infective endocarditis (aortic)

infective endocarditis (aortic)

assignment outlining the care delivered to a patient with a diagnosis of infective endocarditis (aortic) on the assignment outlining the care delivered to a patient with a diagnosis of infective endocarditis (aortic)on the

 

The purpose of this assignment is to demonstrate a critical analysis of the care delivered to this critically ill patient. The patient here is a 32 year old male( lives with brother, working,smoker 10/day,no known allergies, no past medical history, felt suIDenly unwell at work) self presented to accident and emergency with a 24 hour history of headaches and fever. sent home on analgesia and anti-pyretics.bloods normal. returned after 24 hrs feeling no better general aches and pains in all body joints. Blood pressure, pulse and resps normal. ECG ?nil acute Also had painful right big toe with petechaie rash on the pulp and nail bed which became discoloured and necrotic/this picture later was seen in left thumb (septic emboli).CxR, X-rays of toe and thumb showed no osteomyelitis. Had petechaie rash on limbs and some on trunk.blood cultures showed staphylococcus aureus sensitive to flucloxacillin. CT brain normal.MRI normal.Diagnosed and treated for infective endocarditis.ECHO showed left and non coronary cusps of aortic valve thickened, moderate aortic regurgitation, mild tricuspid regurg, pulmonary valve normal, Left ventricular function mildly impaired, ejection fraction 45%. Full blood screening/ Full blood count ? First White cells 4.4, then rose to 11.Platelets 167 dropped to 59Hb- normal included repeated blood cultures/ HIV- neg/viral screening ?neg/Rheumatic factor-neg/Hepatitis screen neg, uric acid normal/calcium, phosphate, magnesium, liver profile and frequent renal profile. Lumbar puncture normal (was initially ? meningitis).Multidisciplinary team involved in care.Consults as follows, cardiology, vascular, microbiologist, Medications given:Initially Tazocin 405g x 12 hrs, then vancomycin aIDed when temperature not settling.Perfalgan given for pyrexia.Post microbiologist review started on floxapen 2g 4hrly, clindamycin 1200 6hrly, ceftriaxone 2g daily and later onto rifampicin 450 twice daily, warfarin, brufen for pain and losec 20mg daily. He was transferred to a surgical centre for aortic valve replacement after 5-6 weeks therapy.Surgery went well.
The assignment must be related to cardiac investigations, rhythm disturbances, treatment used in the care of persons with altered cardiac function and electrolyte and fluids imbalance and their impact on cardiac function.This case assignment should represent the changing pattern of events for the patient and reflect the work of the multidisciplinary team in the care process.
1. Introduction
The introduction should contain:
a) Overall aim
b) A brief introduction to the patient including a social history and an outline of the events leading up to her/his admission to your unit.
c) A brief explanation of the patient?s disease and prognosis (to include pathophysiology and resulting symptoms
2. Assessment
This section should include an overview assessment of your patient. Identify the range of actual or potential problems experienced by the patient and his/her family. Discuss how the problems were identified. The patient?s relevant physiological indices or parameters should be included in this section. Finally from your nursing assessment identify two patient problems that you wish to discuss and explain why these problems were chosen.
3. Interventions & treatment
This section should contain a discussion on the nursing interventions that were delivered in order to help solve or alleviate the two patient problems you wish to discuss. You are expected to draw on relevant research, particularly any relevant nursing research, to inform your arguments in the discussion of your patient care. You should choose research-based studies that support the care needed by this client and discuss how care was, or should have been, influenced by the results of the research.
4. Evaluation
This section should include a discussion on the degree to which the problems were either solved or alleviated.( you can choose any of the problems as follows( cardiac investigations, rhythm disturbances, electrolyte and fluid imbalance and their impact on cardiac function)Were the nursing interventions appropriate? Consider how your evidence-based nursing interventions have impacted on the overall effectiveness and cost of care. On reflection, would any other course of action have proved useful and if so explain why. What evidence is there to support this alternate course of action?
7. Overall Conclusions
A brief summary integrating the main points of the case.
8. List of References
Assignment must be evidence based with primary source data from peer-reviewed journals in past 3-8 years. Promotion of discussion is vital, the following questions can assist in this process:
1. Can you draw any conclusions from the literature, which indicates possible changes in practice?