Problem
Topic: 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.
A. What is the significance of the orthostatic hypotension, wide pulse pressure, and tachycardia?
B. What is the significance of the petechiae and joint pain?
C. Three important diagnostic criteria for infectious endocarditis are anemia, fever, and cardiac murmurs. Explain the cause for each sign.
D. List your top three nursing interventions with rationale for J.R.
E. J.R. is being discharged home with continued IV antibiotics per PICC line.
a. What are five important questions in assessing her home health care needs?