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What You Need To Know About Your Lung Surgery A Guide for Patients and Their Families Welcome Dear patient and family, Our lung surgery team includes doctors, physician assistants, nurses, patient care technicians, care managers, dietitians and respiratory therapists. We are all here to help you and your family members through this stressful experience. Please remember, you and your family are the most important part of our team. It is very important for you and your family to participate in your care after surgery. As part of this plan, we have created this guidebook. We have included important daily activities that aid in the healing process and that will help prevent complications. There are several surgeons in the practice; you may see different surgeons throughout your stay. The doctors make rounds at 7 a.m.; please plan to be here at that time if you wish to see them. Your doctor will also speak to you by telephone on request. Care managers help with coordinating your discharge. One of them will see you in the first few days after surgery. Please let them know if you have any special needs, concerns about your progress or questions regarding availability of resources upon your discharge from the hospital. If you have concerns with your care itself, please ask to speak with the nurse in charge. Your surgeon is ________________________ Tel.# _________________ Contents Testing Prior To Your Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Your Preoperative Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Your Lung Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Your Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Nutrition after Lung Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 References and Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Sample Pre-Procedure Health Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Medication Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Weight Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Lung Surgery Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Lee Memorial Health System — 3 Testing Prior To Your Procedure Prior to your procedure, a nurse may call you to obtain your medical history. If your medical history indicates the need for testing, the nurse will make an appointment for you. In this guidebook, we have provided sample pre-procedure health questions to give you an idea of the types of questions the nurse will ask, on page 23. Preoperative Appointment Schedule Use this table to keep track of your appointments. Not all patients will need every appointment listed below. Scheduled Appointments Who / Where Appointment with Surgeon Preoperative Surgery Appointment Lab Appointment OK to eat before appointment Electrocardiogram EKG Appointment Does not apply to all patients Chest X-Ray Does not apply to all patients Other: Other: 4 — What You Need to Know About Your Lung Surgery Date Time Your Preoperative Checklist Contact Your Insurance Company If you have questions about your insurance coverage, please call your insurance company. If you do not have insurance, please notify the registration staff that you will need information about payment options when they call you for preregistration. Pre-registration After your surgery has been scheduled, you may be called for pre-registration information. You will be asked for the following information when you are contacted: • Patient’s full legal name and address • Home phone number • Marital status • Social Security number • Name of insurance holder, his/her address, phone number, work address and work phone number • Name of insurance company, mailing address, policy and group numbers and insurance card • Patient’s employer, address, phone number and occupation • Name, address and phone number of someone to notify in case of emergency Billing For Services After your procedure, you will receive separate bills from the anesthesiologist, the hospital, the radiology and pathology departments, and the surgical assistant. Please contact your insurance company if it has specific requirements regarding participation status. Review “Exercise Your Rights” The law requires that everyone being admitted to a medical facility have the opportunity to make advance directives concerning future decisions regarding their medical care. Please refer to the Appendix for more information about advance directives. Although you are not required to do so, you may make the directives you desire. If you have advance directives, please bring copies to the hospital on the day of surgery. You may request forms to fill out at the hospital. Vitamins to Take Prior to your surgery, you may be instructed by your surgeon to take multivitamins and iron, which helps build up your blood. Lee Memorial Health System — 5 Anesthesia and You Lung surgery does require the use of general anesthesia. If you have questions or want to request a particular anesthesiologist, please contact your surgeon’s office. Who will administer anesthesia? The Operating Room and Post-Anesthesia Care Unit at the hospital are staffed by board certified and board eligible physician anesthesiologists. All of the anesthesiologists are members of Medical Anesthesia and Pain Management, P.A. and have privileges to practice in Lee Memorial Health System. In most cases, an anesthesia care team will deliver your anesthesia. This team consists of an anesthesiologist—a doctor in the specialty of anesthesia—which supervises a certified registered nurse anesthetist—a nurse with special training in anesthesia. What types of anesthesia are available? Decisions regarding your anesthesia are tailored to your personal needs. The types available