An emergency nurse is providing discharge instructions to a patient with a history of a prosthetic aortic valve replacement who was treated for an unrelated condition. The patient states, "I have a dental cleaning scheduled for next week." Which instruction is most important for the nurse to provide?
Check your blood pressure before and after the dental procedure and report any significant changes.
Ensure you take an extra dose of your anticoagulant before the dental cleaning to prevent blood clots.
Inform the dentist about your heart condition, as you will likely need prophylactic antibiotics before the procedure.
It is safe to proceed with the dental cleaning without any special precautions.
The most important instruction is for the patient to inform their dentist about their prosthetic heart valve and the need for prophylactic antibiotics. According to American Heart Association guidelines, patients with prosthetic cardiac valves are at the highest risk for adverse outcomes from infective endocarditis. Dental procedures that involve the manipulation of gingival tissue, like a cleaning, can cause transient bacteremia. Prophylactic antibiotics are recommended for these high-risk patients to prevent bacteria from seeding on the prosthetic material and causing endocarditis. While monitoring blood pressure is good general practice, it does not address the primary risk of endocarditis. Suggesting no special precautions is dangerous and incorrect. Taking an anticoagulant is not indicated for endocarditis prevention and could increase bleeding risk during the dental procedure.
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