Private duty nursing?

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Bunkenmeyer

Hi everyone. I'm new to this site. After following a slowly dilating aortic root with mild valve insufficiency for several years I'll be heading in for surgery in early December. Hopefully, they'll be able to do a valve sparing procedure so I can keep my valve. I'm starting to feel a bit anxious but also trying to gather as much info as possible before hand. I'm sure I'll be back posting quite a bit over the next few as this gets closer.

One question for today though. Someone today strongly suggested getting a private duty nurse to cover me for the first few days post-ICU. Even with good nursing, the thought is nurses are always stretched pretty thin so you're better off with someone dedicated. I hadn't considered this. It looks like my insurance will cover it if "medically necessary". Otherwise its probably out of the question at $1200 per day. Did anyone look into this?

Thanks.
 
Hmmm.... Interesting question.

I've always felt like the dedicated cardiac nurses were pretty sharp. It helps to go to a hospital that does LOTS of surgeries and has a dedicated CCU for post CICU recovery.

The family of one recent patient took turns watching their husband / father so that they would be there 'just in case' to call in a nurse if needed. I think that would suffice to allay your concerns.

It is also a good idea to have someone around for at least the first week at home, and preferably the first two.

FWIW, I had a couple of situations (Atrial Fibrilation and shortness of breath) which required assistance from a nurse and received prompt response both times simply by pushing the call button. In the event of serious heart rhythm problems, an alarm should also go off in the monitor room (at least at the better heart hospitals).

'AL'
 
I don't know that a private nurse would be needed unless you have no one that will be with you. The hospital I was in was very short handed, to say the least, and my wife came in and helped when she could. On one Saturday morning while I was in ICU, there were only 2 nurses! 2 to cover 8 patients and on this particular day, anything and everything was going wrong with other patients.

If family can come in and stay for as long as possible, that would be my recommendation. I highly doubt your insurance would cover a private nurse while you were in the hospital.
 
Hello and Welcome to this wonderful site!
It really does depend on whether or not there is a nursing shortage at the hospital you are having your surgery at. There seems to be a nursing shortage everywhere. Once I was on the floor, there was one really good nurse I had, but I didn't have her every day. I seemed to be recovering pretty quickly so they didn't seem to check on me as much or respond quickly when I rang. One nursing asst. accidently hit the wrong button on my monitor; she set off the code blue button. Boy, everyone was in there in a flash. Scared me to death because I didn't even know she hit the wrong button. My husband was able to stay with me in the room 24 hours a day. If I really needed something, he would get after them for me. There was only one time where I really noticed that there was a nursing shortage. On the overnight shift, they would forget to come in and take my vitals and give me my meds before bed. I had to call and ask the nurse if I was going to get my meds. She then didn't give me all the meds I was to take. It's a good thing I wasn't out of it and knew exactly what I was supposed to take and at what time. I know she was very busy taking care of people who were having a harder time than myself, but it just didn't make me feel very secure after that happened. If you don't get a private nurse while you are on the floor, you might want to have your spouse keep track of when they do vitals and dispense meds etc...
The hospital might also let your spouse stay in the room with you if you like.

Take Care!
Gail
 
Special duty nurses?

Special duty nurses?

Dear Bunkemyer, You ask a good question. Here is my view.
Nurses at Inova Fairfax where i had my mitral valve replacement are short staffed and seriously overworked as they are in most communities. In the cardiac telemetry unit they can monitor you for serious problems and they will take care of them expertly. Its the small stuff they don't have time for......helping you to the bathroom at first, straightening out the bedclothes, a little backrub, etc. Heres where I agree with Roy. Have a family member with you 24/7. Believe it or not my wife has a bad mitral valve too ( is it catching?) and I told her one of us will be with her at all times till she is discharged; if it turns out she needs surgery.
 
