Question

ut References Mailings Review View Help contain viruses. Unless you need to edit, it's safer to stay in Protected View. Enable Editing KEY NRSG 2515 Infective Endocarditis Infective Endocarditis Mr. H.Y. is a 63-year-old male, who presents to the ER with a two-day history of high-grade fever with chills, "I don't feel well and I think that I may have the flu," he tells the ER nurse and physician. He also complains of "some painful bumps on my fingers and toes that came on last night." He denies IVDA. When asked about recent medical or dental procedures, he responded: "I had an infected tooth removed about two weeks ago." He does not recall receiving any antibiotics either prior to or after the procedure. Patient denies any pain other than the lesions on his fingers and toes. Denies cough, chest pain, breathing problems, palmar or plantar rashes, and vision problems. Experiencing mild malaise and some loss of appetite. Medication • Theophylline 100 mg po twice per day Albuterol MDI 2 puffs four times per day as needed Atrovent MDI 2 puffs po twice per day Nadolol 40 mg po each day Furosemide 20 mg po each day Metformin 850 mg po twice per day Past Medical History Asthma, HTN, DM type 2, COPD, Alcoholic liver disease Rheumatic fever as a child with mitral valve replacement 2 years ago Catage from pancreatic cancer that

Answer 1

1.An acute refers to sudden spurt of signs and symptoms in hours to days where as subacute refers to the signs and symptoms present and spurts out slowly over weeks to months.

Here the patient developed symptoms in a period of two days but the organism could have developed post tooth procedure where antibiotics was not given hence can be categorized in subacute infective endocarditis

2.The history of

• Rheumatic fever as a child is a strong risk factor for this bacteria to grow and cause infections
• The mitral valve replacement is a surgical procedure which could have led to the invasion of the bacteria and causing easy infection
• Tooth extraction without any post prophylaxis of antibiotics can induced the growth of bacteria

3.The clinical manifestation of penicillin are very important because they can cause hives,rash ,urticaria and can lead to anaphylactic reactions and cause irreversible damage and death.

4.This track mark called as Dukes criteria in the diagnosis. The absence of these marks makes the patient less complicated to loss of vision, lesions and heart murmur.