for you consist of the following: • General anesthesia provides loss of consciousness. • Epidural anesthesia does not provide loss of consciousness, instead causes loss of sensation and loss of pain in the region. Will I have any side effects? Your anesthesiologist will discuss the risks and benefits associated with the different options, as well as any complications or side effects that can occur with each type of anesthetic. Nausea or vomiting may be related to anesthesia or the type of surgical procedure. Although they are less of a problem today due to improved anesthetic agents and techniques, these side effects continue to occur for some patients. Medications to treat nausea and vomiting will be given, if needed. The amount of discomfort you experience will depend on several factors, especially the type of surgery. Your doctors and nurses can relieve pain with medications. Your discomfort should be minimal, but do not expect to be totally pain-free. The staff will teach you the pain scale—zero to 10—to assess your pain level. What will happen before my surgery? You will meet your anesthesiologist immediately before your surgery. Your anesthesiologist will review all information needed to evaluate your general health, including: your medical history, laboratory test results, allergies and current medications. With this information, the anesthesiologist will determine the type of anesthesia best suited for you. He or she will also answer any further questions you may have. Prior to surgery, you will also meet your surgical nurses. Intravenous fluids will be started and preoperative medications may be given, if needed. Once in the operating room, monitoring devices will be attached, such as a blood pressure cuff, electrocardiogram—EKG and other devices for your safety. At this point, you will be ready for anesthesia. 6 — What You Need to Know About Your Lung Surgery During surgery, what does my anesthesiologist do? The anesthesiologist and certified registered nurse anesthetist are responsible for your comfort and well-being before, during and immediately after your surgical procedure. In the operating room, the anesthesiologist will manage vital functions, including heart rate and rhythm, blood pressure, body temperature and breathing. They are also responsible for fluid and blood replacement, when necessary. May I choose an anesthesiologist? Although most patients are assigned an anesthesiologist, you may choose one based on personal preference or insurance considerations. If you have questions about your insurance coverage or medical plan participation by the anesthesiologist, please contact your insurance company for guidance. Requests for specific anesthesiologists should be submitted in advance through your surgeon’s office for coordination with the surgeon’s availability. Lee Memorial Health System — 7 Your Lung Surgery A thoracotomy is an operation, performed under general anesthesia, in which part or all of one lung is removed through an incision in your chest. The several types of thoracotomies are explained below. You will be asleep and pain-free during the procedure. A thoracotomy is required for several lung conditions such as: YLung cancer YBenign or non life-threatening tumor YChronic lung disease that results in an increase in the size of air spaces YRepeated fungal infections in the lungs YTuberculosis YLung abscess YTo confirm the presence of lung cancer YTo remove a scar tissue or fix an air leak in the lungs Cancer in lower lobe of lung Lobe removal After lobectomy The Procedure An incision is made in your upper back, under your arm and around to the front of your rib cage. The lung being operated on is deflated, and a breathing tube helps your other lung continue working. One or more tubes are placed in the chest temporarily to drain fluid and air. The entire procedure may take up to five hours. 8 — What You Need to Know About Your Lung Surgery Thoracotomy—lung surgery—operations Lobectomy: a whole lobe from a lung containing a mass is removed. The right lung has three lobes, and the left lung has two lobes. Pneumonectomy: the entire right or left lung is removed. Segmentectomy or Wedge Resection: the part of a lobe containing the lung tumor is taken out, as well as a margin of normal tissue around the tumor. When a wedge-shaped piece is removed, it is called a wedge resection. Lymph nodes in the chest may also be removed to help determine whether the tumor has extended beyond the mass. Chemical Pleurodesis: chemicals are used to help two layers covering the lungs to stick together to prevent buildup of fluid. Pleurectomy: removes the covering around the lung to help re-expansion. Decortication: removal of tissue on the surface of the lung to allow drainage and re-expansion. Abrasive Pleurodesis: a sponge is used to irritate the tissues to allow scar tissue to form and heal the lung. Less-invasive lung surgery As an alternative to opening the chest cavity with a large incision through thoracotomy, many surgical procedures can be accomplished with thoracoscopy. Thoracoscopy is the insertion of a camera or scope through a small insertion in the chest wall. The image is displayed on a screen. The surgeon will make another two or three small incisions in the chest through which long instruments will be inserted for the operation. The purpose of this procedure is: • To assess lung cancer or take a biopsy for study • To investigate causes of unexplained fluid in the pleural cavity • To introduce medications or other treatments directly into the lungs • To treat accumulated fluid, pus or blood in the space around the lungs • Pleurodesis • Lobectomy or wedge resection After the procedure, some of the incisions are closed. Drains (chest tubes) are placed in the other incisions, which will remain in place for one or more days, to remove air and fluids from the chest. When the draining of air or fluid stops, the tube is removed and the opening is left to heal by itself. Surgical risks and complications There are risks associated with any surgical procedure. Risks from being under general anesthesia include nausea, vomiting, urinary retention, cut lips, chipped teeth, sore throat and headache. Risks that are more serious include heart attack, stroke and pneumonia. Lee Memorial Health System — 9 Blood clots in the legs can occur due to inactivity during and after surgery. Blood clots in the legs can become dislodged and travel to the lungs, where they will cause shortness of breath, chest pain and possibly death. Let your nurse or doctor know right away if you experience any of these symptoms. Getting out of bed shortly after surgery helps decrease the risk of blood clots. You will also wear support stockings and may receive injections of medicine which will reduce your risk of blood clots. Other surgical risks: - Infection may occur. - Bleeding may occur, which may require a blood transfusion. - The nerves between the ribs may be damaged, leading to numbness or persistent pain in the area of the incision, and around the front of the chest area. Sometimes fluid or air may leak around the lung and require placement of another tube in your chest. This may result in a longer hospital stay. It is important to inform the doctor if you are allergic to any medications. Please let us know if you have any questions. What can I expect after the operation? After lung surgery, you will be taken to the Intensive Care Unit or the Surgical Progressive Care Unit, where specially trained nurses will watch you closely. An anesthesiologist is available to provide care as needed for your safe recovery. Day before Surgery Find Out What Time You Should Arrive at the Hospital The hospital or surgeon’s office will call you to tell you what time your procedure is scheduled. You will be asked to come to the hospital two hours before the scheduled surgery, so the nursing staff has sufficient time to start intravenous fluids—IVs, get ready for surgery and answer questions. It is important that you arrive on time because surgery could start earlier than scheduled. If you are late, it could create a significant problem, and, in some cases, tardiness could result in moving your surgery to a later time. • Plan to leave all money, jewelry, valuables and medications at home. 10 — What You Need to Know About Your Lung Surgery Shower Prior to Surgery You will receive a bottle of liquid chlorhexidine—antibacterial—soap from the surgeon’s office or from pre-admission testing. Try to take at least four showers prior to your scheduled surgery. Your surgeon recommends the antibacterial soap chlorhexidine to reduce the amount of germs on your skin prior to surgery. Directions: 1. Using a washcloth, create a lather. 2. Wash all areas of your body with the liquid antibacterial soap from the chin down. 3. For 10 minutes, thoroughly wash your chest. 4. Rinse as usual. Dress as usual in clean clothes. Wear clothing that is easy to take on and off, keeping in mind the type of procedure you will be having and what will be comfortable to wear home. Do Not Eat or Drink Do not eat or drink anything after midnight, including water, unless otherwise instructed. No chewing gum, candy or mints. If instructed, take medications with a sip of water. The following instructions are very important and MUST be followed. Otherwise, your surgery may be cancelled. • Follow all instructions given to you by your surgeon’s office or the nurse from pre-procedure testing. • Bring the list of your current medications and their dosage from Page 25. You should discuss your medications with your surgeon, and ask specifically about when to stop taking aspirin, Plavix or Cumadin. • Do not drink alcoholic beverages or take recreational drugs 48 hours prior to surgery. • Do not smoke during the 24 hours before your surgery. Smoking may cause anesthetic problems and increased carbon monoxide in the bloodstream. • If you are diabetic, do not take any diabetes medications or insulin the morning of the procedure, unless otherwise instructed. • For your safety, the following must be removed: • All jewelry and body piercings • Contact lenses – including extended wear • Wigs, hairpins and hair clips • Makeup • Leave at least one fingernail on each hand free of nail polish. • Do not use lotions, gels, hairspray, cologne, perfume or powders. Lee Memorial Health System — 11 Please contact your physician if you have any of the following symptoms prior to your procedure: • Elevated temperature or fever • Respiratory congestion, cold or cough • Open sores or rashes • Scratches, bug bites or bruises on or around the surgical area Any of the above symptoms could indicate an illness that may require delaying your surgery. Day of surgery • You will be taken to the operating room area. Your family may accompany you to the doors of the operating room. They will then be escorted to the waiting room. • Any hair on your chest will be clipped. • The anesthesiologist will insert special IVs and catheters. The anesthesiologist will also discuss with you the options for medications to be used during and after your surgery, including pain medications. Immediately after surgery • You will be taken to either the Intensive Care Unit—ICU—or to the recovery area, then to the Surgical Progressive Care Unit—SPCU—with drainage tubes, IV lines and special monitoring equipment in place. When you first wake up, you may feel groggy, thirsty and/or cold. If the breathing tube remains