Hemodialysis
Category Archives: Hemodialysis Hemodialysis When your kidneys do not work well, dialysis is needed to remove extra fluid and waste products from the body. Hemodialysis is a type of dialysis that uses a machine with an artificial filter to remove wastes and extra fluids from the blood. This treatment also helps control the chemical balance in your body and helps control blood pressure. Each treatment takes about 4 hours and is done 3 times each week. How does hemodialysis work? A dialysis machine pumps small amounts of blood out of the body and through a filter called an artificial kidney or dialyzer. This kidney filters extra fluid and wastes from the blood. The blood is then pumped back into your body. Medicine will be given to you to prevent your blood from clotting. Fluid, called dialysate, is added to the dialysis machine to: Help filter out extra fluid and wastes that have built up Add chemicals that your body uses The dialysate is a mixture of water and chemicals that are present in your blood. This fluid can be adjusted, based on your lab values, to give you the best filtering with fewer side effects. For your safety, the machine has pumps, sensors, monitors and alarms to let the staff know if there is any problem. Access Site For this treatment, there needs to be a site where the blood is taken out of the body and then returned to the blood stream. This is called an access. After the access is made and healed, 2 needles connected to tubing are inserted into the access. One needle draws a small volume of blood out and pumps it through to the dialysis machine and filter. After the blood is filtered, it is return to the body through the other needle. There are three main types of access sites: Fistula – With minor surgery, an artery in the arm is joined to a vein under the skin. This increases the amount of blood that flows through the vein, and makes it bigger. This is the best access because it has fewer complications and lasts longer. Graft – With minor surgery a soft plastic tube is used to join the artery and vein under the skin. This is done when a fistula is not the best method for your care. A graft needs at least 2 weeks to heal before it can be used for dialysis. A catheter – There are two kinds of catheters, temporary and permanent. The temporary catheter is used for 1 to 2 weeks. This catheter is used until a more permanent access is placed. A permanent catheter is placed in the neck vein and tunneled under the skin. The catheter has a risk for infection and is used only until a fistula or graft can be placed. Both the fistula and graft need 2 to 6 weeks to heal and mature before they are able to be used. Side Effects of Hemodialysis During treatment you may: Feel tired and sleepy Feel dizzy Be cold Have muscle cramps Have nausea Let the staff know how you are feeling so that they can help you be more comfortable. After dialysis, it is normal to feel tired so plan to rest. Other Care You will feel changes in your body as the waste and fluids build up between treatments. Follow your diet and fluid restrictions to limit severe changes between treatments. The human kidney makes a hormone called erythropoietin. This hormone is needed to produce red blood cells and vitamin D. Without it, your body cannot absorb calcium from foods and your bones can become weak. Medicine can be given to help replace this hormone. The human kidney also helps control blood pressure and salt balance in your body. It is common to be on medicines to treat high blood pressure. Talk to us or whatsapp if you have any questions or concerns.
Home Care after Total Joint Replacement
Category Archives: Home Care after Total Joint Replacement Home Care after Total Joint Replacement Follow these guidelines for care as your new joint heals over the next 6 to 8 weeks. Do not try to overdo or push yourself beyond the limits of pain. Home Care You will leave the hospital 1 to 3 days after surgery. Home care instructions will be reviewed with you. You will need a follow-up appointment. You will either be given a date or a telephone number to call for an appointment. Your medicines may change after surgery. You will be given prescriptions for new medicines and instructed on which medicines to continue after your surgery. Use your walker or cane as instructed. You will need help when you go home. If needed, your health care team will help you make arrangements for home care, equipment, physical therapy or an extended care facility. Call the doctor if you have: Increased redness, swelling or drainage at the incision A fever over 101 degrees F or 38 degrees C Edges of the wound that start to separate Pain, tingling, numbness or coldness of the leg Your leg turns pale or blue in color Care of Your Incision Your incision may be closed with staples, stitches or special tapes called steri-strips. Gently wash your incision with soap and water and pat dry with a clean towel. Do not apply lotion or powders near your incision. You can take a shower 2 days after your surgery. Do not let the shower water spray directly onto the incision during the first two weeks. Do not take a tub bath for two weeks after your surgery. Staples