As I was preparing for my surgery I was looking at the quality of the surgeon and the quality of the hospital. I knew I would have the least anxiety if I was fully confident in who was taking care of me.
I had a meeting at the hospital with the surgeon and was able to get all my questions asked and answered. I then knew pretty much what to expect. I knew I would be in CCU for up to 24 hours if things went as expected. They explained how I would be taken care of there. Then I was told I would be moved to a private room on the cardiac unit. I was told what to expect there and that my family could stay in that room with me. They had a chair that made into a bed. It did make a difference having a family member with me. Although the nursing staff responded well it was comforting to have a family member there to make sure nothing was overlooked.
I asked about the care I needed when I went home. The first week especially will be a lot easier to have someone there 24 hours a day. Just to get you something, to check on you, to make sure you don't forget your meds, etc. Looking back I would not want to go through the first week at home alone.
As far as paid nurses, if you can afford it fine, but just having a good caring person with you will be a big help.

Good Wishes!
 
Joe has had his surgeries close to home which made it easy to go back and forth to the hospital.

I have been there with Joe for all of his surgeries and other things pretty much most of the daytime hours from 7 AM on and some evening hours. The PAs, aides and nurses are just wonderful on the Cardiac Unit and especially excellent in the ICU. And on the Cardiac floor there was a cardiologist who monitored the patients. He is part of Joe's cardiology group, but was there every day in house. He was absolutely invaluable.

I did give Joe his daily baths and other stuff like that, if he didn't have the breathing tubes or serious things hooked up. I also kept track of what was going on and made it my business to try to be there when the rounds were being done. There are also a million other things a patient needs in addition to serious nursing care, so having someone there is a definite plus. I wouldn't think it has to be a nurse.

At home, you will want someone there for at least the first week, 24/7, and preferably the following week. You'll be fuzzy headed and tired. You'll also be very weak. It doesn't have to be a nurse there either, just someone who cares.
 
Nursing

Nursing

Hi,
My name is Medtronic of borg. I was a nurse in charge of an ER for 7 1/2 years. I say you'd be waisting your money. Set up a schedule with family, as suggested. Also I strongly suggest keeping a note book to keep track of what kind of treatments you get and on what day. Ivs, meds, dressing changes tubes being removed. If you dont know what a machine is or tube ASK. and write it down. When you go into and come out of ICU is very important. My last stay they billed me for 3 days. I showed them a copy of my records and cut the bill by one day $11,000. But more to the point. Don't go to a facility with an ICU nurse to pt ratio that is to high. Three to one is good! Some even go as low as one to one. ASK! Call the hospital and ask for the dir. of nursing or one of her assts. One last thought CCU nurses are fantastic, and well trained!!!
 
The hospital where I had my surgery at was 1 on 1 the day after surgery, and in the cardiac care unit, it was like 3 to 1. I went to the UWMC, where all the doctor's I'd ever had(even my OB/GYN doctor) came to see me. I wasn't pregnant, I'd already had the baby. My cardiac surgon called me "sunshine". Anyways, it was a well staffed hospital and everybody was extremely helpful while I was there.
 
Probly don't need the super care. My nurse cousin came to sit days with me, but she wasn't needed. The staff was in teams; they made their rounds throughout the day and I was well attended at every turn. So my cousin just kinda kept me company, is all. You will sleep a lot and be on pain meds so probably won't require more than average and if you do, they will give it to you. So, not to worry. Haven't heard of anybody on this board in the years I have been a member who required special nursing. God bless

Well, maybe Ross - but he's different anyhow.
 
Maybe Ross

Maybe Ross

But he's different anyway:D :D They all wanted to see his handsome body......;) Bonnie
 
Regarding Care When You Get Home

Regarding Care When You Get Home

Everyone has offered great thoughts regarding the hospital experience. I just wanted to mention that I have come to favor having a professional, such as a home health nurse, check on the patient the first while they are at home. My husband has had two heart surgeries. With the first one, we did not have anyone come into the home to check on him. However, with this last surgery, it was offered, insurance covered it, and I found it helpful. They checked his vitals, examined the incision, and drew his blood for PT INR. He had no complications, but it did spare trying to go out to a lab to have his blood drawn that first week.
I have since learned of a very sad experience. The patient had done well following surgery and was discharged home - perhaps a few hundred miles away. Some mood change and discomfort were noted those first days, but the family had no way to really know what was wrong. By the time the patient was seen locally a few days later, a very severe deep sternal wound infection was diagnosed. The patient was put on IV antibiotics, rushed back to the hospital where the surgery had been done, and after multiple additional surgeries and weeks in ICU did not survive.
It cannot hurt to be checked by a professional those first days at home..... Arlyss
 
I agree with Arlyss on this one about home health care. If insurance covers it, go after it - press the doctor for it. Visiting nurses can pick up on lots of things at home that we cannot and since heart surgery is very, very major surgery, we should get all the help that is available to us. It might not even be needed, but you never know.
 
