Endocarditis Flashcards
You are teaching a patient with endocarditis about his diagnosis. Which statement below is correct?
a. Endocarditis is a viral infection that is easily treated with antibiotics.
b. The risk of this diagnosis is occlusion of the coronary arteries.
c. A long course of antibiotics is needed to treat this disorder.
d. Complications are rare after antibiotics have been started.
ANS: C
Treatment requires prolonged IV therapy with adequate doses of antimicrobial agents tailored to the specific infective endocarditis microbe and patient circumstances. Antibiotic treatment is prolonged, administered in high doses intravenously, and may involve combination therapy. Best outcomes are achieved if therapy is initiated before hemodynamic compromise
A patient is admitted to the ICU with diagnosis of fever of unknown origin. The patient is complaining of fatigue, malaise, joint pain, and shivering. VS include: T 103F, HR 90 beats/min, RR 22 breaths/min, BP 132/78, and O2sat 94% on 2L/NC. Blood cultures are ordered. The patient has a history of MI 3 months ago. The nurse suspects that the patient has developed
a. CAD.
b. heart failure.
c. endocarditis.
d. pulmonary embolus.
ANS: C
Initial symptoms include fever, sometimes accompanied by rigor (shivering), fatigue, and malaise, with up to 50% of patients complaining of myalgias and joint pain. Blood cultures are drawn during periods of elevated temperature.
A patient with infective endocarditis is admitted to the health care facility. The nurse is aware that primary lesions of infective endocarditis can cause emboli. Which organ may be affected by the process of embolization due to right-sided heart lesions? 1 Brain 2 Spleen 3 Lungs 4 Liver
ANS: 3
Right-sided heart lesions move to the lungs, resulting in pulmonary emboli. Systemic embolization occurs from left-sided heart lesions moving to the brain, spleen, liver, and kidneys.
The nurse is assessing a patient with a pacemaker during a follow-up visit. The patient has red, painful, tender, pea-sized lesions on the fingertips and toes. How should the nurse document this finding? 1 Splinter hemorrhages 2 Osler's nodes 3 Janeway's lesions 4 Roth's spot
ANS: B
The nurse should document this finding as Osler’s nodes. Osler’s nodes are red or purple, tender, pea-size lesions on the fingertips and toes that are vascular manifestations of infective endocarditis. Other vascular manifestations include splinter hemorrhages, Janeway’s lesions, and Roth’s spots. Splinter hemorrhages are black longitudinal streaks in the nail beds. Janeway’s lesions are flat, painless, small, red spots on the palms and soles. Roth’s spots are hemorrhagic retinal lesions that are revealed by funduscopic examination.
A nurse is performing discharge teaching for a patient with a diagnosis of subacute infective endocarditis. Which statement by the patient indicates a need for further teaching?
1 “I will make sure to plan rest periods during any of my activities.”
2”Will you give me a prescription so I can take my antibiotics by mouth.”
3”Fatigue, malaise, or chills might indicate a recurrence of the infection.”4
“Before I schedule my dentist appointment, I will tell my health care provider.”
ANS: 2
Intravenous, not oral, antibiotic therapy is the prescribed treatment for subacute infective endocarditis. Rest periods during activities will decrease the cardiac workload. Fatigue, malaise, or chills are signs and symptoms that may indicate recurrent infection. Prophylactic antibiotic therapy is needed before dental procedures to reduce the risk of recurrent infective endocarditis.
While doing an admission assessment, the nurse notes clubbing of the patient's fingers. Based on this finding, the nurse will question the patient about which disease process? 1 Endocarditis 2 Acute kidney injury 3 Myocardial infarction 4 Chronic thrombophlebitis
ANS:A
The nurse is caring for a patient with infective endocarditis and should monitor for which complication that occurs due to pulmonary emboli? 1Ischemia 2Hemiplegia 3Hemoptysis 4Splenomegaly
ANS: 3
Hemoptysis is the coughing up of blood; this condition is caused by pulmonary emboli in patients with infective endocarditis. Ischemia occurs due to emboli in small peripheral blood vessels of the arms and legs. Hemiplegia occurs due to brain embolization. Splenomegaly occurs due to spleen embolization.
What nursing action should the nurse prioritize during the care of a patient who recently has recovered from rheumatic fever?
1Teach the patient how to manage his or her physical activity.
2Teach the patient about the need for ongoing anticoagulation.
3Teach the patient about the need for continuous antibiotic prophylaxis.
4Teach the patient about the need to maintain standard infection control procedures.
ANS:3
Patients with a history of rheumatic fever frequently require ongoing antibiotic prophylaxis, an intervention that necessitates education. This consideration is more important than activity management in preventing recurrence. Anticoagulation is not indicated in this patient population. Standard precautions are indicated for all patients.
The nurse is assessing a patient with rheumatic fever in the outpatient unit of a health care facility. Foe which condition should the nurse assess the patient?
1 Subcutaneous nodules over all bony surfaces
2 Petechiae in the conjunctivae, lips, buccal mucosa, and palate
3 Painful, tender, red or purple, pea-size lesions on the fingertips or toes
4 Black longitudinal streaks in the nail beds
ANS: 1
When assessing the patient with rheumatic fever, the nurse should inspect the patient’s skin for subcutaneous nodules by palpating over all bony surfaces and along extensor tendons of the hands and feet. Patients with infective endocarditis are assessed for petechiae in the conjunctivae, lips, buccal mucosa, and palate; Osler’s nodes are painful, red or purple, pea-size lesions found on the fingertips or toes; and splinter hemorrhages are black longitudinal streaks that may occur in the nail beds.