or stitches will be taken out at your follow up visit. Steristrips will begin to fall off in 7 to 10 days. If they have not fallen off after 2 weeks, you can gently pull them off. Swelling Swelling in the foot, ankle, knee and thigh are common after total joint replacement. To prevent swelling, recline or lie down with your feet higher than the level of your heart for 45 to 60 minutes. Do this 2 times each day. If the swelling does not decrease after sleeping all night and keeping your feet higher than the level of your heart during the day, call your doctor. Your doctor may want you to wear elastic stockings to reduce swelling. If so, wear the stockings during the day and remove them at night. Wash the stockings with soap and water and hang them to dry. Have someone help you put the stockings on and gently pull them off. Sitting Do not sit for longer than 30 minutes at a time. Get up, walk and change your position. Avoid long car trips. If you must travel, stop every 30 minutes. Get out of the car and move around. This will prevent blood clots, decrease swelling and help decrease joint stiffness. Walking Use your walker or cane with all activity so that you do not fall. Do not walk without your walker or cane until your doctor tells you that it is okay. Walk often on level ground and go outdoors if weather permits. Shopping malls are good places to walk during rainy weather. Sleeping Do not use a waterbed until approved by your doctor. If you had a hip replacement, sleep on your back with a pillow between your knees with your legs 8 to 12 inches apart. Do not sleep on your side or stomach. Climbing Stairs During the first few weeks at home, you may go up and down stairs one time each day with help. Have a friend or family member stand behind you as you go up and in front of you as you come down. Hold onto the handrail. Sexual Activity After knee replacement, you may return to sexual activity as soon as you feel able. After hip replacement, you may resume sexual activity 6 to 8 weeks after surgery. It is best to be on the bottom with your legs spread apart and slightly bent. Avoid hip bending or twisting. Do not rotate your leg inward. After several months of healing, you may resume sexual activity in any comfortable position. Driving a Car Do not drive a car until your doctor tells you it is okay – often 6 weeks after surgery. Only drive if you can control your surgery leg and you are not taking pain medicine. Other Special Precautions after Hip Replacement Surgery You may need to follow these precautions to protect your new hip joint while your muscles heal. Follow these limits for 2 to 6 months, or as directed by your doctor. Do not cross your legs at the knees or ankles when sitting or lying down. Do not sit on low surfaces such as chairs, toilets, and car seats. Sit with your hips higher than your knees. Do not twist at the trunk. Move your whole body when you turn. Do not bend forward at the waist more than 90° or lift your knee higher than your hip. Do not turn your knees in while sitting or lying down. Do not sit with your legs close together. Keep your feet 8 to 12 inches apart when sitting. Activities after Your Joint Heals Your new joint can be damaged by rough treatment. Avoid activities that may cause extra stress or injure the joint such as baseball, basketball, jogging and tennis. Do your physical therapy exercises to keep your muscles and ligaments strong to support your joint. Maintain a healthy weight for your height. After your joint is healed, about 6 to 8 weeks after surgery, you may be able to resume slow dancing, swimming and other activities. Check with your doctor before you start any new activity. Water Walking Water walking in a pool is relaxing and strengthens the muscles in the hip and leg. Do not walk in water unless you have your doctor’s permission and your incision is well healed – often 6 weeks
Hysterectomy
Category Archives: Hysterectomy Hysterectomy A hysterectomy is a surgery to remove a woman’s uterus. The uterus is one of the organs of the female reproductive system and is about the size of a closed hand. You can no longer have children after you have your uterus removed, and you will no longer have periods (menstruate). If your ovaries are not removed, you will continue to make female hormones. If your ovaries are removed, menopause will occur. There are different types of hysterectomy surgeries. Ask your doctor what type of surgery you are having and if your cervix, tubes and ovaries are being removed. Vaginal hysterectomy – the uterus is removed through the vagina. No incision in the abdomen is needed. Abdominal hysterectomy – the uterus is removed through an incision in the abdomen. Laparoscopic hysterectomy – several small incisions are made in the abdomen and the doctor works through these small incisions using a laparoscope. This instrument makes it easier for the doctor to see small areas during surgery. Other small instruments are used to detach and remove the uterus. Robotic hysterectomy – It is very similar to a laparoscopic hysterectomy. Instruments are more flexible and the doctor uses a special camera to guide the instruments during