in place you may be taken to the ICU. You will not be able to talk, and your hands may be restrained to prevent you from pulling out any tubes. • Your family will be allowed to visit once you are settled in the ICU or the SPCU. The staff recognizes your family’s contribution to your recovery. They will be able to explain details about the unit, the nursing care, bedside visits and telephone calls. • It is important for your family to remember that your care comes first. The staff may, at times, prevent your family from seeing you so you can rest. • You will awaken gradually from anesthesia. • If you are uncomfortable or restless, you will be given medicine to relieve your discomfort and help you relax. You may have an epidural, which is a thin tube placed along the spinal column. Or, you may have a patient-controlled analgesia pump of IV pain medication, which you administer to yourself, as needed. We use a pain scale with the number zero representing no pain, and the number 10 representing the worst possible pain. This scale helps us evaluate the effectiveness of your medication. • IV lines will give you fluids and medications until you are able to eat. There will be a dressing over your incision. Flexible tubes will be in your chest to drain fluid, blood and air, and to help re-expand the lungs. These tubes will be removed a few days after your surgery, when you are no longer draining fluid or air. 12 — What You Need to Know About Your Lung Surgery Chest tube • The breathing tube may make you cough, and may be uncomfortable and make your throat sore. Once it is removed, you will be placed on oxygen. • Deep breathing exercises will be started soon after you wake up. You will be encouraged to cough and take deep breaths. You will be taught to use the incentive spirometer, which is a breathing exerciser that helps your airways open so you can breathe more easily. • The more you can work with your nurse and follow instructions, the more comfortable you will be. When you transfer to the SPCU • You will transfer to the SPCU where your nurses will continue to monitor you closely. • You will be out of bed, sitting in a chair for your meals. You will also walk for a short distance and progress to taking longer walks in the hall. • It is important to use your incentive spirometer at least 10 times every hour while you are awake. We will show you how to cushion your chest when coughing and during deep breathing. These exercises are very important to your recovery as they help expand your lungs to prevent pneumonia. • Walking and breathing exercises are very important. • Pain in your incision and muscle soreness can be relieved with pain medication. It is important to ask your nurse for pain medicine before you become too uncomfortable. We use a pain scale of zero to 10, with zero representing no pain, and 10 representing the worst imaginable pain. We will ask you what pain level is acceptable to you so we can help you be comfortable enough to walk, do your breathing exercises and rest. • Your chest drainage tubes will be removed when they are no longer needed to drain fluid or air. • The bandage over your incision will be removed on your second day after surgery. • You will be able to take a shower the day after your tubes are removed. • You will continue to do your breathing exercises and walk in the hall until you are ready to go home. • We will work with you to plan your discharge. If you have any special concerns about going home, please let us know. Lee Memorial Health System — 13 Your Recovery Please Remember: 1. It is normal to feel tired even with little activity. It is important to space out activities to allow for enough rest. 2. You may experience shortness of breath or heart pounding sensations that should be relieved with rest. 3. We encourage you to ask for pain medication so that you can do activities. 4. Some patients have periods of depression or become unusually emotional after lung surgery – either in the hospital or after they have gone home. Please do not get discouraged if you do not progress as quickly as you would like, or as the guidebook directs. Everyone is different, and other medical conditions may interfere. Together we will work toward preparing you to leave the hospital. Activities to Wait Six Weeks to Resume Activities that will exert more stress on the body should be delayed for at least four (4) weeks after surgery. Some of the activities you should avoid until this time include: • Lifting, pushing or pulling objects • Swinging your driver or other golf clubs • Playing tennis • Fishing from a boat or dock • Hunting, camping or chopping wood • Swimming, wading or soaking in water • Riding a bike • Jogging • Bowling • Vacuuming • Driving—usually wait two to three weeks Your surgeon may release you for some of these activities at your follow-up visit. Please ask your surgeon if you have any questions about activities to avoid. Sex after Lung Surgery Resuming intimate relationships in the postoperative period takes time. Each person recovers at a different pace, and there is no definite timeline as to when it is safe to resume sexual relationships. Some guidelines to follow include: • Do not set goals for yourself. • Get plenty of rest, plan ahead and refrain from sexual activity within two hours of eating. • Get “in touch” again by hugging, kissing and snuggling. • Resume when you are able to climb two flights of stairs, or take a brisk 10-minute walk without pain or shortness of breath. 