Download DISCHARGE INFORMATION FOR PATIENTS FOLLOWING LUNG

St James’s Hospital
Department of
Cardiothoracic Surgery
DISCHARGE INFORMATION
FOR PATIENTS FOLLOWING
LUNG RESECTION
JANUARY 2012
CONTENTS
Now that your on your way home.........................................................................................1
Getting there ....................................................................................................................1
What happens after I go home?...........................................................................................1
Rest ...............................................................................................................................1
Bathing ..........................................................................................................................1
Wounds .........................................................................................................................1
Stockings.......................................................................................................................2
Physiotherapy/Excercise at home........................................................................................2
Emotions .......................................................................................................................3
Medications ..........................................................................................................................3
Things that you should know about your medications ..................................................3
Painkillers ......................................................................................................................4
Laxatives ..............................................................................................................................7
Fequently asked questions ..................................................................................................8
Will I need further treatment after my surgery? .............................................................8
When will I see my surgeon again? ..............................................................................9
When can I return to work? ...........................................................................................9
When can I fly ...............................................................................................................9
When can i drive ...........................................................................................................9
When can I resume sexual activity?..............................................................................9
Useful Contacts ....................................................................................................................9
This booklet has been prepared to help you and your family prepare for your return home
following surgery. It will give you general information about what to expect following
discharge, however, it is not intended that the booklet will replace talking with medical or
nursing staff.
NOW THAT YOU’RE ON YOUR WAY HOME
It is not necessary to go home in an ambulance, however, you are not permitted to drive yourself home from
hospital. Organise a lift home a few days before your discharge. If you are travelling a long distance you may
need to stop during the trip to stretch your legs.
GETTING THERE
Make arrangements that your first day home is restful. It is usually quite exciting to be going home but it can
be quite tiring so plan plenty of rest.
WHAT HAPPENS AFTER I GO HOME?
Most people find that it takes approximately 6 weeks after the operation for them to make a full recovery.
Obviously there is considerable variation depending on how fit you were before your operation and the type of
operation performed. The best guideline is to do what you can without becoming too tired or short of breath.
It is recommended that you get at least 8-10 hours sleep per night. Sleep disturbance is not uncommon
following hospitalisation and surgery, but it should resolve a few days after returning home. In the first few
weeks you may feel that an hours rest is needed in the afternoon. Get as much rest as you need in whatever
way suits you best. You may prefer to lie on the couch rather than rest in bed.
REST
You may shower or bath daily. The first time you bath it may be advisable to have someone nearby in case
you have any difficulty getting in or out of the bath. Do not use very hot water. You should wash your wound
gently, do not scrub it. Run the water over your wound, do not rub soap in to the wound. Dry by patting with a
towel. If you feel light headed or dizzy sit down.
BATHING
It is normal for your wound to be sore, itchy and numb for the first few weeks after surgery. You will get a
prescription for pain killers and instructions on when to take them. This should help control the wound pain.
WOUNDS
When you return home following your surgery you may receive a visit from a public health nurse who will
check your wounds. In general the wounds will be healing without problems by the time you go home.
Occasionally there may be a slight discharge from the wound which requires a simple dressing, if this is the
case the public heath nurse will attend to the wound as needed. If you have stitches where your chest drains
were, the public health nurse or your GP will remove them on the appropriate day.
Following discharge from hospital if there is any redness, pain or leakage from the wound, it is important to
report it to your GP so that this can be treated quickly and appropriately.
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You will have been given special stockings to help improve circulation and prevent blood clots while in
hospital. You will not require them at home.
STOCKINGS
It is normal to feel a change of mood following your surgery. Some of the most common feelings are anxiety
and depression. These feelings can present themselves in many ways: altered sleeping patterns, lack of
concentration, irritability, inability to relax. You can discuss these feelings with any member of the team, the
lung cancer coordinators or your GP.
EMOTIONS
PHYSIOTHERAPY/EXERCISE AT HOME
You will have been given an incentive spirometer following your operation. You should continue to use this
when you return home. It encourages you to take deep breaths.
