The nurse is assessing a client who is one hour post percutaneous valvuloplasty via a left groin site. Which intervention does the nurse consider the priority?

a. Use a soft bristle toothbrush: Warfarin (Coumadin) therapy can increase the risk of bleeding. Using a soft bristle toothbrush can help reduce the risk of gum bleeding or oral mucosal injury, which is important for clients on anticoagulant therapy.
b. Risk of infection is increased: There is no direct association between warfarin therapy and an increased risk of infection. This option is not relevant to warfarin therapy.
c. Check for black, tarry stools: Warfarin therapy increases the risk of gastrointestinal bleeding. Black, tarry stools can indicate upper gastrointestinal bleeding, which requires immediate medical attention.
d. Limit aspirin to 650mg/day: Aspirin is typically avoided or used cautiously in combination with warfarin due to an increased risk of bleeding. However, there is no specific recommended limit of 650mg/day for aspirin use in conjunction with warfarin. This option does not accurately reflect guidance for warfarin therapy.
e. Keep appointments for PT/INR monitoring: Prothrombin time (PT) and international normalized ratio (INR) monitoring are essential for assessing the effectiveness and safety of warfarin therapy. PT/INR levels need to be within the therapeutic range to prevent both clotting and bleeding complications. Keeping appointments for monitoring ensures timely adjustments to the warfarin dosage.

a. “The left side of your heart is having trouble overcoming the resistance in the blood vessels of your body.”

• This explanation is not specific to mitral stenosis. It describes systemic vascular resistance, which is a broader concept related to hypertension and vascular health. Mitral stenosis specifically involves narrowing of the mitral valve, which affects blood flow between the left atrium and left ventricle.

b. “When your heart beats, some of the blood that should leave the left ventricle is backing up through a leaking valve.”

• This explanation is more accurate for mitral regurgitation rather than mitral stenosis. Mitral regurgitation involves the leaking of blood backward through the mitral valve into the left atrium during ventricular systole. Mitral stenosis, on the other hand, involves narrowing or constriction of the mitral valve, which impedes the flow of blood from the left atrium to the left ventricle during diastole.

c. “The valve between your heart and lungs has become inelastic.”

• This explanation is not entirely accurate. While mitral stenosis does involve changes in the mitral valve structure, such as thickening and calcification, the term "inelastic" does not fully describe the pathology of mitral stenosis. Mitral stenosis is characterized by the narrowing (stenosis) of the mitral valve orifice, which restricts blood flow from the left atrium to the left ventricle.

d. “The mitral valve has become stiff and narrowed which slows the blood between the two chambers.”

• This explanation is the most accurate description of mitral stenosis. It correctly identifies the problem as the narrowing and stiffening (stenosis) of the mitral valve, which impedes the flow of blood from the left atrium to the left ventricle during diastole. This explanation helps the client understand how the condition affects the function of the mitral valve and the flow of blood within the heart.