14 — What You Need to Know About Your Lung Surgery • Check with your doctor before taking medications for erectile dysfunction, such as Viagra or Cialis. • It is not unusual to feel short of breath with sexual activity. Healthful Hints • Stop smoking—only you can make this life-saving choice • Shower and get dressed every day. • Weigh yourself and record it daily. Call your surgeon for unexplained weight gain. • Use your spirometer 10 times per hour while you are awake. • Walk several times each day and gradually increase the time and distance. Your Hospital Discharge Some general guidelines for discharge are: • You may be ready to go home by your third or fourth day after surgery. Usually, you will go home the day after your chest tubes are removed. Plan to leave by 11 a.m. on the day of discharge. We will review your instructions and medications before you go home. You may, or may not, go home on the same medications you were on in the hospital. You will be given prescriptions for any new medicine. • You will be given phone numbers to call for any questions that may come up, and for follow-up care. Instructions for care after discharge • Do not drive or return to work until released by your surgeon. • Walk frequently, but do not lift anything over 10 pounds. • Shower daily. Wash your incision(s) with liquid soap and water, and leave open to air—no bandage. • Make an appointment to see your surgeon in two weeks. You should have a chest x-ray two to three days before your appointment; we will give you a prescription. • Notify your surgeon if you experience increased pain, redness, swelling or drainage over the incision, temperature over 100 degrees, shaking, or chills or increased shortness of breath. Lee Memorial Health System — 15 Tips for Managing Your Diabetes after Lung Surgery • Check your blood sugar two to four times daily before meals or two hours after meals. • Goals for blood sugars: Fasting or before meals = 90-130 Two hours after meals = less than 180 Your doctor may wish you to have target blood sugar goals different from these American Diabetes Association recommendations. If you don’t know, ask your doctor about your target goals. • Contact your doctor for diabetes medication adjustment if blood sugars are consistently out of goal range. High blood sugars put you at greater risk of postoperative infection. This is the time to be vigilant with blood sugar checks. • Diet – Watch portion sizes of carbohydrates (starches, fruit and milk). Choose healthy carbohydrates (whole grains, fresh fruit and non-starchy vegetables). Avoid fruit juices, high sugar food and drinks. Include heart healthy protein with each meal. • If you have not attended outpatient diabetes self-management education classes, ask your doctor for a referral. Nutrition after Lung Surgery You have undergone an extensive surgical procedure which has left you feeling fatigued, weak, with a loss of appetite and possible taste changes from medications. The following recommendations are to help you rebuild your strength and energy level. Simple rules to follow for 6 – 8 weeks post surgery: • Pick foods high in protein: poultry, fish, one tablespoon peanut butter, egg substitute, and lean beef to help with the healing process. • Focus on eating five to six small, frequent meals per day. For example, a midmorning meal may only be half of a banana. • Drink plenty of fluids to prevent dehydration, flush kidneys and to avoid constipation, unless fluid restriction is recommended by your physician. • Strive for no further weight loss while rebuilding your strength. • Take a multivitamin or mineral supplement daily. Ask your physician if iron supplements are needed or if a multivitamin with iron is recommended. Eat lean red meats such as 3 to 4 ounces of beef or lamb per day. This is a good source of iron and protein. • Avoid high salt foods – see “Restricted Sodium Diet” and “Flavoring Foods without Salt”, if recommended by your surgeon. • Pain medication can cause constipation, so increase foods that contain fiber; aim for at least 3 to 5 grams of fiber per serving. Consider stool softeners, Metamucil, high-fiber cereals, prune juice, fruits, vegetables and whole grain products. 16 — What You Need to Know About Your Lung Surgery • Continue walking and moving around. This type of exercise will help with your fatigue. • For more nutritional information, the following websites may be helpful: mypyramid.gov cfsan.fda.gov/label.html mrsdash.com Always follow your physician’s recommendations. Restricted Sodium Diet What is sodium? Sodium is a mineral found naturally in many foods. The most significant source of sodium is table salt, which is about 40% sodium. Processed, convenience and preserved foods contain large amounts of sodium. The body needs only 500 milligrams of sodium per day to function. Why limit sodium? A build up of sodium can cause thirst, shortness of breath, water retention and increased blood pressure. By decreasing sodium intake, you can reduce edema and the risk of heart attack and stroke associated with high blood pressure. Heredity, obesity, lack of exercise, smoking, stress and what you eat, all play a role in heart disease or stroke. General Guidelines: • Do not add salt at the table or in cooking. Instead, use an assortment of herbs and spices. • Read all food labels. • Avoid processed and convenience foods. • Consult your physician if you wish to use a salt substitute or medication containing sodium, like antacids. • Limit milk and milk products to 16 ounces or two cups per day. • Cheese is naturally high in salt – use unsalted cheeses. Shopping Hints: READ LABELS “Dietetic” does not necessarily mean low sodium. Salt and other sodium ingredients are often added to foods during processing. Examples are: • Salt—NaCl • Sodium saccharin • Sodium nitrate • Sea salt • Sodium—Na • Sodium bicarbonate—baking soda • Sodium proprionate • Kosher salt • Brine—salt and water Lee Memorial Health