Question

J.R. is a 50-year-old homemaker with a Streptococcus mutans infection of the aortic valve 1 month ago. During her hospitalization, an ultrasound showed moderate aortic stenosis, moderate aortic insufficiency, chronic valvular vegetations, and moderate left atrial enlargement. J.R. has been readmitted with endocarditis, N/V, and renal failure. She has chills, fever, fatigue, joint pain, and headache. She is immediately started on Penicillin 2 million units IVPB every 4 hours to be continued for 4 weeks. Other medications are Lasix, Metoprolol, and Prochlorperazine. Her vital signs are 152/48 supine and 100/40 sitting, 116, 22, and 100.2 degrees F. Her assessment shows a murmur, 2+ pitting edema in legs, clear lungs. Oriented X 3 but drowsy, multiple petechiae on the skin of arms, legs, and chest soft abdomen.

What is the significance of the orthostatic hypotension, wide pulse pressure, and tachycardia?

What is the significance of petechiae and joint pain?

Three important diagnostic criteria for infectious endocarditis are anemia, fever, and cardiac murmurs. Explain the cause for each sign.

List your top three nursing interventions with rationale for J.R.

J.R. is being discharged home with continued IV antibiotics per PICC line.

What are five important questions in assessing her home health care needs?

Answer 1

●Orthostatic hypotension occurs to a patient when there is a sudden drop of blood pressure below the normal range immediately after a posture change. Here the patient has aortic stenosis which means narrowing of the blood vessels. So when thus patient changes a posture the risk for fall is greater because the blood pressure cannot be effectively maintained with this narrow blood vessels.

The wide pulse pressure can occur when there is a great difference between the systolic and diastolic pressure. This is because 9f the infection in the heart.

The heart rate has increased to meet the demands or the needs of the heart pumping and to maintain a normal circulation

● The petechiae in infectious endocarditis is because of the infection in the endovascular areas of the blood vessels .This infection will result in inflammation of the joint and cause pain at joints.

●When the infective agent enters the cardiovascular system initially affecting the muscle and tissues of the heart. This can cause stenosis due to thrombos formation in the cells.This alters the cardiac functions and causing murmurs.This also impairs the circulation decreasing the blood hemoglobin levels causing anemia.In order to fight the infection the body temperature raises.

●The nursing intervention and rationale are

• Acute pain (joint ,head) related to inflammatory process as evidenced by pain in the joint and headache
  • Assess the level of pain ,baseline information to plan for care
  • Administer analgesics, NSAIDS to reduce pain
  • Provide calm and quite environment to relax
  • Provide massage to enhance circulation and relaxation
• Risk for fall related to disturbed cardiac function as evidenced by low blood pressure or orthostatic hypotension
  • Monitor vital signs, baseline to plan care
  • Administer intravenous fluids to stabilize the blood pressure
  • Teach patient the posture when getting up from lying down or sitting position to standing position
• Imbalanced thermoregulation related to infection as evidenced by raise in body temperature
  • Monitor vital signs
  • Administer antipyretics to reduce body temperature
  • Administer antibiotics to treat infection
  • Meticulous hand hygiene to prevent cross contamination
  • Aseptic procedures to prevent infection

●Educate the patient about the medication and its side effects and its complex details about administration with proper healthcare professionals help

Maintain the PICC line dry ,to prevent infection and detachment

Cover it to prevent unnecessary exposure to external environment

Report in case of any bleeding, hematoma, discharge, tenderness at the site.

Complete antibiotic course as recommended, not to stop in between which can aggravate the symptoms on reoccurrence.

●The important questions to assess her home healthcare needs are

• Ability of patient to do activities of daily living with pr without support
• Guidance and support in taking the IV injection
• Knowledge about self care
• Family participation in the care
• Diet of the patient
• Follow up