(DRAFT) POST CABG SURGERY MANAGEMENT PLAN – 721
REVIEW – 725
[LOC_NAME] Phone: [LOC_DAY_PHONE] fax: [LOC_FAX_PHONE]
Patient Details
GP Details:
Patient agreement for the GP Management Plan proceed
[PAT_FIRSTNAME] [PAT_SURNAME]
[PAT_HOME_STREET],
[PAT_HOME_SUBURB],
[PAT_HOME_POSTCODE],
[PAT_HOME_STATE]
[GP_GIVENNAME]
My GP has explained the steps & costs of the GP Management Plan & I agree to proceed.
Yes
Where I am referred to other service providers as listed on this GP Management Plan, I consent to my GP sharing
relevant information about myself to that provider. I have advised my GP of any information I wish to be withheld.
Yes
[GP_SURNAME]
[GP_REG_NO]
HOME Ph: [PAT_HOME_PHONE]
DOB: [PAT_DOB]
AGE: [PAT_AGE]
I understand that [LOC_NAME]
all [LOC_NAME]
has one health record for patients and that this record is shared by
Yes
health team providers.
Nature of the disease, Risk Factors and Complications (What is my condition?)
What is coronary artery bypass graft (CABG) surgery?
If you have coronary artery disease, your coronary arteries become narrowed or blocked, restricting the supply of oxygen and nutrients. This starves the heart
of oxygen, which causes angina. Angina is the feeling of chest pain, chest tightness and sometimes breathlessness or choking.
A CABG can bypass the blocked arteries so that blood can flow more easily. A new blood vessel (a graft) is attached from your aorta (your main artery) to a
point in the coronary artery beyond the blockage. Your graft(s) can be created from blood vessels taken from your chest wall, leg or arm.
A CABG won't cure coronary artery disease so it's possible for blockages to recur in both the grafts and other blood vessels, but it does improve symptoms
such as angina.
Possible complications
Some of the possible complications of heart bypass surgery include:

Haemorrhage

Infection of the wound

Heartbeat irregularities (arrhythmia)

Fluid build-up in the lungs (pleural effusion)

Blood clots in the leg veins (thrombosis)

