Infective Endocarditis Case Summary

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

The following are symptoms according to the American Red Cross Nursing Assistant text book the patient could experience: “Slurring of words, Drooping of the features on one side of the face (for example, the eyelid and the corner of the mouth), trouble seeing in one or both eyes, weakness or numbness in an arm or leg, a sudden, severe headache, dizziness or loss of balance, confusion, or a loss of consciousness, a generally ill appearance, or abnormal behavior” (Page 91). Our text book in chapter 18 calls the weakness hemiparesis and the paralysis is called hemiplegia. These are experienced on one side of the body. F.A.S.T is a great way to check

The patient is an 85-year-old female who is brought to the ED by her family because of increasing confusion and supposedly she had a degree of altered mental status of two hours previous to presentation. In the ED she is completely worked up. CT shows advanced atrophy with microvascular changes and several lacunar infarcts nothing acute. Specific gravity in the urine reveals her to be markedly dehydrated. She culture completely, started on IV antibiotics, IV fluids and B12. On the day after admission she still presents as persistently confused. She is evaluated by PT. The patient who was formerly ambulating with a walker and allegedly driving a car is unable to be ambulated. Before the history indicates that she has a slow downward

A week after initial admission, the patient is on the medical surgical floor recovering from his transverse colostomy five days ago. At 1200 vital signs are as follows, temperature 99.1; pulse 96; respirations 18; blood pressure 141/69; pulse ox is 94% on 1L NC in AM. The patient appears acutely ill and lays in bed with his eyes closed even when family comes into the room to check on him. He is alert and oriented to person, but not place or situation. He appears lethargic and is slow to respond to questioning, this appears to be due to recent administration of pain medication. Pupils are equal round and reactive to light and grips are week bilaterally in hands. Abdomen is firm, distended, and non-tender. Colostomy site appears to be

The patient is an 88-year-old gentleman who is brought to St. Joe's ER complaining of inability to walk. The patient 6 days ago began to having trouble walking with his walker. He reported left arm pain which radiated up his left arm. The patient had pain in the left foot. The patient was taken to St. Joseph's Hospital in Wayne. In the ER he was diagnosed with gout and begun on Colchicine. Since that time he has shown no improvement. He has become essentially chair-bound and unable to walk so he is brought to St. Joe's ER. His medical history is significant for atrial fibrillation, hypertension, hyperlipidemia, coronary artery disease and the patient also has a colostomy bag he had a procedure done and they were unable to connect is

Based on the medical report dated 03/25/16, the patient continues to have significant headaches and bilateral neck and shoulder pain. IW has numbness and tingling in both arms with neck pain.

Musculoskeletal- erosive destructive changes in the elbows, wrist, and hands consistent with rheumatoid arthritis, has bilateral total knee replacements with stovepipe legs and perimalleolar pitting edema 1+. I feel no pluses distally in either leg.

A seventeen year old male arrived at the medical facility ambulatory. The patient was in route to neurology for evaluation when he abruptly became camtose (in a state of unconsciousness or coma). Patient was observed afflicted with hemiparesis (feeling weak on one half of the body or the other) in his left side which quickly escalated to hemiplegia (loss of the ability to move half of the body). Also leading up to the coma the patient showed ataxia (lack of muscle coordination) (Gylys, 2013), and during attempts to verbally keep him conscious he was aphrasic (unable to speak). The patient’s record indicates hereditary cerebrovascular disease (any functional abnormality of the cerebrum caused by disorders of the blood vessels of the brain)

Infective endocarditis has been around for many centuries. A man named Lazaire Riviere, while performing an autopsy, first discovered infective endocarditis in 1674 (Brusch, 2015). Since the first findings documented were after death, there was still much research to do in this area of cardiovascular science. William Olser was the first person to compile an in-depth explanation of infective endocarditis in English in the year of 1885. Furthermore, in 1966, the first modern-times symposium of infective endocarditis was developed as a series of journal articles by authors Lerner and Weinstein, which was published in the New England Journal of Medicine (Brusch, 2015). Although the understanding and research of this disease is well understood

The patient’s chief complaint was weakness and reduced sensations in the left leg and left arm since June 2005 when he suffered from stroke. Also, the patient complained of difficulty in performing activities of daily living like buttoning his shirt, eating, etc. since then. The patient also mentioned that he has difficulty in identifying the weight of an object e.g. light or heavy when he uses his right hand. The patient described his weakness as heaviness which starts from left elbow, which goes down till left fingers and from left knee till left toes. The weakness started when patient suffered from stroke back in 25th June 2005. His left side was totally paralyzed even though the patient could use his left side before stroke for activities like writing, throwing, balling, etc. The patient had several episodes of fall after that till date. Currently, he said he falls

the heart, particularly the heart valves. It happens when microscopic organisms spread through the circulation system and area inside the heart

Phialemonium curvatum can rarely causes heart infections too. However immunosuppressed patients are more favored to become infected due to their lower immunofunction. Endocarditis infection normally occurred in the heart valves and P. curvatum has been directly linked to this infection through the transplantation of a prosthetic aortic valve or penile injections. In the endocarditis infection, P. curvatum create a mass on the heart valve. IF it was untreated, it can lead to the impairment of the heart valve and it may cause a brain infract and consequently death (Osherov et al, 2006). The patients who were suffered endocarditis caused by P. curvatum can be possibly treated with antifungal medications such as amphotericin B and

Mrs Carter’s ability to mobilise will be assessed to determine her ability to mobilise safely and independently, since the left sided hemiplegic may cause mobility impairment. The Physiotherapist will be needed to assess Mrs C the patient and also engage her in activities to tackle the muscle weakness in her left extremities (Mant & Walker, 2011). Mobility impairment may put her at risk of Deep vein thrombosis (DVT) (Tollefson et el 2012) and

Before discussing Infective Endocarditis, it’s imperative to understand where the endocardium is along with its function because endocarditis affects this area of the heart. The Endocardium is the innermost layer of heart tissue that lines the cavities and valves of the heart and is composed of loose epithelial and connective tissue. The endocardium regulates contractions of the heart and helps regulate the composition of the blood that feeds the tissues of the heart (Kenney, 2015). Infective Endocarditis, IE, is an infection of the endocardium that generally occurs when bacteria or germs from another part of the body, such as the mouth, spread through the bloodstream and attach to damaged areas in the heart (Endocarditis Definition, 2015). Individuals that have an increased risk of developing Endocarditis include:

The patient 78-year-old female who is brought to the ED after dialysis treatment complaining of severe pain in her extremities. It is chronic pain, but it has worsened over the past 2 weeks in her arms, leg and back. She is known to have history of DVT, coronary artery disease, asthma,end-stage renal disease on dialysis,congestive heart failure, hypertension, had a past pulmonary emboli, COPD, non-insulin-dependent diabetes, arthritis, hypothyroidism had a right hip replacement and afistula in her left upper arm. The patient underwent a physical therapy eval in the ED, which reveals she needs moderate assistance to transfer to sit to stand, again moderate assist of two to transfer the goal is to develop independence of transfer. The gait