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Department of Thoracic Surgery

Preparing for Your Operation

Exercise Before Your Operation

You will work together with your thoracic surgeon, our nurses, and our respiratory therapists, to achieve the best possible physical condition before your operation, to help you recover more easily and more quickly. If you are still smoking, you must stop before your operation - at least two weeks, and if possible, four weeks.

If you need help with stopping smoking, please talk with your nurse, or your physician. You will be given instructions, and exercises to strengthen your breathing and other muscles before surgery. The following guidelines will help.

Arm Exercises


  • You can stand or sit to do this exercise.
  • Place your arms level with your shoulders, so that your arms are straight and parallel to the floor.
  • When you breathe in: raise your arms above your head, clasp your hands together, and hold for 2 seconds.
  • When you breathe out: lower your arms slowly, exhale through pursed (puckered) lips, and stop when your arms are parallel to the floor.
  • Repeat this exercise 10 times.
  • Do this exercise 10 times a day.

Leg Exercises


  • You should sit in a chair to do this exercise
  • Lift one leg off the chair, tightening the muscles on top of your thigh, and then straighten your leg out; hold your leg out straight for 3 seconds
  • Bend your knee and lower your leg slowly; relax, and then repeat 10 times
  • Do this exercise 10 times a day.

Breathing Exercises

This exercise helps your diaphragm (a a muscle between your abdomen and your chest which contracts to let you breathe).

  • You should sit in a chair to do this exercise.
  • Sniff twice, hold your breath for 2-3 seconds.
  • Tighten your stomach muscles, and then blow out slowly.
  • Repeat this exercise 10 times.
  • Do this exercise 10 times a day.

Other Exercises


  • Walking is always good exercies. You should gradually strive to achieve walking a distance of at least 1 mile, twice daily, in less than 20 minutes. You may increase this to 2 miles as desired.
  • Stair climbing also assists in improving circulation and breathing capacity. You could climb 2 flights of stairs, 4 times a day. The speed with which you climb these steps should gradually improve.
  • If you are concerned about how to start this walking or stair climbing program, please discuss this with your nurse, or physician. If you have other medical problems, or a history of any cardiac problems, please discuss this with your physician.

Before your operation

The evening before your operation you may eat the diet prescribed by your physician. Typically this will include a regular meal and may drink fluids up until midnightmidnight. . Do not eat or drink anything after.

For patients undergoing esophageal operations, a clear liquid diet may have been prescribed for you in preparation for your operation

You and your family will have had an opportunity to visit with the anesthesia nurse practitioner in the Vanderbilt Preoperative Evaluation Clinic (VPEC) prior to your operation. You will be given directions to the admissions area of the VanderbiltUniversityMedicalCenter, and instructions on when to arrive. Your time of arrival is important as physicians, nurses, staff, operating room personnell (anesthesiologists, circulator nurses, scrub nurses, etc.) are preparing for your specific operation.

Please remove any lipstick or nail polish on the day of your operation. Please leave all valuables and jewelry at home or with a family member.

Then you will be taken to the pre-operative area, where you will change into a hospital gown. You will meet with an anesthesiologist again and an intravenous (IV) line will be started. You may receive a sedative medication to help you relax. You will be taken to the operating room shortly after you are given this medicine.

When your operation is over your thoracic surgeon will speak with your family members. You may be asked to meet the doctor in the 3rd floor consultation room (opposite the elevators). You will go to the Recovery Room when your operation is completed. There you will be monitored until you are fully awake. If you go home after your procedure or operation, you will receive detailed instructions and additional contact information.

Except for outpatient procedures, you will be admitted to the hospital on the Thoracic Surgery unit (9 North; telephone 615 322 0918). If you go home after your procedure or operation, you will receive detailed instructions and additional contact information.

The Thoracic Surgery unit, 9 North, is a 'Step-Down' Unit with capacity for monitoring heart rate and rhythm, blood pressure, and oxygen by experienced nurses and staff. You will receive your care for several more days, depending on your operation. Your activities and care will lead to your discharge from the hospital.

After your operation

After your operation, you will be monitored to ensure your recovery is as smooth and comfortable as possible. Various equipment, lines, and tubes will be used. They all have a purpose, and all are specific for your operation, and your medical care. The recovery room staff, and your physicians will evaluate your condition at routine intervals. You will be weighed every day, usually before 6 a.m. The nurse will measure how much fluid you receive (your intravenous fluid and what you drink) and how much fluid is removed (urine, drainage from chest tubes, etc.). The nurses will help you to understand how you can help with your fluid balance.

 

Breathing - You will receive oxygen as needed. It is given to you through a small tube placed just at your nose, or you may wear a face-mask. Notify the nurse immediately if you feel short of breath or 'winded'.