surgery. To Prepare Tell your doctor all the medicines you are taking. Be sure to include any prescription or over the counter medicines, vitamins and herbs. You may be told not to take aspirin or ibuprofen (Advil, Motrin) for a few days before your surgery. If you take aspirin daily, do not stop taking it without asking your doctor first. If you are taking blood thinners or medicines to prevent clots, check with the doctor who prescribed the medicine to see if you should stop the medicine before surgery. Ask your doctor if you should take your medicines the morning of your surgery. If so, take them with small sips of water only. Do not eat or drink anything, including water, after midnight before your surgery. If you have any allergies to medicines, foods or other things, tell the staff before your surgery. An adult family member or friend will need to take you home when you leave the hospital. It is not safe for you to drive or leave alone. During Surgery You will wear a hospital gown. An IV (intravenous) tube is put in a vein in your arm for giving medicines and fluids. You will be taken on a cart to the operating room and then helped onto a table. Medicine is given in your IV to keep you asleep and free from pain. You will have a catheter that drains urine from your bladder. This tube is often removed the morning after your surgery. Another tube may be put in through your nose and is passed down to your stomach to remove fluids so that you will not feel sick to your stomach. This tube is often taken out before you leave the recovery room. The surgery area or abdomen is cleaned. Your uterus is removed. Your cervix, tubes and ovaries may also be removed. Any incisions are closed with stitches, staples or special tapes called steri-strips. A bandage is put over the incisions. After Surgery In the Hospital You are taken to the recovery room where you are watched closely until you wake up and are doing well. Your breathing, blood pressure and pulse are checked often. If you are staying at the hospital, you will be taken to your room. A pad will be placed between your legs in case you have vaginal bleeding. You also may have special stockings on your legs while you are in bed to help prevent blood clots. The staff may teach you how to cough, deep breathe and use an incentive spirometer. An incentive spirometer is a device used to help you take deep breaths. These exercises help open the airways of the lungs and prevent pneumonia. If you have abdominal incisions, place a pillow or a folded blanket over your incisions for support when deep breathing or coughing. Do these exercises every 1 to 2 hours while you are awake. You will be given medicine to control your pain. Tell your nurse if you have pain. The IV is used to give you medicine and fluids until you are able to eat and drink well. You may be given a few ice chips if you are not sick to your stomach. You will be given clear liquids at first and then slowly progress to regular foods. Stitches that dissolve on their own. Staples which are often taken out a few days after surgery. Steri-strips that come off on their own in 7 to 10 days. If you have a vaginal hysterectomy, you will not have an incision. For your safety, when you leave the hospital, you will need to have an adult family member or friend take you home. You should have someone stay with you for at least the first 24 hours you are home. Your bandage will be removed the day after surgery. Your incision may have: At Home Take your medicine as directed. Schedule a follow-up visit with your doctor. You will need to see your doctor in 4 to 6 weeks. Wash any incisions gently with soap and water and pat dry. You may take a shower or sponge bath, but do not take tub baths. A small amount of vaginal discharge is normal for 2 to 4 weeks after surgery. Change the pad every few hours. Wash the vaginal area with soap and water and pat dry. Do not put anything in your vagina until your doctor checks you. Do not douche. Do not have sexual intercourse. Do not use tampons. Activity Limits Limit your activities for 4 to 6 weeks. Do not lift over 10 pounds for at least 2 weeks. You may do light housework such as washing dishes and cooking. Do not do strenuous activities, such as vacuuming or exercising for at least 2 weeks. Do
LEEP (Loop Electrosurgical Excision Procedure)
Category Archives: LEEP (Loop Electrosurgical Excision Procedure) LEEP (Loop Electrosurgical Excision Procedure) Loop Electrosurgical Excision Procedure, or LEEP, is a procedure to remove tissue from the cervix that is not normal and may lead to cancer. The cervix is the opening of the uterus (womb) and is located at the top of the vagina. LEEP is usually done in the doctor’s office or clinic. How to Prepare Two days before the procedure, avoid sex and do not use creams in or around the vagina. Do not douche. Take an over-the-counter pain medicine 2 hours before the procedure. Ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) are options. How it is Done You will be given ibuprofen to help with any discomfort from the procedure. Go to the bathroom and empty your bladder before the test. Remove all metal, including any piercings, if possible Be sure to let the nurse or doctor know if you have any metal inside your body that cannot be removed. You will be asked to undress from your waist down and will have a paper sheet to cover you. A sticky pad, called a grounding pad, will be placed on your thigh. It is cold. You will be asked to lie down on the exam table and place your feet in holders at the end of the table, called stirrups. Let your knees fall to the sides. Take slow, deep breaths to relax the muscles around your vagina during the exam. A tool shaped like a duck bill, called a speculum, will be placed into the opening of your vagina to allow your provider to see inside your vagina. An iodine solution is applied to the cervix to make abnormal cells easier to see. This solution also cleans the cervix to prepare for the procedure Your provider will look at your cervix with a big magnifying glass, called a colposcope. The colposcope looks like a pair of binoculars on a stand. The colposcope does not go inside of you. • Your cervix is numbed with a local anesthetic. This is the same medicine the dentist uses to numb you for dental work. It can cause your heart to beat fast and may make you feel shaky. This will pass in a few minutes. A wire loop is inserted through the vagina. The abnormal tissue from the cervix is removed with this loop. This tissue will be sent to the lab for closer study. You may feel mild cramping during the procedure. It is important that you do not move while the procedure is being done. Possible Risks Your provider will review these risks with you before the procedure. Rare risk of infection or heavy bleeding. Chance not all abnormal tissue will be removed with this procedure, and you will need more surgery. Very rare risk of preterm labor with pregnancies that happen after this procedure. Caring for yourself after It will take several weeks to heal from this procedure. Plan to rest for the next week. You may have some bleeding, no more than a heavy period, for a few days and light bloody discharge for a few weeks. Place nothing in the vagina for 6 weeks after the procedure. This includes no sexual intercourse, no tampons, and no douching. This will reduce your risk of bleeding from the area that is healing. Eat a normal diet. Take ibuprofen (Advil, Motrin) or acetaminophen (Tylenol) or similar medicine as directed on the bottle. The discharge may first look like brownish-black coffee grounds, and you will have some bleeding, which should be similar to a period. In time this will change to a yellow watery discharge. You may wear a pad. You may take a shower. Do not take a tub bath, use a hot tub or go swimming for 6 weeks as this increases your chance for infection. Call if you have: A lot of bleeding where you soak a pad in an hour Severe abdominal cramps or pain that gets worse over time Chills or fever of 100.4 degrees Fahrenheit or 38 degrees Celsius or higher Vaginal discharge that has a bad odor Follow Up You will receive the results and instructions for future follow-up appointments. A follow up visit will be scheduled for you. It is very important that you keep all of your appointments.
Miralax and Dulcolax Bowel Prep
Category Archives: Miralax and Dulcolax Bowel Prep Miralax and Dulcolax Bowel Prep A bowel prep is done to clear the bowel or large intestines and rectum, of all solid matter before certain tests or procedures. Please review these instructions as soon as you get them and then follow the instructions to prepare. Begin the bowel prep 1 day before your scheduled procedure. To Prepare Tell your doctor if you have diabetes or take blood thinners. You may need to stop some of your medicine a few days before your test. Ask your doctor if you should take any of your medicines the morning of your test. If so, take with sips of water only. You will need to buy 2 laxative medicines from a pharmacy: Miralax (Polyethylene Glycol 3350) in large bottle (8.3 ounces or 238 grams) Ì 4 Dulcolax (bisacodyl) laxative tablets (5 milligram tablets) – Often sold in boxes of 10 or more tablets There may be store brands of these products that cost less. Ask the pharmacist to help you find what you need. Buy a large 64-ounce bottle of sports drink such as Gatorade, Powerade or other sports drinks that are not red in color. If you have diabetes, buy a no or low calorie drink such as Crystal Light instead. This will be used to mix your Miralax the day before your test. Do not use carbonated beverages. You may also want to buy some other clear liquids from the list below to drink the day before your test. Arrange to have an adult bring you to your appointment and take you home after your test. 5 Days before your test and until your test is done: Do not take iron tablets or vitamins with iron. Do not take fiber supplements like Metamucil, Citrucel or Fiberall. Do not eat popcorn, corn, nuts, seeds or green leafy vegetables such as kale or spinach. On the day before your test Starting in the morning, drink only clear liquids on this list and avoid all red colored liquids.Clear liquids for your prep include: Water Fruit juices you can see through and have no pulp such as apple, white cranberry or white grape