NUR 631 Topic 9 DQ 1

Sample Answer for NUR 631 Topic 9 DQ 1 Included After Question

Select two of the following questions for your discussion response. Indicate which questions you have chosen using the format displayed in the “Discussion Forum Sample.” 

Scenario

Mr. K.P. is a 71-year-old male, who presents to your office with a 3-day history of more than 103F with chills. The patient reports, “I don’t feel well, and I think that I may have the flu.” 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 responds: “I had an infected tooth removed about 2 weeks ago.” He does not recall receiving any antibiotics either prior to or after the procedure.

PMH:

  • Asthma since childhood
  • Rheumatic fever as a child x 2 with mitral valve replacement 2 years ago
  • HTN x 20 years
  • DM type 2, x 9 years
  • COPD x 4 years
  • H/O tobacco abuse
  • Alcoholic liver disease

Urinalysis: The urine was pale yellow, clear, and negative for proteinuria and hematuria. A urine toxicology screen was also negative.

ECG: Normal

Transthoracic ECHO: A 3-cm vegetation on the aortic valve was observed. No signs of ventricular hypertrophy or dilation were seen.

Blood Cultures: 3 of 3 sets (+) for Streptococcus viridans (collection times 1030 Tuesday, 1230 Tuesday, 1345 Tuesday)

 Laboratory Blood Test Results

  • Na 135 meq/L
  • K 3.7 meq/L
  • Cl 100 meq/L
  • HCO3 22 meq/L
  • BUN 17 mg/dL
  • Cr 1.0 mg/dL
  • Glu, random 145 mg/dL
  • Hb 14.1 g/dL
  • Hct 40%
  • Plt 213,000/mm3
  • WBC 19,500/mm3
  • Neutros 80%
  • Bands 7%
  • Lymphs 12%
  • Monos 1%
  • Alb 4.0 g/dL
  • ESR 30 mm/hr
  • Ca 8.9 mg/dL 

Questions

  1. Which type of infective endocarditis is suggested by the patient’s clinical manifestations—acute or subacute? Explain your answer.
  2. Which three of the illnesses in this patient’s medical history may be contributing to the onset of infective endocarditis and why are these diseases considered risk factors? Explain each of the factors.
  3. What are the six diagnostic modified Duke University criteria that favor a diagnosis of infective endocarditis in this patient? Explain your answer.
  4. Explain the pathophysiology of proteinuria and hematuria in a patient with infective endocarditis.
  5. Identify four elevated laboratory test results that are consistent with a diagnosis of bacterial endocarditis. And explain the pathophysiology of the elevated values.

A Sample Answer For the Assignment: NUR 631 Topic 9 DQ 1

Title: NUR 631 Topic 9 DQ 1

Which type of infective endocarditis is suggested by the patient’s clinical manifestations—acute or subacute? Explain your answer.

In most cases approximately 50% are Sub Acute IE and are from Streptococcus viridans, bacteria 2’ release by oral cavity and makes it way into the circulatory system to develop transient bacteremia. In addition, usually is not dangerous because of low pathogenicity but with clients that have heart conditions predisposes pathological condition in heart. Therefore, given the hx of rheumatic fever as a child and having a mitral valve replacement 2 years ago places the client at a high risk for IE. In addition, any valvular condition MV, AV,TV, and the valves get colonized by virulence bacteria; Immune complexes reach end of fingers and under finger nails and immune complexes get stuck in capillaries causing vascular lesions and inflammation aka (Type III HS); lesions from palm and of feet are clinical manifestations and vasculitis problems are evident (McCance & Huether, 2019).

4. Explain the pathophysiology of proteinuria and hematuria in a patient with infective endocarditis.

In clinical setting if the client presents with Proteinuria and Hematuria- then evidence that Antigen-Abs complexes get deposited into glomeruli and sever inflammatory changes are made and produce (Diffuse Glomerulonephritis) and almost all glomeruli in both kidneys are inflamed. If glomeruli is to extreme point of inflammation that capillaries start rupturing and basement membrane is injured hence; client develops proteinuria and hematuria and in some cases renal failure is seen in Acute IE than Sub Acute IE (Takata, 2022).

McCance, K. L., & Huether, S. E. (2018). Pathophysiology – e-book (8th ed.). Elsevier Health Sciences.

