Question

Chiens where the mechanis m for beast called infectie cardals at preventive Were o reduce the risk of l ove andandi infection within the will be imple e er that you would implement when 10. T ous wonds describe nursing car caring for a clisi with v ar bort disease

Answer 1

8. Difference between mechanical and tissue valve :-

MECHANICAL BIOPROSTHETIC LIFESPAN 30 YEARS OR MORE 10-15 YEARS THROMBOGENICITY MORE LESS NOISE MORE NEGLIGIBLE PATIENT-PROSTHESIS MORE LESS MISMATCH VALVE DETERIORATION DURABLE HIGHLY SUSCEPTIBLE HEMODYNAMICS IMPROVING CLOSE TO NATURAL ANTICOAGULATION LIFELONG 3 MONTHS RISK OF REOPERATION LESS MORE

9. Preventive measures to be taken to decrease the risk of infective endocarditis are :-

- reduced hospital acquired bacterimia

- good oral hygiene for at risk group

- antibiotic prophylaxis for high risk groups

- in future, antibiotic coating/ materials

10. Nursing interventions :-

1. Assess Heart Sounds

To identify murmur?

Is it an S1 or S2 murmur?

Which valve are you listening to?

What should the valve be doing at that time?

The easiest way for a nurse to determine the presence of a valve disorder is to listen for murmurs. A murmur indicates abnormal or turbulent blood flow through the valve.

If the valve should be open, but doesn’t open fully – stenosis

If the valve should be closed, but doesn’t close fully – regurgitation

2. Assess and Monitor CV status

Pulses

Capillary refill

Skin color, temperature

Heart rate

Blood Pressure

Arrhythmias (ECG)

Valve disorders can compromise cardiac output. Assess cardiovascular status to determine if there is decreased perfusion to the tissues. If BP is dropping, HR may increase to compensate.

3. Assess respiratory status

Lung sounds

SpO2

Shortness of Breath

Sputum

If blood is not going forward or backing up, it can cause pulmonary congestion leading to pulmonary edema. This would cause decreased SpO2, crackles in the lungs, and possibly even pink-frothy sputum

Notify provider of new or sudden onset or murmurs, especially if accompanied by signs of poor perfusion or pulmonary edema

Papillary muscle rupture and mitral valve prolapse may occur suddenly. They are most often accompanied by chest pain, shortness of breath, or other signs of heart failure. This is an emergency that requires surgical intervention immediately.

4. Educate patient about post-op requirements after valve replacement surgery

Prophylactic antibiotics prior to any invasive procedures

Bleeding Precautions (anticoagulant therapy)

Use soft bristle toothbrush

Maintain good oral hygiene

Avoid dental procedures for 6 months post-op

Patients who receive artificial valve replacements will require lifelong anticoagulant therapy. They need to be taught precautions for anticoagulant therapy, including using electric razors and soft bristle toothbrushes and how often they will require monitoring, if at all.

Patients with artificial heart valves are at high risk of developing endocarditis. They need to be taught about preventative measures, including receiving prophylactic antibiotics prior to any invasive procedures.

Oral hygiene is imperative to prevention of endocarditis after valve repair. This may seem silly but it is a HUGE deal. The evidence has shown that bacteria from the oral cavity are highly likely to translocate (move) to the heart and become lodged in/on the valves. This is also why patients should avoid dental procedures for 6 months after valve surgery. It is so important that you, as the nurse, educate them on why this is so important.