Name Group Members INSTRUCTIONS: All questions apply to this case study. Your re
ID: 122422 • Letter: N
Question
Name Group Members INSTRUCTIONS: All questions apply to this case study. Your responses should be brief and to the point. Adequate space has been provided for answers. When asked to provide several answers, they shoukd be Ested in order of priority or significance. Do not assume information that is not provided. Please print or write clearly. If your response ls not legible, will be marked as 7 and you will need to rewrite it Scenario J.F. is a 50-year-old married homemaker with a genetio autolmmune deficiency she has suftered frorm recurront bacterial endocarditis. The most recent episodes were a Staphylococcus aureus infec- tion of the mitral valve 16 months ago and a Streptococcus mutans infection of the aortic valive 1 month ago. During this latter hospitalzation, an ech showed aortic stenosis, moderate aortic insufficlency, chronlc valvular vegetations, and moderato atrial enlargement. Two years ago J .F. roceived an 18-month course of TPN therapy for mainutrition caused by idiopathic, relentless nause and vomiting (NV). She has also had CAD for several years, and 2 years ago rior wall MI. In addition, she has a history of chronic joint pain. suftered an acute ante- Now, after being home for only a week, J.F. has been readmitted to your Tioo floor with endocarditis, she also has NV, and renal failuro. Sinco yesterday she has been vomiting and retching constarnthy had chillis, fevor, fatigue, joint pain, and headache. As you go through the admisson process wit you note that she wears glasses and has a dental bridge. She is immediately started on TPN at 125 units IV q4h, to be continued for 4 weeks. Other medications are furosemide 80 mg PO qd, amiodipine 5 mg PO qd, K-Dur 40 mEq PO qd (dose adjusted according to laboratory results), metoprolol 25 mg PO bid, and droperidol 0.25-0.5 ml IVP pm for NN. Admission are 152/48 (supine) and 100/40 (sitting), 116, 22, 37.9 C. When you assess her, you find a grade IINI holosystolic murmur and a grade IIVI diastolic murmur, 2+ pitting tibial edema but no peripheral cyanosis; clear lungs; orlentation x 3 but drowsy soft abdomen with slight LUQ tenderness; hema- turia; and multiple petechiae on skin of arms, legs, and chest VS 1. What is the significance of the orthostatic hypotension, the wide pulse pres O O O o orthosraatic wpotension ec SoLttme sure, and the tachycardia? 83 nec etxs mess, he and petechiae? Copyright 2001 by Mosby,Inc. All ights reservedExplanation / Answer
Abdominal tenderness, hematuria, joint pain and petechiae are the signs of emobilization that results in infraction of various organs and this is the complication of endocarditis. Infraction of Spleen results in abdominal tenderness. Infraction of kidney results in hematuria and this reduces urine output. Arthritis results from emobilization to joints and petechiae results from emobilization to small skin vessels.
Related Questions
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.