Takata, T., Mae, Y., Sugihara, T., & Isomoto, H. (2022). Infective Endocarditis-Associated Glomerulonephritis: A Comprehensive Review of the Clinical Presentation, Histopathology, and Management. Yonago acta medica65(1), 1–7. https://doi.org/10.33160/yam.2022.02.011

A Sample Answer 2 For the Assignment: NUR 631 Topic 9 DQ 1

Title: NUR 631 Topic 9 DQ 1

Which type of infective endocarditis is suggested by the patient’s clinical manifestations—acute or subacute? Explain your answer.

Infective endocarditis is a general term used to describe infection and inflammation of the endocardium, especially the heart valves and nearby structures. Many pathogens can cause acute, subacute, and chronic infective endocarditis. Subacute bacterial endocarditis (EBE) is most often caused by a type of streptococci bacteria that live as normal flora of the oral and pharynx (Birlutiu et al., 2018). Patient K.P. presents with a case of subacute bacterial endocarditis related to a tooth infection and recent extraction. Streptococcus viridans was found in all three blood cultures, indicating bacteremia. Streptococcus organisms account for approximately 50-60% of cases of subacute bacterial endocarditis (Birlutiu et al., 2018). The aggravating event of removing the tooth and exposing more bacteria clumps into the blood could contribute to the acute set of symptoms prompting treatment. Similar to the effect of how after abscess drainage, sepsis manifests.

The mouth and throat are susceptible to infection portals with a lot of surface area. Furthermore, the mouth has direct contact with capillaries, fragile tissues, and high absorption. This leaves an opportunity for bacteria to leech into the bloodstream over a period of weeks to years (Birlutiu et al., 2018). Bacteria begin to adhere to the cardiac endothelium triggering an inflammatory response and a buildup of micro plaques that begin as byproducts of the immune response. With ongoing exposure to infection or weakening of defenses, more bacteria stick onto the plaques creating septic lesions and lead to turbulent blood flood.

Bacteria infiltrate the sterile microthrombi produced in bacteremia and accelerate fibrin formation by activating the clotting cascade. This septic microthrombi leaves the patient at high risk for stroke and organ damage. Hallmark signs of infective endocarditis are fever, new or changed cardiac murmur, and petechial lesions of the skin, conjunctiva, and oral mucosa (McCance et al., 2019). Risk factors include prosthetic heart valves, acquired valve insufficiency, previous endocarditis infection, intravenous drug use, poor dentation, and device-related secondary infections. During dental procedures, bacteria can enter the bloodstream (McCance et al., 2019).

Characteristic physical findings include Osler nodes (painful erythematous nodules on the pads of the fingers and toes) (McCance et al., 2019).

Which three of the illnesses in this patient’s medical history may be contributing to the onset of infective endocarditis and why are these diseases considered risk factors? Explain each of the factors.

The three significant medical history are diabetes, mitral valve replacement and history of rheumatic disease. Prosthetic valves are more prone to infection compared to native valves. Diabetes increases the risk of mortality in infectious endocarditis. Rheumatic fever is usually a childhood illness that can develop if strep throat, scarlet fever, and strep skin infections are not treated properly (Hajsadeghi et al., 2018). This causes an exaggerated inflammatory reaction that attacks healthy tissues such as the joints, heart, eyes and other body systems. Acute illness with a strep infection can cause illness in people with prior rheumatic fever. In addition to diagnosing endocarditis with blood cultures and echocardiogram, it is important to seek expert consultation on how to proceed.

References

Birlutiu, V., Birlutiu, R. M., & Costache, V. S. (2018). Viridans streptococcal infective endocarditis associated with fixed orthodontic appliance managed surgically by mitral valve plasty: A case report. Medicine, 97(27), e11260. https://doi.org/10.1097/MD.0000000000011260

Hajsadeghi, S., Hassanzadeh, M., Hajahmadi, M., & Kadivar, M. (2018). Concurrent diagnosis of infective endocarditis and acute rheumatic fever: A case report. Journal of Cardiology Cases17(5), 147–150. https://doi-org.lopes.idm.oclc.org/10.1016/j.jccase.2017.12.011

McCance, K. L., Huether, S. E., Brashers, V. L., Rote, N. S., & McCance, K. L. (2019). Pathophysiology: The biologic basis for disease in adults and children. Elsevier.