[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medical–surgical nursing](https://durgical.com/en/nursing/areas/med-surg/) › Ward care after heart surgery (bypass, valve replacement): sternal wound, lungs, mobilisation and going home

# Ward care after heart surgery (bypass, valve replacement): sternal wound, lungs, mobilisation and going home

- Safe practice

After heart surgery the ward nurse protects the breastbone, helps the lungs expand, walks the patient often, watches rhythm and wounds, and prepares home care.

Updated Nov 13, 2026

## Key points

- Sternal precautions for about 6 weeks: no reaching back, nobody pulls on the arms, very light lifting only, arms close to the body when rising.
- Continue the breathing exercises learned in hospital and walk often at a slow pace, increasing gradually.
- Report a pulse that is irregular, below 60 or above 100–120, a weight gain over 1 kg in a day, fever or wound redness or drainage.
- A mechanical valve needs a blood thinner for life; a tissue valve usually does not need one long term.
- Valve patients may need antibiotics before dental work and invasive procedures: they tell every dentist and doctor.

## What it is

After a few days in intensive care, the patient arrives on the ward after coronary bypass or valve surgery. The nurse watches for rhythm problems, bleeding, wound infection, fluid build-up and changes in thinking or mood, which are known complications. Breastbone precautions protect the healing sternum: no pulling on the arms, little lifting and arms close to the body when rising. Breathing exercises and frequent short walks help the lungs and circulation. People with a mechanical valve need a blood thinner for life, and all valve patients need to protect the valve from infection. The intensive care phase is on the critical-care pages.

## What it requires

- Rhythm, vital signs, saturation and fluid balance after transfer from intensive care.
- Care of the sternal wound and, after bypass, the leg wound where the vein was taken.
- Lung expansion: breathing exercises and early walking.
- Pain control so the patient can breathe deeply and move.
- Teaching for home: sternal precautions, wounds, medicines, warning signs, mood and cardiac rehabilitation.

## How it is applied (and why)

- Monitor rhythm, pulse, pressure and saturation as ordered — new rhythm problems are common after heart surgery.
- Inspect the sternal and leg wounds each shift — finds bleeding, opening or infection early.
- Record weight, intake and output — fluid build-up shows as a sudden weight gain.
- Assess pain and give the ordered analgesia — so the patient can do the breathing exercises and walk.
- Coach the breathing exercises taught in hospital — lung complications are a known risk.
- Help the patient up without pulling the arms, which stay close to the body — protects the healing sternum.
- Walk the patient often, short and slow, increasing gradually — improves lungs, circulation and recovery.
- Ask about mood, sleep and memory, and involve the family — low mood and fuzzy thinking can follow surgery.
- Teach sternal precautions, wound care, the medicine plan, warning signs and rehabilitation; check teach-back — recovery continues at home.

## In nursing practice

- Call for chest pain or breathlessness that does not ease with rest, or a new irregular, very slow or very fast pulse.
- Call for redness, swelling, opening or more drainage of a wound.
- Call for fever or chills, dizziness, fainting or unusual tiredness.
- Call for a weight gain over 1 kg in a day or on two days in a row, more swelling or less urine.
- Call for a severe headache, confusion, weakness of one side, or bleeding in a patient on a blood thinner.

## Common mistakes

- Pulling the patient up by the arms.
- Stopping the breathing exercises once the patient leaves intensive care.
- Keeping the patient in bed instead of walking often.
- Missing a sudden weight gain because the patient was not weighed.
- Not explaining that mood changes are common and can be talked about.

## Test yourself

Think of the answer, then tap the question to see it.

## What are sternal precautions after heart surgery?

For about 6 weeks: no reaching back, nobody pulls on the arms, only very light lifting, arms kept close to the body when rising.

## Which mood or thinking changes can follow heart surgery?

Mood swings, low mood, trouble sleeping and memory problems or fuzzy thinking; the patient and family can talk about them with the team.

## Which valve type needs a blood thinner for life?

A mechanical valve; tissue valves usually do not need long-term blood thinners.

## Which findings after heart surgery should be reported?

Chest pain or breathlessness at rest, an irregular, very slow or very fast pulse, fever, wound redness or drainage, and a weight gain over 1 kg in a day.

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## Connections

## Related 4

- [Postoperative care on the ward: the first 24–48 hours](https://durgical.com/en/nursing/postoperative-care-on-the-ward-the-first-24-48-hours/)
- [Airway clearance: incentive spirometry, deep breathing, coughing and oscillating devices](https://durgical.com/en/nursing/airway-clearance-incentive-spirometry-deep-breathing-coughing-and-oscillating-de/)
- [Patients on anticoagulants: bleeding watch, monitoring tests, interactions and teaching](https://durgical.com/en/nursing/patients-on-anticoagulants-bleeding-watch-monitoring-tests-interactions-and-teac/)
- [Cardiac monitoring at the bedside: leads, alarms and rhythm changes to report](https://durgical.com/en/nursing/cardiac-monitoring-at-the-bedside-leads-alarms-and-rhythm-changes-to-report/)

## Related conditions 4

- [Myocardial Infarction (Heart Attack)](https://durgical.com/en/conditions/myocardial-infarction/)
- [Aortic Valve Stenosis](https://durgical.com/en/conditions/aortic-valve-stenosis/)
- [Mitral regurgitation](https://durgical.com/en/conditions/mitral-regurgitation/)
- [Rheumatic heart disease](https://durgical.com/en/conditions/rheumatic-heart-disease/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Heart bypass surgery - discharge: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/patientinstructions/000102.htm) (MedlinePlus, US National Library of Medicine, 2026); [Heart bypass surgery: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/002946.htm) (MedlinePlus, US National Library of Medicine, 2026); [Heart valve surgery: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/002954.htm) (MedlinePlus, US National Library of Medicine, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/nursing/ward-care-after-heart-surgery-sternal-wound-lungs-mobilisation-and-going-home/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/ward-care-after-heart-surgery-sternal-wound-lungs-mobilisation-and-going-home/