The nurse on a burn unit has just received a change-of-shift report about these clients. Which client does the nurse assess first?

Choice A reason: Blood clots form more easily in mechanical replacement valves due to the artificial surface of the valve, which can cause the blood to clot more readily. This increases the risk of thromboembolic events, such as stroke or valve obstruction. Therefore, patients with mechanical valves need to take anticoagulants for life to prevent clot formation and ensure the valve functions effectively.

Choice B reason: The statement that the vein taken from the leg reduces circulation in the leg is incorrect in this context. Vein grafts from the leg are typically used in coronary artery bypass grafting (CABG) surgery, not in valve replacement surgery. Therefore, this explanation does not apply to the patient's situation of needing anticoagulants after valve replacement surgery.

Choice C reason: The idea that the valve replacement surgery left a lot of small clots in the heart and lungs is not accurate. The surgery itself does not leave clots; rather, the ongoing risk of clot formation is due to the presence of the mechanical valve. This risk necessitates lifelong anticoagulation.

Choice D reason: The mechanical valve does not place the patient at a greater risk for a heart attack specifically. The concern with mechanical valves is the increased risk of blood clot formation, which is why anticoagulants are prescribed. Heart attacks are typically caused by blockages in the coronary arteries, which is a different issue.

Choice A reason: Complete bedrest for the duration of the treatment with subcutaneous enoxaparin is not the best approach for managing infective endocarditis. While bed rest may be recommended initially to reduce cardiac workload, long-term bed rest is not necessary and could lead to complications such as muscle atrophy or thromboembolism. Subcutaneous enoxaparin is used for prophylaxis against deep vein thrombosis, but it does not address the underlying infection.

Choice B reason: Long-term anticoagulant therapy with IV heparin followed by oral warfarin is not the standard treatment for infective endocarditis. Although anticoagulant therapy may be necessary in some cases, such as for patients with prosthetic valves or specific cardiac conditions, it is not the primary treatment for the infection itself. The focus should be on eradicating the infection with appropriate antibiotics.

Choice C reason: Administration of IV penicillin, followed by oral penicillin for 10 weeks, is not the typical treatment regimen for infective endocarditis. While penicillin may be part of the antibiotic therapy, the duration and route of administration need to be tailored to the specific causative organism and the patient's clinical condition. Usually, a combination of antibiotics and a specific treatment plan is developed based on culture and sensitivity results.

Choice D reason: Hospitalization for initial IV antibiotics, followed by continued IV antibiotics at home, is the best treatment approach for a client newly diagnosed with infective endocarditis. This allows for intensive management and monitoring during the critical initial phase of treatment, ensuring that the infection is adequately controlled. Transitioning to continued IV antibiotics at home provides the necessary long-term therapy while allowing the patient to recover in a familiar environment. This approach ensures compliance with the treatment regimen and reduces the risk of complications.