Endocarditis Case Study (45 min)
Included In This Lesson
Study Tools For Endocarditis Case Study (45 min)
Outline
Ms. Collins, a 25-year old female, presents to the Emergency Department (ED) complaining of chest pain and tooth pain. You notice her eyes are bloodshot and she has what appear to be recent track marks from IV drug use on her arms. She is breathing rapidly and seems very uncomfortable. She has very poor dentition and appears to have multiple cavities and broken teeth. She denies any medical history.
Upon further assessment, Ms. Collins’ lungs are clear, pulses are 2+ bilaterally in radial and pedal pulses, S1 and S2 are present with a loud systolic murmur over the mitral and tricuspid valves. She has small bruises on her hands and arms and says her fingers are always cold. She admits to the use of IV heroin and cries that she wants to stop using. Per the provider, you insert a 20g peripheral IV in her left forearm and send a CBC and BMP. Her vital signs are as follows: BP 98/62 mmHg Ht 170 cm HR 92 bpm and regular Wt 55 kg RR 32 bpm SpO2 92% on Room Air Temp 37.9°C Pain 4/10, “comes and goes” The ED provider orders the following: Blood – Blood Cultures x 2, Lactate level Diagnostics – CXR, Cardiac Echo. Interventions – 12-Lead ECG. Nasal Cannula to keep SpO2> 92%. Meds – Vancomycin 1,000mg IVPB one time, now. Morphine 2 mg PRN q4h for pain. The 12-lead ECG shows normal sinus rhythm at 96 bpm with no ST abnormalities. After drawing blood cultures, you initiate the Vancomycin IVPB. The echocardiogram is completed which shows vegetation on valves and moderate to severe endocarditis with an EF of 50%. She is still complaining of chest pain so you also administer 2 mg Morphine IV push and place her on a bedside monitor. Ms. Collins’s lab results have resulted, the following abnormal values were reported: WBC 23,000/mcL BUN 38 mg/dL Creatinine 2.4 mg/dL Lactate 2.7 mmol/L You return 30 minutes later to take another set of vital signs and find Ms. Collins’ left eye and mouth drooping, she reports a new headache. You notify the provider who orders a STAT Head CT. The scan shows multiple small embolic strokes. Ms. Collins is admitted to the cardiac telemetry unit for monitoring and continuous heparin infusion. She is also initiated on three different IV antibiotics to be administered around the clock. After 24 hours, her facial drooping and headache have resolved. Her vital signs are as follows: BP 90/56 mmHg SpO2 94% on 2L nc HR 102 bpm Pain 5/10 chest, comes and goes 3/10 left jaw pain, continuous RR 26 bpm After 3 weeks of IV antibiotics, Ms. Collins is taken to the OR to remove 6 infected molars. She recovers well and is tolerating all antibiotics and medications. Her most recent echocardiogram showed less vegetation and inflammation and an EF of 65%. Three weeks later she has completed a 6-week course of antibiotics and is able to receive a balloon valvuloplasty. She is now ready to be discharged home on clopidogrel (Plavix) and Aspirin.
What initial nursing assessments need to be performed for Ms. Collins?
What are your top concerns for Ms. Collins at this time? Why?
What other orders do you anticipate the provider ordering for Ms. Collins?
Which order would you implement first? Why?
What, physiologically, is going on with Ms. Collins at this time?
What is the likely cause of Ms. Collins’ endocarditis? Explain.
Doctors determine that Ms. Collins needs to have her mitral valve repaired, but that multiple teeth will need to be pulled first to prevent further infection or complications. Why might Ms. Collins’ blood pressure still be low at this time?
Why is it important that Ms. Collins’ infected teeth are removed?
What education topics would you want to provide to Ms. Collins before discharge?
Rina’s NCLEX Study Plan 2026
Concepts Covered:
- Endocrine System
- Studying
- Urinary System
- Tissues and Glands
- Nervous System
- Circulatory System
- Medication Administration
- Hematologic System
- Skeletal System
- Digestive System
- Respiratory System
- Emergency Care of the Cardiac Patient
- Reproductive System
- Endocrine and Metabolic Disorders
- Basics of Human Biology
- Muscular System
- Sensory System
- Communication
- Legal and Ethical Issues
- Basics of NCLEX
- Prenatal Concepts
- Prioritization
- Fundamentals of Emergency Nursing
- Documentation and Communication
- Delegation
- Community Health Overview
- Factors Influencing Community Health
- Concepts of Mental Health
- Test Taking Strategies
- Note Taking
- Substance Abuse Disorders
- Behavior
- Concepts of Population Health
- Concepts of Pharmacology
- Health & Stress
- Labor and Delivery
- Gastrointestinal Disorders
- Microbiology
- Depressive Disorders
- Postpartum Care
- Emergency Care of the Trauma Patient
- Emotions and Motivation
- Growth & Development
- Intelligence and Language
- Psychological Disorders
- State of Consciousness
- Respiratory Disorders
- EENT Disorders
- Infectious Disease Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Hematologic Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Renal and Urinary Disorders
- Oncologic Disorders
- Anxiety Disorders
- Cognitive Disorders
- Eating Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Bipolar Disorders
- Developmental Considerations
- Psychological Emergencies
- Somatoform Disorders
- Perioperative Nursing Roles
- Preoperative Nursing
- Central Nervous System Disorders – Brain
- Lower GI Disorders
- Peripheral Nervous System Disorders
- Cardiac Disorders
- Integumentary Disorders
- Musculoskeletal Disorders
- Noninfectious Respiratory Disorder
- Postoperative Nursing
- Respiratory Emergencies
- Intraoperative Nursing
- Disorders of Pancreas
- Urinary Disorders
- Neurological Emergencies
- Central Nervous System Disorders – Spinal Cord
- Renal Disorders
- Infectious Respiratory Disorder
- Sexually Transmitted Infections
- EENT Disorders
- Shock
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- Disorders of the Posterior Pituitary Gland
- Endocrine
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- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Neurological
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- Acute & Chronic Renal Disorders
- Disorders of the Adrenal Gland
- Immunological Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Musculoskeletal Trauma
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- Male Reproductive Disorders
- Newborn Complications
- Disorders of Thermoregulation
- Neurological Trauma
- Integumentary Important Points
- Multisystem
- Emergency Care of the Neurological Patient
- Emergency Care of the Respiratory Patient
- Prefixes
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- Fetal Development
- Terminology
- Proteins
- Statistics
- Med Term Basic
- Med Term Whole
- Basics of Mathematics
- Basics of Sociology
- Pregnancy Risks
- Labor Complications
- Newborn Care
- Postpartum Complications
- Understanding Society
- Adult
- Dosage Calculations
- Adulthood Growth and Development
- Learning Pharmacology