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ADELAIDE CARDIOTHORACIC Your Surgery and Beyond Thoracic Surgery

The purpose of this booklet is to give you and your family a basic understanding of your hospital journey As a patient you are an individual with special needs so this booklet is only a guide Your health team will include your surgeon an anaesthetist other doctors nurses physiotherapists pharmacists and other health care professionals as required They will all do their best to include you and your family in the planning of your care so you feel well informed at all times ADELAIDE CARDIOTHORACIC HEART AND L UNG SURGEONS Assoc Prof Jayme Bennetts Dr Gareth Crouch Suite 3 Anzac Medical Suites 41 Anzac Highway Ashford SA 5035 Telephone 08 8375 5950 Greg Rice Julie Pick Nurse Practitioner Level 6 Flinders Private Hospital 1 Flinders Drive Bedford Park SA 5042 Telephone 08 8204 5626 Email contact adelaidecardiothoracic com au Website www adelaidecardiothoracic com au Disclaimer The information contained within this publication is for general information only Readers should always seek independent professional advice where appropriate Adelaide Cardiothoracic will not accept any liability for any loss or damage arising from reliance upon any information in this publication Please refer any questions about this information to your treating medical officer and or nursing staff This booklet was written and compiled by Adelaide Cardiothoracic and Bronwyn Krieg Email bronwyn krieg sa gov au Adelaide Cardiothoracic and Bronwyn Krieg Version 1 0 dated April 2020

Contents I have seen my surgeon and need to have heart surgery What happens next 2 Contents Your Hospital Journey 15 Day of Admission 15 Day of surgery 16 What do I need to do when I Day 1 after surgery 17 Preparing for my surgery 2 arrive at the hospital 3 Day 2 after surgery 18 Types of thoracic surgery Day 3 after surgery 193 Preparing for hospital Day 4 after surgery 205 What do I need to bring to hospital 4 What plans should I make for Day 5 after surgery 219 Quittingfrom smoking discharge hospital 6 Discharge 22 Who will make decisions if I cannot 10 Who will make decisions if I cannot 7 What can I do by the time I am My hospital stay 11 discharged 23 What do I need to do on the days leading up to mypain surgery 8 Controlling after your operation 15 Going home 24 Mymyhospital journey day 16 Can surgery be postponed or by day What can I expect after surgery 26 or cancelled 8 What can I do by the time I am discharged 23 What if I experience depression 28 What happens in theatre 9 Going home 24 When can I resume my usual What cancan I expect immediately When I resume my usual activities activities 30 30 after surgery 10 After your discharge from hospital 32 Is there anything I need to watch out for What do I need to know about the what now 32 Lung cancer mesothelioma 33 Intensive Care Unitand ICU 11 are my rights and What canare I expect I am What my once rights and responsibilities What 34 responsibilities 33 transferred to a ward 12 Contact information 36 Contact information 35 How do I control my pain after my References links and acknowledgements 37 operation 13 References links and Early movement after surgery 14 acknowledgments 35

Preparing for my surgery I have seen my surgeon and need to have surgery What happens next You may have been given a date for your surgery by your surgeon If you feel you are getting worse while awaiting surgery contact your surgeon as soon as possible You will be advised by letter regarding the date of your surgery and will receive instructions regarding what medications you need to stop and when Before your operation you may need some tests performed Your surgeon will organise these for you My operation is The date of my surgery is I am being admitted to My admission date is The time of my admission is Do I need to stop taking any medication before my surgery When do I stop them Warfarin _ _ _ _ _ _ _ Clopidogrel _ _ _ _ _ _ _ Dabigatran _ _ _ _ _ _ _ Apixaban Ticagrelor _ _ _ _ _ _ _ Aspirin Anti inflammatory tablets Prasugrel _ _ _ _ _ _ _ _ _ _ _ _ _ _ Rivaroxaban _ _ _ _ _ _ _ _ _ _ _ _ _ _ Diabetic medication Cardiac medication Diuretics Other Natural therapies including fish oils Are there any other special instructions I need to remember page 2

Types of thoracic surgery Speak with your surgical team regarding which procedures or surgeries your surgeon has planned for you A lung resection removal of part of the lung may be performed by wedge biopsy or resection lobectomy or by pneumonectomy Wedge biopsy resection Small abnormalities are cut out of the lung using specialised lung staplers Lobectomy The lungs are made of five lobes three on the right and two on the left One or sometimes two of the affected lobes is removed and the rest of the lung tissue can continue to work as normal Pneumonectomy An entire lung is removed along with its airway and its blood vessels This is usually done for cancers that have affected more than one lobe of the lung In all cases the removed tissue is sent to the pathology laboratory for testing Procedures on the pleural space are sometimes needed to prevent fluid accumulation or collapse of the lung and include Pleurodesis Talc powder is put into the pleural space causing the lung to stick to the chest wall to prevent accumulation of fluid or air in the space around the lung Pleural biopsy A pleural biopsy removes a tissue sample from the membrane that lines the inside of the chest wall Adelaide Cardiothoracic Thoracic Surgery Book April 2020 page 3

Approaches Video assisted thoracic surgery VATS Small incisions are made in the chest wall which are about one to five centimetres in length A lighted scope and other surgical instruments are put through these small cuts to enable surgery to be performed on the lung and pleura the lining of the chest cavity There is no rib spreading and recovery can be faster Thoracotomy An incision is made on the side to back of the chest approximately ten centimetres long then the ribs are spread to enable entry into the chest cavity

Preparing for hospital What do I need to do when I arrive at the hospital You will be informed what time you are expected at the hospital On arrival you will need to report to the Admissions office or to the reception desk where they will check all your details including Name Current address Date of birth Contact details Private medical insurance details Ethnicity Medicare details Emergency contact details They will also provide you with directions to the ward where you are to be admitted If you would like a tour of the hospital prior to surgery please ask the nursing staff on the ward once you are admitted The ward staff are happy to take you and your family on a tour so that you will know where the operating theatre and intensive care unit ICU are located prior to your operation

What do I need to bring to hospital If applicable please bring the following into hospital with you Private health details Ambulance cover card Alert information Veteran Affairs card Safety Net card Medicare card Pension details Pacemaker identification Chest x rays CT scans Clothing Remember Non slip footwear is always a good idea Both men and women can wear pyjamas jacket opening down the front or a loose tracksuit so the upper body wounds and tubes can be cared for while maintaining lower body privacy However for the first day or so wearing a hospital gown will protect your clothing from potential staining Ladies if you are large breasted bring bras into hospital with you as these can help support your wound You may also like to bring slippers and a dressing gown not too long and will require clothing to wear home remember comfortable loose clothing is best over a chest wound Toiletries Remember to label your toiletries bag Your toiletries bag should contain a toothbrush toothpaste soap or body wash shampoo and conditioner deodorant a brush comb and any other personal items you may require for example lip balm moisturiser or shaving gear No talcum powder because it becomes slippery on the bathroom floor and it may put you at risk of a fall Medications Please bring your medications or a list of your medications with you Is there anything else I might like to bring to hospital If you use a walking aid eg frame or CPAP or other health aid at home you may like to get your family to bring it to the hospital ready for your recovery Oxygen therapy fasting and normal post operative loss of appetite all contribute to having a dry mouth and chapped lips so you may like to bring with you a good mouth wash and lip cream balm Also you are able to use your mobile phone and don t forget your charger Don t forget to label your bags and your reading glasses Please label your bags as they will need to be stored in a secure location while you are in theatre and recovery Also remember to label your reading glasses and any other personal items such as your mobile phone charger as they can be easily misplaced during your time in hospital Please do not bring any valuables or large amounts of money into hospital While every care is taken we cannot be responsible for the safety of your belongings Ask your nurse if you require a small number of valuables to be kept in the hospital safe page 6

