Health Maintenance After Discharge - The Patient's Role
Plans for health maintenance after discharge are started as soon as you can care for your own needs. It is essential that you thoroughly understand the medications you are taking: their dosage, purpose, and side effects.
At the time of discharge, a transplant coordinator will work with you to help identify a reliable and convenient pharmacy to fill your prescriptions. We will make every effort to have your discharge medicines available to you before you leave the hospital so we can be assured you have everything you need and fully understand your medication schedule.
Be sure you know all of them by name. When you need new supplies of medications and have checked to see no refills remain, ask the physicians or nurses in the clinic for new prescriptions.
You should learn to measure your weight, temperature, and pulse. You should measure your weight at the same time each day, usually in the morning, to allow for more accurate comparison.
A weight gain of two to four pounds a day is significant and may indicate fluid retention. In order to evaluate the need for medication adjustment, notify your physician or nurse coordinators.
Your temperature should be taken daily or at any time that you feel feverish. If your temperature is above 38.0 Centigrade (100.4 Fahrenheit) and remains elevated for several hours, call your physician. Do not take anything to lower your temperature until instructed by your physician.
Temperature lowering drugs include Tylenol or aspirin or any compounds such as
Bufferin, Anacin or Excedrin. Ibuprofen (Advil) will also reduce fever. We do not recommend regular use of this class of drugs, i.e., NSAIDs (nonsteroidal anti-inflammatory drugs), but their occasional use is probably safe.
Fever may indicate the onset of infection, or very rarely, a rejection episode, and these medications could mask the symptoms.
Prior to discharge, you will have been instructed on how to take your pulse (heart rate), both at rest and during activity. Note and report any significant changes in rate or regularity.
You will be instructed to monitor your blood pressure at home to determine your response to antihypertensive medications. You will need to purchase a blood pressure monitoring device for home use. Many brands are available. In general, those with digital readouts are easiest to use and are available at most pharmacies and discount stores.
The following are answers to questions frequently asked by transplant patients over the years at Stanford.
- You should avoid persons with obviously contagious infections. The common cold cannot be completely avoided and is not unduly hazardous.
- Wear a mask when you enter a hospital. Hospitals may contain people with contagious infections, and a mask simply minimizes the risk of contracting airborne infections. Masks are not needed outside the hospital. Hand washing is the best way to minimize the spread of infection.
- Report any blisters, sores, suspicious growths or lumps in armpits, groin or elsewhere on your body to your physician.
- DO NOT SMOKE. Smoking contributes significantly to the development of heart and lung disease in the general population. Since you are taking immunosuppressive medications, your lungs are already at risk for developing lung infections, and smoking will add to the risk. Smoking directly damages the delicate lung tissue and may lead to mucous build up, coughing, breathing problems, and lung infection. If you need assistance in locating a program to help you stop smoking, ask your physician or nurse. The social workers also have excellent behavior modification books available for your use.
- In your own home, there is no need to rearrange your life style.
Children who contract the usual childhood diseases generally pose no threat. Infectious mononucleosis and chicken pox are an exception. Contact your physician immediately following contact with people with these illnesses.
Safe sexual activity may be resumed without concern after incisional healing, usually within six to eight weeks following surgery. If sexual dysfunction occurs, feel free to discuss it with your physician.
Dishes do not need to be sterilized.
Bed linen may be laundered routinely and does not need to be changed on a daily basis.
Pets offer no threat of disease with the exception of toxoplasmosis, which is found specifically in cat feces. Do not change kitty litter boxes. -
Indoor or outdoor activities are limited only by the threat of potential injury or the limits of physical stamina. Use common sense in all activities. Restrictions apply only when there are extremes in pressure changes such as flying in unpressurized cabins, gliding, hang gliding, and scuba diving.
The physiologic response of the denervated heart is different from normal, and the lack of normal reflexes may be hazardous in these activities.
Swimming in clean pools and the ocean is an excellent form of exercise, and relaxing in a clean hot tub is acceptable after full recovery. There is no need to restrict exposure to the general public. You may attend movies, sports events, parties, etc.