Exercise is encouraged to prevent chest infection, stiffness, bedsores and constipation. You may experience
some breathlessness whilst you are carrying out activities. This is acceptable as long as it is not distressing for
you.
Going up and down the stairs does require more energy than walking, so it is important to take the stairs
slowly. If your bathroom or bedroom is located upstairs there is no need to make alternative arrangements,
just take it slowly. If you become dizzy, light headed or breathless sit down and rest.
When exercising, you should still be able to talk comfortably. If you cannot, you may be overdoing it. You are
advised to walk most days and increase your exercise gradually. You should aim to make walking part of your
daily routine. A guide to walking is shown below
Week 1: 5-10 minutes of brisk walking daily
Week 2: 10-15 minutes of brisk walking daily
Week 3: 15-20 minutes of brisk walking daily
Week 4: 20-25 minutes of brisk walking daily
Week 5: 25-30 minutes of brisk walking daily
Week 6: 30-35 minutes of brisk walking daily
TIMES WRITTEN ABOVE ARE GUIDELINES ONLY
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DO NOT EXERCISE IF YOU:
Feel overtired, unwell or very breathless
Have chest pain or palpitations
Feel light-headed, dizzy or faint
Have a viral infection or fever
Most people find that it takes approximately 3 months to make a full recovery. Obviously there is considerable
variation depending on how fit you were before your operation and the type of operation performed.
Sit or stand
Lift your arm up over your head
Repeat 10 times
Sit or stand
Lift your arm out to the side.
Repeat 10 times
It is important to try to maintain good posture at all times. This means you should gently pull your shoulders
back and sit/stand up straight. You may feel your shoulder is tight and it is important to exercise your
shoulders regularly. Remember your shoulder joint should work normally after the surgery. Here are some
simple exercises you should practice daily.
SHOULDER EXERCISES
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MEDICATIONS
Whatever medications you take it is important to know the following:
The name of the medicine, Why you are taking it, When and how to take it, What side effects might be expected
THINGS THAT YOU SHOULD KNOW ABOUT YOUR MEDICATIONS
All medicines can cause side effects. Usually these only affect a small number of people. Talk to your doctor or
pharmacist if you develop any unusual symptoms or find any side effects troublesome. Do not stop, decrease or
increase the amount of medication without your doctorʼs advice.
SIDE EFFECTS
You will find more details of specific medications in the following pages. Please read the information carefully
and ask if you do not understand anything or if something requires clarification. Please note that many different
manufacturers make medicines, and will give their medicines a brand name. Brand names may be recognised
in this booklet by the symbol ®.
PAINKILLERS
It takes about 4-6 weeks for your wound to completely heal. In this time aches and pains can be expected. If
pain is not controlled by the medication prescribed on discharge, please contact your GP. Many of the painkillers
you will be prescribed on discharge can cause constipation, therefore, it is important to take laxatives as
prescribed with your painkillers.
Common Preparations: Paralief®, Panadol®.
PARACETAMOL
When and how do I take it?
The usual dose is TWO tablets up to FOUR times daily as needed. Do not take more frequently than every four
hours and do not take more than eight tablets in twenty four hours.
Is there anything else I should know?
Do not take any other preparations containing paracetamol at the same time eg. Lemsip®, Solpadeine®. If you
are unsure whether a preparation contains paracetamol, ask your pharmacist.
Common Preparations: DF118® tablets 30mg
DIHYDROCODEINE
How do I take it?
The usual dose is one tablet every four to six hours as required for strong pain (or as directed by your doctor). It
can be taken in addition to paracetamol.
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Are there any side effects that I should know about?
You may experience some side effects such as nausea, vomiting, constipation, headache, dry mouth,
confusion, dizziness or drowsiness. If affected do not drive or operate machinery.
Is there anything else I should know?
Do not take alcohol when taking these tablets – this may cause increased drowsiness.
OxyContin® tablets and OxyNorm® capsules both contain the drug oxycodone. This drug belongs to a group
of medicines called opioids, which are prescribed for the relief of severe pain.
OXYCODONE
The prolonged (slow) release tablets are designed to provide pain relief over a twelve hour period. This means
that they are only taken twice daily.