What plans should I make for discharge from hospital Planning for discharge begins before your surgery The following is a list of some important tips when planning for your discharge from the hospital help you to and from your appointments Arrange for help at home for daily activities such as cleaning groceries laundry and gardening for two to four weeks Nursing and home care services are not routinely supplied but are available if necessary You should be able to care for yourself by the time you are ready to go home Most patients are ready to be discharged between three and five days after surgery Arrange for a family member or friend to stay with you each night for up to one week after you get home from the hospital Ask your surgeon how long you will need off work as it will vary depending on your surgery You will not be able to drive for Look into any sickness benefits that may be available to provide you with support during your recovery If you are not going to be able to manage at home by the time you are ready to leave hospital rehabilitation can be arranged for you A Discharge Planning Coordinator two to four weeks after surgery You will need to arrange for someone to be available to can be available to you and your family before your surgery and during your hospital stay Country and Interstate Patients If you are a country or interstate patient you will need to have accommodation close to the hospital available to you from the time of discharge You will need to stay in Adelaide until 10 days after surgery OR until a follow up visit with your surgeon before being able to return home This is to minimise the chances of complications occurring after you have left Adelaide and may be some distance from help You will need to pay for your own accommodation while staying in Adelaide as accommodation is not provided by the hospital For Country South Australian Patients You may be eligible for a subsidy towards your travel and accommodation through the Patient Assistance Transport Scheme PATS if you are a permanent resident of South Australia and live more than 100 kilometres from the hospital Please ask your local doctor call your local PATS office or check online at www countryhealthsa sa gov au pats for further information For Interstate Patients Request the PATS information for your state Adelaide Cardiothoracic Thoracic Surgery Book April 2020 page 7

What do I need to do on the days leading up to my surgery Please notify your surgeon s office if you have any signs that may suggest an infection such as fever or high temperature cough cold or flu symptoms burning or pain on urination or redness around cuts or scratches on your skin need to defer surgery due to a change in your personal circumstances are unsure about which medications you should cease or continue have any other questions You can call Adelaide Cardiothoracic on 08 8375 5950 Ashford or 08 8204 5626 Flinders Private Can my surgery be postponed or cancelled Unfortunately yes In the event of an emergency or unforeseen circumstances your surgery may need to be postponed or cancelled However should your surgery be postponed every effort will be made to reschedule your surgry as soon as possible

Quitting smoking Research has shown that compared to non smokers smokers have a higher chance of surgery related complications like heart attack stroke and death Smokers are more likely than nonsmokers to experience complications from all types of surgeries Why does smoking impair healing after surgery Nicotine in cigarette smoke increases your heart rate and blood pressure making your heart work harder so that it needs more oxygen The carbon monoxide in cigarette smoke competes with the oxygen in your blood making it harder to get the oxygen you need for your heart and body Chemicals in cigarette smoke make your blood thicker stickier and more likely to clot and can paralyse and destroy the cilia in your lungs tiny hairs that act like brooms which work to keep your lungs clear Smoking increases the amount of mucus in your lungs and narrows your airways This can increase the likelihood of your airways and the air sacs in your lungs partially collapsing making it harder to breathe Three to six weeks after stopping the body s defenses against bacterial infection improve How can I quit smoking if I am scheduled for surgery Many people have used an up coming surgery as a reason to quit even if just a day or two before the procedure The date of a surgery can be used as motivation to set a quit date which is the first step of a successful plan to quit smoking You will not be able to smoke while in hospital which can also help Once a quit date is set there are lots of ways to go about quitting like talking to your GP or pharmacist about nicotine patches and getting social support from family members and friends For further information visit QUITLINE 137848 Cancer Council of SA at www cancersa org au quitline or quitlinesa org au My QuitBuddy App is available free for download Smoking decreases your resistance to infection and you will have a higher risk for chest and wound infections after surgery You are more likely to have longer healing times problems with wounds not healing well and bad scarring Smoking can also slow down and interfere with the healing of bones and other body tissues But I ve smoked for years How can stopping help now Just within a day or two after stopping the body can bring more oxygen to cells and blood flow improves making it easier for healing Adelaide Cardiothoracic Thoracic Surgery Book April 2020 page 9

Who will make decisions if I cannot will makeafter decisions if I cannot An Advance Care Directive gives those IfWho there are problems who care about youDirective a clear gives those An Advance Care If there aresurgery problems your heart youafter may understanding ofyou youra needs who care about clear and your you may not not besurgery able to make understanding of your and to wishes should you lose needs your ability be able to make decisions decisions about your care wishes shouldthem you lose your ability to communicate for yourself about your care In the unlikely even that you cannot In the unlikely even that you communicate with your family or cannot communicate with your your healthcare team howteam would family or your healthcare how you want decisions to be made for would you want decisions to be made for your you about yourhealth ongoing you about ongoing care health care living arrangements living arrangements and other and other personalAnd matters And personal matters who would who would you want to make those you want to make those decisions for decisions for you you An Advance Care Directive allows Care Directive allows you An Advance you to to write down your wishes preferences and wishes instructions for write down your your future health care end of preferences and instructions for life living arrangements and your futurematters health and or care end of personal life living arrangements and Appoint one or more Substitute personal matters and or Decision Makers to make these Appoint one more Substitute decisions onoryour behalf if you are unable to make them for Decision Makers to make these yourself on your behalf if you decisions are unable to make them for The kit and form can be downloaded yourself online for free at communicate them for yourself An AnAdvance AdvanceCare CareDirective Directivereplaces replaces existingEnduring EnduringPower Powerof of existing Guardianship Medical Medical Power Power of of Guardianship Attorney and and Anticipatory Anticipatory Direction Attorney Direction It will give you peace of mind that those Itcaring will give of mind for you you peace will know what that you want whencaring you are to know make what your own those forunable you will decisions or communicate your wishes you want when you are unable to and values make your own decisions or communicate your andCare values The kit contains thewishes Advance Directive Form and a step by step guide givesthe youAdvance everything you The kit that contains Care need to complete your Advance Care Directive Form and a step by step Directive Form including example guide that gives you everything you statements information for Substitute need to complete Advance Decision Makers your witnesses andCare interpreters factincluding sheets and other Directive Form example resources and links statements information for Substitute Decision Makers witnesses and interpreters fact sheets and other resources and links www advancecaredirectives sa gov au The kit and form can be downloaded online for free at www advancecaredirectives sa gov au A hard copy of the form can be A hard copy of the form can be ordered by ordered by phone by calling Service phone on 132324 during SA onby13calling 23 24Service during SA business business hours hours page 10 Surgery Patient Information Booklet October 2017 Cardiac page 7

What happens in the theatre Whatare happens in the Below some general things once you Below to areexpect some general enter theatre once thingsthe to expect youoperating enter room theatre The team includes your leastteam threeinclude nurses The surgeon operatingatroom your a perfusionist youranaesthetist surgeon at least three nurses who the heart lung youroperates anaesthetist and a surgical assistant and a surgical assistant machine It will be cold and have many bright It will be cold and have many bright lights machines and instruments lights machines and instruments Intravenous IV lines are small Intravenous IV be lines are small tubes tubes that will inserted in your that willofbe inserted into the veins veins your arms to supply with of your arms to supply you with medications and replace fluids during surgery Anotherfluids line may medications and replace during also be inserted in surgery Another into line an willartery also be your wrist and is used to monitor inserted into an artery in your wrist your blood pressure and an additional line CVC or Central theatre Venous Catheter will be inserted into a Nurses willneck place onto your chest vein in your ordots chest which will be connected to a heart monitor willchest show Nurses will The placeheart dotsmonitor onto your your heart beat which will be connected to a heart monitor monitor will show After theThe firstheart IV line is inserted your anaesthetist may give you some further your heart beat medication to help you feel relaxed and After the first IV is inserted your drowsy anaesthetist may give The anaesthetist willyou asksome you to breathe medication to help you feel relaxed and into a lightweight mask and give you drowsy medication through your IV line so you are asleep during surgery The anaesthetist will ask you to breathe While you are asleep a urinary into a lightweight mask and give you catheter may be put in IV which will you drain medication through your so that urine from your bladder are asleep during surgery used to monitor your blood pressure Sometimes surgery takes longer than expected so your family should not be alarmed if your procedure is not finished at the expected time If a significant problem occurs the health care team will do their best to notify your family