System — 17 • Monosodium glutamate—MSG • Any ingredient with sodium in its name Sodium claims on food labels: • Sodium or salt free - less than 5 milligrams sodium per serving • Low sodium - 140 milligrams sodium per serving • Very low sodium - 35 milligrams or less sodium per serving • Reduced sodium - at least 25 percent less sodium when compared to the regular version of the food • Light in sodium - 50 percent less sodium per serving • Unsalted, without added salt or no salt added- no salt was added during processing • If the label bears the statement “not a sodium free food” or “not for control of sodium in the diet,” then the food is not a good choice. Dining out: Generally, foods served in restaurants are seasoned with salt or monosodium glutamate. Request to have your foods prepared without salt. Good choices are broiled or roasted meats, fish or poultry without sauces or gravies. Baked potato and salad should be ordered with butter or salad dressings on the side. Fruits, sherbet or ice cream are lower in sodium than rich pastries or desserts. “Fast foods” are generally high in sodium. Careful selection is required – choose a hamburger, roast beef or slice chicken sandwich without condiments. Lettuce, tomato and mayonnaise are allowed. Chinese and Mexican foods are extremely high in salt. Remember to keep portion sizes smaller if using high sodium foods to help keep the right sodium balance. Flavoring Foods without Salt Vegetables Asparagus: lemon, chives Broccoli: lemon, oregano, rosemary Carrots: lemon, orange, nutmeg, mint, basil, marjoram, oregano, thyme, brown sugar, ginger, cinnamon, mace, anise, dry mustard Corn: green pepper, fresh tomatoes, paprika, hot pepper sauce Peas: mint, dill, fresh mushrooms, basil, marjoram, savory Potatoes: mace, chives, rosemary, dill Sweet Potatoes: mace, ginger, basil, cinnamon, cloves, brown sugar, nutmeg, allspice, oregano, lemon, orange Spinach: nutmeg, oregano, basil, marjoram, rosemary, thyme, allspice, mace, lemon Tomatoes: basil, oregano, thyme, sugar, dill, marjoram, vinegar 18 — What You Need to Know About Your Lung Surgery Meats, Poultry, Fish and Eggs Beef: bay leaf, dry mustard, nutmeg, sage, dill, green pepper, fresh mushrooms, tomatoes Fish & Eggs: dill, basil, tarragon, curry, dry mustard, paprika, cayenne, thyme, green pepper, fresh mushrooms, tomatoes, hot pepper sauce, chives, Bay leaf adds flavor to fish chowders Lamb: curry, mint, dill, sage Pork: sage, caraway, nutmeg, apples, applesauce, cranberry sauce, tarragon, dry mustard Poultry: sage, tarragon, fresh mushrooms, poultry seasoning, curry, peach, apricot, pineapple, lemon, hot pepper sauce, bay leaf Veal: bay leaf, curry, ginger, apricot or current jelly, fresh mushrooms, tomatoes, tarragon, dry mustard Sample Menu Breakfast Lunch Dinner Half banana 1 cup oatmeal 2 tablespoon pecans 1 cup decaf coffee 2 tablespoon milk 1 slice whole wheat toast 1 tablespoon jelly One-half cup milk Sandwich: 2 slices light wheat bread 1 ounce lean roast beef 1ounce low sodium Swiss cheese Lettuce, tomato, 2 teaspoons mustard Pasta Salad: ¼ cup whole wheat pasta ¼ cup mixed vegetables 1 teaspoon olive oil/vinegar/ spices Medium apple Unsweetened tea 3 ounce baked chicken, without skin 1 cup brown rice 1 cup broccoli, steamed 1 dinner roll 1 teaspoon soft margarine 1 cup tossed salad 1 tablespoon low fat Italian dressing 1 tablespoon light margarine One-half cup fresh strawberries 1 slice Angel food cake topped with whipped topping Morning Snack Afternoon Snack Before Bed Snack Medium orange Light yogurt—8 ounce cup 3 cups popcorn - air-popped with no added salt Approximate Nutritional Analysis Calories ~1960 Total fat Saturated fat Monounsaturated fat Polyunsaturated fat Trans fat Omega 3 fats 64 gram 10 gram 25 gram 12 gram 0.2 gram 2.5 gram Cholesterol Carbohydrates Total fiber Soluble fiber Protein Sodium 110 gram 259 gram 27 gram 8 gram 87 gram ~1650 milligram Lee Memorial Health System — 19 Restricted Sodium Diet Food Group Daily Servings Foods Allowed Foods to Avoid Milk and Milk products 2 servings per day ------------1 cup milk 4 ounces yogurt Milk and dairy products to include: buttermilk, cream, sour cream, heavy cream, half and half, yogurt, non-dairy creamer, evaporated milk Malted milk, milkshakes, Dutch processed chocolate milk Meat, Poultry, Fish, Dried Beans, Eggs, Cheese and Nuts 5 servings per day -------------1 ounce cooked meat 1 tablespoon natural peanut butter 1 ounce low sodium cheeses ¼ cup cottage cheese ½ cup unsalted nuts ¼ cup dried beans & peas 1 egg Any fresh or frozen meats like beef, pork, veal, lamb, fish, poultry, shellfish, venison, buffalo, canned tuna or salmon packed in water, tofu, legumes cooked without salt, egg, egg whites, egg substitutes, low sodium peanut butter, frozen dinners with less than 450 milligrams sodium, low sodium cheese, unsalted cottage cheese or ricotta, unsalted nuts, walnuts, almonds, pecans All salted, cured, in brine, koshered, canned or smoked meats, fish and poultry including ham, bacon, sausage, spare ribs, salt pork, ham hocks, corned beef, luncheon meats, hot dogs, spam, fish packed in oil, foods prepared in butter, tomato, or cream sauces, gravy, frozen dinners with more than 450 milligrams sodium, crab, lobster, imitation seafood, marinated herring, pickled eggs, salted nuts Bread, Cereal, Rice, Pasta, Potatoes 6 ounces per day -------------1 slice bread ½ cup cooked rice or pasta ½ hamburger roll or bagel 1-6” pancake 1 cup cold cereal Enriched white, wheat, rye and pumpernickel breads, rolls made without fat, most cereals, cooked cereals without added salt, unsalted plain crackers, unsalted breadsticks, graham crackers, Matzo, white or brown rice, Pasta or noodles with