Planning for your hospital stay following mini-maze surgery for atrial fibrillation
These suggestions have emerged from the experience I had at the University of Cincinnati Hospital following the Wolf Mini-maze on January 5, 2006.
Please note: The following will not apply to all post-op hospital stays; they do not all apply to mine. People respond differently to the physical and emotional challenges of a mini-maze and other surgery. For example, I had an easy time with pain and in dealing with the nurses and doctors, and a more difficult time with sleep and with not being able to move around more freely (for couple of days longer than expected).
I hope that some of the suggestions will be useful to those of you that will undergo this operation or something similar to it.
For one or more days (after the Wolf mini-maze), you will be in an intensive care unit with 10 lines into your body, plus 5 electrodes stuck on your chest: two pacing lines, two chest drainage tubes, two pain ball tubes, arterial and IV lines (a total of three), a Foley catheter, plus five EKG leads, a blood pressure cuff, and a finger cuff to measure O2 saturation.
All except one of these will be plugged into equipment behind you or into the wall; the catheter will be draining into a bag hung at the foot of your bed. If you need to get out of bed, the nurse must unplug these lines and plug them into a portable monitor, and then you or someone else must carry your Foley catheter bag.
You will be on pain and other medication, including Prednisone to prevent pericarditis resulting from cutting through the pericardium to get to the outer surface of the heart. Your may be putting up with other unpleasant-nesses, such as such as nausea and the others listed below.
After the first day or so, you will be moved to a step-down unit, if there is room. There, your lines – except for your catheter—will be plugged into a portable monitor. Now you can move off the bed without calling the nurse.
This sounds like a difficult situation, but it is very tolerable for a short time, assuming your pain is under control. With a little planning, you can do just fine! Please remember that I have listed everything that I can think of that might be a problem for you ...
Pain
Don’t hesitate to ask for pain medication, and be sure to take it regularly even if the pain doesn’t seem severe enough to require it at the time. Don’t try to “tough it out”, unless you are sure you can win. If you let the pain get ahead of you, it is much more difficult to treat.
Do be aware that the seemingly mundane side effects such as nausea and constipation can make a big difference in your weakened state. Not being able to keep food down can keep you weaker for longer, and throwing up your medication delays its going to work for you. As for constipation, well …. Be sure that a stool softener has been ordered for you.
Fentanyl, a pain killer, which might have been administered during the operation, and Percocet, which you can take post-op may be the side-effect culprit. You can ask about medications other than an opiate that might control your post-op pain without these side effects, such as Tylenol. Be aware that pain medication may be coming from other sources, such as the “pain balls” used after the Wolf mini-maze for incision pain.. Pain medication may also be coming through your IV.
Time will take care of nausea as a medication side effect. Diversion helps. Ask for jello or ginger ale and take tiny amounts at first, even though you are hungry.
Please note: You should, of course, mention any side effects of any medication to your nurse in case one of them might require medical attention.
Your Room Environment
Dry air
Dry cold indoor winter air (and dry O2 coming through the cannula in your nose, if it O2 is administered) can cause itchy throat and cough, unpleasantly dry nasal passages, and may cause your nasal passages or sinuses to bleed, creating a bloody smell that adds to your nausea.
>> Drink even if not thirsty, use cough drops, keep liquids next to your bed. Ask your nurse before using nasal sprays. Ask your nurse before using Vaseline or any petroleum product when O2 is present. Ask to have your O2 humidified. You can use chapstick, but not lotion, at least not anywhere near your incisions. Ask your nurse for suggestions if you are uncomfortable...
Heat/Cold
If you get cold easily or are used to sleeping in warm pajamas, you may get chilled when you wear the hospital gown. It is made of very light material and fits very loosely – think “naked” Also, the blankets may be made of very light cotton. When several are used, they weigh a lot and tangle easily
>> Bring a nightcap, sox and a shawl. Bring a blanket from your motel. Ask for a “bear hugger”, which is a blanket into which warm air is pumped. In summer, you can bring a personal fan
Mobility
For a brief period of time, probably one or two days, you will not be in control of your bedroom.
As mentioned above, for the first day or so, you will have a number of lines in and on your body, so you won’t be able to move from your bed without a lot of unhooking. You can’t reach things, you can’t walk to the sink, you can’t get things out of your luggage, you can’t pick up something that fell off your overcrowded bedside table.
The most important thing you can do to overcome this problem – and that will make your life in the hospital a great deal easier -- is to bring a helper-companion with you
This person can:
> get things for you in or out of the hospital > go to the desk and ask your nurse a quick question or make a request for something “when you get the time”. > walk you around, or do other things to help the overworked staff >divert you from pain, nausea, drug side effects, or the restless feeling that comes from being imprisoned on your bed >make or answer phone calls >take some free time for him- or herself -- see the sights, got to a show > be your supportive friend!!!
Having someone come with you can be a great help. Ideally, this person would be someone who is part of the medical community or who knows the system well enough not to be confused or intimidated by rusing-around ward activities, lines of communication, and the pecking order. Next best is a person with status that will be acknowledged by the doctors and nurses, or who demonstrates that they have “done their homework” on the procedure. Nurse and doctors are more likely to treat such people as part of the team rather than as someone who should remain passive and obedient.
Miscellaneous
Sleeping
Getting some sleep can be a challenge, with noise and light from activity outside your room conspiring to keep you awake.
>> Bring a sound masking device (check out the Marsona brand), ear plugs, and a sleep mask or stocking cap that you can pull down over your eyes (the hat will keep your head warm, too).
Bed size
If you are over 6” 1’, ask about an oversize bed. All those tubes can make shifting around, trying to get comfortable a chore.
Food
The quantity may be very small and it may be miserably prepared.
>> Bring some with you or have your companion get you some. Clear any special food with the nurse. This is especially important for liquids, as he/she will be charting what goes in and what goes out.
The Patient Role
Dealing with nurses
Avoid calling your nurse when you know she is especially busy, such as during shift changes when those on the previous shift give reports on the status and needs of their patients to the oncoming shift. You can ask the nurse about her other patients, to get a feeling for their demands on her.
Write down your requests and your questions ahead of time so you can ask them all at once when he or she comes for a regular visit. Avoid “nickel & diming” her. This means buzzing her and asking her to do something, then buzzing her again with something you forgot to ask her to do the first time. Avoiding this is one reason nurses usually ask, “Is there anything else I can do for you?”
Don’t be afraid to ask questions – within reason. Don’t apologize for asking.
Do what you usually do to make other people feel good about helping you. But be aware that In your vulnerable position, it is easy to go overboard with compliments that may sound insincere.
Dealing with your doctor
You can ask the residents who visit you all you want. but I’d respect the fact that the doctor has many other patients to deal with – not mention a long list of other tasks. So save only your most important questions for him. And write your questions down ahead of time!!! You companion can make sure your ask them all and can write down the answers.
I believe that most doctors these days are gratified by gratitude of their patients and by the respect shown for their expertise. But, they do not expect to be treated like gods or dictators, and will not respect – nor find believable – patients who treat them that way. ______________
Avoiding infection
Check this site for suggestions:
http://www.hospitalinfection.org/protectyourself.shtml I hope some of these suggestions will be helpful to you. You might start your planning now by thinking,” Who can I get to go with me?”
By the way, the advisability of having a knowledgeable advocate with you during your stay is emphasized in a Time magazine article, "What doctors hate about hospitals" May 1, 2006, pp 42-52.
|