What can I expect immediately after surgery Following surgery you will be transferred to either the Recovery Unit or the Intensive Care Unit ICU You may feel cold and shivery when you first wake up but this is normal and we can provide you with a warm blanket You can expect to stay in the ICU for approximately 12 to 24 hours after your surgery but occasionally it may be longer if you require special medications or treatment Your ICU medical team will decide when you are able to move to a ward When you first awaken from the anaesthetic do not be alarmed if you feel some discomfort You will quickly receive pain medication to relieve it Upon waking you will notice that you are connected to a variety of monitors and equipment These tubes may seem awkward and uncomfortable Please find a detailed list below Chest drains You may notice you have one or more chest drains placed just below your incision wrapped in the dressing that covers this area Your chest drains may remain in place for several days after surgery and will be removed when the amount of air draining through them stops bubbling and fluid slows or stops Urinary catheter A catheter may be inserted to drain urine from your bladder and is usually removed once you are able to walk without assistance to the bathroom or on doctor s orders typically on the second day after your surgery Incisions You will have one or more incisions on your chest The dressing will remain in place for a few days after your surgery at which time your nurse will remove them In most cases a dressing will not be reapplied Chest x ray You may have a chest x ray after your operation page 12 Heart monitor You may be attached to a bedside heart monitor by electrodes that continuously monitor your heart rate and rhythm Intravenous lines Intravenous lines are used to supply fluid and medication to you They will be removed when appropriate Patient controlled analgesia Patient controlled analgesia PCA is a type of pain management system delivered by a pump and allows you to decide when you will get a dose of pain medicine You don t need to wait for a nurse and you can get smaller doses of pain medicine more often PainBuster catheter You may also have a PainBuster catheter local anaesthetic delivery system in your chest wound for approximately 48 hours to help with pain control The PainBuster delivery system delivers local anaesthetic straight to the wound helping to alleviate pain

What can I expect once I am on the ward The surgical ward aims to provide a safe and caring environment where you and your family will be treated with dignity and respect Staff understand that coming into hospital can be a very stressful time and therefore will listen to your needs act on your concerns and provide excellent health care focussed on your comfort and well being Following your transfer from the ICU you will be reviewed by your surgeon a nurse as well as by other staff involved in your care Can I make and take telephone calls Yes You can make outgoing and receive incoming calls on your mobile or you can make landline phone calls from the phone next to your bed Phone calls to the hospital from family and friends will be put through to your room when they call When are visiting hours Visiting hours are between 10 00am and 8 00pm You may have visitors out of these hours but this needs to be arranged with the nursing staff Please note that visitors may be asked to leave the room in order for the doctor or nurse to provide you with treatment or care We advise it maybe inappropriate for children or infants to be brought into the ward environment Please discuss the appropriateness with the nursing staff prior to arrival We also politely ask that any visitors who are unwell with flu like symptoms or gastroenteritis please refrain from visiting When are meal times Breakfast between 7 00am and 8 00am Lunch between 12 00pm and 1 00pm Dinner between 5 00pm and 6 00pm Supper around 7 00pm Newly admitted patients may receive a set meal Please let your nurse know if you have a special dietary requirement Emotional Wellbeing There may be times post operatively that you have feelings of apprehension and fear This is quite normal Don t hesitate to speak to your nurse about this If you are feeling tired and do not want to receive visitors or need to restrict them please speak to your nurse Adelaide Cardiothoracic Thoracic Surgery Book April 2020 page 13

Early mobilisation after your surgery as well as practising special exercises speeds up your recovery and reduces the chance of complications after your operation A physiotherapist will help you by teaching exercises to expand the lungs and clear secretions and encourage early mobility and arm movement exercises as soon as possible after your surgery and will give advice for when you return home After a thoracotomy you may find your rib cage feels stiff or tight on the side of the operation Performing specific exercises given to you by your physiotherapist morning and night will ensure that within four to six weeks after your operation your shoulder movement should be back to normal Chest problems may occur after thoracic surgery for the following reasons There is a tendency to take shallow breaths after the operation and you might find you avoid the occasional deep breath sigh or cough due to discomfort or the fear you may disrupt or cause damage this will not happen You may feel tired after your operation and less inclined to get up and move around This is a normal response however it is important to exercise as well as have rest periods to reduce the risk of complications such as blood clots and chest infections page 14 Secretions increase after the operation and tend to be thicker and more difficult to cough up The lung is collapsed during the operation and needs to continue reinflating after the operation The best way to do this is to walk around the ward Getting up and moving around soon after the operation can help you to recover more quickly This can shorten the amount of time you need your extra oxygen supply and can lead towards leaving hospital earlier You may be given a TriFlo Breathing Exerciser see example below to help you perform your breathing exercises You should practice this every half an hour with the aim to keep two balls suspended as long as you can TriFlo Inspiratory Exerciser

How do I control my pain after my operation When injury Will I have a lot of pain to the body after my operation occurs as in surgery painful impulses are sent to the brain The amount of pain you have varies from person to person For most people pain relief will be delivered by a Patient Controlled Analgesic PCA system a pump which allows you to decide when you need medication via injection How will my pain be prevented or relieved Some patients may also have a PainBuster catheter that delivers local anaesthetic directly into the wound Some people feel a lot of pain others not very much YOU are the expert on your pain Only YOU know how much pain you are feeling Pain following surgery is NOT good for you It is important for you to be comfortable enough to take deep breaths and cough to be able to do your exercises or to get out of bed and walk If pain prevents you from doing this complications can How will occur Once you no longer need such strong pain killers pain relief will be given by mouth PLEASE REMEMBER Pain killers cannot always remove your pain completely Some discomfort may still be present but we will do our best to make you as comfortable as possible the nurse know how much pain I have It is very important that you tell your nurse or surgeon how much it hurts and where the pain is You should also tell your nurse if you are feeling sick so that any nausea can be treated Don t wait to be asked or think that you are being a nuisance You will also be asked at regular intervals how much pain you have when you are resting and when you are moving or coughing You will be asked to rate your pain on a scale of 0 10 where 0 is no pain and 10 is unbearable pain OR you may prefer to describe your pain as Mild Moderate or Severe 0 NO HURT 2 HURTS A LITTLE BIT 4 6 HURTS A HURTS EVEN LITTLE MORE MORE 8 HURTS A WHOLE LOT You will probably How long will require strong my pain last pain medications for two to three days after surgery two to three your wounds have begun to heal and your pain often decreases However you may have some discomfort for some time This can be controlled by simple tablets such as paracetamol with perhaps the occasional stronger analgesic If you have pain just tell your nurse or after discharge your GP Occasionally you may experience side effects such as constipation dizziness confusion or hallucinations from the stronger pain medications Hallucinations are when you see hear smell taste or feel something that is not there 10 HURTS WORST Let your doctor or nurse know if you experience any side effects so we can change your medication to something more suitable for you Adelaide Cardiothoracic Thoracic Surgery Book April 2020 page 15

