nursing

Case Study, Chapter 28, Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders

1. 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.

a. What risk factors predisposed Ms. Waters to develop infective endocarditis?

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

c. What additional clinical manifestations should the nurse include in the assessment of the patient?

d. What medical management should the nurse anticipate for the patient?

e. What nursing management should be provided for the patient and family?

2. Mrs. Robbins, a 58-year-old patient with suspected aortic stenosis, presents to the cardiac care clinic for evaluation. About 1 month ago she noticed that she was having increasing difficulty completing the 2-mile walk that she had been doing for the last 5 years. The cardiologist has ordered a Doppler echocardiogram to diagnose aortic stenosis definitively.

a. On this visit, Mrs. Robbins states that she is having difficulty sleeping and has episodes of chest pain. How does the nurse correlate these clinical manifestations to aortic stenosis?

b. The nurse assesses Mrs. Robbins for what types of heart sounds that are consistent with aortic stenosis?

c. What is the rationale for prophylactic antibiotics prior to invasive procedures for the patient with aortic stenosis?