Task:
The most recent episodes were a Staphylococcus aureus infection of the mitral valve 16 months ago and a Streptococcus viridans infection of the aortic valve 1 month ago. During the latter hospitalization, an echocardiogram showed moderate aortic stenosis, moderate aortic insufficiency, chronic valvular vegetations, and moderate left atrial enlargement. Two years ago, J.F. received an 18-month course of total parenteral nutrition (TPN) for malnutrition caused by idiopathic, relentless nausea and vomiting (N/V). She has had coronary artery disease for several years and, 2 years ago had an acute anterior wall myocardial infarction (MI). In addition, she has a history of chronic joint pain. Now, after having been home for only a week, J.F. has been readmitted to your floor with endocarditis, N/V, and renal failure. Since yesterday, she has been vomiting and retching constantly; she also has had chills, fever, fatigue, joint pain, and headache. As you go through the admission process with her, you note that she wears glasses and has a dental bridge. Intravenous (IV) access is obtained with a double lumen peripherally inserted central catheter (PICC) line. Other orders and your assessment are shown in the box.
What is the significance of the orthostatic hypotension and tachycardia?
What is the significance of the abdominal tenderness, hematuria, joint pain, and petechiae?
What are splinter hemorrhages and what is their significance?
Mark the area on the accompanying diagram where you would place the stethoscopeto auscultate an aortic valve murmur.<!– [if gte mso 9]> <w:LsdException Locked=”false” Priority=”99″ Se
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