Your hospital journey The following describes a journey typical pathway through hospital after heart surgery Your hospital Your hospital journey Your experience may differ from this due to your personal circumstances The following describes a typical pathway through hospital after heart surgery The following describes a typical pathway through hospital after thoracic surgery Your may differ from this due to your personal circumstances Dayexperience of Admission Your experience may differ from this due to your personal circumstances Staff On admission you will see your surgeon an anaesthetist and a Day ofHealth admission Health Staff Tests and Investigations Tests and Investigations Assessments Assessments Treatments and Medications Treatments and Pain Management Medications Hygiene Pain Management Activity and Hygiene Safety physiotherapist Your surgeon will discuss your surgery with you On admission you will see your surgeon an anaethetist You will have a physiotherapist and a nurse Your surgeon will discuss your surgery with you Blood tests including blood type chesthave x ray Amay You Hearttests rhythm test ECG Blood including blood type Height A chest x ray or other scan pulse and temperature will weight blood pressure If you are a diabetic we will check your blood beArecorded heart rhythm test ECG sugar level Height weight blood pressure pulse and temperature will be A nurse will shave your body ready forcheck surgery You will recorded If you are a diabetic we will your blood take your normal medications unless the doctor has sugar level informed you otherwise A nurse will shave your body ready for surgery You will take Your normal anaesthetist will discuss the the typedoctor of painhas relief you willyou have your medications unless informed otherwise You will need to shower with surgical sponges the night prior to surgery and the surgery afterpain yourrelief shower Your anaesthetist willmorning discuss of with you the best please for you do not use talc deodorant or perfume A physiotherapist will explain how to perform breathing You will need to shower with surgical spongesdeep the night prior and coughing exercises and the use of the TRIFLO breathing to surgery and the morning of surgery after your shower device do willnot be use explained please talc deodorant or perfume to eat or drink from midnight on the night before the Nutrition and ANothing physiotherapist will explain how to perform deep breathing Activity Hydration operation or asexercises directed and by your coughing the anaesthetist use of the TriFlo breathing and Safety and maywill beask explained The nurse you to provide a urine sample for testing Elimination device on admission to eat or drink from midnight on the night before your Nutrition and Nothing or as directed by your Hydration operation Pastoral services are available foranaesthetist your spiritual religious and Your Individual emotional needs are also available ask Needs The Elimination nurse will askTranslators you to provide a urine samplePlease for testing your nurse on admission and YEducation our Individual Planning Needs The nurseservices will explain your operation and what toreligious expect and Pastoral are available for your spiritual during yourneeds hospital stay Please theavailable nurse anyPlease questions askk emotional Translators areask also that may be worrying you your nurse Education and Planning The nurse will explainCoordinator your operation and what expect A Discharge Planning is available to to provide during hospital stay managing Please ask the nurse questions help oryour advice regarding at home afterany discharge that may be worrying you Speak with your nurse if you require help or advice regarding managing at home after discharge page 16 Cardiothoracic Patient Information Booklet October 2017 Adelaide page 15 Adelaide Cardiothoracic Patient Information Booklet October 2017 page 15

Day of surgery Day of surgery Treatments and Before surgery medication may be given to help you relax You must stay inmedication bed following Medications surgery maythis be medication given to helpYou youwill have Treatments and Before after thisstay medication Medications oxygen relax You must in bed following this medication You will have after Theatre After youroxygen shower but this priormedication to going for surgery a staff will check and you thenwill mark operation site When it is time for with your you surgery be the taken to Theatre member with a permanent marker the operating theatres with your nurse Then it is time for your surgery you will be taken to the An anaesthetist will insert an intravenous line and then give operating theatres with your nurse you medication to help you relax and fall asleep Your anaesthetist will insert an intravenous line and then give Aftermedication theatre you in the Care Unit you to will helpwake you up relax andIntensive fall asleep After theatre you will wake up in the intensive care unit Tests and After your surgery you will have Tests and After Investigations your tests surgery you will have Blood Investigations tests Blood A chest x ray AHeart chestrhythm x ray test ECG Assessments Assessments After A heart rhythm test be ECG surgery you will transferred to the Intensive Care Unit ICU blood You can expectpulse to stayoxygen in ICU for approximately Your pressure saturation levels 12 24 hours but occasionally this is longer if you require special temperature and wound drains will be checked frequently medications or treatment Your blood pressure pulse surgery and painwound medication via an Pain Management After temperature drainswill willbe begiven checked frequently You intravenous IV line or you may take tablets by mouth will have a breathing tube attached to a breathing machine this willsurgery be removed once youa can breathe yourself sponge You Hygiene Before you will have shower withfor a surgical will not be able to talk while the breathing tube is in place After surgery you will have a wash in bed Activity and After a nurse will movewill you sideor regularly Aftersurgery surgery pain medication befrom givenside via to a drip Pain Management Safety to intravenous IV line relieve pressure on your skin You will be encouraged to commence your deep breathing exercises You may be asked Before will havefor a shower Hygiene to sit outsurgery of bed you or be taken a small with walkaifsurgical you aresponge able surgery you will have wash in calves bed in the Intensive ItAfter is important to pump yourafeet and to avoid deep Care Unit vein thrombosis and pulmonary embolism You may be given Activity and special After surgery a nurse will move from side to side regularly stockings to improve youryou blood flow Safety to relieve pressure on your skin You will be encouraged to surgery you will have a drip to give you fluids When you Nutrition and After commence your deep breathing exercises You may be asked Hydration can drink again we may restrict the amount of fluids you drink to sit out of bed or be taken for a small walk if you are able for the first few days For example after a pneumonectomy Aftermay surgery you mayto have drip per to give Nutrition and you be restricted 1 5 alitres day you fluids You may Hydration have sips of water or ice when the breathing tube has been Elimination After surgery you may have a tube in your bladder and you removed may have wound drains These will be checked regularly by Elimination your Afternurse surgery you will have a tube catheter in your and toyou have is common notwill open yourwound bowelsdrains Itbladder for oneThese to two will daysbe after by your nurse achecked generalregularly anaesthetic Inform your nurse however if you get abdominal pain or a distended stomach page 16 Adelaide Cardiothoracic Thoracic Surgery Book April 2020 page 17

Day 1 after surgery Day 1 after surgery Health Staff Your doctors and a physiotherapist will visit during the day Health Staff You will be reviewed by the ICU Team Your surgeon and a Nurses will care for you throughout the day physiotherapist will visit during the day Tests and During the day you will have Tests and During the day you will have Investigations Blood tests Investigations Blood x ray tests A chest A chest x ray Assessments Your blood pressure pulse oxygen saturation levels Heart rhythm test ECG temperature and wound drains will be checked regularly may receive pulse additional oxygen via a mask or nasal Assessments Blood pressure temperature and breathing will tubes Treatments and You pecs You will be weighed today before breakfast checked regularly Medications sbe Medications such additional as antibiotics willvia be agiven IV lineV You may receive oxygen maskvia or an nasal and by mouth once you are ready You may also have specs once the breathing tube has been removed injections under your skin for blood thinning medications Treatments and You will continue to be attached to a heart monitor and Pain Management You will receive regular pain medication either by IV line or Medications medications will be given via an IV line and by mouth orally orally once you are ready You may also have injections under your skinwill to be givehelped you blood thinning medication Hygiene You with a bed wash shower Pain Management painphysiotherapist medication willwill be assist given via nurse and youan toIV sitline outand of bed Activity and ARegular orally if your breathing tube has been removed start you gentle walking about the bed and teach you leg safety Hygiene exercises You will be helped withContinue a bed wash shower to do in bed to do deep breathing andphysiotherapist using your TriFlo trying to of keep two Activity and exercises A nurse and will every assist hour you to sit out bed balls suspended You may like to hug a pillow to cough Safety start gentle walking moving about the bed and teach you leg will exercises to do in bed Nutrition and You be given a light diet Fluid restrictions will continue Hydration Continue deep breathing exercises and using your TRIFLO Hug a pillow to cough Elimination You may still have a tube catheter in your bladder Nutrition and You will be given a light diet and fluids once the breathing Your Individual to dress in your own clothes although your Hydration You tubemay haslike been removed wound will still be checked regularly today Needs Elimination You will probably still have a tube catheter in your bladder Your chest drains may be removed today Education and Ask your nurse or doctors any questions you might have Your Planning Individual Everyone to help you You may isbehere transferred to the ward today Needs Education and Ask your nurse or surgeon any questions you Planning might have Everyone is here to help you Adelaide Cardiothoracic Patient Information Booklet October 2017 page 18 page 17

