Jessica Year Married Explained for Students (Easy Guide)
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Original Question
Jessica is a 50-year-old married woman with a genetic autoimmune deficiency; she has had recurrent infective endocarditis. The most recent episodes were a Staphylococcus aureus infection of the mitral valve 16 months ago and a Streptococcus viridans infection of the aortic valve 1 month ago. During the latter hospitalization, an echocardiogram showed moderate aortic stenosis, moderate aortic insufficiency, chronic valvular vegetations, and moderate left atrial enlargement. Two years ago, Jessica received an 18-month course of parenteral nutrition (PN) for malnutrition caused by idiopathic, relentless nausea and vomiting (N/V). She has had coronary artery disease for several years and 2 years ago had an acute anterior wall myocardial infarction (MI). In addition, she has a history of chronic joint pain. Now, after having been home for only a week, Jessica has been readmitted to your floor with infective endocarditis (IE), N/V, and renal failure. Since yesterday, she has been vomiting and retching constantly. She also has had chills, fever, fatigue, joint pain, and headache. As you go through the admission process with her, you note that she wears glasses and has dentures. Intravenous (IV) access is obtained with a double-lumen peripherally inserted central catheter (PICC) line. Other orders and your assessment are shown in the box. Admission Orders STAT blood cultures (aerobic and anaerobic) × 2, 30 minutes apart STAT CMP & CBC Begin PN at 85 mL/hr Piperacillin sodium/tazobactam sodium (Zosyn) 2.25 g q6h Vancomycin (Vancocin), renal dosing per pharmacy, IVPB q12h Furosemide (Lasix) 80 mg PO daily Amlodipine (Norvasc) 5 mg PO daily Potassium chloride (K-Dur) 40 mEq PO daily Metoprolol (Lopressor) 25 mg PO bid Ondansetron 4 mg IV every 6 hours PRN Transesophageal echocardiogram ASAP Admission Assessment Blood pressure 152/48 (supine) and 100/40 (sitting) Pulse rate 116 beats/min Respiratory rate 22 breaths/min Temperature 100.2°F (37.9°C) Oriented × 3 to person, place and time, but drowsy. Grade II/VI holosystolic murmur and a grade III/VI diastolic murmur. Lungs clear bilaterally. Abdomen soft with slight left upper quadrant tenderness. Multiple petechiae on skin of arms, legs, and chest; splinter hemorrhages under the fingernails, hematuria noted in voided urine. Laboratory Test Results Na 138 mEq/L (138 mmol/L) K 3.9 mEq/L (3.9 mmol/L) Cl 103 mEq/L (103 mmol/L) BUN 85 mg/dL (30.3 mmol/L) Creatinine 3.9 mg/dL (345 mcmol/L) Glucose 165 mg/dL (9.2 mmol/L) WBC 6700/mm3 (6.7 x 109/L) Hct 27% Hgb 9.0 g/dL (90 g/L) What is the specific pathophysiology of Jessica’s infective endocarditis? What assessment data above supports this diagnosis? What is significant about abdominal tenderness and petechiae with this diagnosis? What are you going to specifically monitor the following anatomy for and how? (i.e. monitor coronary arteries for signs of angina, MI, heart failure, and cardiac dysrhythmias through EKG, BNP, pulse, blood pressure, respiratory rate, cardiac enzymes, and patient’s description of chest pain.) a. Cerebral: b. Extremities: c. Spleen: d. Kidneys: e. Bowels: 5. List which labs are abnormal and give a brief explanation of that abnormality. 6. Why is Vancomycin ordered? What are key nursing considerations with administering this medication?
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