Question

NRSG 2435 Infective Endocarditis (1) Protected View Saved to this PC Layout References Mailings Review View Help net can contain viruses. Unless you need to edit, it's safer to stay in Protected View. Enable Editing NRSG 2515 Infective Endocarditis KEY Infective Endocarditis Mr. H.Y. is a 63-year-old male, who presents to the ER with a two-day history of high-grade fever with chills, "I don't feel well and I think that I may have the flu," he tells the ER nurse and physician. He also complains of "some painful bumps on my fingers and toes that came on last night." He denies IVDA. When asked about recent medical or dental procedures, he responded: "I had an infected tooth removed about two weeks ago." He does not recall receiving any antibiotics either prior to or after the procedure. Patient denies any pain other than the lesions on his fingers and toes. Denies cough, chest pain, breathing problems, palmar or plantar rashes, and vision problems. Experiencing mild malaise and some loss of appetite. Medication Theophylline 100 mg po twice per day Albuterol MDI 2 puffs four times per day as needed Atrovent MDI 2 puffs po twice per day Nadolol 40 mg po each day Furosemide 20 mg po each day Metformin 850 mg po twice per day Past Medical History Asthma, HTN, DM type 2, COPD, Alcoholic liver disease Rheumatic fever as a child with mitral valve replacement 2 years ago Family History Mother: ovarian cancer, died from CVA at age 59 DFecus Father: history of alcohol abuse, MI at age 54, DM type 2, died in his 60s from pancreatic cancer that When finished, make sure to click Submit. Optionally, click Save as Draft to save changes and continue working later, or click Cancel to quit without saving changes

Answer 1

1.Ans:The patient has subacute infective endocarditis.

Rationale: Subacute infective endocarditis is caused by S. viridans

• acute infective endocarditis is caused by S. aureus.
• Subacute is less aggressive infection on abnormal heart valves.

2. Ans: the three medical conditions that predisposes to infective endocarditis are:

• Mitral valve replacement :artificial heart valves causes entry of microorganisms and attached to the heart valves and damage the heart tissues.
• Rheumatic fever: It is an inflammatory disease that can cause permanent damage to the heart and heart valves.
• Dental infection:  dental infection and dental procedures leads to end of microorganisms and results in infection of heart valves.

3.Ans: Penicillin is a drug of choice for infective endocarditis .It is important to identify clinical manifestations of penicillin allergy .the clinical features of penicillin allergy is to initiate alternative drug. The history of mild rashes after taking penicillin is not considered as true allergy. Unless the patient has signs of hypersensitivity, bronchospasm, angioedema, a trial with penicillin may be warranted.

4.Ans: Track marks are associated with petechiae from septic emboli of life threatening infective endocarditis. The abscence of track mark indicates that his condition is not life threatening.