Because a client has mitral stenosis and is a prospective valve recipient, the nurse preoperatively assesses the client’s past compliance with medical regimens. Lack of compliance with which of the following regimens would pose the greatest health hazard to this client?
A. Medication therapy
B. Diet modification
C. Activity restrictions
D. Dental care
Correct Answer: A. Medication therapy
Preoperatively, anticoagulants may be prescribed for the client with advanced valvular heart disease to prevent emboli. Post-op, all clients with mechanical valves and some with bioprostheses are maintained indefinitely on anticoagulation therapy. Adhering strictly to a dosage schedule and observing specific precautions are necessary to prevent hemorrhage or thromboembolism. Some clients are maintained on lifelong antibiotic prophylaxis to prevent recurrence from rheumatic fever. Episodic prophylaxis is required to prevent infective endocarditis after dental procedures or upper respiratory, GI, or GU surgery.
Option B: Eat heart-healthy foods such as fruits, vegetables, whole grains, fish, lean meats, and low-fat or nonfat dairy foods. Limit sodium, sugar, and alcohol. Stay at a healthy weight. Lose weight if needed. Be safe with medicines. Take medicines exactly as prescribed. Call a doctor or nurse call line if the clients think he is having a problem with the medicine. You will get more details on the specific medicines the doctor prescribes.
Option C: Be active. Ask the doctor what type and level of exercise is safe. If the stenosis is severe, the client will likely need to restrict the level of activity. Walking may be a good choice. The client may also want to swim, bike, or do other activities.
Option D: Take care of the teeth and gums. Get regular dental checkups. Good dental health is important because bacteria can spread from infected teeth and gums to the heart valves. Avoid colds and flu. Get a pneumococcal vaccine shot. If you have had one before, ask your doctor if you need another dose. Get a flu vaccine every year.
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