Endocarditis Case Study 1. Ms. Collins, a 25-year old female,

Endocarditis Case Study 1. 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. • What initial nursing assessments need to be performed for Ms. Collins? 2. 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 Ht170 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” • What are your top concerns for Ms. Collins at this time? Why? • What other orders do you anticipate the provider ordering for Ms. Collins? • What assessments are outside of the normal range? • Why do you think the doctor has ordered a CBC? • Why do you think the doctor has ordered a BMP? • What is the patient’s weight in pounds? • List 4 other questions that you would want to ask about her pain: 3. 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. • Which order would you implement first? Why? • Why do you think the doctor has ordered blood culture? Why do they want to perform two sets of blood cultures? • Which one of the orders listed above could you delegate to a nursing support tech? 4. 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/mcLBUN 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. • What, physiologically, is going on with Ms. Collins at this time? • What is the likely cause of Ms. Collins’ endocarditis? Explain. • What is the pathophysiology of Endocarditis • What are the causes of Endocarditis? • What are the signs and symptoms of Endocarditis? • Explain in detail the following assessment findings that can be signs and symptoms as the Endocarditis advances: o Osler nodeso Splinter Hemorrhageso Janeway Lesionso Roths spots • Why might Ms. Collins’ blood pressure still be low at this time? • Why is it important that Ms. Collins’ infected teeth are removed? • What is the normal range for the following lab values:o WBCo BUNo Creatinineo Lactic acid • What do you think could be happening to Ms. Collins now that her left eye and mouth are drooping, and she reports a headache? • List the signs and symptoms of a stroke: • What puts Ms. Collins at risk of developing a stroke? • List 6 potential nursing diagnosis for a patient suffering a stroke, of the 6 that you list, make one your priority. For each diagnosis, list two interventions and a measurable outcome for each intervention. In total you will have 6 problems, 12 interventions and 12 measurable outcomes. o Nursing diagnosis 1â–ª Intervention 1• Measurable Outcomeâ–ª Intervention 2• Measurable Outcomeo Nursing diagnosis 2â–ª Intervention 1• Measurable Outcomeâ–ª Intervention 2• Measurable Outcomeo Nursing diagnosis 3o Intervention 1â–ª Measurable Outcomeo Intervention 2â–ª Measurable Outcomeo Nursing diagnosis 4o Intervention 1â–ª Measurable Outcomeo Intervention 2â–ª Measurable Outcomeo Nursing diagnosis 5o Intervention 1â–ª Measurable Outcomeo Intervention 2â–ª Measurable Outcomeo Nursing diagnosis 6o Intervention 1â–ª Measurable Outcomeo Intervention 2â–ª Measurable Outcome 5. 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 education topics would you want to provide to Ms. Collins before discharge? • What is considered a normal EF (ejection fracture)? • What is the rationale for discharging the patient with the following medications? o Plavixo Aspirin Developing a teaching pamphlet on Endocarditis: • Your pamphlet must be colorful and include the following:o Risk factorso Signs and symptomso When to call the primary care providero Treatmentso Prevention strategieso Online and community resources for further information (list at least three).o Be creative with the design, include at least 4 pictures and make the information engaging and understandable for the patient.

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