Last week, we wrote about recovery right after open heart surgery. Those first 24 hours are crucial, yet sometimes patients don't remember them well. The next four or five days in the hospital and four to six weeks at home are when the patient will learn to take care and recover.

After leaving the Intensive Care Unit, the patient goes to a monitored area where nurses continuously watch the patient's heart rhythm. We walk with patients in the halls at least once, and patients need to be up in a chair for all meals, with a progressive increase in their activity tolerance. The goal is for our patients to be able to perform all activities of daily living independently and walk without assistance, or return to their pre-surgery capabilities.

We emphasize the importance of deep breathing and coughing because anyone who has been immobile for a time risks secretions pooling in their lungs - which are then more susceptible to infection and pneumonia. We caution them about certain activities - specifically lifting - because most open heart patients have had their breastbone separated for access to the heart. We also discuss pain management and the return of a normal heart rhythm. It's important patients are eating well before they go home to continue to get better.

Even people without diabetes tend to have temporary high blood sugars, particularly after heart surgery, which can lead to a risk of infection. We check blood sugars regularly and give insulin as necessary. This helps patients' bodies heal faster and better in this high-stress time. Blood sugars should normalize before the patient leaves the hospital.

Because patients have had intravenous fluids during surgery, we monitor their fluids and weigh them daily to make sure they are flushing out extra water.

Many other professionals assist in their recovery as well. Cardiac rehab starts when patients arrive on the telemetry floor, and continues for six weeks after they leave the hospital. Patients learn safe exercise and what activities they may have to limit for a time after surgery. Dieticians visit with patients to help them learn about dietary changes they need to make at home. Pharmacists also visit with patients to provide information and answer questions about medications they will need to take at home.

The first few weeks at home are an important time for the recovering heart surgery patient. Most patients are happy to get home, to sleep in their own beds, enjoy familiar surroundings, and return to family and pets. They must continue to work on keeping their lungs healthy through coughing and deep breathing, to continue their exercise program, both in cardiac rehab and at home. It is a time to try new recipes suggested by the dietitians and get used to any dietary changes.

Some people can experience depression in the first few months. It is unclear exactly why, but it could be the emotional toll of facing mortality, combined with the physical effect of the stress on the body during surgery. It is helpful to talk with family, a therapist or a pastor, and can require further treatment. It can also be helpful to join Mended Hearts, a support group for people who have had heart disease. Not only is the support helpful, but they have a lot of fun, too.

Most people recover very well from heart surgery, and many comment that they feel better than they have for years. However, it is a big event in anyone's life, and takes commitment from the patient and family, the surgeons, the nursing and hospital staff to help the patient heal well, keep moving and make the lifestyle changes needed to make a full recovery.

Donna Fuller is a registered nurse and progressive care certified nurse with the telemetry unit 4North at St. Patrick Hospital and Health Sciences Center.