locations and include support groups,
camp for children, diabetes screenings and
pre-diabetes classes.
Contact Us
Inova Alexandria Hospital
703-504-3678
4320 Seminary Road
Alexandria, VA 22304
Inova Fairfax Hospital
703-698-2500
2700 Prosperity Avenue, Suite 100
Fairfax, VA 22031
Inova Fair Oaks Hospital
703-391-3746
3700 Joseph Siewick Drive, Suite 408A
Fairfax, VA 22033
Inova Loudoun Hospital
703-858-6358
44045 Riverside Parkway
Leesburg, VA 20176
Inova Mount Vernon Hospital
703-698-2500
2501 Parker’s Lane
Alexandria, VA 22306
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INOVA HEART AND VASCULAR INSTITUTE
Patient Resource Handbook
Imagine a Healthy Heart
and Happy Future
Hope & Help
Right now, that may be challenging. Heart disease and
surgery can cloud your vision, leaving you and your
loved ones confused and concerned.
for heart patients,
We in Mended Hearts understand.We share your
experience. Our members include heart patients
themselves, their family members or caregivers.
their families, their caregivers
We offer hope by…
• visiting hospitalized heart patients like you to
listen to your concerns and answer some of your
many questions
• encouraging patients and those who care for them
• since Mended Hearts visitors also have heart
disease, showing that an active, productive life with
cardiovascular disease – even after surgery – is
truly possible
• hosting social events to help you relax with others
who understand and to coax back “into the
world” patients who may feel isolated
• holding monthly programs where members share
their strength and positive outlook
We’re here to help by…
• providing heart-specific information so you and
The Mended Hearts, Inc.
those caring for you better understand your
choices
Northern Virginia Chapter 200
• assisting health care professionals and
organizations in their work with affected patients
and families
• holding health information workshops geared
toward your special needs and
interests
• maintaining a speakers bureau available to adult
and youth groups at their request
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INOVA HEART AND VASCULAR INSTITUTE
Patient Resource Handbook
The Mended Hearts, Inc.
Northern Virginia Chapter 200 —
The Mended Hearts, Inc.
Our chapter aims to support and inform local
patients with heart disease, helping you through
your hospital stay if you choose, encouraging your
family and providing information about area
resources you may need or want after you get home.
Our visitor program is supported by Inova Fairfax
Hospital, where the visits take place.The hospital
believes our group’s work fits its own mission of
providing quality health care to local communities.
To help ensure that we understand and honor its
high standards, the hospital further trains our
volunteers, who are already accredited by our parent
organization,The Mended Hearts, Inc.
For more than 50 years, Mended Hearts has been
creating networks of patients, spouses, family
members, friends and medical professionals – all
faced with the realities of heart disease. Our
volunteers make 227,000 hospital visits to patients
each year and 30,000 visits to their caregivers.We
even have “virtual visiting” via an Internet program
that offers members online support, answers
questions and helps locate resources in your area.
Chapter 200 is also affiliated with the American
Heart Association, which underwrites administrative
costs and supplies a variety of educational materials.
Call our toll-free helpline today:
1-888-HEART99 (1-888-432-7899).
Through Chapter 200 our members receive
Heartbeat, the national Mended Hearts quarterly
journal. Members can also access the “Members
Only” area of the national Web site.
Our chapter sends members NOVA FAX, our
monthly newsletter with details on monthly
programs, upcoming social events and heart-specific
news of local interest.
Chapter 200 members enjoy benefits from the
national Mended Hearts as well as the special focus
offered by others in our own community – perhaps
your neighbors – who share your health concerns.
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Important Phone Numbers
Inova Heart and Vascular Institute............................................................................. 703-776-4003
Inova HealthSource (Wellness Classes).................................1-855-My-Inova (1-855-694-6682)
CVOR Patient Care Director.......................................................................................703-776-8966
CVICU Family Phone Number................................................................................... 703-776-2211
CVICU/CVSD Patient Care Director..........................................................................703-776-7248
CVSDU Nurses Station................................................................................................703-776-3295
Cardiac Rehabilitation Program/
Heart Enhancement Program.....................................................................................703-776-3635
Inova Diabetes Center................................................................................................. 703-698-2500
Mended Hearts toll-free helpline ......................................... 1-888-HEART99 (1-888-432-7899)
Web Resources
www.inova.org/heart
The Society of Thoracic Surgeons (STS) Web site offers a wide range of information about
cardiac surgery, clinical trials and resources on its patient information page:
www.sts.org/sections/patientinformation
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Section VII: Patient Notebook
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