After receiving change-of-shift report on four patients admitted to a heart failure unit, which patient should the nurse assess first?

Rationale:
A. Percutaneous transluminal balloon valvuloplasty (PTBV) is a minimally invasive procedure that dilates the stenotic mitral valve without replacing it. Since no prosthetic valve is implanted, clients typically do not require lifelong anticoagulation, which is a major advantage over mechanical valve replacement.

B. While PTBV is less invasive than open surgery, it usually requires moderate sedation or general anesthesia for patient comfort and safety. Local anesthesia alone is rarely sufficient.

C. PTBV improves valve opening temporarily, but valve restenosis can occur over time, so the correction is not necessarily permanent. Valve replacement provides a more long-term solution.

D. While PTBV avoids prosthetic material and thus may reduce some infection risks, infection is generally not the primary concern with valve replacement, and the overall difference in infection risk is not a primary advantage cited for PTBV.

Rationale:

A. While documentation is important, a weight gain of ≥2 lb (≈1 kg) in 1–3 days and generalized edema indicates fluid retention and possible worsening heart failure, which requires immediate provider notification, not just documentation.

B. Although adherence to diuretics is important, simply confirming this does not address the acute risk of fluid overload and possible decompensation. Immediate action is required.

C. Education is important for prevention, but in this case, the patient is already showing signs of worsening heart failure, so reinforcing education alone is insufficient.

D. Rapid weight gain and generalized edema over a short period are red flags for fluid overload. The nurse should contact the provider immediately to report findings and receive guidance for interventions such as adjusting medications, evaluating for hospitalization, or further monitoring.