Popsicles Ice Soft drinks such as ginger ale or lemon lime soda Gatorade, Powerade or other sports drinks Clear broth or bouillon Jello Kool Aid or other drink mixes Coffee or tea with no milk or cream added Do not eat any solid food or milk products until your test is done. Drink at least 4 (8-ounce) glasses of water through the day as well as other clear liquids. Taking Your Prep Medicines You will take some pills and drink a medicine mixture that will clear your bowels of all solid matter. You will need to go to the bathroom often and your bowel movements will become very watery. The medicines may cause you to have cramps or feel bloated. Be sure you take all of the prep medicines as directed, so your bowels are clear for your test. If your bowels are not cleared, you may have to have the test rescheduled and do another prep. The bowels are clear or clean when there is only pale yellow fluid without flecks of stool. Many people start the medicines early in the afternoon at about 3:00 PM. If you are working the day before your test, you may want to wait until you are home in the early evening, about 6:00 PM. At 3:00 PM or when you are home from work: Take 4 Dulcolax tablets with a drink of clear liquids. Mix the Miralax in a 64-ounce bottle of Gatorade or other clear liquid of choice. To make room for the Miralax in the sports drink bottle, pour out a cup of the sports drink and drink it. Pour the Miralax powder into the sports drink bottle. Cap the bottle and shake the bottle to dissolve the powder. Most people prefer to drink the liquid chilled, so you may want to place it in the refrigerator. 3 hours after taking the Dulcolax tablets Start to drink the Miralax mixture. Drink one glass every 10 to 15 minutes. Drink it quickly rather than sipping small amounts because it does not taste that good. Finish drinking half of the mixture. Place the other half of the mixture into the refrigerator. You will need to drink the rest of the mixture in the morning, 6 hours before your test. Continue to drink other clear liquids through the evening. Set an alarm for the morning to get you up 6 hours before your test time. The Morning of Your Test or Procedure 6 hours before your test: Drink the rest of your Miralax mixture as before. Drink 2 (8-ounce) cups of clear liquids after you finish the Miralax mixture. You can drink clear liquids up to 4 hours before your test. If you are to take morning medicines before your test, take with a small sip of water within 2 hours of your test time. Your test will be delayed or canceled if you drink anything other than a sip of water with your medicines. Bring all medicines you usually take (in their original containers) to the hospital with you. You will need to have an adult with you to take you home after your test. You will not be able to leave by yourself and it will not be safe for you to drive because of the medicine you are given at the start of the test. You may be told to arrive up to 1 hour before your test is scheduled so that staff can get you ready. Expect to be here for 2 to 4 hours for your test and recovery time. Talk to the doctor if you have any questions or concerns.
Nebulizer Treatments
Category Archives: Nebulizer Treatments Nebulizer Treatments Some medicines need to be given through a nebulizer treatment. Nebulizer treatments are also called breathing treatments, aerosol treatments or med nebs. A nebulizer changes liquid medicine into a fine mist that you breathe into the airways of your lungs. Sometimes it is used for people who have a hard time using inhalers. How often you have the nebulizer treatments will depend on: The type of medicine you are to take How short of breath you are or the amount of wheezing you have Taking a Treatment The treatment can be done with a mask or mouthpiece based on which works best for you. If using a mouthpiece, place the mouthpiece in your mouth past your teeth. Make a seal around the mouthpiece with your lips. When using a mask, place it over your mouth and nose. Check your pulse before your treatment and write it down. You will see a fine mist when the treatment is started. Sit down, relax and take normal, regular breaths in through your mouth. When all the medicine is used up, turn off the pump. The treatment will last about 10 to 15 minutes. Take a couple deep breaths and cough at the end of your treatment to bring up any loose mucus. Spit the mucus into a tissue and throw the tissue into the trash. Wash your hands. Stop the treatment if: You feel light headed, dizzy or shaky. Your pulse rate gets much faster. Wait a few minutes and if the symptoms go away, restart the treatment. If the symptoms do not go away, or if they come back when you restart the treatment, call your doctor. You may need to change your medicine or dose. How to Prepare Your Medicine Follow these steps to get your medicine ready to do the nebulizer treatment: Wash your hands with soap and warm water. Rinse and dry your hands. Gather your medicine and the nebulizer cup. Check your medicine label to be sure it is the right medicine. Also check that you have the correct dose or strength of medicine your doctor ordered. Look at the expiration