A big part of nursing is teaching your patients.

I have taken care of a number of heart by pass patients and done a lot of teaching to them.

I had one woman that had a by pass. She just absolutely was impossible. I had to explain on a daily basis that getting out of bed and walking was an important part of her healing. Finally she got out of bed and we would go for short walks at first in the hallway and increase the distance each day. Every day I would have her get out of bed to the shower, then let her rest in a chair while I made the bed, got fresh water and her medication etc. Back to bed for an hour and then up to walking. Soon she was walking and showering on her own.

I cautioned her not to sit for long periods after she went home as prolonged sitting would cut off the circulation to her legs and perhaps cause blood clots to form. I told if that happened , gangrene would set in. I instructed her to increase her walking each day, to shower daily and keep the chest and leg incisions clean. I got good feedback from her on all of her discharge instructions from her activities to her medications. She was discharged 8 days after her surgery.

About two weeks later, I answered the phone at the nurse's station and it was admitting office placing the same woman to our floor. I went to admitting and brought her to our floor in a wheelchair. She would not say much on the way to her room. I tried to be cheerful and talk to her but without much response. I thought that maybe she was depressed as that was a common thing with her type of surgery. I left her to get undressed and checked out her orders. She was scheduled for surgery for early A.M. the next morning.

The surgery was amputation of her left leg above the knee. When I went back to her room to do her admission paper work, she was crying.

I asked her if she wanted to talk about it. She said " I am so ashamed of myself. I did not do what you told me when I went home. I sat in my recliner all day and even slept in it sometimes. I never went for walks. I only showered and kept my incisions clean and took my meds. I just don't like going for walks. Now I am going to lose my leg because I refused to walk and not sit all day." I let her get her cry it out and talked with her for a long time. She said she was afraid to face me. I told her that I did not hold it against her. I teach my patients what to do and not to do but I can't make them follow the doctor's or my instructions. She said she understood and was glad that I was not mad at her.

She recovered from the surgery without any problems. I learned a few months later that she lost the other leg too from sitting all the time. She just never understood the importance of not sitting for long periods.

She has since passed away, from what I don't know. She died about a year or two later after the second amputation.

Most patients follow their discharge instructions and then you get those that don't. Her family did not inforce the instructions either. Why? All of her problems could have been prevented, if only she had not sat all day long. Some patients just don't take the teaching seriously.