Day 2 after surgery Health Staff Your surgeon and a physiotherapist will visit during the day Day 2 after surgery Nurses will care for you throughout the day Tests and tests will be by your surgeon required Your doctors andordered a physiotherapist will visit as during the day Health Staff Any Investigations Nurses will care for you throughout the day pressure pulse temperature and breathing will Assessments Tests and Blood Any tests will be ordered by your doctors as required Investigations be checked regularly willpressure be weighed today before breakfast Blood pulse temperature oxygen saturation Assessments You and breathing will be checked regularly receiving oxygen this may be ceased The line in your neck Treatments and IfYou will be weighed today before breakfast Medications or chest will remain Treatments Oxygen will continue through mask or nasal specs Painand Management Medications Pain medication through your IV may be stopped as directed your doctor and tablets or IV injections given for pain relief Pain medication through your line will be stopped by your Pain Management by doctor andmay tablets or you injections given for pain relief Hygiene The nurse assist with having a shower If a Painbuster catheter was used this will be removed Activity and A nurse and physiotherapist will assist you to sit out of Hygiene Theand nurse may assist you with having a shower Safety bed gentle walking moving about the bed Continue breathing exercises andwill using youryou TRIFLO A nurse and physiotherapist assist to get out of bed Activity and deep Safety and walk 3 or 4 times around the ward Continue your arm Nutrition and You may have a normal diet as tolerated and deep breathing exercises and using your TriFlo Hydration Nutrition and The You nurse may have normal diethave as tolerated will willaask if you opened Fluid yourrestrictions bowels The Elimination continue Hydration tube in your bladder may be removed If not previously Elimination done The nurse askdrains if you may havebe opened your today bowels your will chest removed The tube in your bladder may be removed can dress in your own clothes Your Individual You Your chest drains may be removed Needs and A Discharge Planning Coordinator will meet with you and YourEducation Individual You can dress in your own clothes although you may prefer discuss managing at home after discharge Needs to wait until your chest drains have been removed

Day 3 after surgery Health Staff Your doctors and a physiotherapist will visit during the day Day 3 after surgery Nurses will care for you throughout the day Health Staff Tests and Investigations Tests and Assessments Investigations Yourtests surgeon andordered a physiotherapist will visit during the day Any will be by your doctors as required Nurses will care for you throughout the day Any tests will be pulse ordered by your surgeon as saturation levels Blood pressure temperature oxygen required Most patients have a blood test and breathing will be checked regularly You will be weighed Blood pressure pulse temperature and breathing will Assessments Treatments and Your doctors may make changes to your medications be checked regularly You will be weighed daily Medications You may be prepared for discharge Treatments and Your heart monitor may be removed today The CVC Regular pain medication provided Pain Management Medications Central Venous Catheter will in be your neck or chest may be today testshowering results have been received The nurses will once assistblood you with if needed Hygiene removed Activity and Safety Pain Management Hygiene Activity and Nutrition and Safety Hydration If you have pacing wires they may be removed today Your You will continue walking short distances five to six times surgeon may make changes to your medications a day You will sit out of bed for meals Continue your Regular pain medication will be provided arm exercises deep breathing exercises and using your The nurse will assist you with showering TriFlo You will commence walking short distances 3 4 times a Normal No for restrictions unless indicated day Youdiet canas sitdesired out of bed meals Continue deep by your surgeon breathing exercises and using your TRIFLO nurse will if you have opened your bowels Elimination Nutrition and The Normal diet asask desired Hydration Your chest drains may be removed today Elimination Individual Your Needs Your Individual Needs page 8 The tube in your bladder will be removed if it hasn t already been The nurse will ask if you have opened your bowels You can dress in your own clothes if you like Dress in your own clothes

Discharge from Day 4 after surgery onwards Day 5Health afterStaff surgery Your doctors and a physiotherapist will visit Nurses will care you throughout day Your surgeon and athe physiotherapist will visit Health Staff for Tests and Investigations Tests and Investigations Assessments Assessments Treatment and Medications Treatments and Medications Pain Management Nurses will care for you throughout the day Tests are usually not required at this stage however if needed doctors will organise for you Tests areyour usually not required at thisthese stage Blood pressure pulse temperature and breathing will be Blood pressure pulse temperature and breathing will be checked regularly checked regularly You will be prepared for discharge You will be prepared for discharge Regular pain medication will be provided Pain Management Regular pain medication will be provided Hygiene Self care Dress in your own clothes Self care Dress in your Your physiotherapist willown helpclothes you with your exercise plan Yourmay physiotherapist will help with your exercise plan ifYou You climb the stairs todayyou with your physiotherapist you climb stairs at with home mayneed climbtothe stairs today your physiotherapist if you Continue deepstairs breathing exercises and using your TriFlo need to climb at home Continue deep breathing exercises and using your TRIFLO Nutrition Normal diet Hygiene Activity and Safety Activity and Safety nurse will ask if you have opened your bowels Elimination Nutrition The Normal diet YourElimination Individual Needs Your Individual Education and Needs Planning Education and Planning Please ask will if you anything or need The nurse askrequire if you have opened youranswers bowels to questions we are here to help Please ask if you require anything or need answers to questions Your willtoconfirm we nurse are here help your discharge arrangements At some time during your post operative period a nurse Your nurse will confirm your discharge arrangements will discuss follow up arrangements with you At some time during your post operative period the Cardiac Surgery Rehabilitation Program that is available in your area will be discussed with you

Discharge Discharge Health Staff An appointment will be made for you to see a doctor in about An appointment be your madeoperation for you to see your surgeon in Health Staff two to four weekswill after about two weeks after your operation An appointment will Please forfor these details before you leave also be ask made you appointment to see your cardiologist in about six hospital If you are from the country or interstate you may weeks time Please ask for these appointment details before need to see one of the doctors prior to returning home you leave hospital If you are from the country or interstate to see yourafter surgeon prior will to returning to your Tests and you Any may testsneed that you need discharge be explained to Investigations home you by your doctors Tests and Any tests that you need after discharge will be explained to You will continue to have your blood pressure pulse Assessments Investigations you by your surgeon temperature and breathing checked regularly until discharge Assessments You will continue to have your blood pressure pulse Treatment and temperature A pharmacistand or nurse will speak to you aboutuntil the medication breathing checked regularly discharge Medications you will be taking home with you on discharge Treatments and A pharmacist or nurse will speak to you about the medications wounds and home dressings prior to discharge Medications Your you will be taking with will yoube onchecked discharge Pain Management Pain Management Continue to take pain afterprior you to godischarge home as Your wounds andregular dressings willmedicine be checked prescribed by your doctors Ask any questions you may have Continue tocontrol take regular pain medicine after you go home about pain as prescribed by your surgeon Ask any questions you may have about pain control Activity and Self care Continue dress to walk exercise after you go home as in and normal day clothes Hygiene Hygiene Self care dress in normal day clothes Safety Activity and Safety discussed with your physiotherapist Continue to walk and exercise after you go home as Continue your and your deep breathing discussed with arm yourexercises physiotherapist exercises as well as using your TriFlo after you go home Continue your deep breathing exercises and using your Remember that you cannot drive for two to four weeks and TRIFLO after you go home ask your doctor if you have any weight lifting restrictions Remember that you cannot drive for 4 6 weeks and you must Nutrition not Normal dietweight heavier than 5kg for at least 12 weeks lift any Elimination Nutrition and Hydration Your Individual Elimination Needs Your Individual Education Needs and Planning Education and At Your Follow up Planning Appointment Continue walking and drinking plenty of water to prevent any constipation Normal diet The nursewalking will explain how to care of of your wounds Continue and drinking plenty water to and prevent infection prevent constipation The explain how care for your wounds and Y ou nurse will bewill discharged withtomedications and a follow up prevent infection appointment You will be discharged with medications and a follow up At your follow up your doctor willhospital review your appointment Seeappointment After your discharge from wound your medications may remove your drain andhave What Now on page 20 and seek medical help if you sutures and discuss with you any results any problems post discharge Other No smoking see page 9 Avoid drinking alcohol while you are on pain medication page 22 page 22