date on the label and be sure that your medicine is not out of date. If the date is past, you need to get new medicine. Open the nebulizer cup. Measure your medicine and put it into the nebulizer cup. Use only the amount of medicine your doctor ordered. Close the cup. Keep the cup upright and attach it to the tubing and the mouthpiece or mask. Check that the tubing is attached to the pump and turn the nebulizer pump on. Relax and breathe in the medicine. Continue until there is no more mist. Clean Your Equipment to Prevent Infections Clean the outside of the nebulizer pump and tubing each week with a disinfectant wipe or damp cloth, or as directed by the manufacturer. Never put the pump or tubing in water. Clean the nebulizer cup and the mouthpiece or mask after each use and as directed to prevent infections. After each treatment Disconnect the cup from the tubing and from the mouthpiece or mask. Set the tubing aside until the next treatment. Open the nebulizer cup and rinse the cup parts and the mouthpiece or mask under warm running water. Shake off the excess water and place parts on clean paper towels to air dry. Cover the parts with another clean paper towel until your next treatment. Wash your hands with soap and warm water. Rinse and dry your hands. At the end of each day Wash the cup parts, mouthpiece or mask with liquid dishwashing detergent and warm water. 2. Rinse parts well with warm running water. Place parts on paper towels to air dry. Cover with a clean paper towel until your next treatment. One time each week or as directed Soak the pre-washed parts in white vinegar solution for 30 minutes. All parts should be completely covered by the solution while soaking. To make the solution, mix 1 part white vinegar and 3 parts water. For example, mix 1 cup of white vinegar with 3 cups of water in a container. Rinse the parts well with warm running water. 3. Place the parts on clean paper towels to air dry. Cover with a second clean paper towel until your next treatment. Confusion If you have questions about your nebulizer pump or you need new equipment parts, ask your equipment provider. If you have any questions about your medicine or the treatment, ask your therapist or doctor.
Nitroglycerin
Category Archives: Nitroglycerin Nitroglycerin Nitroglycerin is a medicine used to treat chest pain called angina. Take nitroglycerin as directed by your doctor If you are pregnant or breastfeeding, talk to your doctor before using this medicine. Always keep your nitroglycerin with you. This medicine may make you dizzy or lightheaded when you stand up or get out of bed. Get up slowly from a sitting or lying position. Ask your doctor if it is safe for you to drink alcohol while using nitroglycerin medicine. Keep nitroglycerin in its original bottle to keep its strength. Store it at room temperature away from moisture and heat. Be sure to replace the bottle if it has passed the expiration date. Keep the medicine out of the reach of children. If you use tablets: When you have chest pain, sit down and rest. Place 1 tablet under your tongue and let it dissolve. Do not swallow, chew or crush the tablet. If you still have chest pain after 5 minutes, put a second tablet under your tongue. If the chest pain does not go away after another 5 minutes, use a third tablet. You may take up to 3 tablets in 15 minutes. If you still have pain, Do not drive yourself or have someone drive you to the hospital in a private car because you may be having a heart attack. Your condition could get worse on the way to the hospital. If you have aspirin, chew 1 adult tablet (325 mg) or 4 baby aspirin tablets. If you use spray: When you have chest pain, sit down and rest. Hold the can up with the spray button on top as close to your mouth as you can. Press down on the button and spray the medicine into your mouth towards the back of your throat. If your chest pain lasts longer than 5 minutes, spray a second dose into your mouth. If the chest pain does not go away after another 5 minutes, spray a third dose. You may use up to 3 sprays in 15 minutes. If you still have pain, Do not drive yourself or have someone drive you to the hospital in a private car because you may be having a heart attack. Your condition could get worse on the way to the hospital. If you have aspirin, chew 1 adult tablet (325 mg) or 4 baby aspirin tablets. Call to the doctor if you have: Trouble breathing Increased chest pain Dizziness, fainting or severe weakness Sweaty, pale skin Severe headaches Itching or swelling Seizures or coma Blurred vision Dry mouth
Pacemaker
