Question

Mr. Dugan is an 18-year-old patient who is being admitted from the emergency department with a diagnosis of sepsis. The patient is a current IV drug user. The patient's vital signs are: T: 104 F, HR:138 RR: 32, and oxygen saturation: 90% at 6 liters per min via high-flow nasal cannula. The patient states "I have been taking my antibiotics like my doctor wants me to, but the infection keeps coming back." The patient is noted to have the following physical findings: splinter hemorrhages; a systolic murmur on a^uscultation, Osler's nodes on his fingers and Janeway's lesions on his palms and the soles of his feet.

He is ordered Vancomycin, 2 gm, IV QD. (20 points each)

• Identify three diagnostic studies, with rationales, that should be ordered by the provider and why.
• Provide a possible explanation for the systolic murmur and any patient teaching implications.
• Besides IV drug use, identify five other risk factors for infective endocarditis.
• After a week in the hospital, the physician orders a PICC line to be placed and consults home health for antibiotic administration and teaching. Develop a teaching plan for a patient who requires home antibiotic therapy, providing a rationale for each intervention.

Answer 1

ANSWER 1. THREE DIAGNOSTIC STUDIES , WITH RATIONALES, THAT SHOULD BE ORDERED BY THE PROVIDER:

1. BLOOD TESTS: BLOOD CULTURE IS DONE TO DETECT THE SPECIFIC BACTERIA RESPONSIBLE FOR THE INFECTION.IT IS ALSO HELPFUL IN DETECTING ASSOCIATED SYMPTOMS LIKE ANEMIA BY HEMOGLOBINE TEST.
2. ECHOCARDIOGRAM:TWO TYPES OF ECHOCARDIOGRAM ARE UTILIZED TO CHECK FOR ANY SIGNS OF INFECTION .

• TRANSTHORACIC ECHOCARDIOGRAM :IT IS USED TO CHECK FOR ANY STRUCTURAL DAMAGE TO THE HEART OR PRESENCE OF ANY INFECTION.
• TRANSESOPHAGEAL ECHOCARDIOGRAM:TO EXAMINE THE HEART VALVES IN DETAIL FOR ANY INFECTION.

      3. CHEST XRAY: TO DETECT IF THE ENDOCARDITIS HAS PRODUCED ENLARGEMENT OF THE HEART   DUE TO INFECTIONS OR TO EXAMINE ANY SIGNS OF INFECTION SPREAD TO THE LUNGS .

ANSWER 2:RISK FACTORS FOR ENDOCARDITIS:

• HEART VALVE DAMAGE LEADS TO SCARRING WHERE INFECTION GROWS.
• PREVIOUS HISTORY OF ENDOCARDITIS WHICH HAS CAUSED TISSUE DAMAGE.
• PRESENCE OF ANY DEFECT IN THE HEART.
• PRESENCE OF PREVIOUS HEART VALVE REPLACEMENT.

ANSWER 3:TEACHING PLAN FOR HOME ANTIBIOTIC THERAPY WITH RATIONALE FOR EACH INTERVENTION:

PICC REFERS TO THE PERIPHERALLY INSERTED CENTRAL CATHETER TO DELIVER IV MEDICATIONS TO PATIENTS WITH SERIOUS INFECTIONS WHO REQUIRE LONG-TERM TREATMENT BUT DOES NOT REQUIRE TO STAY IN HOSPITAL.

1. INTERVENTION:PROPER MAINTENANCE OF GOOD DENTAL HYGIENE AND PERIODIC VISITS TO THE DENTISTRY.

RATIONALE: TOOTH INFECTION IS A MJOR SOURCE OF INFECTIVE WHICH MAY LEAD TO ENDOCARDITIS.

2.REPORT TO THE PROVIDER IF THERE ARE ANY COMPLAINTS OF CHEST PAIN, SHORTNESS OF BREATH, FEVER.

RATIONALE: THE INFECTION MIGHT RETURN.