What can I do by the time I am discharged What can I do by the time I am discharged By the time you are discharged you will be able to walk short distances the atime are discharged you will be able to By climb flightyou of stairs walk without short distances shower supervision and climblight a flight of stairs prepare meals shower without supervision and assuming you were able to do these things prior to coming to the hospital prepare light meals Prior to discharge willable receive a these things Feel free questions regarding assuming youyou were to do priortotoask coming to the hospital physiotherapy program a script for any your care or planned discharge new medication a discharge plan The important information We following ask you toishave someone available Prior to discharge youor will receive regarding rehabilitation home care if for patients recovering from heart to help you at home for a week after a physiotherapy program a script necessary and discharge instructions If you are discharged If you live alone for any new medication a surgery you are not discharged on Day 5 after have special needs or do not have a discharge plan regarding Recovery from heart surgery can your surgery you will be encouraged companion or family member to attend rehabilitation or home care if take three ordays longer daily to carry on with your exercise closely to youmonths for a few after your necessary a follow up return home please notify the staff program continue to eat a healthy diet Listen to your body and do appointment referrals if requried early in your admission so that we can andtrydischarge and to rest asinstructions much as possible everything in moderation help organise something for you If you are not discharged on available Day 5 We ask you to have someone If you are feeling very tired or sore surgery youa will beafter toafter helpyour you at home for week slow down encouraged to carry on with your Feel free to ask questions regarding you are discharged If you live alone your Tiredness normaldischarge after heart exercise program daily continue to care or is planned have needs or dotrynot haveas a eat special a healthy diet and to rest surgery do not be surprised if you companion or family member to attend much as possible feel strong one day and tired and closely to you for a few days after you weak the next return home please notify the staff and Be patient recovery varies from ask The to seefollowing the Discharge Planning information is for patients from person recovering to person Coordinator thoracic surgery Recovery from surgery can take three months or longer Listen to your body and do everything in moderation If you are feeling very tired or sore slow down Tiredness is normal after surgery do not be surprised if you feel strong one day and tired and weak the next Be patient recovery varies between different people Adelaide Cardiothoracic Thoracic Surgery Book April 2020 page 23

Going home Going home Medications Following surgery your medications and Medications the times you take them may be Following surgery your different from what they were before medications and the times you surgery take them may be different from what they werewill before surgery Your pharmacist provide you with a detailed medicationwill listprovide which will Your pharmacist you outline new medications with aany detailed medication list medications that areany to be continued which will outline new medications that are to be those that are to be stopped and details that are to be ofcontinued any herbal those or vitamin supplements stopped and details of any herbal You havesupplements an opportunity to ask or will vitamin any questions about your medications You will have an opportunity to ask Beany surequestions to know the names about your of your medications and understand their medications and understand their purpose dose effects and how purpose dose effects and forfor how long you will need to take them long you will need to take them Our pharmacist will also work with you to assist in a smooth transition from hospital to home Before you leave the hospital you will be given a supply of medication and you may receive an invoice Your community pharmacist can further assist you with any questions Please take the medications as prescribed as there may be serious Our pharmacist will also work consequences to increasing doseswith or you to assist in aofsmooth transition from missing doses the blood thinning hospital to home Before you go you medication will be given a supply of medication and Make healthcare yousure mayother receive an invoice professionals Dentist Cardiologist etc Yourthat community pharmacist can further know you are taking blood thinning assist you with any questions medication Your healthcare team will determine which type of blood thinning medication is right for you Some patients will be discharged on a blood thinning medication called warfarin There are some important things to note about warfarin The effect of warfarin can be Blood thinning medications Blood thinning medications are given to some patients after heart valve surgery or if they are in atrial fibrillation irregular heart beat When taking medication that thins your blood it is important to watch for bleeding this may include frequent bruising bowel movements that are bloody or black urine that is pink or blood tinged vomit that is brown or red severe headaches nose bleeds and severe abdominal pain You are advised to wear a medical alert bracelet that indicates that you are taking blood thinning medication page 24 measured through a blood test called an INR International Normalised Ratio The INR will indicate how long it takes for the blood to clot If your blood is too thin you may bleed excessively if it is not thin enough clots may form which can cause serious complications You will initially need regular blood monitoring at least twice a week if you are discharged on warfarin You can do this at a lab close to your home or local GP The frequency of blood monitoring will gradually reduce over time as your warfarin dose stabilises Your GP will adjust your warfarin dose based on the INR results If you have had a mechanical heart valve implanted it may be possible for you to have your own machine to monitor your INR in combination with your GP Ask your medical team about

Going home Going home cont Medications Following surgery your medications and Travelling home the times you take them may be If you have travel a long different fromtowhat they were before distance to get home stop for a surgery short walk and stretch your legs Your pharmacist willhours provide every one to two Tryyou to with a have enough roomlist in which the carwill to be detailed medication able to sitnew and medications rest comfortably outline any medications thatthat are you to berequest continued It is important those are be stopped painthat relief in to hospital so youand aredetails ofcomfortable any herbal orforvitamin supplements your ride home You will have an opportunity to ask Driving any questions about your medications Youtocan resume drivingof your Be sure know the names approximately two to fourtheir medications and understand weeks after surgery purpose dose effects and for how long you will need to takeifthem Consult your doctor you have any questions concerns Our pharmacist will or also work with you to assist in a smooth transition from a seat belt as it will not Wear hospital to home Before you harm your incision It is a leave legal the hospital you will be supply requirement thatgiven you awear a of medication and youafter may thoracic receive an seat belt even surgery small pillowpharmacist can be invoice YourAcommunity place under your seat belt to can further assist you with any questions prevent rubbing on your incision You may choose to sit Blood thinning medications in the back where there is no air Blood thinning medications are given to bag some patients after heart valve surgery or if they are in atrial fibrillation irregular heart beat When taking medication that thins your blood it is important to watch for bleeding this may include frequent bruising bowel movements that are bloody or black urine that is pink or blood tinged vomit that is brown or red severe headaches nose bleeds and severe abdominal pain You are advised to wear a medical alert bracelet that indicates that you are taking blood thinning medication page 24 Please take the medications as prescribed as there may be serious to try an emergency consequences to increasing doses or You may like stop in your driveway or a local road missing doses of the blood thinning before venturing out medication PLEASE NOTE If you hold a Make sure other healthcare commercial Dentist heavy vehicle or professionals Cardiologist etc machinery licence you may not be able know that you are taking blood thinning to recommence driving commercially medication for three months and may need Your healthcare team clearance from yourwill GPdetermine prior to recommencing driving medication which type of blood thinning is right for you Air travel Some will be discharged onnot a fly recommended that you do It ispatients blood thinning medication within ten days of your called surgery It is warfarin There are some important best to consult your doctor before making any air travel plans after things to note about warfarin thoracic surgery The effect of warfarin can be You maythrough need a amedical clearance measured blood test called to fly if this is within two to four an INR International Normalised weeks of your surgery Your Ratio surgical team can provide this The INR will indicate how long it takes for the blood to clot If your blood is too thin you may bleed excessively if it is not thin enough clots may form which can cause serious complications You will initially need regular blood monitoring at least twice a week if you are discharged on warfarin You can do this at a lab close to your home or local GP The frequency of blood monitoring will gradually reduce over time as your warfarin dose stabilises Your GP will adjust your warfarin dose based on the INR results If you have had a mechanical heart valve implanted it may be possible for you to have your own machine to monitor your INR in combination with your GP Ask your medical team about

Travelling Going home cont Travelling Home Showering and incision If you have to travel a long distance to care get home stop for a short walk and Different people heal at1 2 different stretch your legs every hours Try to rates Several months may be have enough room in the car to be able needed for skin to heal thoroughly to sitfor andswelling rest comfortably is in and to resolve Iteven important you request young andthat healthy people pain medication before you leave the You will shower prior to your for the hospital so you are comfortable ridedischarge home from the hospital and can resume your normal hygiene habits once you are Driving home Your incisions may itch or feel can sore tight or numb for a You resume driving few weeks Some approximately fourbruising to six weeks after around the incisions is also surgery normal Consult your doctor if you have any Use warm not hot water questions or concerns You may wash your incisions Wear seat soap belt asand it will not let harm gentlya with water your incision is a legal the water flowIt over yourrequirement that you wear a seat incisions but do not belt scrubeven themafter cardiac surgery A small pillow may be used under your seat belt to prevent rubbing on your incision You may choose to sit in the back where there is no air bag PLEASE NOTE If you hold a commercial vehicle licence you will not be able to recommence driving commercially for 3 months and will need clearance from your cardiologist prior to recommencing driving Air Travel It is recommended that you do not fly within 10 days of your surgery but it is best to consult your doctor before making any air travel plans after heart surgery You may need a medical clearance to fly if this is within two to four weeks surgery can your incisionsYour dry surgeon do not use ofPatyour powdersthis or lotions on your incisions provide until completely healed Showering and incision care Showers are probably better than baths in shower the first prior few weeks You will to your discharge from Do not swim forthe at hospital least sixand weeks resume your normal hygiene after surgery and then only habits if your wounds healed once youhave are home Your incisions or feel sore tight or numb youitch have increased wound Ifmay for a few weeks Some around swelling redness painbruising or the incisionsorisaalso normal feeling in discharge crackling your GP the Use skin warmcontact not hot water Before you handle a dressing or You may wash your incisions inspect your wound thoroughly gentlyyour withhands soap and let at the lather withwater soap for water15flow over your incisions least seconds and then rinsebut do notclean scrub running them tap water under Pat your incisions dry do not use powders or lotions on your incisions Showers are probably better than baths in the first few weeks Do not swim for at least 6 weeks after surgery and then only if your wounds have healed Follow up appointments Upon discharge you will be given instructions regarding your follow up appointments Ensure you have follow up appointments with Your Cardiac Surgeon two weeks after your surgery Your Cardiologist six to eight weeks after discharge It is also advised that you make an appointment to see your GP within the first week after discharge Cardiac Surgery Patient Information Booklet October 2017 page 25