Stroke.
MANAGEMENT PLAN
How do patients recover after CABG surgery?
You will have a checkup with the cardiologist about 7 to 10 days after you go home. During this visit, the cardiologist will discuss your recovery, make
recommendations for improving your lifestyle, and fine-tune your medications if necessary. Patients are advised to wear elastic support stockings during the
day for the first four to six weeks after surgery and to keep their leg elevated when sitting. This swelling usually resolves after about six to eight weeks.
Healing of the breastbone takes about six weeks and is the primary limitation in recovering from CABG surgery.
By the sixth week after surgery, most people resume almost all of their regular activities. You can drive, travel, return to your normal sex life, go to movies,
eat out, and even return to work. However, your healing will progress most smoothly if you don't let yourself get exhausted, and if you remember to rest
when you are tired. You will notice that as your activity increases, your strength will increase too. Six weeks after discharge, you should be able to walk two
to three miles in one hour.
Need To Know: Activities to avoid
The bone in the middle of your chest (the sternum) was opened during surgery. This bone does not completely heal for at least 12 weeks. For that
period of time, no extra stress should be put on it. Remember to avoid heavy lifting (no more than 15 pounds), playing golf, tennis or vigorous
swimming. Light activities such as lighter golfing (chip, putt), carefully riding a bicycle or wading in a pool will aid the healing process.
Cardiac Rehabilitation
Your cardiologist will discuss beginning an exercise program. This will be one of the most important things that will keep your cardiovascular system
healthy.
Many people choose rehabilitation classes to help them recover. These programs teach the importance of exercise, how to get started, and how to know your
limits. Some programs may also help you make changes in diet, quit smoking, or control stress. Through these programs, you will meet other people who
have gone through the same procedure, and will have the chance to exchange stories and tips for recovery.
Daily Exercise Program
Usually, cardiac rehabilitation classes are held three times a week. On at least two other days, exercising for approximately one hour will aid your recovery.
Walking is the best exercise for improving the overall health of your heart. It may reduce the chances of future heart problems and will probably prolong
your life. A walking program should be tailored to your abilities, and reach a pace of about three miles an hour within a few weeks.
Keeping Your Arteries Clear
Before bypass surgery, there are significant blockages in the coronary arteries. If preventive measures are not taken, the processes that caused those original
blockages can occur in the new bypass vessels after surgery. So, it is important to reduce the risk factors for coronary artery disease that can be controlled.
These include: smoking, high blood pressure, diabetes, high cholesterol, and a sedentary lifestyle.
Smoking
Smoking causes major damage to your cardiovascular system. The risk of renewed heart disease is even greater than the risk of lung cancer. Patients who
continue to smoke after bypass surgery are likely to have their new arteries blocked sooner than those who do not smoke. That's why it's essential for
patients who smoke to quit after their surgery. If you intend to smoke after surgery, it defeats the purpose of the original surgery.
Secondhand smoke may also increase your risk, so this is a good time for all members of your household to quit.
High Blood Pressure
Many patients have hypertension (high blood pressure) before surgery. It is essential to monitor your pressure carefully after surgery. Poor control of blood
pressure after surgery can worsen blockages in your arteries and speed up changes in your bypass grafts.
Your doctors will help you work out a plan for controlling blood pressure with diet, and perhaps medication. Keep track of the blood pressure numbers
yourself, so you know how well you are doing.
Diabetes
Diabetes increases the risk for coronary artery disease. Control of blood sugar after heart surgery is just as important as before surgery, to keep the bypass
grafts open. Continue to work closely with your diabetes team to keep your diabetes in check.
Elevated Cholesterol
Poor control of cholesterol after surgery increases the risk that your new bypass grafts will be blocked. If changes in diet and lifestyle are not successful in
reducing the level of cholesterol, then medications may be necessary in addition to the changes in diet recommended by your doctors. Remember that all
medications have side effects, so altering your diet is an ideal strategy to improve your lifelong health.
Sedentary Lifestyle
Moderate amounts of physical activity, including daily walks, swimming, or biking for fun can make big differences in how you feel and how your heart
works. To become more physically active:
 Start slow. Begin by walking or being active just 15-30 minutes each day, and work up slowly from there.
 Find ways to do more physical activities. From washing the car, to gardening, to taking the stairs rather than the elevator, all movement counts as
physical activity.
 Find activities you enjoy doing. Physical activity seems easier when it's fun.
 Be active with a friend. Walking, biking, or other activities are great ways to spend time with people.
Stress
Learning about and controlling stress can help your recovery and make it easier to tackle other lifestyle changes. There are many ways that people reduce
daily stress: Some have quiet hobbies, some meditate, and some are physically active. Do whatever works for you, or sign up for a stress-control class.
Remember, everyone is exposed to stress. But how you handle it can either support or undermine your long-term health.
Diet
Improving eating habits can help reduce risk for heart disease. Here are some tips to reduce the saturated fat and cholesterol in your diet:

Try lean meats like skinless chicken or turkey, and fish instead of higher fat meats like bacon, sausages, and marbled steaks.

Try main dishes featuring whole-wheat pasta, rice, beans, and/or vegetables.

Use lower-fat cooking methods, like boiling, broiling, baking, roasting, poaching, steaming, sauteing, stir-frying, or microwaving.

Trim off the fat you can see before cooking meat or poultry.

Substitute leaner foods for egg yolks and organ meats.
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

Choose fat-free or 1% milk, and nonfat or low-fat yogurt and cheeses.
Eat five or more servings of fruits or vegetables each day.
Choose whole-grain cereals and breads.
Major dietary change is a challenge for anyone. But, by making gradual changes, you may find that you actually enjoy a healthy diet more. A registered
dietitian can help you to make the transition to healthy eating.
ACTION PLAN - When to call the Doctor with concerns:
When recovering at home, it is important to know when to notify the surgeon of any complications that arise after surgery. The following signs and
symptoms are warnings of possible complications and should be reported to the surgeon immediately:

Difficulty breathing

Fever over 100 degrees
 Black, tar-like stools

Pain that sharply increases, or becomes uncontrollable

Wound drainage problems; redness, bleeding or opening at the incision site

A decrease in ability to function (ex: cannot walk to the bathroom)

A change in level of consciousness or ability to wake

Persistent diarrhea, constipation, nausea, or vomiting

Inability to tolerate food or drink

Unexplained leg pain in one or both legs
Capacity to self manage
I have explored readiness for change and barriers for self management
I have checked that the patient has enough knowledge, confidence and family support to manage the condition
Contacts and further Information
For Heart bypass surgery information: http://www.betterhealth.vic.gov.au/ (look for heart bypass surgery)
A copy of this plan has been given to the patient.
Charge item 721
Enter recall for review 6 months
Enter recall for new plan 2 years
DATE COMPLETED:
[MIS_TODAYL]
Yes
This section is only to be completed at Review appointment
Review Date
Enter recall for review 6 months
Claim item 725