A nurse is caring for an adolescent in an emergency department.
Vital Signs.
2300: Medical History.
Blood pressure 120/78 mm Hg. Apical pulse rate 100/min.
Respiratory rate 20/min.
2400: Temperature 37.9° C (100.2° F). Oxygen saturation 98% on room air.
Nurses’ Notes.
Blood pressure 112/64 mm Hg. Apical pulse rate 108/min.
Respiratory rate 28/min.
Temperature 38.9° C (102° F). Oxygen saturation 95% on room air.
Medical History.
History of rheumatic fever with resulting cardiac valve damage.
Nurses’ Notes.
2300: Adolescent brought to emergency department by their parent.
Adolescent reports intermittent low-grade fever and anorexia.
Manifestations presented a few days after having dental work performed.
Now they are worse.
Adolescent noticed shortness of breath with exertion today.
Adolescent in semi-reclining position.
Respirations easy and unlabored while at rest.
Mild dyspnea observed when adolescent ambulated to the room.
Lung sounds clear bilaterally.
Oral mucous membranes pink with petechiae noted.
Adolescent reports diffuse joint pain as 2 on a scale of 0 to 10. 2400: Adolescent restless and sweating, sitting in high-Fowler’s position.
Dyspnea noted at rest.
Adolescent reports pain in mid-chest as dull, aching, and as 2 on a scale of 0 to 10. Few coarse rales auscultated bilaterally.
The nurse reports the 2400 assessment findings to the provider.
Which of the following should the nurse anticipate the provider will prescribe? For each potential provider’s prescription, specify if the potential prescription is anticipated or contraindicated for the client.
A.
Obtain blood cultures x 3.
B.
Administer antibiotic therapy.
C.
Obtain an echocardiogram.
D.
Restrict dental hygiene.
E.
Perform strenuous exercise regimen twice daily.
The correct answer and Explanation is :
Given the adolescent’s clinical presentation and medical history, here’s an analysis of each potential prescription:
A. Obtain blood cultures x 3
Anticipated. The adolescent’s symptoms, including fever, petechiae, and recent dental work, raise concern for infective endocarditis, especially given the history of rheumatic fever and cardiac valve damage. Blood cultures are crucial for diagnosing bacterial infections that could lead to endocarditis. This step helps identify the causative organism and tailor antibiotic therapy.
B. Administer antibiotic therapy
Anticipated. Given the history of rheumatic fever and current symptoms of fever and petechiae, the adolescent may have infective endocarditis. Antibiotic therapy is essential for treating bacterial infections, especially if blood cultures reveal a pathogenic organism. This treatment is crucial to prevent complications and manage the infection effectively.
C. Obtain an echocardiogram
Anticipated. An echocardiogram is important for assessing the heart valves and detecting signs of endocarditis or other cardiac abnormalities. This imaging can confirm the diagnosis and evaluate the extent of any damage or infection. It helps guide appropriate treatment and management strategies.
D. Restrict dental hygiene
Contraindicated. While the adolescent’s recent dental work may be related to the current symptoms, restricting dental hygiene is not advisable. Maintaining good oral hygiene is important to prevent further complications and infections. However, the adolescent might need antibiotics prior to any future dental procedures to prevent endocarditis, given their cardiac history.
E. Perform strenuous exercise regimen twice daily
Contraindicated. Strenuous exercise is contraindicated in the presence of acute symptoms such as fever, dyspnea, and chest pain. The adolescent should avoid strenuous activities until their condition stabilizes and a thorough evaluation is completed. Exercise could exacerbate symptoms or lead to further complications.
Correct Answer: A. Obtain blood cultures x 3
Explanation: The adolescent’s presentation with fever, petechiae, recent dental work, and a history of rheumatic fever suggests a potential diagnosis of infective endocarditis. The provider will likely start by obtaining blood cultures to identify the causative organism. This is followed by appropriate antibiotic therapy and potentially an echocardiogram for further evaluation.