Question

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.

1. What are diagnostic criteria that favor a diagnosis of infective endocarditis in this patient?

2. What are appropriate treatments for this patient?

3. Identify a priority nursing diagnosis, secondary nursing diagnosis, and collaborative problem for this patient.

4. Identify ten nursing interventions.

5. How will you evaluate your nursing interventions and patient outcomes?

Answer 1

1.The Duke's criteria are used to diagnose the infective endocarditis

• Blood culture should reveal the presence of bacterial growth
• Echocardiogram can reveal the presence of murmur
• Here the patient has a previous history of mitral valve replacement and rheumatic fever
• Fever due to infection
• Histopathologucal examination in case of tissue taken during surgery
• Elevated immunoglobulin G level

2.The appropriate treatment for infective endocarditis are

• Antibiotic therapy are the empirical treatment to destroy the bacteria. Penicillin group are the choice of medication
• Along with penicillin aminoglycoside are administered to the patient

3.Priority nursing diagnosis

Impaired body temperature/Altered body temperature related to infection or bacterial growth secondary to infective endocarditis as evidenced by high grade fever,malaise

4.Nursing intervention

• Monitor vital signs to get baseline data and plan for care
• Administer antibiotics as per order to control infection
• Administer analgesics and antipyretics to reduce pain and fever
• Follow meticulous hand washing to prevent cross infection
• Follow infection control practice to prevent transmission of infection
• Dressing and topical application on the lesion to enhance healing
• Provide small and frequent meal as per the preference to reduce anorexia
• Monitor the patient for any side effects and complications
• Assess the patient vision level as the disease can affect the vision
• Educate the patient about the disease condition

5.Evaluation and outcome

• The patient should maintain a normal temperature
• The lesion should have decreased in intensity
• Patient is able to eat adequately
• Patient is capable of doing daily activities without any fatigue ,tired or body pain