NUR265 FOURTH MODULE 2026 EXAMPREP
MASTER REVISION RESOURCE
◉ Pacemaker patient teaching. Answer: Cellphones. keep your
cellphone at least 6 inches (15 centimeters) away from your
pacemaker. Don't keep your phone in a shirt pocket. When talking on
your phone, hold it to the ear opposite the side where your
pacemaker was implanted.
•Household Appliance - Using properly operating household
appliances such as microwave ovens, electric blankets and most
power tools cannot damage your pacemaker.
•Security systems. Passing through an airport metal detector won't
interfere with your pacemaker, although the metal in it could sound
the alarm. Notify airport security. You have a pacemaker. But avoid
lingering near or leaning against a metal-detection system.
•To avoid potential problems, carry an ID card stating that you have
a pacemaker.
•Medical equipment. Make sure all your doctors and dentists know
you have a pacemaker. Certain medical procedures, such as magnetic
resonance imaging, CT scans, cancer radiation treatment,
electrocautery to control bleeding during surgery, and shock wave
lithotripsy to break up large kidney stones or gallstones could
interfere with your pacemaker.
◉ Heart Valve Surgery. Answer: Open heart surgery similar to CABG
,◉ Prosthetic Heart Valve (synthetic/mechanical). Answer: Life long
anticoagulant therapy with warfarin is required
•INR must be monitored frequently
•Therapeutic goal for patients with mechanical heart valves if 3.0 to
4.0 (Warfarin)
•Teach patients sign and symptoms of bleeding and diet restrictions
◉ Biologic Heart Valve. Answer: Cadaver valves
•Porcine - pig
•Bovine - cow
Advantages
•Tissue valves associated with little risk for clot formation
•Long term anticoagulation is not indicated
Disadvantages
•Replaced every 7-10 years
•Calcium in younger patients breaks down the valves
◉ Care of the external incision (heart valve surgery). Answer: Watch
for fever, drainage, redness at site
,•Return to normal activities after 6 weeks
•Avoid heavy lifting for 3 to 6 months - allow incision to heal
•Avoid invasive dental procedures - increased potential for
endocarditis
•Prosthetic valves - avoid MRI (newer not a problem)
•Medical Alert Bracelet - indicating they are taking anticoagulants
◉ Endocarditis. Answer: Infection of the endothelial surface inside
the heart and valves.
●Can develop with prosthetic heart valves, structural cardiac
defects, IV drug use and in patients with debilitating diseases (CHF),
indwelling catheters, or prolonged IV therapy.
◉ Endocarditis diagnosis. Answer: Positive Blood cultures
•New regurgitant murmur or worsening murmur
•Endocardial involvement on Echocardiogram
◉ Endocarditis Treatment. Answer: Antimicrobials 4 -6 weeks
•Avoid anticoagulants - do not prevent embolization from
vegetations. May result in bleeding. (Exception - if patient has a
prosthetic valve).
◉ Infective Endocarditis clinical manifestations. Answer: Fever
, •Anorexia and weight loss
•Cardiac murmur - almost all patients develop murmurs. New
murmur's or increase in intensity should be reported/documented
•Heart failure - most common complication
•Arterial embolization - fragments of vegetation (clots). Platelets
and fibrin adhere to endocardium.
•Can affect spleen, kidneys, brain, GI (mesenteric) or pulmonary
circulation
•Petechiae
•Splinter hemorrhages - nail beds (black or red streaks)
◉ Infective Endocarditis complications. Answer: Stroke (embolic)
•Damage to the kidneys
•Heart, brain, lung emboli
•Splenomegaly
◉ Cardiomyopathies (Dilated cardiomyopathy). Answer: a condition
in which the heart becomes enlarged and cannot pump blood
effectively. Symptoms vary from none to feeling tired, leg swelling,
and shortness of breath. It may also result in chest pain or fainting.
