Healthcare Assignment: Endocarditis Case Study of Patient J.F.

This assignment presents a detailed analysis of a 50-year-old patient, J.F., with recurrent infective endocarditis, focusing on her complex medical history and current presentation. The solution addresses various aspects of her condition, including orthostatic hypotension, tachycardia, abdominal tenderness, hematuria, joint pain, and petechiae. It explains clinical findings such as splinter hemorrhages and the appropriate placement of a stethoscope for auscultation. The assignment also covers diagnostic criteria, including blood tests (CBC, BUN, creatinine, glucose, Hct, and Hgb) and echocardiograms. The solution also discusses the interpretation of lab values, potential risks like inability to oxygenate, and necessary monitoring parameters. Furthermore, it explores the questions needed for assessing the patient's home situation, education for J.F. and her family, and short- and long-term goals. It concludes with an example of a patient statement regarding oral hygiene.

Running head: ENDOCARDITIS
ENDOCARDITIS
Name of the Student
Name of the University
Author note

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Answer 1
Orthostatic hypotension, also known as postural hypotension, occurs when there is a
sudden decrease in the systolic blood pressure almost about 20mmHg or there is a fall in the
diastolic blood pressure to at least 10mmHg (Cahill et al., 2017). It leads to dementia, cognitive
function, heart failure, stroke and cardiovascular disease if not treated immediately.
Tachycardia is a disease, which makes the heart to beat faster (100 times per minute). It
signifies stroke, cardiac arrest, and heart failure if not treated immediately.
In both the disease, the valve of the heart cannot close properly.
Answer 2
Abdominal tenderness is a pain a person is experiencing when pressure is applied to their
abdomen during a checkup. Doctors generally perform diagnosis to identify the organs by
touching the belly. J.F might go through this diagnosis.
Hematuria is a condition that arises when blood comes out during urination. Hematuria
signifies the occurrence of infection in the urinary tract.
Joint pain occurs when there is an injury in the ligaments leading to inflammation and
joint pain. A severe joint pain signifies the occurrence of arthritis that needs serious medical
treatment.
Petechiae is a circular spot developing on the skin that further leads to bleeding. It
signifies the breakage of blood vessels that causes the dripping of blood under the skin (Baddour
et al., 2015). All together sign of embolization.

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Answer 3
Splinter hemorrhages are smaller blood spots under the nails. It occurs due to the damage
in the tiny blood vessels in the nail bed. It signifies the cause of blood clots; microemboli in the
capillaries. If it is caused without any injury, there it is analyzed that splinter hemorrhages
caused due to blood vessel damage (Cahill et al., 2017).
Answer 4
The stethoscope needs to be placed at the J.F’s base of the heart.
Answer 5
Signs and symptoms for embolization that J.F might go are the radiation of pain in the
chest, difficulty in breathing, wheezing, weakness and facial drooping.
Answer 6
The diagnostic criteria required for infectious endocarditis in case of J.F are by checking
the murmuring sound of the heart, which is done with a stethoscope by the physician. The

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physician also checks whether the person is suffering from fever or feeling of an enlarged spleen.
However, if the doctor feels that the person is undergoing an infective endocarditis blood test
would be recommended. Complete blood count (CBC) is done to check whether the patient has
anemia (Van Dijck et al., 2015). Lower count in red blood cell (RBC) signifies endocarditis. The
physician might order for an echocardiogram; it is an ultrasound of the heart done to get a clear
image of the heart.
Answer 7
The values that are not within the normal range for J.F report are BUN, creatinine,
glucose level, Hct, and Hgb. The BUN level is higher than the normal range of 7 to 20 mg/dL,
which means J.F is suffering from renal failure, or she is suffering from dehydration or heart
failure. Normal creatinine ranges from 0.6 to 1.2 mg/dL. J.F lab test showed a very high
creatinine level signifying kidney failure. The normal blood glucose level is 100-140 mg/dL
("American Health Association – Committed to Excellence," 2020). J.F has a blood glucose level
of 160 mg/dL that signifies that she is suffering from stress and hypertension. Hct normal range
is 37-48% for female and Hgb level for women is 12 to 15.5 gm/dL J.F is having lower Hct
which means that her body is lacking red blood cells. Low hemoglobin count means that she is
suffering from anemia.
Answer 8
Yes, it is appropriate from J.F as she is suffering from low blood glucose; hence it is
strongly recommended to keep a tract of her glucose level before and after taking food.
Answer 9

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The greatest risk for J.F would be the inability to oxygenate. The growth in the vascular
volume with aortic stenosis would cause heart failure. Things required to be monitored increased
dizziness, dyspnea, lethargy, anxiety and crackles. Regular monitoring of heart sounds beside an
hourly output of urine needs to be noted.
Answer 10
The questions required for assessing are whether J.F knows to measure blood glucose,
whether she has electric system, phone or running water system in her home, if she can
administer TPN (Total parenteral nutrition) properly, whether J.F can take IV (intervenous)
antibiotics by herself regularly and if she is having a proper support system at her home.
Answer 11
Six things that are required to teach J.F and her family are various sterile techniques used
during medication and maintained in regular lives, effective hygiene for hand, use of syringe and
size to be flushed, different flushing technique, identifying the signs of infection and bathing
practice.
Answer 12
a. “I will remove my bridge after every meal and clean it thoroughly before replacing it.”
Answer 13
Two short-term goals would be the ability for validating IV and TPN antibiotic and by
precise care of PICC (Peripherally inserted central catheter) line from the second day itself. The
long term goals would be PICC line should remain undamaged; she should be free from PICC
line obstacles and must exhibit operative coping practices.

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References
American Health Association – Committed to Excellence. (2020). Retrieved 4 February 2020,
from https://americanhealthassoc.org/
Baddour, L. M., Wilson, W. R., Bayer, A. S., Fowler Jr, V. G., Tleyjeh, I. M., Rybak, M. J., ... &
Bolger, A. F. (2015). Infective endocarditis in adults: diagnosis, antimicrobial therapy,
and management of complications: a scientific statement for healthcare professionals
from the American Heart Association. Circulation, 132(15), 1435-1486.
Cahill, T. J., Baddour, L. M., Habib, G., Hoen, B., Salaun, E., Pettersson, G. B., ... &
Prendergast, B. D. (2017). Challenges in infective endocarditis. Journal of the American
College of Cardiology, 69(3), 325-344.
Van Dijck, I., Budts, W., Cools, B., Eyskens, B., Boshoff, D. E., Heying, R., ... & Gewillig, M.
(2015). Infective endocarditis of a transcatheter pulmonary valve in comparison with
surgical implants. Heart, 101(10), 788-793.