Case Study #3
Management of Patients with Structural, Infectious, and Inflammatory Cardiac Disorders
Ariane Waters is 21 years of age and 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.
What risk factors predisposed Ms. Waters to develop infective endocarditis?
Body piercings can be major risk factors for infected endocarditis, especially the tongue piercing since the oral cavity is a main port of entry for the infective endocarditis organisms.
Explain the pathophysiology of infective endocarditis as it relates to this case.
Endocarditis is a noncontagious chronic infection of the valves or lining of the heart chambers, mainly caused by bacteria, although fungi can also be associated with this infection. To develop this infection, you need to have some bacteria or fungi in the bloodstream. The blood usually does not contain any bacteria or fungi. However, some may get into the blood if you have an infection or wound in another part of the body. In particular, dental and mouth infections are situations where bacteria can quite easily get into the bloodstream. In this case, an infection with tongue piercing would be an easy portal. In time, small clumps of material called vegetations may develop on infected valves. The vegetations contain bacteria or fungi, small blood clots, and other debris from the infection. The vegetations may prevent affected valves from opening and closing properly.
What additional clinical manifestations should the nurse include in the assessment of the patient? The nursing assessment will include monitoring for s/s of heart failure which would include: crackles in the lungs, edema, SOB,...
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