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?
KRISTELLE
Concepts Covered:
- Cardiac Disorders
- Cardiovascular
- Circulatory System
- Nervous System
- Skeletal System
- Emergency Care of the Cardiac Patient
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Renal
- Respiratory
- Test Taking Strategies
- Note Taking
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Respiratory System
- Urinary System
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- Lower GI Disorders
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- EENT Disorders
- Central Nervous System Disorders – Brain
- Documentation and Communication
- Preoperative Nursing
- Disorders of the Adrenal Gland
- Disorders of the Thyroid & Parathyroid Glands
- Endocrine System
- Legal and Ethical Issues
- Adult
- Basics of NCLEX
- Communication
- Understanding Society
- Immunological Disorders
- Substance Abuse Disorders
- Studying
- Fetal Development
- Terminology
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Eating Disorders
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Anxiety Disorders
- Depressive Disorders
- Oncology Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Respiratory Emergencies
- Noninfectious Respiratory Disorder
- Basics of Chemistry
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Digestive System
- Behavior
- Postpartum Care
- Basic
- Integumentary Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Basics of Human Biology
- Postoperative Nursing
- Urinary Disorders
- Neurological Emergencies
- Prenatal Concepts
- Disorders of Thermoregulation
- Community Health Overview
- Neurological Trauma
- Renal Disorders
- Concepts of Mental Health
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Postpartum Complications
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Health & Stress
- Multisystem
- Proteins
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Endocrine and Metabolic Disorders
- Musculoskeletal Disorders
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Female Reproductive Disorders
- Basics of Sociology
- Neurological
- Intelligence and Language
- Labor and Delivery
- Reading
- Oncologic Disorders
- Bipolar Disorders
- Med Term Basic
- Peripheral Nervous System Disorders
- Infectious Disease Disorders
- Muscular System
- Central Nervous System Disorders – Spinal Cord
- Learning Pharmacology
- Prioritization
- Somatoform Disorders
- Writing
- Pediatric
- Emergency Care of the Respiratory Patient
- Sensory System
- State of Consciousness