OXYCONTIN® PROLONGED RELEASE TABLETS
How, when & how often do I take it?
The tablets should be swallowed whole with a glass of water. Do not chew, crush or dissolve them – this could
cause serious side effects. The label on your medicine will tell you how many tablets to take. Doses should be
taken every twelve hours eg. if you take a dose at ten oʼclock in the morning, the next dose should be taken at
10 oʼclock at night.
Are there any side effects that I should know about?
Constipation – a laxative will usually be prescribed to overcome this. Other common side effects include
nausea, drowsiness, dizziness, headache, itchy skin, dry mouth and confusion.
Is there anything else I should know?
It is recommended not to drink alcohol whilst taking OxyContin® tablets. Your dosage may be gradually
reduced after you leave hospital – follow the instructions of your doctor and pharmacist.
These capsules are designed to provide fast or immediate relief of severe pain.
OXYNORM® CAPSULES
How, when & how often do I take it?
The capsules should be swallowed whole with a glass of water. The label on your medicine will tell you how
many capsules to take and how often. Doses are usually taken every four to six hours, but only when needed
for strong pain.
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Are there any side effects that I should know about?
Common side effects include constipation, nausea, drowsiness, dizziness, headache, itchy skin, dry mouth
and confusion.
Is there anything else I should know?
It is recommended not to drink alcohol whilst taking OxyNorm®.
Common Preparations: Versatis® 5% medicated plaster
LIDOCAINE 5% W/W PLASTER
This is a plaster which contains lidocaine, a local anaesthetic, which works by numbing the nerves in the area
to which it is applied.
When and how do I use the plasters?
The plasters should be worn for twelve hours only out of twenty four, so that you have a twelve hour period
with no plaster. For example, if you have more pain during the day, then wear from 8am until 8pm. Apply to the
painful area(s), following the directions in the pack. The plaster may be cut into smaller pieces to fit if required.
Are there any side effects that I should know about?
Skin irritation around the application site is the most common side effect. If irritation or a burning sensation
occurs, remove the plaster.
Is there anything else I should know?
After first opening the sachet of five plasters, they should be used within 14 days. Ensure the outer sachet is
kept sealed to avoid the plasters drying out. Used plasters should be folded in half with the sticky sides
together and disposed of out of the reach of children.
DICLOFENAC
Common Preparations: Difene®, Voltarol®
This is used to reduce pain or inflammation after your surgery.
When and how do I take it?
Swallow capsule whole, with or after food, with a glass of water or milk. Follow the dosage directions on the
medicine label.
Are there any side effects that I should know about?
If you suffer any stomach pain, heartburn or indigestion, please report this to your doctor.
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Common Preparations: Lyrica®
PREGABALIN
This can be used to treat pain caused by damage to nerves.
How and when do I take it?
The capsules should be swallowed whole with water. The dose will have been decided by your doctor and
your pharmacist will have labelled your medicine with the directions of how many to take and how often.
Are there any side effects that I should know about?
Pregabalin is associated with dizziness and sleepiness. This may be increased if you are also taking
OxyContin® or OxyNorm®. If you experience any changes in your vision, please report this to your doctor
straight away.
Is there anything else I should know?
It is advised not to drink alcohol while taking pregabalin. As it may cause dizziness, sleepiness and decreased
concentration, you should not drive or operate machinery if affected.
LAXATIVES
SENNA
Common Preparations: Senokot®
When & how often do I take it?
The usual dose is two tablets, taken together at night. The tablets normally act within eight to twelve hours.
Is there anything else I should know?
If symptoms of constipation continue, please consult your doctor.
Common Preparations: Laxose®, Duphalac®
LACTULOSE
How do I take it?
The syrup can be taken directly from a spoon or measuring cup, or it can be mixed with water or fruit juice. It
is usually taken twice or three times daily. Taking a glass of water at the same time will help this medicine to
work.
If symptoms of constipation continue, please consult your doctor.
Disclaimer
The information about medications in this booklet is not exhaustive. Ask your doctor or pharmacist
for advice or see the patient information leaflets in the medicine boxes.