◉ Cardiomyopathy Interventions. Answer: Treat the same as heart
failure
MASTER REVISION RESOURCE
◉ Pacemaker patient teaching. Answer: Cellphones. keep your
cellphone at least 6 inches (15 centimeters) away from your
pacemaker. Don't keep your phone in a shirt pocket. When talking on
your phone, hold it to the ear opposite the side where your
pacemaker was implanted.
•Household Appliance - Using properly operating household
appliances such as microwave ovens, electric blankets and most
power tools cannot damage your pacemaker.
•Security systems. Passing through an airport metal detector won't
interfere with your pacemaker, although the metal in it could sound
the alarm. Notify airport security. You have a pacemaker. But avoid
lingering near or leaning against a metal-detection system.
•To avoid potential problems, carry an ID card stating that you have
a pacemaker.
•Medical equipment. Make sure all your doctors and dentists know
you have a pacemaker. Certain medical procedures, such as magnetic
resonance imaging, CT scans, cancer radiation treatment,
electrocautery to control bleeding during surgery, and shock wave
lithotripsy to break up large kidney stones or gallstones could
interfere with your pacemaker.
◉ Heart Valve Surgery. Answer: Open heart surgery similar to CABG
,◉ Prosthetic Heart Valve (synthetic/mechanical). Answer: Life long
anticoagulant therapy with warfarin is required
•INR must be monitored frequently
•Therapeutic goal for patients with mechanical heart valves if 3.0 to
4.0 (Warfarin)
•Teach patients sign and symptoms of bleeding and diet restrictions
◉ Biologic Heart Valve. Answer: Cadaver valves
•Porcine - pig
•Bovine - cow
Advantages
•Tissue valves associated with little risk for clot formation
•Long term anticoagulation is not indicated
Disadvantages
•Replaced every 7-10 years
•Calcium in younger patients breaks down the valves
◉ Care of the external incision (heart valve surgery). Answer: Watch
for fever, drainage, redness at site
,•Return to normal activities after 6 weeks
•Avoid heavy lifting for 3 to 6 months - allow incision to heal
•Avoid invasive dental procedures - increased potential for
endocarditis
•Prosthetic valves - avoid MRI (newer not a problem)
•Medical Alert Bracelet - indicating they are taking anticoagulants
◉ Endocarditis. Answer: Infection of the endothelial surface inside
the heart and valves.
●Can develop with prosthetic heart valves, structural cardiac
defects, IV drug use and in patients with debilitating diseases (CHF),
indwelling catheters, or prolonged IV therapy.
◉ Endocarditis diagnosis. Answer: Positive Blood cultures
•New regurgitant murmur or worsening murmur
•Endocardial involvement on Echocardiogram
◉ Endocarditis Treatment. Answer: Antimicrobials 4 -6 weeks
•Avoid anticoagulants - do not prevent embolization from
vegetations. May result in bleeding. (Exception - if patient has a
prosthetic valve).
◉ Infective Endocarditis clinical manifestations. Answer: Fever
, •Anorexia and weight loss
•Cardiac murmur - almost all patients develop murmurs. New
murmur's or increase in intensity should be reported/documented
•Heart failure - most common complication
•Arterial embolization - fragments of vegetation (clots). Platelets
and fibrin adhere to endocardium.
•Can affect spleen, kidneys, brain, GI (mesenteric) or pulmonary
circulation
•Petechiae
•Splinter hemorrhages - nail beds (black or red streaks)
◉ Infective Endocarditis complications. Answer: Stroke (embolic)
•Damage to the kidneys
•Heart, brain, lung emboli
•Splenomegaly
◉ Cardiomyopathies (Dilated cardiomyopathy). Answer: a condition
in which the heart becomes enlarged and cannot pump blood
effectively. Symptoms vary from none to feeling tired, leg swelling,
and shortness of breath. It may also result in chest pain or fainting.
◉ Cardiomyopathy Interventions. Answer: Treat the same as heart
failure