Pulmonary hygeine is very important for you after the operation. You may need assistance in coughing to remove the mucus or secretions from your lung. Before your operation you may have received an Incentive Spirometer to help you exercise your lungs, along with instructions and a few days to practice deep-breathing.

After your operation your nurse will show you again how to use this breathing exercise macine (incentive spirometer) and assist you in its use. You can also help by coughing and deep breathing as instructed. Generally this will include deep breaths and cough about 10 times every one to two hours while awake. Small, 'throaty' coughs, or just 'clearing your throat' will not clear the mucus. To cough well, place a pillow over your incision. Take a deep breath in through your nose. As you get ready to cough, hug the pillow and cough twice. Repeat these steps until your chest feels clear.

Being physically active will exercise your lungs and help with your breathing and oxygenation. After your operation you may feel tired, but your lungs will improve more rapidly the more you sit up in a chair and take frequent walks in the hall.

We will ask you to rate your pain on a scale of 0 to 10 in order to measure how well your pain medicine is working. A score of 0 means that you have no pain at all. A score of 10 means you have the worst pain you have ever had.

0 - 10 Numeric Pain Intensity Score

 

No pain                                    Moderate pain                  Worst possible pain __________________________________________________________________

0     1          2          3          4          5          6          7          8           9        10 

Recovery in the Vanderbilt University Hospital

Pain Medication - In order to be able to deep breathe and cough, it is important that you take the pain medicine that your surgeon has ordered. The anesthesiologists may have given you a thoracic epidural catheter. This pain control device will remain for several days to assist you in your comfort, and your recovery. It makes coughing, deep breathing, and walking more comfortable. Please tell your nurse if your pain medicine is not keeping you comfortable, especially when you are doing your deep breaths and coughing.

Physical Activity - Once you are out of the ICU, you will begin walking. Your nurse will show you how to support your incision to help decrease the discomfort with coughing and other physical activities (such as getting in and out of bed). Your nurse may help you walk for the first few days. You will need to walk outside your room and in the hall at least 3 times a day. You may need assistance with various lines, or tubes and containers, during your walk. The nurses and staff will assist you. Your family can also help with the nurses approval and supervision.

Most of the tubes are removed a few days after the operation. The following are brief descriptions of the tubes and equipment used during your hospital stay:

Chest Tube - The chest tube is placed after your anesthetic and during your operation. This tube drains air and blood which may collect around your lung after the operation. The chest tube is connected to a special collection container at the side of your bed. The nurse will measure the amount of fluid that drains into the container. Your surgeon will remove the tube when the lung has reexpanded and the air and fluid have stopped draining. The tube usually can be removed in 4 to 5 days.

Cardiac Monitoring - electrode pads will be put on your chest and attached to a heart monitor. This machine monitors your heart rate and rhythm and has an alarm that sounds on occasion. It is sensitive and on occasison, may make a sound even if the nurse touches you or if you move around in bed.

Intravenous (IV)/Arterial Line – You may have several IV lines. These are important for giving you fluids and medicines. The arterial line gives important information about your blood pressure, pulse, and amount of oxygen in your blood.

Foley Catheter - This tube drains urine from your bladder. It is inserted after your anesthetic and before your operation. The nurse measures the amount of urine while you are in the ICU. It is usually removed several days after surgery.

Epidural Catheter - This tube is inserted by the anesthesiologist before your operation to help treat your pain after your operation. While it is in place, you should have very little or no pain. Please tell your nurse if you are having pain.

Patient Controlled Analgesia (PCA) - This is a pain control method where the pain medicine is in an intravenous (iv) solution and you can push a special control button to give yourself the pain medicine whenever you feel you need it. Your thoracic surgeon, or the anesthesiologist, will prescribe the medication with certain limits, so that you cannot receive too much. If your pain is not adequately relieved, please tell your nurse so that your surgeon can adjust the amount you receive.

Prevention of Blood Clots - Blood clots, or deep venous thrombosis (DVT) can occur in the legs after any operation. If these blood clots form, they can break off and acutely block off blood flow to the lung. This serious condition is called pulmonary embolism. Subcutaneous heparin, or antithrombotic sequential compression stockings may be used to help prevent blood clots in the legs, and pulmonary embolism.

Subcutaneous heparin - Heparin, when used in this manner and at a low dose, is a drug which aids in reducing the risk of blood clots in the legs, but does not prevent the normal blood from clotting in response to injury. This is used throughout your hospitalization.

Antithrombotic Sequential Compression Stockings - These are plastic sleeves which wrap around your legs and squeeze your legs while you are in bed. This helps your circulation and helps prevent blood clots. When you are able to walk in the hall several times a day, you will not need to use them anymore.

Vital Signs - The nurse will check your vital signs (blood pressure, pulse, breathing rate, and temperature) and your oxygen saturation (the percentage of oxygen in your blood) to make sure you are breathing well and recovering comfortably from your operation as expected.