Going home cont Follow up appointments Upon discharge you will be given instructions regarding your followup appointments Ensure you have a follow up appointment with your thoracic surgeon two to four weeks after your surgery your GP within the first week after discharge Sleeping You may find it difficult to fall asleep or you may find that you wake up at 2 00am or 3 00am and cannot fall back to sleep This will improve You will be unable to sleep on the operated side for several weeks You may also experience vivid dreams due to the general anaesthetic This will subside It is normal to have a nap during the day but try to limit it to 45 minutes To help you get to sleep at night it is best to not nap past 3 30pm in the afternoon Make sure you have adequate pain control before you go to bed at night Physical activity helps in making you tired at night which may help with sleep

What can I expect after surgery What s after surgery Goingnormal home cont Energy levels Diet You may maynot feelhave generally and It You much tired appetite have little energy some patients can take several weeks for your find theyto are breathless when appetite return to normal Physical they exert themselves activity may help improve your This is usually normal and should appetite improve over time as you recover from Manysurgery patients notice that their sense of taste is diminished or almost It is common to have a day when absent It will return you feel well and do a lot and to then You may findare it easier to eatthefive or find you exhausted six small next day meals per day instead of trying to eat three larger meals If you feel your fatigue or breathlessness Some patients complain of nausea is not improving at getting the smell of food formore a week or is worse or is than you please see your two expected after surgery doctor Choose bland foods that do not have a strong odour Try eating cold foods as Constipation they tend to have a milder odour than Thefoods pain medication narcotics hot or iron supplements you are prescribed can cause Swelling constipation It is normal to ahave generalised may use laxative of your You swelling This mayfor choice orafter ask surgery your pharmacist persist for four to six weeks recommendations If you have an incision in your leg You should not of gothat longer expect swelling leg than two days without a bowel Elevate your feet whenever you movement at rest Adding fibre to your diet such as are Avoid crossing legs as this fresh fruits andyour vegetables high interferes with blood flow fibre breads and cereals may Try to get in a couple of naps during the day but try to limit them to 45 Drink adequate fluids To help amounts you get toofsleep at minutes Exercise improve bowel night it is will bestalso to not nap past 3 30pm function in the afternoon Make sure you have adequate pain Moods control before you go to bed at Experiencing a change in your night emotions can be more common than you Again physical might think activity may help make you tired at night which may You with may sleep experience mood swings help and feel depressed This is common and will pass Energy levels Youmay mayfeel have good days generally tired and and bad have You days Do notsome be discouraged little energy patients find they breathless when exertopenly Communicate your they feelings are with your family members themselves This is usually normal and should improve over time as you Depression recover from surgery change in you ItExperiencing is common toa have a day when you emotions can be more common feel well and do a lot and to thenthan find you might think you are exhausted the next day about it with IfJust youtalking feel your fatigue or others can do wonders to is help are not is sure breathlessness not We improving why there is a prevalence for getting worse or is more than you depression after see surgery but it is expected please your doctor very real and usually resolves after Please note that energy levels can be six to twelve months down a little for up to six to nine However you feel that are not months andif that this is notyou unusual coping please discuss with your GP or doctor Constipation The pain medication narcotics or iron supplements you are prescribed can cause constipation You may use a laxative of your Sleeping or hopeless choicedepressed or ask your pharmacist Have you been bothered by feeling down You may find it difficult to fall asleep for or recommendations you found youwake have pleasure in doing things or Have you may find that you uplittle at interest You should not go longer than two or 3 00am fall If2 00am you answer yes and to cannot these questions speak your GP or visit daystowithout a bowel movement back to sleep This will improve for Adding fibre tooryour diet information such as fresh Beyond Blue www beyondblue org au guidance further fruits and vegetables high fibre help socks with a tight band Avoid page page 26 28

The following page can be pulled out and placed on your fridge or wall so that you have a guide to your recovery readily available to you

ADELAIDE CARDIOTHORACIC Simple cooking light gardening watering light weeding avoid pushing pulling and twisting until week 6 onwards Exercising can gently commence other exercise delay swimming until wound is healed and ask doctor for guidance on recommencing sport Walking at your own pace increasing distance over time Lifting 4 kgs increasing over time delay heavy lifting Coughing Deep Breathing and TriFlo Exercises Continue for two weeks post discharge four times per day Sex Resume as normal building up to longer drives Driving you can resume driving take a few short trips Can attend to home duties as tolerated WEEK 4 Longer outings movies restaurants Lifting only 2 4 kgs as above Walking 15 20 minutes 2 times a day comfortable pace on flat ground Gentle exercise bike don t lean on arms Don t hold your breath Lifting only 2 4 kgs no groceries children pets etc Walking 10 15 minutes 2 times a day stroll on flat ground NO DRIVING or WORK for 2 4 weeks as per doctor Stairs slowly Sex gently at your own pace WEEK 3 Sex Gently just cuddles until week 3 avoid pushing pulling and twisting NO DRIVING or WORK for 2 4 weeks as per doctor Stairs slowly with rests Light tasks only Water garden dusting dishes WEEK 2 SLOW DOWN if you experience PAIN DIZZINESS and or SHORTNESS of BREATH during or after activities REMEMBER TO LISTEN TO YOUR BODY Gradually returning to activities gives you time to heal post your surgery NOTE THIS IS A GUIDE ONLY AND MAY VARY FOR DIFFERENT PEOPLE CONSULT YOUR DOCTOR FOR ADVICE ON STRENOUS ACTIVITIES When can I resume my usual activities

The following page can be pulled out and placed on your fridge or wall so that you have a guide to what you need to watch out for readily available to you

After your discharge from hospital what now After discharge what do I do if Gototoyour yourlocal localEMERGENCY EMERGENCY or Go or call call an an AMBULANCE AMBULANCE If you have If you have Chest pain that feels like angina or a heart attack shortness of breath not relieved by rest sudden severe headache Sudden severe headache sudden severe abdominal pain Sudden severe abdominal pain bright red stools or bleeding from your bowels Bright red stools or bleeding from your bowels coughing up bright red blood or excess sputum Coughing up bright red blood fainting spells Fainting spells sudden numbness or weakness in arms or legs Shortness of breath not relieved by rest Heart rate faster than 150 beats per minute with shortness of breath or a new irregular heart rate Consider calling or visiting your Sudden numbness or weakness in arms or legs Local Doctor If you have temperature than 38 C times within 24 hours elevated Consider calling more or visiting your two Local Doctor extreme fatigue If you have pain in calf that becomes worse when lifting toes towards your Elevated temperature more than 38 C two times within 24 hours head Extreme fatigue flare up acute gout Pain in calf that becomes whenyour liftingwound toes towards your head bleeding or worse ooze from persistent Acute gout flare up sharp pain when taking a deep breath Persistent bleeding or ooze from your chest or leg wound skin rash Sharp pain when taking a deep breath urinary tract infection burning frequent urination urgency or Skin rash bloody urine Urinary urination urgency weightTract gainInfection of more burning than onefrequent kilogram within 24 hoursor bloody urine worsening ankle swelling or leg pain Weight gain of more than 1kg within 24 hours worsening shortness of breath Worsening ankle swelling or leg pain new onset of nausea vomiting or diarrhoea Worsening shortness of breath New onset of nausea vomiting or diarrhoea If y ou have any questions please call us at If you have any questions please 5950 call us at 5950 or 08 8204 5626 08 8375 or 08 088375 8204 5626 page 32 page 32

