MAHARAJA VINAYAK NURSING COLLAGE JAIPUR
JAIPUR NURSING COLLEGE
JAIPUR
CASE PRESENTATION
ON
ENDOCARDITIS
SUMBITTED BY: SUBMITTED TO:
MR. PRADEEP JAJORIA DR.YOGESH YADAV
MSC NURSING 1st Year MEDICAL & SURGICAL
JAIPUR NURSING COLLEGE JAIPUR NURSING
JAIPUR COLLAGE JAIPUR
DATE OF SUBMISSION-06-06-2017
101
Profile of the patient
Name of the patient Mr. Sunil Raj
Age 45
Marital status Married
Hospital registration No. 2018
Ward/Bed No. ICCU14
Address Asha Bhava, new colony, chomu
Raj.
Telephone No. -
Religion Hindu
Education Primary
Admission Date 04/03/13
Discharge Date 12/03/13
Diagnosis Endocarditis
Name of Doctor Dr. A.K. Choudhary
Occupation of patient Agriculture
Monthly family income 1000/-
Nursing alert No specific allergy or sensitivity
to other medication
Weight 58 kg
Height 5.9 ft
102
Chief complain with duration The patient was suffering from
severe carditis and
polyarthritis. He is also
suffering fever dyspnea also.
These symptoms are occur
since 1 week
History
1. History of patient illness
The patient was admitted in the hospital on 04/08/13 with
the complaints of fever, chest pain, carditis, polyarthritis,
heart murmir etc. he is under the treatment of Dr. A.K.
choudhari. Now it diagnosed that he had endocarditis.
2. History of past illness
The patient does not have any past medical history such as
any communicable disease like TB, Malaria, Jaundice etc.
3. Family history
Type of family nuclear
No. of family members 5
Head of family Mr. Kumar C.N.
4. Health facility near home
Type no facility
Transportation facility available
5. Housing
Type pucca house
No. of rooms 2
Toilet Indian
Electricity yes
Drinking water tap water is available
6. Personal history
Oral hygiene maintenance
Bath tapid bath
103
Diet vegetarian
No. of meals per day 3
Fluid four glass per day
Tea and coffee one cup of tea
Sleep and rest uninterrupted
Naps normal
7. Elimination
Bowl per day regular
Urine frequency 3 time day and 1 time at night
8. Sexual and martial history
Spouse good
Spouse occupation housewife
Relationship satisfactory
Staying together yes
No. of children 2
General health unhealthy
9. Substance use
10. No action to any substance
11. Observation ad assessment
General appearance nourished
Sensorium oriented
Emotional state normal
Foul body odour no
Foul breath no
Posture normal
Gait normal
Bleeding no bleeding
Discharge no specific discharge
Hair clean
Pediculosis no
Eye/ENT normal eye, no abnormality/no
difficulty in ENT
104
Teeth and guns healthy
Oral mucosa no lesions
Giands no enlarged
Chest no abnormality
Abdomen normal
Limbs no abnormality
Toes and nails shape and curvature is normal
Skin dry skin
Dependency level of patient partially dependent
Anatomy and physiology
Anatomy of heart
The human heart is conical, muscular, hollow of gain located
within the mediastinum of thorax and resting upon the
diaphragm with its narrow apex directed downwards and slightly
to left. It measures about 12 cm long and 9 cm breath. The heart
is protected by a double membraneous sac called pericandium
Human heart is 3 chambered. It has 2 auricle and 2 ventricles
the auricles are the upper chanbers while ventricles are lower
chambers externally a transverse groove is present between
auricles and ventricles called coronary sulcus. The auricles are
thin walled and are separated a by a intrauriular septum. The
right auricles are receives deoxygenated blood from various body
parts through to large venis known as superior venacava and
inferior venacava. The left auricles receives blood from blood
forn the lungs by pulmonary veins. The ventricles are thick
walled shich are separated by interventricular septum from the
right ventricle arises an artery known as pulmonary artery.
Which carry deocygenated blood to the lungs for purification
from the left ventricle arises a blood vessel known as arota it
carry deoxygenated blood to the various body parts.
