Question

Provide your possible answers to the following case study. Apply all you understand from the lecture including critical thinking for this case study.

Scenario:

Ariane Waters, 21 years of age, is a female patient who is admitted to the hospital with the diagnosis of infective endocarditis. Ariane had her tongue and nose pierced 6 weeks ago. The drug screen is negative. She presents with tricuspid insufficiency murmur grade II, and a temperature of 104°F. The patient complains of extreme fatigue, and anorexia. The echocardiogram reveals vegetations on the tricuspid valve. (Learning Objective 4)

b.) Explain the pathophysiology of infective endocarditis as it relates to this case.

Answer 1

INFECTIVE ENDOCARDITIS

microbial infection of the endothelial surface of the heart.

Risk factors

• prosthetic cardiac valves
• history of bacterial endocarditis
• congenital heart disease
• IV injection drug users
• patients receiving hemodialysis or prolonged IV fluid or antibiotic therapy.
• those who are taking immunosuppressive medications and corticosteroids.
• invasive procedures involving mucosal surface

since this patient is drug test negative, and no other medical condition, but she pierced her nose and tongue recently (almost 6 weeks ago). Here comes the risk factor of invasive procedure involving mucosal surface or body piercing (oral, nasal and nipple piercing)

Primary symptoms would be fever and heart murmur

when disease get worse other symptoms appears like

• clusters of petechia may be found on the body
• Osler nodes ( small and painful nodes)in the pads of finger and toes
• Irregular, red or purple, painless macules on the palms fingers, hands, soles and toes
• Roth spots(haemorrhages with pale centres )in eyes
• splinter haemorrhages
• cardiomegaly, heart failure, tachycardia, splenomegaly may occur
• valvular stenosis
• mycotic aneurysm
• atrioventricular block

central nervous system

• headache
• stroke
• transient cerebral ischemia

Pathophysiology

tongue piercing and nose piercing caused the bacterial entry; bacteremia, which rarely lasts for more than 15 minutes.infectiuos organisms may be staphylococci, streptococci, enterococci, pneumococci, or chlamydia. microorganisms cluster as vegetation on the endocardium. the vegetation may embolisms to other parts of the body. the infection may erode through the endocardium into the underlying structures like valve leaflets, causing tears or other deformities, later, pulmonary emboli may occur with right-sided heart infective endocarditis.