Case SLudy 4 8acLerlal LndocardlLls

!l ls a 30 year old marrled homemaker wlLh a geneLlc auLolmmune deflclency she has suffered from
recurrenL bacLerlal endocardlLls 1he mosL recenL eplsodes were a SLaphylococcus aureus lnfecLlon of
Lhe mlLral valve 16 monLhs ago and SLrepLococcus muLans lnfecLlon of Lhe aorLlc valve uurlng hls laLLer
hosplLallzaLlon an echocardlogram revealed aorLlc sLenosls moderaLe aorLlc lnsufflclency chronlc
valvular vegeLaLlons and moderaLe aLrlal enlargemenL 1wo years ago !l recelved an 18 monLh course
of 1n Lherapy for malnuLrlLlon caused by ldlopaLhlc relenLless n/v She has also had CAu for several
years and 2 years ago suffered an acuLe anLerlor wall Ml she has a hlsLory of chronlc [olnL paln
now afLer belng home for a week !l has been readmlLLed Lo your floor wlLh endocardlLls
n/v and renal fallure Slnce yesLerday she has been vomlLlng and reLchlng consLanLly she also had
chllls fever faLlgue [olnL paln and headache As you go Lhrough Lhe admlsslon process wlLh her you
noLe LhaL she wears glasses and has a denLal brldge She ls lmmedlaLely sLarLed on 1n aL 123 ml/h and
on penlclllln 2 mllllon unlLs lv q4h Lo be conLlnued for 4 weeks CLher medlcaLlons are furosemlde 80
mg C qd amlodlplne 3 mg C kuur 40 mLq C qd (dose ad[usLed accordlng Lo laboraLory resulLs)
meLoprolol 23 mg C bld and droperldol 02303 ml lv prn for n/v Admlsslon vS are 132/48 (suplne)
and 100/40 (slLLlng) 116 22 379C When you assess her you flnd a grade ll/vl holosysLollc murmur
and a grade lll/vl dlasLollc murmur 2+ plLLlng Llblal edema buL no perlpheral cyanosls clear lungs
orlenLaLlon x3 buL drowsy sofL abdomen wlLh sllghL LuC Lenderness hemaLurla and mulLlple peLechlae
on skln of arms legs and chesL

Symbol Lerms abbrevlaLlon Meanlng/ deflnlLlon

1 echocardlogram

1 An echocard|ogram ls a LesL LhaL uses sound waves Lo
creaLe a movlng plcLure of Lhe hearL 1he plcLure ls much
more deLalled Lhan a plaln xray lmage and lnvolves no
radlaLlon exposure An echocard|ogram allows docLors Lo
see Lhe hearL beaLlng and Lo see Lhe hearL valves and oLher
sLrucLures of Lhe hearL

ulagnoses/medlcal condlLlons
1 eneLlc auLolmmune
deflclency









2 8acLerlal endocardlLls





uescrlpLlon/meanlng of Lhe dlagnosls or medlcal problem
2 When Lhe lmmune sysLem of Lhe body ls weak and
mlsLakenly aLLacks Lhe body cells lL ls called auLo lmmune
def|c|ency 1hls ls a very complex dlsorder LhaL has some
serlous repercusslons ln Lhe long run for any human belng
hLLp//wwwbuzzlecom/arLlcles/auLolmmune
deflclencyhLml

InIective endocarditis is an inIection oI the lining oI the
heart's chambers (called the endocardium) or the heart's valves.
II leIt untreated, endocarditis can cause other complications,
such as a blood clot (embolism), an irregular heartbeat
(arrhythmia), valve damage or destruction, and, in time,
congestive heart Iailure (CHF).


3 nausea and vomlLlng



4 8enal fallure (chronlc)

3 nausea ls sub[ecLlve and ls commonly descrlbed a sensaLlon
LhaL precedes vomlLlng vomlLlng ls a physlcal evenL LhaL
resulLs ln Lhe rapld forceful e[ecLlon of lnLesLlnal conLenLs
ln reLrograde fashlon from Lhe sLomach vla Lhe mouLh
4 rogresslve decrease ln renal funcLlon wlLh subsequenL
accumulaLlon of wasLe producLs ln Lhe blood elecLrolyLe
abnormallLles and anemla
hyslcal flndlngs and cllnlcal presenLaLlon
Skln pallor ecchymoses edema hyperLenslon emoLlonal
lablllLy/depresslon Cllnlcal presenLaLlon varles wlLh Lhe
degree of renal fallure and lLs underlylng eLlology Common
sympLoms are generallzed faLlgue nausea anorexla
prurlLus lnsomnla LasLe dlsLurbances
3

MedlcaLlon
lurosemlde





Amlodlplne (norvasc)





uroperldol (lnapslne)



MeLoprolol (Lopressor 1oprol xL)





enlclllln



uses CPl P1n edema AcLlon loop dlureLlc decrease na and Cl
reabsorpLlon ln ascendlng loop of Penle and dlsLal Lubule ConLra
allergy Lo sulfonylureas anurla hepaLlc coma/severe elecLrolyLe
depleLlon SL dec 8 hyperglycemla dec k noLes MonlLor
elecLrolyLes renal funcLlon hlgh doses lv may cause oLoLox

uses P1n sLable or unsLable anglna AcLlon calclum channel
blocker relaxes coronary vascular smooLh muscle SL perlpheral
edema PA palplLaLlons flushlng noLes Lake w/o regard Lo meals

uses n/v anesLheLlc premedlcaLlon AcLlon Lranqulllzer sedaLlon
anLlemeLlc ConLra componenL senslLlvlLy SL drowslness mod
dec 8 occaslonal Lachycardla and exLrapyramldal rxns C1 lnLerval
prolongaLlon arrhyLhmlas noLe lv slowly over 23 mln