Functions of heart
105
1. The function of the heart is to maintain a constant
circulation of blood throughout the body
2. Cardiac cycle : the successive events that are taking place
with each heart beats are known as cardiac cycle
3. Cardiac output: with each heart beat the heart sends about
70 ml of blood form either ventricle into the
systemic/pulmonary circulation. This is known as stroke
volume. The total volume of blood ejected out in 1 minute is
known as cardic output
4. Cardiac output: a life long series of electrical impulse
generated in the heart by its specilised cell cause the
muscle fibres of auricle and ventricles to contact and relax
rhythmically and in a co-ordinated manner. These
specialised cells constitute the conduction system of heart.
5. To pump blood to various parts of the body
6. Oxygenation of blood
Description of disease
Endocarditic
Introduction of disease
Endocarditic is the infection of endocardium heart valves or
cardiac prosthesis. Endocarditic is mainly two types infective
endocarditic and rheunantic endocarditic infective endocardits is
an infectio of the valve and the endothetial surface of heart it is
caused by direct invasion or bacteria and other organism leading
to deformity of the valve leftlets
Rhemantic endocarditis is associated with rhemantic fever cause
by group A bata disease is acute inflammatory reaction involving
all layers. The resulting damage to the heart form disease is
chronic condition characterized by scanning and deformity of the
heart vlaves.
Definition
106
Rheumantic endocarditis is damage done to the heart
particularly the valves resulting in valve leakage or obstruction
(narrowing or stchosis) there are associated compensatory
changes in the size of heart’s chambers and the thickness of
chamber walls.
Etiology
According to book According to patient
Streptococcal pharangitis Rhemantic heart disease
Cardiac vascular disease
Degenerative heart disease
Rhemantic heart disease
Calufic acrtic stenosis
Asymmetrical spetal
hypertlrophy
Long term hemodialysis
Pathophysiology
Due to any etiological cause
Fibrin and platelets cluster on valve tissue and engulf circulation
bacteria or fungi
Leukocyte accumulate in the affected tissue and from nodules
These nodules are replaced by scar tissue
Inflammation of myocardium
Thematic pericarditis occurs during acute illness
Rheumantic endocarditis
107
Clinical manifestation
According to book According to patient
Polyarthritis, warm and Polyarthritis
swollen joints Carditis
Carditis Feer heart murmurs
Subcutaneous nodules Shortness of breath
Fever
Heart murmurus, pleura and
pericardial rubs
Shortness of breath
Crackles and wheezes
Diagnostic evaluation
According to book According to patient
1. Throat culture - To 1. Throat culture
oletermine presence of 2. Blood culture
streptococcal organisms electrocardiogram
2. Blood culture – Identifying 3. Urinalysis
the causative organisms
3. Increased sedimentation rate
4. Elevated
iantistreptolysintiter
5. Urinalysis – Showing
proteinuria and microscopic
hematuria
6. Electro cardio gram – show a
trial fibrillation
Management
108
Medical management
1. Antimicrobial therapy
Note and missed doses of antibiotics due to patients
unavailability wile off the unit for diagnostic tests are
given after return to the client.
Missed antibiotic doses may have irreversible
deleterious consequences.
2. Rest to maintain optimal cardiac function
3. Antibiotic therapy
4. Salocylates to control fever and pain
5. Monitoring patients temperature for treatment effectiveness
6. Prevention of recrurrent episodes
Nursing care plan
Nursing assessment
1. Ask patient about symptoms of fever or throat or joint pain
2. Ask patient about chest pain chest pain, dyspnea, fatique
3. Observe for skin lesion or rash on trunk and extremities
4. Palpate for firm non tender movable nodules near tenders
or oint
5. Auscultate heart sounds for members or tubs
Subjective Data Objective Data
Joint pain Heart murmaurs
Fever Trachycardia
Throat pain Fatique
Dyspnea Substaneous nodules
Abdominal pain Shortness of breath
chills Sore throat
Need of the patient
1. Self care deficient
2. Physical need
109
3. Psychological need
4. Knowledge deficient
5. Nutritional need
6. Recreational spiritual need
S.N Nursing Nsg Nursing Rational Eval
o Diagnosis objecive interventions uatio
s n
1 Hypertherm To 1. Monitor To Nor
