Tips of caring for struggling father after coronary bypass surgery (still in ICU)

[SRC]

Last Thursday, my father received a quadruple bypass surgery (not sure if that is the right term, but 4 grafts were needed). It has been 6 days now and he is still in the ICU. The  doctors are not worried about the surgical results. But he has been in the ICU for so long because of joint and limb pain and he is just not motivated to move. There has been a lot of ups and downs. The surgery prep started off with us finding out he did not stop taking his Plavix. Luckily, the surgeon deemed him for for the surgery and it went all all things considered.  For the first two days at the ICU, he made a lot of effort. Then the following two days he essentially lay in his bed annoyed by the constipation and was having joint pain. He kept asking for laxatives/stool softener and the following day he had so many accidents because he couldn't make it in time to the toilet. At that point he has lost all motivation. Also, it seems that his pain is related to his hips and legs and he is unable to tell in time when it is going to get bad, so the nursing staff give the pain medication to him when pain level is at a 9 or 10 and resulting in him being very uncomfortable for 2-3 hours. He is not the quietest patient when uncomfortable in anyway and there has been several times were staff has had to be very firm with him, I am pretty sure they are also not happy.

We are rotating amongst us 5 kids and our mom to stay at the ICU with him. He is never alone, someone is with him day and night. We are all very discouraged that he is not out. He is also very snippy with us if we insist on him walking it doing his exercises. The nursing staff I think are unhappy with him and I noticed they are not as attentive as they used to be. The drive to the hospital is a 2 hour round trip and we are all very exhausted. There has also been a death in the family during all of this, so all of us are mentally and physically exhausted. I knew it would be a slow recovery, but I am not sure what can be done to motivate him. 

Any tips or opinions would greatly appreciated.

PS. I hope this does not come off as rude or ungrateful. We are all very happy he got the surgery. 

 

[Katy]

Trust me, cardiac care unit nurses are used to grumpy old men. I think I’d ask for anxiety meds for him. He clearly got embarrassed and now no longer wants to try. Maybe a dose or two of anxiety meds will lower that inhibition and enable him to sleep better when alarms are going off all night. 

I’m sorry for your loss with the other family member. 

[Just Kate]

I don’t really have any advice, but I wanted to offer you a big hug as my family is going through almost the same thing right now. 

My dad had emergency quadruple bypass surgery on March 11. He was also in the ICU for a long time, but that was because they didn’t have a bed on the Cardiac Step-Down floor for him. He had some pretty severe stomach issues while in the hospital and had a lot of trouble eating and going to the bathroom. He was finally discharged on March 21, but we had to take him back (through the ER) the next day because he became so sick. He was finally diagnosed with Rotavirus. After lots of fluids and meds for his stomach, he was discharged again yesterday. 

He is doing pretty well now, but I can completely sympathize with the stomach issues that can happen after surgery. We just tried to encourage my dad, so it really sounds like you are doing the best that you can do there. Heart surgery is so tough…and depending on your dad’s age and physical activity before the surgery, I know it can take time to recover. 

Is there an ICU nurse that you really like that you could pull aside and talk to? Like Katy said above, they are definitely used to grumpy old men. Maybe the nursing staff would have some tips for you?

Sorry you are going through this!! Our hospital is about 40 minutes away and I am completely exhausted. Your dad is lucky to have his kids and wife there to be there for him through this. 

Edited March 27 by Just Kate

[Laura Corin]

Post-surgery depression is common with heart surgery.  Something to consider.

[TechWife]

Yes, quadruple bypass is the correct term.
What has PT said? If he’s refusing to work with them, is  it possible he might be willing to work with the PT if family weren’t right there watching? It might be a good time for a coffee break. 
Also, what is the surgeon saying? If there are still ongoing problems with bathroom issues it might be appropriate to ask for an internal medicine or hospitalist consult. 
I’m sorry this is happening.

ETA: The PT should be able to explain to him that if he doesn’t get moving he’s going to start loosing muscle and endurance, which will make it even harder.

What usually motivates him? 

Edited March 27 by TechWife

[Harriet Vane]

3 hours ago, Laura Corin said:

Post-surgery depression is common with heart surgery.  Something to consider.

This.

It’s something to be aware of right now AND over the next 12-18 months.

[Mrs Tiggywinkle Again]

Is there any discussion about rehab or cardiac rehab? He is probably losing muscle at this point if he’s not moving.  
ICU depression and psychosis are a thing especially post cardiac surgery, plus the constant stimulation of having people there.

Honestly, it might be better for him if someone wasn’t there 24/7. He may need a little space.  I’d definitely be asking about rehab possibilities as well.

[prairiewindmomma]

Honestly, if he’s not cooperative at all and not moving much, embrace the hospital time because you have someone else to help with toileting and pain management and receiving the brunt on his grumpiness.

Buy a treat for the nurse’s station, apologize that your dad is being a PITA, and ask for insight.

He needs to get up and moving, the end. It’s going to hurt and he needs to embrace the suck if he wants to go home. I was blunt and said, “You can either choose to lie in bed and die, or you can get your (self) up and get moving again, but if you dont get up and going soon you are going to have more problems that you cant fix than you have now.” 
 

I do wonder about infection, depression, etc. but it sounds more like he is being stubborn.

