Combined Surgical & Cardiac Care Protocol

My Home Nurses || NM
Home Health Care Intervention & Patient Teaching Template

Reviewed and approved 06/30/2026
Annie Tchinjo RN, MSN  |  Terri Lorenz, RN  |  Felix Leshey MRes

INTEGRATED PATHWAY DIRECTIONS: This standardized template incorporates both the Anterior Approach Total Hip Arthroplasty (THA) protocol and the Cardiovascular/Cardiac Surgery management guidelines. Confirm patient surgical status on the referral or After Visit Summary (AVS).

1. MANDATORY VISITING TIMELINES

• Orthopedic (THA) Discharges: Weekday (Mon–Thu) discharges require initial RN and PT evaluation the next calendar day. Weekend (Fri–Sat) discharges require evaluation within 24–48 hours.
• Cardiac Surgery/CHF Discharges: Initial home care nursing visit must occur precisely on Post-Discharge Day 1. A return visit is required on Day 2 if unstable, or on Post-Discharge Day 3 or 4 if stable.
• Follow-Up Requirements: Verify a clinic follow-up appointment at the 3-week mark for THA patients, and within 7 days for cardiac patients.

2. CORE CLINICAL EVALUATIONS

• THA Specifics: No structural hip dislocation precautions (e.g., no restrictions on crossing legs or bending).
• Cardiac/CHF Specifics: Daily tracking of weight, temperature, blood pressure, and pulse. Perform baseline phlebotomy as ordered on post-discharge day 1 and 3.
• Home Performance Screening: Screen for fluid retention: significant windedness on stairs, tight footwear or difficulty tying shoes, tight clothing/belt, and orthopnea (need for extra pillows or sleeping in a recliner).
• Incision & Sternal Stability: For cardiac patients, assess sternal stability (no popping, cracking, or clicking) and inspect all incisions.

3. DIETARY & FLUID PARAMETERS

• Sodium Constraints: Enforce < 2,000 mg/day; limit single meals to 500–600 mg. Prioritize labels < 300 mg per serving. Avoid high-sodium items and salt shakers; use herbs and vinegars for flavor.
• Fluid Restrictions: Limit to 32–64 ounces (1–2 liters) daily. Account for all liquids, including ice chips, soups, gelatin, and ice cream.
• Thirst Mitigation: Use ice-cold, alcohol-free mouthwash, lemon wedges, hard sour candy, sugar-free gum, or frozen fruit slices/vegetables to manage thirst without exceeding limits.

4. MEDICATION MANAGEMENT & SAFETY

• General: Enforce strict adherence using pillboxes and alarms.
• Cardiac Classes: Monitor potassium levels for diuretics. Monitor for dry cough with ACE inhibitors; avoid potassium-rich foods. Screen for genital infection symptoms with SGLT2 inhibitors.
• Anticoagulation: For Coumadin, verify enrollment with the NMFF Coumadin Clinic or managing cardiologist.
• Orthopedic Support: Continue assigned analgesics and systemic antithrombotic prophylaxis (e.g., Aspirin, Lovenox) as ordered.

5. MOBILITY & LIFESTYLE

• Activity: Cardiac patients should progress toward 30 minutes of aerobic activity daily, avoiding heavy lifting or straining. THA patients should avoid lunges or squats past 45 degrees.
• Edema Control: Elevate legs to minimize swelling and correctly use antiembolism stockings (TED hose).
• Lifestyle: Enforce tobacco/vaping cessation, limit alcohol, and restrict caffeine.

6. DAILY TRACKING CHECKLIST

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MHN/NM HH - COMBINED SURGICAL & CARDIAC VISIT NOTE
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[ ] CLINICAL SEQUENCE: Post-D/C Day 1 visit done [ ] 3-week POV (THA) [ ]
[ ] CARDIAC METRICS: Today's Weight: ____ | Baseline Weight: ____
    - Stair windedness [ ] | Shoe/Footwear tightness [ ] | Orthopnea [ ]
[ ] WOUND/STERNAL: Incision integrity [ ] | Sternal stability (Cardiac) [ ]
[ ] DIET/FLUIDS: Sodium < 2000mg [ ] | Fluid Cap 32-64oz [ ]
[ ] MEDS: Pillbox check [ ] | SGLT2 Screening [ ] | Anticoagulant check [ ]
[ ] ACTIVITY: Gradual progression [ ] | TED hose compliance [ ]
[ ] COLOR ZONE: [ ] GREEN (Stable) [ ] YELLOW (Caution) [ ] RED (Emergency)
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