VALVULOPLASTY AND REPLACEMENT: NURSING MANAGEMENT
Patients who have had valvuloplasty or valve replacements are admitted to the intensive care unit; care focuses on recovery from anesthesia and hemodynamic stability. Vital signs are assessed every 5 to 15 minutes and as needed until the patient recovers from anesthesia or sedation and then assessed every 2 to 4 hours and as needed. Intravenous medications to increase or decrease blood pressure and to treat dysrhythmias or altered heart rates are administered and their effects monitored. The intravenous med-ications are gradually decreased until they are no longer required or the patient takes needed medication by another route (eg, oral, topical). Patient assessments are conducted every 1 to 4 hours and as needed, with particular attention to neurologic, respiratory, and cardiovascular systems..
After the patient has recovered from anesthesia and sedation, is hemodynamically stable without intravenous medications, and assessment values are stable, the patient is usually transferred to a telemetry unit, typically within 24 to 72 hours after surgery. Nursing care continues as for most postoperative patients, in-cluding wound care and patient teaching regarding diet, activity, medications, and self-care.
The nurse educates the patient about long-term anticoagulant therapy, explaining the need for frequent follow-up appoint-ments and blood laboratory studies, and provides teaching about any prescribed medication: the name of the medication, dosage, its actions, prescribed schedule, potential side effects, and any drug-drug or drug-food interactions. Patients with a mechanical valve prosthesis require education to prevent bacterial endo-carditis with antibiotic prophylaxis, which is prescribed before all dental and surgical interventions. Patients are discharged from the hospital in 3 to 7 days. Home care and office or clinic nurses reinforce all new information and self-care instructions with the patient and family for 4 to 8 weeks after the procedure.