[TechWife]

1 hour ago, Mrs Tiggywinkle Again said:

Is there any discussion about rehab or cardiac rehab? He is probably losing muscle at this point if he’s not moving.  
ICU depression and psychosis are a thing especially post cardiac surgery, plus the constant stimulation of having people there.

Honestly, it might be better for him if someone wasn’t there 24/7. He may need a little space.  I’d definitely be asking about rehab possibilities as well.

People who require ICU are not appropriate rehab patients. 

[Just Kate]

4 hours ago, TechWife said:

People who require ICU are not appropriate rehab patients. 

Yes, my dad was just discharged yesterday and I called today to set up cardiac rehab. It will begin on April 23. His cardiologist has to sign the order for rehab and he won’t do that until at least 4 weeks after surgery. 

[Hannah]

8 hours ago, TechWife said:

People who require ICU are not appropriate rehab patients. 

I'm curious what the definition of rehab is in the USA?   

My husband had major surgery and was in hospital for 10 weeks, 4 of which were in 'high-dependency care'.  A step down from ICU, where people here are mostly on ventilators or are having continuous dialysis, but which still means that you need 24/7 surveillance, are attached to IV's, oxygen lines and monitors.  It sounds like this is the case with the OP's father.  That he is not on artificial ventilation?  Anyway, what we called rehab started almost immediately with mobilization that required him to swing his legs off the bed on day two, progressing in tiny increments to walking down the corridor with the PT and IV's and Oxygen cylinder in tow and then to very light arm exercises in bed.  His diet also went through a rehab process from intravenous feed to fluids to soft food, etc.

[TechWife]

5 hours ago, Hannah said:

I'm curious what the definition of rehab is in the USA?   

My husband had major surgery and was in hospital for 10 weeks, 4 of which were in 'high-dependency care'.  A step down from ICU, where people here are mostly on ventilators or are having continuous dialysis, but which still means that you need 24/7 surveillance, are attached to IV's, oxygen lines and monitors.  It sounds like this is the case with the OP's father.  That he is not on artificial ventilation?  Anyway, what we called rehab started almost immediately with mobilization that required him to swing his legs off the bed on day two, progressing in tiny increments to walking down the corridor with the PT and IV's and Oxygen cylinder in tow and then to very light arm exercises in bed.  His diet also went through a rehab process from intravenous feed to fluids to soft food, etc.

Yes, they are different. What you’re describing is just part of what we call recovery in the US. Every patient I’m in a hospital gets appropriate nutrition, therapies and general exercise. However, hospitalization here is very short for most illnesses and procedures, so when they go home, patients still spend time recovering at home. Here, rehab  is an intensive program undertaken following a hospitalization for a major event, such as a stroke, amputation, joint replacement, extensively long hospitalization or, like the OP, heart surgery. It can be inpatient, with the person staying at the rehab facility or outpatient, with the patient commuting from their own home. Rehab is a formal program with more PT, OT and ST than is an available in the hospital, and a social worker is sometimes involved as well. The purpose of it is to restore strength and function as close to the level that the patient had before their health event as possible. Patients are monitored closely by nurses, therapists and other aids, as well as electronic monitors (like heart monitors) as needed. Rehab programs last anywhere from a week to several months depending on what the patient needs, how well they progress toward their goals and what their insurance will pay for. 

Edited March 28 by TechWife

[Mrs Tiggywinkle Again]

15 hours ago, TechWife said:

People who require ICU are not appropriate rehab patients. 

I was thinking he’d go to a step down unit first for a bit, not be discharged directly from ICU to a rehab.  I know when my grandmother went to rehab nobody would accept her straight from home; she had to be in the hospital for a few days to get accepted. Rehabs in my area at least are all in skilled nursing homes and don’t provide much actual medical care; mostly strengthening and reconditioning to get the patient ready to return home after a significant medical event or surgery. 
 

I was thinking inpatient rehab; outpatient rehab is different and often doesn’t start until the patient has been home a week or two.  But if the OP’s dad isn’t really moving much at all, inpatient rehab at might be appropriate.

Edited March 28 by Mrs Tiggywinkle Again

[TechWife]

3 minutes ago, Mrs Tiggywinkle Again said:

I was thinking he’d go to a step down unit first for a bit, not be discharged directly from ICU to a rehab.  I know when my grandmother went to rehab nobody would accept her straight from home; she had to be in the hospital for a few days to get accepted. Rehabs in my area at least are all in skilled nursing homes and don’t provide much actual medical care; mostly strengthening and reconditioning to get the patient ready to return home after a significant medical event or surgery. 

Here, most cardiac patients have shorter hospital stays & do go home and then do outpatient rehab. The sternum has to begin to heal before they can do extensive exercise. The cardiologist told my husband that the “broken bone” takes longer to heal than any other aspect of the surgery.

We are blessed to live in an area with great hospitals and rehabilitation programs. Following his bypass surgery, DH spent less than 24 hours in CTICU, then 2 1/2 days on cardiac intermediate care, then discharge to home. He started outpatient cardiac rehab several weeks later.

For non-cardiac events, the rehab process often begins much more quickly as they aren’t waiting for bones to heal. A good deal of the time they are targeting brain function, where access to early therapy is important.