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FREQUENTLY ASKED QUESTIONS
Following surgery you may need to be referred to a medical cancer specialist (an oncologist) for consideration
for further treatment such as chemotherapy or radiotherapy. The need for further treatment will depend on the
type of cancer you have and the extent of the disease. The decision regarding the need for further treatment
is based on investigations carried out on the piece of lung that was removed. Once available the results of
these tests will be discussed by your surgeon, an oncologist and a respiratory physician. A decision regarding
the need for further treatment is then made. This process can take up to two weeks to complete, therefore, it
is likely that you will be discharged before the decision is made. If this is the case, you will be contacted at
home by either the lung cancer co-ordinator or a Doctor regarding a follow up plan.
WILL I NEED FURTHER TREATMENT AFTER MY SURGERY?
Your surgeon will see you in the Out Patients Department approximately 6-8 weeks after your operation. This
appointment may be given to you prior to your discharge or sent by post.
WHEN WILL I SEE MY SURGEON AGAIN?
Returning to work will be assessed on an individual basis, it will depend on the type of work you do, the type
of surgery you have had done and also on the possible need for further treatment following your operation.
You will definitely not return to work before the six week follow up out patients appointment with your surgeon.
If you have any doubts or questions about returning to work discuss them with the team.
WHEN CAN I RETURN TO WORK?
In general patients are advised that they cannot fly for at least six weeks following lung resection surgery.
However, ask your Doctor as there are sometimes exceptions to this and advice will be given on a case by
case basis.
WHEN CAN I FLY?
You cannot drive for six weeks following your operation.
WHEN CAN I DRIVE?
Most people, both partners, tend to worry about having sex after an operation. Everyone worries that having
sex may damage the wound. Provided you feel relaxed, rested and ready for sex, sexual activity can be
resumed whenever you feel confident about it.
WHEN CAN I RESUME SEXUAL ACTIVITY?
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St. Jamesʼs Hospital
USEFUL CONTACTS
Lung Cancer Coordinators
Cardiothoracic Advanced Nurse Practitioners
Physiotherapist
Robert Adams Ward
Keith Shaw Ward
Private 2
Mr Vincent Youngʼs Secretary
Prof Eilis McGovernʼs Secretary
Mr Ronan Ryanʼs Secretary
Irish Cancer Society - National Cancer Helpline website
- www.cancer.ie
Daffodil Cancer Information Centre
St. James Hospital
Phone 01 - 4103000
Phone 087 - 2146575
or Bleep 101 via
hospital switchboard
Phone 01 - 4103338
Phone 01 - 4162503
Phone 01 - 4162088
Phone 01 - 4103389
Phone 01 - 4103211
Phone 01 - 4103534
Phone 01 - 4162323
Phone 01 - 4162323
Freephone
1800 - 200 - 700
Phone 6165604
Email: [email protected]
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CHARITABLE DONATIONS
St. Jamesʼs Hospitalʼs Thoracic Service provides a state-funded public service but, in order to continue to
improve the service it provides, the department aims to invest funds over and above those provided by
government to ensure patients receive the best possible care.
Additional funds received will be focused on purchasing new equipment and providing greater comfort for
patients. Donations received recently have been used to purchase portable chest drain suction units, incentive
spirometers and also an active and passive exercise machine for post operative physiotherapy.
There are many ways the work done by the department can be supported. People may choose to make an
individual donation, hold a fundraising event of their own or choose to take part in an event organised by St.
Jamesʼs Hospital Foundation, the charity that supports the work of St. Jamesʼs Hospital. The department is
grateful for all donations. All donations help – and all donations will be most gratefully received and
acknowledged.
Donations for the Thoracic Service may be made to St. Jamesʼs Hospital Foundation by post or personally at
the office. Cheques, drafts or postal orders should be made payable to St. Jamesʼs Hospital
Foundation/thoracic fund. To make an electronic transfer please contact the Foundation directly.
St. Jamesʼs Hospital Foundation, St. Jamesʼs Hospital, Dublin 8
01 428 4086 www.stjames.ie/foundation
St. Jamesʼs Hospital Foundation processes donations and grants for the hospital
and fundraises on its behalf. CHY 7269
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