case presentation on infective (aortic) bacterial endocarditis

present the care delivered to patient during one nursing duty and demonstrate a critical analysis of the care delivered to a critically ill patient relating to cardiac investigations,rhythm disturbance,treatment in care for patient with altered cardiac cardiac function, fluid and electrolyte imbalance and its impact on cardiac function. Presentation is to represent the changing pattern of events and reflect the work of the multidisciplinary team.Structure (1)introduction: overall aim. Patient is a 32 year old 80kg male. No previous Hx.Non smoker, social drinker.Works in family business.Self referral to A/E with 2 day Hx of headache and pyrexia (39)nausea and general malaise.Also c/o pain in R big toe, pulp of toe redness.Brief explaination of disease and prognosis(include pathophysiology and resulting symptoms.(2)Assessment of pt.Identify range of actual or potential problems experienced.Discuss how these were identified.Include patients physiological parameters. Identify 2 problems for detailed discussion and explain why these were chosen.(3)Interventions and treatments.Discuss nursing interventions delivered to alleviate or solve the 2 pt problems discussed.(Must use relevant research, particularly nursing research) to inform the arguments.Use research based studies that support the care needed for infective endocarditis or should have been- influenced by the results of the research.(4)Evaluation:Discuss the degree to which the problems were solved/alleviated.Were nursing interventions apropiate? Discuss how evidence based nursing here has impacted on the overall effectiveness and cost of care.On reflection would any other course of action prove useful and why(using evidence).
Blood cultures showed gram positive staphaureus bacteraemia
Heart Rate: sinus tachy 106-110
Echo reduced LV function and dilated LV with ej 30%. Ct brain normal. day 2 mri showed abscess formation at parietal/ occipitaljunction.also developed splinter haemorrhages in left hand and widespread petechaie over body and limbs.regular blood screening etc. referrals to cardiology/ vascular/infectious diseases/microbiologist/opthalmology/cardiac surgeon. Aortic valve replaced 4 weeks after first admission.Tx given, IV fluids, IV tazocin, vancomycin and floxapen. Brufen for pain. Perfalgan for temp.MRSa screen (normal).Urine mixed staph growth.Pt nursed in CCU.

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