no salt added, barley, homemade stuffing without salt, unsalted pretzels, unsalted tortilla chips, unsalted potato chips and unsalted popcorn, boiled, baked or mashed white or sweet potatoes with no salt added Breads, rolls, crackers or pretzels with salted tops, quick breads, instant hot cereals, pancakes, waffles, self-rising flour, biscuit mixes, regular bread crumbs or crackers, salted: pretzels, popcorn, potato chips, snack foods, commercially prepared potato, rice, pasta or stuffing mix, pasta in butter, cream or cheese sauces All fruit juices, low-sodium, salt-free vegetable juices, low sodium carbonated beverages, coffee, tea Regular vegetable or tomato juices, commercially softened water used for drinking or cooking Beverages 20 — What You Need to Know About Your Lung Surgery Food Group Daily Servings Foods Allowed Foods to Avoid Vegetable 2 ½ cups per day Fresh, frozen vegetables and -------------low sodium, canned or dried ½ cup cooked vegetables prepared without 1 cup raw salt ¾ c vegetable juice Vegetables that are canned, pickled in brine, prepared in butter, tomato, cream or cheese sauces, seasoned with ham, bacon or salted pork, sauerkraut Fruit Fats and Oils 5 gram fat per serving 1 ½ cups per day -----------------½ cup fruit juice 1 medium apple, banana, orange ½ cup canned fruit 5 tsp per day -------------1 teaspoon margarine 1 tablespoon salad dressing 1 tablespoon Any fruit that is fresh, frozen, canned or dried, fruit juices, fruit flavored drinks Maraschino cherries, dried fruit with sodium sulfite vegetable oil Light soft margarine, transfat free margarine, unsalted butter, unsalted salad dressings Gravy—canned or mixes, regular salad dressings with bacon bits or salt Sweets and desserts Use Sparingly Jelly, jam, sugar, syrup, honey, molasses, plain sugar candy like jelly beams, gum drops, hard candy or marshmallows, angel food cake, sherbet, fruit ices, gelatin desserts, popsicle, meringues Regular commercially prepared and packaged baked goods, Dutch processed chocolate candy Miscellaneous As desired Pepper, spices and herbs, vinegar, lemon or lime juices, garlic or onion powder, low sodium: ketchup, soy sauce, chili sauce, mustard Any seasoning made with salt, including garlic salt, celery salt, onion salt, sea salt, rock salt, kosher salt, meat tenderizers, soy sauce, monosodium glutamate, Worcestershire sauce, steak sauce, barbecue sauce, ketchup, flavored vinegars, pickles, olives, relish, horseradish sauce, salt substitute with sodium & potassium chloride, regular soups—canned, cream or dehydrated, broths or bouillon Mrs. Dash seasoning powders without sodium or salt Low sodium soups—canned or dehydrated, broths, bouillons, homemade soups without salt, cream soups made with milk allowance Lee Memorial Health System — 21 References and Resources Additional information on lung disease Lee Memorial Health System Web Site at www.LeeMemorial.org American Lung Association, Gulf Coast Area . . . . . . . . . . . . . 239-275-7577 American Lung Association National Web Site . . . . . . . www.lungusa.org Support groups Caregivers Support Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diabetes Support Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mended Hearts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Older Adult Services SHARE Club . . . . . . . . . . . . . . . . . . . . . . . Cancer Support Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-343-1126 239-573-5720 239-432-0985 239-772-6765 239-938-9303 Education programs for risk factor modifications American Lung Association . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-275-7577 Auricular Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-337-3277 Lee Health Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-573-5720 Lung Cancer Navigation Services . . . . . . . . . . . . . . . . . . . . . . 239-343-9510 If you have been diagnosed with lung cancer, nurse navigation services are available to you. The Lung Cancer Nurse Navigator is a nurse with specialized knowledge of lung cancer and its treatment. This one-on-one assistance helps to ensure a timely initiation of treatment by addressing needs that may arise during this experience. The navigator can provide you with valuable education regarding your diagnosis and connect you with many resources in the community. 22 — What You Need to Know About Your Lung Surgery Sample Pre-Procedure Health Questions A registered nurse representing Lee Memorial Health System may call you prior to your surgery date to gather information regarding your health history so we can determine the need for preoperative tests, such as blood tests and X-rays. The telephone interview will last approximately five to 10 minutes. Please review the following questions so you are prepared. Height:_ ____________________________________________________________ Weight:_____________________________________________________________ Allergies:____________________________________________________________ Name of family doctor:_________________________________________________ Significant family medical history:_______________________________________ ___________________________________________________________________ ___________________________________________________________________ Medications : Dosage/How often?___________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Have you had any other surgeries? Be sure to tell the nurse about any procedure involving your veins, arteries, lungs or breasts, or any metal implants you may have.________________________________________________________ ___________________________________________________________________ Skin: Any bruises, bug bites or scratches? Be sure to tell the nurse about any skin problems._ __________________________________________________________ ___________________________________________________________________ Alcohol Use: How much? How often?