ia related to maintai temperature determin mal
infection of n the as frequently e eff temp
cardiac normal ectivene eratu
2. Administer
tissue as body ss of re is
antipyretic
evidenced temper therapy main
medication
by ature taine
To
temperature 3. Monitor WBC d
reduce
elevation, count
fever
chills,
4. Give
trachycardia To
salicyates as
, evaluate
prescribed to
trachypnoea patients
suppress
etc. response
rheumatic
to
activity
treatmen
5. t
Administer
To
pencillin
reduce
therapy as
fever
presctibed
and to
relieve
pain
110
To
eradicat
e
hemolyti
c
strepioco
ccus
2 Decreased Mainita 1. Monitor Early Cardi
cardiac in clinical detection ac
output cardiac manifestation of outp
related to output s of cardiac ut is
de creased decreased output main
cardiac cardiac improves taine
contractility output treatmen d
t opnions
2. Encourage
bed rest Rest
during acute decrease
phase, limit s 02
self care consump
tion and
3. Observe the
demand
signs and
on
symptoms of
myocardi
acute
um
rheumantic
carditis Docume
nt the
4. Auscultate
presence
heart sound
of
every 4
mermer
hours
or
pericardi
111
5. Monitor al frictio
intake and tub
output every
Fluid
1 to 8 hours
retensio
n ay
occur
with
decrease
d cardiac
output
3 Activity To 1. Monitor To plan Activ
intolerance increas cardio alter ity in
related to e the respiratory activities main
joint pain activity response to taine
To plan
and easy to activity d
for
fatigability particip
2. Monitor changes
ate in
patient for in
activitie
evidence of activity
s
excess level
physical or
To
emotional
reduce
fatigue
cardiac
3. Encourage work
alternate rest load
and activity
To
period
promote
4. Provide activite
range of and
nation passive
exercise
112
programme exercises
5. Provde To
diversinal prevent
activities to exertion
the patient
To
6. Provide minimize
required care unnecess
ary
disturba
nce
4 Acute pain To 1. Provide Pain may Pain
related to reduce comfort respond is
inflammatio pain position and to non- redu
n of the comfort pharma ced
endocarcliu measures cological
m intervent
2. Eg. Massage,
ions
rest and
position To
changes reduce
pain and
3. Administer
inflamma
anti
tion it
inflammatory
will
, analgesics
enhance
as prescribed
the
4. Use non- effect of
pharmacologi analgesi
c cs
interventions
Demonst
for relieving
ration of
113
pain caring
can help
5. Listen to
to
patient
decrease
expression of
d anxiety
pain
experience Comfort
able
6. Provide
position
comfortable
relieves
position to
pain
the patient
5 Deficient To 1. Review To Kno
knowledge increas patients identify wled
related to e the knowledge teaching ge is
lack of knowle about needs incr
experience dge condition ease
Health
and about d
2. Discuss care
exposure to the
common provider
inflammatio disease
signs and can be
n about
symptoms of notified
disease and
the disease and trea
treatment
ted
3. Discuss life
initiably
style changes
promptly
that may
recquired to To
prevent the reduce
disease the risk
of
114
4. Provide the recurren
patient with t
information infective
about the endocard
action itis
purpose and
To
side effects
promote
of the
safe
medications
medicati
on
therapy
115
Health education
1. Teach about medications such as dioxin (Lanoxin).
2. Instruct the patient to maintain good nutrition.
3. Teach the patient about the proper hand washing disposal
of tissue.
4. Teach the patient to the importance of using patient’s own
tooth brush, soap and wash cloths when living in group
situations.
5. Consel the patient on importance of receiving adequate rest
6. Advice the patient to seek treatment immediately should
sore throat occur.
7. Discuss importance of keeping follow-up appointments after
hospital discharge.
8. Teach that vaccines reduce the risk of severe infections
that could participate heart failure.
Bibliography
1. Allison grant, Ross and Wilson, Antomy and Physiology in
health and illness, 4th edition
Page No. 340-346
2. Bane G. Brenda, Brunner and Suddhart’s
Medical and surgical nursing, 10th edition,
W olt er’s Kulwr Company, London
Page No. 780-782
3. Black M. Joyce, Jane Hakanson Hawks
Medical and surgical nursing, 6th edition, sanunders
Page No. 1484-1487
4. Le wis, Medical and surgical nursig, Assessment
Management clinical problem, 7th edition Mosby publisher,
missoure, Page No. 878-882
116
5. William L ippincott, Lippincott manual of medical surgical
nursing, 8th edition, Wolters Kulwer comp[any, London Page
No. 376-377.
117
