Name: Crisha Ann Bacuta Year/ Course: 2- BSN

1. Why is N.B. at risk for infective endocarditis?

The reason why N.B is at risk due to his age for the reason it this incidence is higher in
older adults and the invasive endoscopic cholecystectomy because cholecystectomy is generally
recommended for people with symptoms related to gallstones. however, People at high
risk of surgical complications including elderly people and people with co-existing illness can
become very unwell as a result of inflammation of the gallbladder.

2. What asymptomatic underlying cardiac conditions might have contributed to his infective
endocarditis?
The asymptomatic underlying cardiac conditions might have contributed to N.B’s
infective endocarditis are the Mitral valve prolapse and degenerative valve lesions. It is the
calcification degeneration of a bicuspid aortic valve or senile calcification degeneration of a
normal aortic valve.
3. Explain the cause of N.B.’s assessment findings.
Stroke signs include embolism of vegetations to the cerebral circulation and cerebral
infarction. Petechiae are caused by the fragmentation and microembolization of vegetative
lesions. A new systolic, crescendo-decrescendo murmur has been discovered: The involvement
of the aortic valve Fever: An infection that affects 90% of patients with infective endocarditis.
4. What is the relevance of the endoscopic surgery that N.B. had a few weeks before this hospital
admission?
The relevance of endoscopic surgery that N.B had few weeks before the admission to the
hospital is by providing a route for introduction of bacteria into the bloodstream to trigger the
infectious process due to the fact bacteria get into the bloodstream regularly when eating, during
teeth brushing and when passing stools. Normal heart valves are very resistant to infection, but
diseased valves have defects on the surface where bacteria may attach. The bacteria rapidly form
colonies, grow vegetations and produce enzymes, destroying the surrounding tissue and opening
the path for invasion.
5. What diagnostic tests should the nurse expect to be ordered and what will the results show?
The results regarding to the diagnostic test that the nurse expected to be ordered are Two
blood cultures drawn 30 minutes apart from two different sites are positive in 90% of patients;
usually shows Staphylococcus aureus or Steptococcus viridians; mild leukocytosis, increased
erythrocyte sedimentation rate (ESR), and elevated C-reactive protein (CRP); and
echocardiogram may show vegetation on the heart valves.

6. What treatment should the nurse anticipate for N.B.?

The treatment that the nurse should anticipate for N.B are the Identification of the
organism with blood cultures and appropriate IV antibiotic therapy; antipyretics to control fever;
rest, with increase in activity after fever abates and if there are no symptoms of heart failure; and
valve replacement if there is no response to antibiotic therapy
7. Discuss how N.B.’s infective endocarditis could have been prevented.
Preoperative antibiotic prophylaxis is administering antibiotics before performing surgery
to help decrease the risk of postoperative infections. Lifelong antibiotics are not necessary to
prevent infective endocarditis. however, Preoperative antibiotic prophylaxis should be given to
people who are most likely to have severe complications if they develop infective endocarditis for
the reason Infective endocarditis is an infection inside the chambers of the heart or on the heart
valves. Infectious endocarditis may be triggered by a clot forming on the lining of the heart or on
one of its valves in response to damage on the valve surface. Once this clot forms, bacteria that
may be present in the bloodstream (bacteremia) can stick to the clot and proliferate (multiply)
within it, eventually interfering with the heart's function.
8. Priority Decision: Based on the assessment data presented, what are the priority nursing
diagnoses? Are there any collaborative problems?
Nursing diagnoses: 1.Hyperthermia related to infection, elevated temperature
2.Decreased cardiac output related to valvular insufficiency 3.Risk for impaired skin integrity
related to immobility. In addition, For Collaborative problems: Potential complications: emboli,
heart failure