Category Archives: Pacemaker Pacemaker A pacemaker is a small device that helps control your heart rate by: Speeding up the heart rate when it is too slow Slowing down the heart rate when it is too fast Helping the rhythm of the heart beat regularly – this is if you have a pacemaker combined with a defibrillator, also called an ICD A pacemaker is placed in the chest during surgery. Wires called leads are put into the heart muscle. The device with the battery is placed under your skin, below your shoulder. When it is time for you to go home after surgery, an adult family member or friend needs to take you home. It is not safe for you to drive or leave alone. Have an adult stay with you at home for the first day after your surgery. Arrive on time for your appointment. The surgery will take 1 to 2 hours. To Prepare Talk to your doctor if you take blood thinners or have diabetes. You may need to adjust or change your medicines for some time before the surgery. You may need to shower the evening before and the morning of your surgery with a special soap called CHG (4% chlorhexidine gluconate). It is sold in most pharmacies under the brand name of Hibiclens. Wash from your neck to your waist with this soap the night before your surgery and then again the morning of your surgery. Use 4 ounces (½ cup or 118 ml) of CHG soap each time you shower. Do not eat or drink anything, including water, after midnight before your surgery. Ask your doctor if you should take your medicines the morning of your surgery. If so, take with sips of water. Do not smoke or use any tobacco products for at least 24 hours before your surgery. During Surgery You will wear a hospital gown. An IV (intravenous) is put in a vein in your arm. Medicines to make you sleepy are given through the IV. Your neck or chest is cleaned. Men may have their chest hair clipped. The skin is numbed. The wire leads are put into a vein and guided into your heart using an X-ray. The wire leads are placed in your heart muscle. The other end of each wire is connected to the pacemaker. The pacemaker is placed in a small space under your skin. The incisions are closed with stitches under the skin that will dissolve. You may have narrow pieces of tape across the incisions called steristrips. These hold the skin layer together during healing. These will loosen and fall off in about 10 days. If the tape is not used, special glue may be used to close the incisions. After Surgery In the Hospital An ice pack may be put on the site. Your blood pressure, heart rate and incisions will be checked often. Your dressing will stay in place for 48 hours after your surgery. The head of your bed is raised. Do not lift your arm over your head on the same side where your pacemaker is placed. If you have discomfort, ask your nurse for pain medicine. You will have a chest x-ray to check your lungs and the pacemaker. Antibiotics are given in your IV to prevent infection. A nurse will explain how your pacemaker works, answer any questions and explain pacemaker checks. Ask your doctor when you can drive or go back to work. Your Care At Home You will not be able to feel your pacemaker working. You will be able to see and feel the outline of the pacemaker through your skin. Incision care Wash your hands well before and after touching your dressing or the incision. Remove the outer dressing 48 hours after your surgery. Do not remove the narrow pieces of tape across the incision. These tapes will loosen and come off on their own in 5 to 10 days. Do not rub the pacemaker site. Do not use lotion or powder on the incisions. Bathing Do not take a tub bath or shower for the first 5 days after surgery. The incisions must stay clean and dry. You may take a sponge bath, but do not get the incisions wet. You may shower or bathe on the 6th day but let the water gently run over the incision. Do not let the shower water directly hit the incision, and do not soak the incision under water in the bath. Gently pat the incisions dry with a clean towel. Avoid soaking the incision under water in a bathtub, hot tub or swimming pool until the site is healed, often about 14 days after surgery. Activity Limits Your doctor may tell you to limit certain activities for 7 to 14 days to allow your pacemaker site to heal. Use your arms but do not lift the arm on the side of the pacemaker above shoulder level. You can raise your arm to wash or comb your hair but avoid raising your elbow above your shoulder on your pacemaker side. Do not push, pull or lift anything heavier than 10 pounds or 4 kilograms. A gallon of milk weighs about 8 pounds. Avoid vigorous exercise, contact sports and activities such as vacuuming, shoveling or washing windows. Schedule an appointment with your doctor for follow-up care. Other Information Tell all your health care providers, including your dentist, that you have a pacemaker. Carry the ID card your doctor gave you. This card has information about your pacemaker. Stay away from large magnets and tools that may generate strong electrical fields, such as car ignition systems and electric arc welders because they may interfere with your pacemaker. Keep items that contain magnets at least 6 inches away from your pacemaker. This includes cell phones, MP3 players, magnetic therapy products, stereo speakers and hand held massagers. Do not place cell phones or MP3 players in shirt pockets over the pacemaker. Use cell phones on the opposite ear of where
Peritoneal Dialysis