________________________________________________ Lee Memorial Health System — 23 Smoking: Do you smoke?_______ How many years?_______ How many per day?________ Have you had an EKG, stress test, echocardiogram or chest X-ray in the past year? If yes, where?__________________________________________________________ Cancer: Do you have or have you ever had cancer?________ Where?__________________ Did you have chemotherapy, radiation or stem cell treatment?__________________ Family history of cancer?________ Do you have any bleeding problems?_____________________________________ Have you or a relative ever had any problems with anesthesia?________________ Do you have any body piercings or tattoos?________________________________ Heart: chest pain heart attack high blood pressure heart failure pacemaker defibrillator emphysema productive cough Respiratory: shortness of breath asthma Neurological: headaches seizures faintness stroke back problems head injury Psychological: depression substance abuse suicide thought or attempt Infectious disease: tuberculosis HIV hepatitis Gastrointestinal: liver problems hiatal hernia pancreatitis reflux weight loss or gain Endocrine: diabetes thyroid problems bladder problems Miscellaneous: arthritis glaucoma blood reaction 24 blood transfusion recreational drug use — What You Need to Know About Your Lung Surgery prostate problems Medication Sheet Physician name and telephone number Name Pharmacy Pharmacy telephone number Allergies Date Prescription Medications / Over-The-Counter / Vitamin Supplements Dose Frequency Lee Memorial Health System — 25 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Feb. March April May June July Aug. Sept. Oct. Nov.. Weigh yourself at the same time every day and and write on this chart. Call your doctor if you’ve gained 2 pounds in one day or 5 pounds in one week. — What You Need to Know About Your Lung Surgery Jan. Weight Chart 26 Dec. Lung Surgery Guidelines This is only a guideline . . . everyone is different! Other medical conditions may interfere. Category Day 1 Personal Care Wash your face, brush your teeth and comb your hair o Wash your face, brush your teeth and comb your hair o Take a sponge bath o Take a sponge bath May shower after chest tubes removed o Measure your oral intake and output o Measure your oral intake and output o Check your weight o Check your weight o Monitor/check your oxygen saturation; cough, deep breathe and use your I.S. ten times per hour o Monitor/check your oxygen saturation; cough, deep breathe and use your I.S. ten times per hour o Out of Bed two times o Out of bed for meals o Walk 25-50 feet, with assistance, two times o Walk 50-100 feet, three times o Treatments Incisional and chest tube dressing change o Incisional and chest tube dressing change o Teaching & Discharge Planning Educational Handout o Support system evaluation o Screen for potential discharge needs o Screen for pulmonary rehab or smoking cessation o Intake/ Output Respiratory Activity Day 2 Lee Memorial Health System — 27 Lung Surgery Guidelines (continued) Category Day 3 Personal Care Wash your face, brush your teeth and comb your hair o Wash your face, brush your teeth and comb your hair o Take a sponge bath May shower after chest tubes removed o Take a sponge bath or shower May shower after chest tubes removed o Measure your oral intake and output o Measure your oral intake and output o Check your weight o Check your weight o Monitor/check your oxygen saturation; cough, deep breathe and use your I.S. ten times per hour o Monitor/check your oxygen saturation; cough, deep breathe and use your I.S. ten times per hour o Out of bed for meals o Out of bed for meals o Walk 100-300 feet, three to four times o Walk 300 or more feet, four or more times o Chest tube dressing change o Chest tube dressing change o Intake/ Output Respiratory Activity Treatments 28 — What You Need to Know About Your Lung Surgery Day 4 Notes _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Lee Memorial Health System — 29 Notes _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 30 — What You Need to Konw About Your Lung Surgery Discharge Information 2 3 1 Lee Memorial Health System Hospitals Cape Coral Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-424-2000 636 Del Prado Blvd., Cape Coral, Florida 33990 Gulf Coast Medical Center . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-343-1000 13681 Doctor’s Way, Fort Myers, Florida 33912 HealthPark Medical Center . . . . . . . . . . . . . . . . . . . . . . . . . . 239-343-5000 The Children’s Hospital of Southwest Florida . . . . . . . . 239-343-5000 9981 S. HealthPark Drive, Fort Myers, Florida 33908 Lee Memorial Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239-343-2000 The Rehabilitation Hospital . . . . . . . . . . . . . . . . . . . . . . . . . 239-343-3900 2776 Cleveland Avenue, Fort Myers, Florida 33901 Lee Convenient Care Locations Fort Myers, 4771 S. Cleveland Ave. . . . . . . . . . . . . . . . . . . . 239-343-9800 North Fort Myers, 13279 N. Cleveland Ave. . . . . . . . . . . . 239-997-9733 Cape Coral, 1682 NE Pine Island Road. . . . . . . . . . . . . . . . . 239-424-1655 Outpatient Center Locations* 1 HealthPark Commons, 16281 Bass Road . . . . . . . . . . . . . . 239-432-3000 2 The Sanctuary, 8960 Colonial Center Drive . . . . . . . . . . . 239-343-9400 3 Plantation Rd, 13601 Plantation Road, Fort Myers . . . . 239-343-0776 * Outpatient departments of Lee Memorial Hospital P.O. Box 2218 • Fort Myers, Florida 33902 • www.LeeMemorial.org 5700.03 3-11