Differential Diagnosis- Infective Endocarditis

Case Study 2

Liz is a 79-year-old female with a history of aortic stenosis and hypertension. The patient underwent elective aortic valve replacement yesterday. This AM during rounds, the patient is sitting up in the chair. Vital signs: 99.4-54-20-85/50. Pa 29/13, CVP10. Urine output 20 ml/hr for the last 3 hours. Cardiac output 3.9, cardiac index 1.8. Patient’s preop ef was 50%. Labs are as follows:

K 4.0 Normal
Cr 1.5 Adult female 0.5-1.1 mg/dL
BUN 42 8-21 mg/dL
Decreased Output
Hgb 9.8 Adult female11.7-15.5 g/dL
Hct 29.1 Adult female 38-44%
Plt 138 150-450 x 10^3/uL Thrombocytopenia
Postoperative chest X-ray normal
Slightly elevated temperature
Bradycardia
Hypotension
Pa 29/13 Normal 20-30/8-12
CVP 10 Normal 2-6
Cardiac output 3.9 Normal 4-8 L/min
Cardiac index 1.8 Normal 2.5-4.0
What is the definientia diagnosis. Please do not chose hypovolemia?

What treatment and management will this patient being on?

What patient education will you provide for your patient?

What is Norvasc used for? what are the side effects? What is the black box warning on Norvasc?

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The most probable differential diagnosis for this patient is infective endocarditis. Patients who have undergone valve replacement surgeries are at high risk of sepsis due to a compromised immune system after surgery, the presence of an intravenous catheter and the nature of the surgery which is invasive (Horstkotte & Bodnar, 2013). The pharmacological management will include the use of intravenous 1gram ceftriaxone up to six weeks and administration of crystalloid intravenous fluids to enhance the patient’s hemodynamic status.

The patient will be education to watch for danger signs such as: bleeding, swelling or drainage from the surgical incision site, pain and numbness (Lough, 2015). Besides, the patient will be educated on the need for lifestyle modification so that the performance of the replaced valve is not affected. This modification will include: avoidance of smoking, eating a diet with lower cholesterol and salt, mild physical exercise to lose weight, and either quitting or moderating alcohol intake to promote a healthy heart (Lough, 2015)Differential Diagnosis- Infective Endocarditis.

Norvasc is a calcium channel blocker also referred to as amlodipine. It is used for the management of hypertension such that, it lowers the blood pressure by dilating the blood vessels and improving the flow of blood (Karch, 2016). By lowering blood pressure, Norvasc helps to reduce the risks of a patient getting a heart attack or stroke. The major side effects of Norvasc include; fatigue, edema, nausea, and abdominal pain. The black box warning on Norvasc is that Norvasc often results to symptomatic hypotension more so in patients who have severe aortic stenosis (Karch, 2016). Besides, it tends to worsen acute myocardial infarction and angina in patients who have severe obstructive coronary artery disease.

References

Horstkotte, D., & Bodnar, E. (2013). Infective endocarditis. London, England: ICR Publishers.

Karch, A. M. (2016). Focus on nursing pharmacology.

Lough, M. E. (2015). Priorities in critical care nursing Differential Diagnosis- Infective Endocarditis.

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