Discharge from the Vanderbilt University Hospital

Most patients go home from the hospital several days after their operation. The hospital stay depends on your condition prior to the operation, the operation performed, and how your body responds to the operation. This section will give you some general guidelines to follow once you are home. Your nurse and/or surgeon will review this information with you. They can answer any questions you might have. If you have questions, let your nurse know and additional information will be provided. You will receive a discharge letter before you leave the hospital with detailed instructions.

When to Call Your Thoracic Surgeon

Do not hesitate to call your surgeon for any problem that is of concern to you or your family. Generally, the common questions can be answered by one of our clinic nurses. Telephone (615) 322 0064, and your surgeon will be contacted with any other questions or concerns.

Some changes may represent an infection in the lungs or in the incision and should be evaluated further by your surgeon or your physician. Call your surgeon if you have any of the following signs or symptoms:

  • A large increase in mucus coughed up from your lungs.
  • A change in the color of the mucus (for example, yellow, green, bright red).
  • Difficulty breathing or new shortness of breath.
  • A fever of 101.5 for more than 24 hours.
  • Your incision becomes red or more painful.

Recovery and Convalesence at home

 

Physical Activity

 

Begin to resume normal physical activity as soon as possible after your operation. This helps to clear your lungs and helps the circulation in your legs.You'll begin by sitting up in a chair next to your bed in the hospital, and rapidly progressing to walking in the hall with assistance. You will continue this at home. Get up and get dressed each morning. Regular activity is important to recovery. Use both arms as you normally would. Walking also helps recovery. Begin with short walks gradually increasing your distance every day. Space activities throughout the day. Avoid rushing and stop to rest if you feel tired. To help the incision heal, don't lift objects eighing more than 20lbs; for example, a child or heavy bag of groceries) for up to 6 weeks after surgery. You make take a shower at home. The Steristrips (paper strips on your incision) will fall off by themselves in a few weeks. 

Breathing exercises

Deep breathing exercise should be continued at home so that your lungs will stay clear. You should continue with the deep breathing exercises until your cough does not produce mucus (sputum). The deep breathing exercises usually are most effective when you are sitting in a chair with your back well supported.

Place both hands over the lower front part of your rib cage.
Take a deep breath in through your nose and blow out slowly through your mouth with pursed (puckered) lips. With each deep breath, try to expand your rib cage as much as possible.
Take four deep breaths in a row and then rest.
After 10 minutes of deep breathing, take one deep breath in, support your incision with a pillow and cough.
This exercise should be done at least twice a day if you continue to cough up mucus.

Shoulder range of motion exercises

Your shoulder on the side of your operation may become stiff. Therefore, range of motion exercises should be done 2 to 3 times a day until your shoulder is not stiff anymore. These exercises are best done in front of a mirror so that you can watch your posture.

With both hands clasped together, lift arms straight over your head and then lower to the starting position. Repeat 5 times.

With both hands clasped together, lift your arms up over your head and touch the back of your neck. Then lower your hands to the starting position and repeat the exercise 5 times.
Place one hand behind your back and with the tip of your thumb, try to touch your shoulder blade.
Lower your hand to the starting position, and repeat 5 times.

Posture

Keeping your back straight (keeping a good posture) is important after your operation, so that your lungs can expand properly. Therefore, keep your shoulders level and your back straight when you sit, stand, and walk.

Nutrition

It is normal to lose your appetite for several days after an operation. However, good nutrition is important to help your body recover. Even if you are not hungry, try to eat at least half of each meal or small portions six times a day. Your appetite should return to near normal after a few weeks, especially as your activity increases. If your appetite is poor, try to eat high calorie and high protein foods. Small meals, 4 to 6 times a day, may be easier to eat. If you are not eating enough, a vitamin supplement can be used.

Constipation is a common problem after surgery, usually caused by the pain medicines. Drinking plenty of fluids and eating fresh fruit or bran will help prevent this problem. A stool softener may be ordered for you by your doctor. Please tell your doctor if this becomes a problem.

Medications

It is not unusual to have increased pain the first few days you are home due to increased activity. Your doctor may order pain medicine for your to use at home. You may have pain in your incision for several weeks after your operation, and you will be given pain medicine to take at home. Do NOT take pain medicine before driving or with alcohol.

By 6 to 8 weeks after your operation, most of the pain in your incisions will be gone. You will also notice that the 'bump' along the incision will have gone down. It is normal for the area around your incision to feel numb for many months, and this will improve with time. This numbness may be worse on cold or damp days. Your pain will slowly decrease as healing occurs, but you may be stiff or achy for up to three months after surgery, especially on cold or wet days.

Wound Care

Tightness, itching, numbness or tingling around the incision area are often normal. These feelings may last for about 6 to 12 weeks, or longer.

Copyright © 2004, Vanderbilt University Medical Center, Department of Thoracic Surgery

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