Lung cancer and mesothelioma Lung cancer symptoms typically begin to appear 10 to 30 years after a person starts smoking which in 80 percent of patients is the main cause of lung cancer Lung cancer can also be caused by second hand smoke exposure to an inhaled toxic substance family history or result from other lung diseases such as emphysema or lung fibrosis Mesothelioma is a disease caused by extended exposure to asbestos a toxic mineral once used extensively in construction and manufacturing The cancer has a dormant period of about 40 years Some patients present years after that while others may show symptoms 10 to 15 years after maximum exposure Everyone reacts to a diagnosis of cancer differently It is often difficult to take in the diagnosis immediately It is normal to ask why me or to feel sad angry helpless or worried about your future Talk to your doctor about what your diagnosis means for you Support Mesothelioma The Asbestos Diseases Society of South Australia ADSSA 1800 157 540 or online at www adssa inc com au is committed to providing counselling support and information to asbestos disease victims assisting the family and friends of those who develop asbestos related diseases Legal support If you have been diagnosed with an asbestos related disease you may be eligible for compensation You can find a leading lawyer in asbestos by checking the Doyles Guide Directory www doylesguide com australia and type asbestos and your state i e asbestos South Australia in the search bar The mesothelioma support organisations can also assist you in contacting an expert asbestos lawyer For further information Lung cancer Cancer Council 131120 provides a confidential telephone information and support service where you can speak to an experienced Cancer Council nurse Cancer Councilis open Monday to Friday 8 30am 5 30pm Asbestosis Mesothelioma Association of Australia AMAA 1800 017 758 or www asbestosassociation com au Cancer Council Australia www cancersa org au 131120 Adelaide Cardiothoracic Thoracic Surgery Book April 2020 page 33

What are my rights and responsibilities You have the right to Considerate and respectful care regardless of your beliefs and ethnic cultural and religious practices Know your healthcare team Know the name of the doctor who has primary responsibility for coordinating your care and the identity and functions of others who are involved in providing care Seek a second opinion and to refuse the presence of any health care workers who are not directly involved in the provision of your care Receive information from your doctor in nontechnical language regarding your illness its likely course the expected treatment the plans for discharge from the hospital and for follow up care Receive from your doctor a detailed description of any proposed treatment the risks the various acceptable alternative methods of treatment including the risks and advantages of each and the consequences of receiving no treatment before giving consent to treatment Also unless the law prohibits you may refuse a recommended treatment test or procedure and you may leave the hospital against the advice of your doctor at your own risk after completion of hospital discharge forms Participate in decisions affecting your healthcare Be informed of the estimated costs charged by the hospital Refuse participation in any medical study or treatment considered experimental in nature You will not be involved in such a study without your understanding and permission Refuse participation in student teaching activities Confidentiality and privacy Details concerning your medical care including examination consultations and treatment are confidential No information or records pertaining to your care will be released without your permission or the permission of your representative unless such a release is required or authorised by law or necessary to enable another health care worker to assist with your care Know before your discharge from the hospital about the continuing health care you may require including the time and location for appointments and the name of the doctor who will be providing the follow up care You also have the right to assistance with discharge planning by qualified hospital staff to ensure appropriate post hospital placement Not be restrained except as authorised by your doctor or in an emergency when necessary to protect you or others from injury Retain and use your personal clothing and possessions as space permits unless to do so would infringe on the rights of other patients or unless medically contra indicated page 34

You have the right to Expect safety where practices and environment are concerned Privacy for visits during established patient visiting hours Make a comment or complaint about the treatment or the quality of the health services or care without fear that you will be discriminated against Have your dietary and other special needs considered You have the responsibility to Respect the privacy and confidentiality of other patients It is illegal to disclose any information about another patient s presence in the hospital or their treatment This includes verbal and digital communication as well as the use of photographs videos etc and information published online and or via any social media platform Violations will be taken seriously and may lead to the discharge of the offending patient and their exclusion from ACHA Health hospitals in the future Civil and or criminal proceedings may also result Provide accurate and complete information about present complaints past illnesses hospitalisations medications and other matters relating to your health Report unexpected changes in your condition to the responsible practitioner Report if you do not comprehend a contemplated course of action or what is expected of you Follow the treatment plan recommended by the practitioner primarily responsible for your care This may include following instructions of nurses and allied health personnel as they carry out the coordinated plan of care and implement the responsible practitioner s orders Keep appointments and when unable to do so for any reason to notify the responsible practitioner or the health care facility Behave in a lawful manner and contribute to a safe and comfortable environment For further information please visit Ashford Hospital and Flinders Private Hospital Rights and Responsibilities http acha org au application files 3014 9396 6030 ACHA036_Patient_Rights PDF _________________________________________________________________ Calvary Wakefield Private Hospital Rights and Responsibilities https www calvarycare org au about you rights and responsibilities ___________________________________________________________ Adelaide Cardiothoracic Thoracic Surgery Book April 2020 page 35

Contact information Contact information Adelaide Cardiothoracic Suite 39 Level 2 Level 6 Flinders Private Hospital A D E L A I D E Ashford Specialist Centre 1 Flinders Drive 57 59 Anzac Highway C A R D I O T H OBedford R A C IPark C SA 5042 Ashford SA 5035 If you have any questions or require any further information please do not hesitate to contact us at Adelaide Cardiothoracic by phone at 08 8375 5950 or 08 8204 5626 between 9 00am and 5 00pm Monday to Friday Suite contact adelaidecardiothoracic com au 3 Anzac Medical Suites Email Level 6 Flinders Private Hospital 41 Anzac Highway 1 Flinders Drive Phone 08 8375 5950 Phone 08 8204 5626 Website www adelaidecardiothoracic com au Ashford SA 5035 Bedford Park SA 5042 References Links and Acknowledgements Email contact adelaidecardiothoracic com au Website www adelaidecardiothoracic com au Australian Commission on Advanced Care Directives South If you have any questions or require any further information please do not hesitate Australia Safety and Quality in Health Care to contact us between 9 00am and 5 00pm Monday to Friday About the Australian Charter of Healthcare Rights A guide for patients consumer s carers and families www safetyandquality gov au www advancecaredirectives sa gov au Heart Foundation www heartfoundation org au

References Links and Acknowledgements Australian Commission on Safety and Quality in Health Care About the Australian Charter of Healthcare Rights A guide for patients consumers carers and families www safetyandquality gov au Advanced Care Directives South Australia www advancecaredirectives sa gov au

For more information ADELAIDE CARDIOTHORACIC HEART AND L UNG SURGEONS Suite 3 Anzac Medical Suites 41 Anzac Highway Ashford SA 5035 Telephone 08 8375 5950 Level 6 Flinders Private Hospital 1 Flinders Drive Bedford Park SA 5042 Telephone 08 8204 5626 Email contact adelaidecrdiothoracic com au Website www adelaidecardiothoracic com au Terms of use This material has been developed for general information and educational purposes only It does not constitute medical advice Please consult your healthcare provider if you have or suspect you have a health problem The health information provided has been developed by Adelaide Cardiothoracic and is based on the available scientific evidence at the time of writing The information is obtained and developed from a variety of sources including but not limited to collaborations with third parties and information provided by third parties under licence It is not an endorsement of any organisation product or service While care has been taken to preparing the content of this material Adelaide Cardiothoracic its employees and related parties cannot accept any liability including for any loss or damage resulting from the reliance on the content or for its accuracy currency and completeness Any use of Adelaide Cardiothoracic s materials or information by another person or organisation is at the user s own risk The entire contents of this material are subject to copyright protection This document has been reviewed and endorsed by consumers in November 2019 www ausgoal gov au creative commons All rights reserved Adelaide Cardiothoracic Booklet written and compiled by Adelaide Cardiothoracic and Bronwyn Krieg Printed May 2020