Med Surg Case Study #17: Rheumatic Endocarditis

Mrs. Jane Thompson

Chief Complaint: Mrs. Thompson presents with complaints of persistent fatigue, shortness of breath, and intermittent chest pain.

Medical History:

• Type 2 Diabetes Mellitus

• Hypertension

• History of Rheumatic Fever in childhood

• Mitral Valve Prolapse

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0800

Nurse's Note: 08:00 AM - Mrs. Thompson was admitted to the medical-surgical unit. Appears fatigued, slightly short of breath, and reports intermittent chest pain. Skin cool and pale. States chest pain began yesterday and has been worsening.

Vital Signs:

• Blood Pressure: 130/80 mmHg

• Heart Rate: 80 bpm

• Respiratory Rate: 18 breaths/min

• Temperature: 98.6°F

• Oxygen Saturation: 93%

1200

Nurse's Note: Mrs. Thompson continues to complain of fatigue. She rates her chest pain at 6/10 on the pain scale. Administered acetaminophen as ordered for pain relief. Vital signs stable, no significant changes noted.

Vital Signs

• Blood Pressure: 140/90 mmHg

• Heart Rate: 85 bpm

• Respiratory Rate: 20 breaths/min

• Temperature: 99.0°F

• Oxygen Saturation: 90%

1600

Nurse's Note: Mrs. Thompson appears more fatigued. Complaints of increased shortness of breath. Auscultation reveals a new systolic murmur. Notified the physician of the changes in the patient's condition.

Vital Signs

• Blood Pressure: 150/95 mmHg

• Heart Rate: 90 bpm

• Respiratory Rate: 22 breaths/min

• Temperature: 99.5°F

• Oxygen Saturation: 89%

Physician's Orders:

1. CBC, CMP, and coagulation panel every 8 hours.

2. Echocardiogram

3. Administer IV antibiotics (penicillin).

4. Administer diuretics (furosemide).

5. Continuous cardiac monitoring.
   

Question 1: Why is an echocardiogram ordered for Mrs. Thompson?

Question 2: Why is furosemide prescribed for Mrs. Thompson?

Question 3: What vital sign changes would be of concern in Mrs. Thompson's case?

Answers to Questions Below

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Answers

Question 1: Why is an echocardiogram ordered for Mrs. Thompson?

The echocardiogram is ordered to assess Mrs. Thompson's cardiac function and evaluate any potential valve abnormalities, given her history of rheumatic fever and new-onset systolic murmur.

Question 2: Why is furosemide prescribed for Mrs. Thompson?

Patients with cardiac conditions, especially those affecting the valves like rheumatic endocarditis, may experience fluid retention. This can lead to symptoms such as shortness of breath and fatigue. Furosemide helps to alleviate this fluid overload by increasing urine output, thereby reducing excess fluid in the body.

Question 3: What vital sign changes would be of concern in Mrs. Thompson's case?

Increasing heart rate, elevated blood pressure, rising respiratory rate, and decreased O2 saturation would be concerning vital sign changes. These could indicate worsening cardiac function and increased stress on the heart. Continuous monitoring is crucial to detect any deterioration promptly.