Category Archives: Peritoneal Dialysis Peritoneal Dialysis Peritoneal dialysis is a treatment used to clean the blood of extra fluid and waste that builds up in the body when the kidneys do not work. Catheter Placement and Care A tube or catheter is placed through the abdominal muscles. One end is put into the peritoneal space. The peritoneal space is the empty space that surrounds the organs of the abdomen. The other end of the tube comes out of the abdomen about 6 inches. A large dressing will be over the catheter site to protect the site, promote healing and prevent infection. The staff will change the dressing about 5 days after surgery. Keep the dressing dry. The catheter is not used for 2 weeks after placement so the area can heal. If you need dialysis during this time, hemodialysis will be done. How Peritoneal Dialysis Works Continuous Ambulatory Peritoneal Dialysis (CAPD) This 3-step process is called an exchange. Fill A bag of solution called dialysate is put into the abdomen through the catheter. This bag holds about 2 quarts of fluid. It takes about 10 to 20 minutes to fill. When the bag is empty, it can be clamped off or the tubing can be capped off. Dwell The solution stays in the abdomen for 4 to 6 hours. While the solution is in the abdomen, extra fluid and wastes move from the blood and into the solution. Drain Using gravity, the solution is then drained out of the body into a drain bag. The drained fluid is much like urine and will be clear yellow. It takes about 10 to 20 minutes to drain. When the solution is drained, a new bag of dialysate is connected to the catheter and the steps are repeated. These 3 steps are done about 4 times each day with meals and at bedtime. Each cycle takes 20 to 40 minutes. After you are trained, you can do peritoneal dialysis anywhere there is a clean, private area. To prevent infection, the exchange must be done under clean conditions and the patient may need to wear gloves and a mask. Continuous Cycling Peritoneal Dialysis (CCPD) With CCPD, there are fill, dwell and drain cycles, but the dwell time is shorter and a machine does the exchanges. The dwell time is about 1½ hours. The machine is set up and the person is connected to this machine for 8 to 10 hours during the night. The person is unhooked from the machine during the day. Call to the doctor when you have any of these signs of PD problems: Shortness of breath Swelling in the arms, legs, face or abdomen Extreme itching or bone pain, this can be a sign of too much phosphorus in the body Dizziness, nausea or cramping in the toes, feet or stomach Cloudy bags or drained dialysis solution is pink in color Redness, pain or swelling Leaking from the catheter site Catheter adapter or catheter falls out, or comes apart Hole in the catheter Changes in blood pressure
Preparing for Your Surgery
Category Archives: Preparing for Your Surgery Preparing for Your Surgery There are some things you will need to do to get ready for your surgery. Before Surgery Before surgery, you may be scheduled for some tests such as: Physical exam Blood tests Chest x-ray Electrocardiogram (ECG or EKG) Tell your doctor what medicines you are taking including prescriptions, over the counter medicines, vitamins and herbs. Your doctor may tell you to stop taking some medicines before your surgery. Ask your doctor if you should take any of your medicines the morning of your surgery. Call your doctor before surgery if you have an infection or other illness. Plan to have an adult family member or friend take you home when your doctor discharges you. It is not safe for you to drive or leave alone. The Day Before Surgery If you are a smoker, do not smoke for at least 24 hours before your surgery. Do not eat or drink anything after midnight before your surgery. This includes water, gum and candy. Your doctor may need you to clean out your bowel before your surgery. Follow these steps if checked ( yes ) Take a laxative as ordered by your doctor the day before surgery. For the evening meal the night before surgery, drink only clear liquids. These include: ■ Water ■ Clear broth or bouillon ■ Clear fruit juices without pulp such as apple, white grape and lemonade ■ Clear drinks such as lemon-lime soda, Kool-aid or sport drinks ■ Coffee or tea without milk or nondairy creamer ■ Jello or popsicles You may be told to take a shower with a special soap called chlorhexidine gluconate (CHG) before your surgery. This soap may be given to you, or you will need to buy a 4-ounce bottle or larger of 4% CHG soap at a drugstore. A common brand name for this soap is Hibiclens. There may be a store brand that costs less. Ask the pharmacist where to find it in the drug store. It is often with first aid supplies. You need to shower with CHG soap: The day before your surgery The morning of your surgery Follow the instructions from your doctor or nurse on how to use CHG soap or ask for the handout, “Getting Your Skin Ready for Surgery. The Day of Surgery If you are to take any of your medicines this morning, take them with small sips of water only. Take a shower before coming to the hospital. Shower with CHG soap if you were told to do so by your doctor. Bring these with you: A list of the medicines, vitamins and herbs you take Health insurance card or financial assistance form Identification card Please leave valuable belongings at home. If you have any allergies to medicines, foods or other things, tell the staff.
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