Download What You Need To Know About Your Lung Surgery

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:
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— 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.
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— 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.
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— 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.
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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.
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— 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.
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— 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.
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— 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.
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— 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
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— 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