Question

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Topic 1: Care of the Patient with Inflammatory Diseases of the Heart

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 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 the 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

1.In orthostatic hypotension Her blood vessels get narrowed due to clott so if she has any change in the posture which can cause her to fall.because of the thrombi present in the blood vessels her blood presure cannot become stable soon.

In wide pulse presure due to infection and heart valves weak heart works more harder than normal.

In tachycardia inorder to compensate with decreased blood presure heart reate become faster

2.in petachiae small or purple spot would occur on the skin.it occurs when small capillarey bolld vessels destruct and bleeds

Inflammation occurs in any part of the bone,ligaments ,cartilage or myscles leads to the occurence of arthrittis

3.aneamia occurs in endocardittis due to the causative organism of endocardittis which increases anemia and reticulocytes when infection increSes.

Fever occurs due to the infection or inflammattion in endometrial valves caused by intoduction of bacteria in it.

Cardiac functin get varied because of the i flammation in the heart valves.due to this cardiac murmur can hear in infective endocardittis.

4.administration of antibiotics according to physicians order to reduce infection

Vital signs should be checked every hourly to know the variation in blood presure and pulse

Measures should be taken to prevent falling due to orthostatic hypotension

Diet should include iron rich food to reduce aneamia

5.assess the understanding of contineuing medication

Assess the knowledge about die

Check patient and family understands about how to prevent falling

Check that they clearly understand aboutsign

And symptomps of complications

Check they u xerstood about the importance of follow up

Check tbet thir understanding about care of picc line

Chek they understood that how to prevent infection in home