I think that each family is slightly different in how they can relate to medical things.

Some people are aware of a lot of medical things and some people have had very little experience with anything medical, and then there are others who hate to be involved with anything having to do with the body, and might even fear it. So you will have to be very honest with your own particular situation and feelings on this subject.

There are things which can crop up after surgery that have to be taken care of pronto. You have to be unafraid to call the doctors to get help and you will have to be willing to look at a surgical scar and to take some basic vital signs. You will have to be comfortable with being up close and personal with your patient.

That being said, they will not discharge you from the hospital unless you are safe to go home. And the vast majority of patients will have an uneventful recovery.

My husband has had many, many medical problems. I can truthfully say that I can do a few very basic nursing type things and I don't mind at all calling the doctor for help if it's needed. We are lucky to have excellent and responsive doctors. I can also spot something unusual if it happens because I've been focused on Joe's health for a long time. And I don't mind "icky" stuff. And I don't mind carting him off to the ER if I have to.

But after his gallbladder surgery, which went wrong, and he was in extremely serious condition, he was discharged from the hospital in terrible condition. We had Visiting Nurses come to the house for about a month. They didn't stay the whole day, but took vital signs, changed dressings and drain bags and called the doctors when it was needed. They were a great help and I was very happy to have them there. This was an unusual situation though. His heart and lung surgeries were not a problem.

I think this is something you can speak with your surgeon about. If you, as a family "caregiver" are not comfortable doing just some minimal things, then ask if it will be possible to have in home nursing care. The surgeon can tell if additional help is needed and they will also brief you on what things to look for which might be warning signs that there are some complications.

My guess is that the majority of people can handle aftercare very well. It will be a matter of helping with daily things and making sure the patient is progressing. I think most people can handle that.

Just think it through. You'll know what you're comfortable with.
 
The "handoff"

The "handoff"

No doubt about it...the most dangerous time post op is when the patient is "handed off" from the care of the surgeon to his or hers PCP. There is often a period of time when nobody is in charge. Its OK if you have a wife like Nancy but if not, visiting home nurses are the way to go.
 
Marty-

You bring up a point that isn't mentioned too much and that is the period of time when no one is in charge. I had a very candid conversation with a couple of Joe's doctors in which I told them I didn't want to be out there "swinging alone" and that I wanted them to be available, and that one of them would be the one in charge and would act as the clearing house. They were most agreeable because they knew what a difficult place I was in.

You should feel free to be candid when necessary. These good guys are in a helping profession and 99 percent of them really care and want to help.
 
cardiac care manager?

cardiac care manager?

I had a cardiac care manager assigned to me that I could call 24/7. I had her office number, and her pager number so if I needed her, she would be available to answer my questions and help me out. They also have a cardiology fellow on call at all times, so that is nice too. I was never released to my PCP, I was released to my cardiologist. They were great though, and still are. Most places will give you directions and while you are still in the hospital will teach you and the person taking care of you everything you will need in case of something vital happening. I agree with Nancy though, you have to be comfortable doing that though. It's up to you, if your insurance company covers it, I say go for it!
Good luck!
 
INR

INR

They will want you to do an INR right away. I was clueless to what this was all about. Thank goodness for a neighbor who told me about a clinic near here. (even tho it was a draw and had to be sent down to hospital ) Will never forget, walked in with slippers and bathrobe on. Could have cared less..the next week was able to go down with clothes on:D but still hated the idea of every week. Thank goodness for finding this site and all about Protime. Got mine right away. Bonnie
 
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