Warnlng do noL acuLely sLop Lherapy as marked worsenlng of
anglna can resulL uses P1n anglna AMl CPl AcLlon beLa
adrenerglc recepLor blocker
ConLra arrhyLhmla w/ Lachycardla SL urowslness lnsomnla Lu
bradycardla bronchospasm

uses bacLeremla endocardlLls perlcardlLls resp LracL lnfxns
menlnglLls neurosyphllls skln/skln sLrucLure lnfecLlons AcLlon
bacLerlclde dec cell wall synLhesls SpecLrum mosL gram (+) (noL
sLaphylococcl) sLrepLococcl n menlnglLldes syphllls closLrldla and
anaerobes (noL bacLeroldes) ConLra allergy SL allerglc rxns
lnLersLlLlal nephrlLls dlarrhea selzures
1reaLmenL/ lnLervenLlon/
LherapeuLlc procedures



9arentera| nutr|t|on (n) ls feedlng a person lnLravenously
1n bypasslng Lhe usual process of eaLlng and dlgesLlon 1he person
recelves nuLrlLlonal formulas LhaL conLaln nuLrlenLs such as salLs
glucose amlno aclds llplds and added vlLamlns lL ls called tota|
parentera| nutr|t|on (1n) or tota| nutr|ent adm|xture (1nA) when
no food ls glven by oLher rouLes
use
%otal parenteral nutrition (TPN) is provided when the
gastrointestinal tract is nonIunctional because oI an
interruption in its continuity or because its absorptive capacity
is impaired.
|1|
It has been used Ior comatose patients, although
enteral Ieeding is usually preIerable, and less prone to
complications. Parenteral nutrition is indicated to prevent the
adverse eIIects oI malnutrition in patients who are unable to
obtain adequate nutrients by oral or enteral routes.
|2|

MeLhod of dellvery
The preIerred method oI delivering PN is with a medical
inIusion pump. A sterile bag oI nutrient solution, between 500
mL and 4 L, is provided. The pump inIuses a small amount
(0.1 to 10 mL/hr) continuously in order to keep the vein open.
Feeding schedules vary, but one common regimen ramps up
the nutrition over one hour, levels oII the rate Ior a Iew hours,
and then ramps it down over a Iinal hour, in order to simulate a
normal metabolic response resembling meal time. This should
be done over 12 to 24 hours rather than intermittently during
the day.
Chronic PN is perIormed through a central intravenous
catheter, usually through the subclavian or jugular vein with
the tip oI the catheter at the superior vena cava without
entering the right atrium. Another common practice is to use a
PICC line, which originates in the arm, and extends to one oI
the central veins, such as the subclavian with the tip in the
superior vena cava. In inIants, sometimes the umbilical vein is
used.
Battery-powered ambulatory inIusion pumps can be used with
chronic PN patients. Usually the pump and a small (100 ml)
bag oI nutrient (to keep the vein open) are carried in a small
bag around the waist or on the shoulder. Outpatient TPN
practices are still being reIined but have been used Ior years.
Patients can receive the majority oI their inIusions while they
sleep and instill heparin in their catheters when they are done
to simulate a more "normal" liIe style oII the pump.
http://en.wikipedia.org/wiki/Parenteralnutrition
LaboraLory LesLs

Chem 7


hat is it?
The Basic Metabolic Panel (BMP) is a Irequently ordered
panel oI tests that gives your doctor important inIormation
about the current status oI your kidneys, blood sugar, and
electrolyte and acid/base balance. Abnormal results, and
especially combinations oI abnormal results, can indicate a
problem that needs to be addressed. The BMP is a group oI 8
speciIic tests that have been approved, named, and assigned a
CPT code (a Current Procedural Terminology number) as a
panel by Medicare. Since the majority oI insurance companies
also use these names and CPT codes in their claim processing,
this grouping oI tests has become standardized throughout the
United States.
The BMP includes:
O lucose
O Calclum
Both increased and decreased levels can be signiIicant.
Electrolytes
O Sodlum
O oLasslum
O CC2 (carbon dloxlde blcarbonaLe)
O Chlorlde
The concentrations oI sodium and potassium are tightly
regulated by the body as is the balance between the Iour
molecules. Electrolyte (and acid-base) imbalances can be
present with a wide variety oI acute and chronic illnesses.
Chloride and CO2 tests are rarely ordered by themselves.
/3ey Tests
O 8un (blood urea nlLrogen)
O CreaLlnlne
BUN and creatinine are waste products Iiltered out oI the
blood by the kidneys. Increased concentrations in the blood
may indicate a temporary or chronic decrease in kidney
Iunction. When not ordered as part oI the BMP, they are still
usually ordered together.
hen is it ordered?
The BMP is oIten ordered in the hospital emergency room
setting because its components give doctors important
inIormation about the current status oI your kidneys,
electrolyte and acid/base balance, blood sugar, and calcium
levels. SigniIicant changes in these test results can indicate
acute problems, such as kidney Iailure, insulin shock or
diabetic coma, respiratory distress, or heart rhythm changes.
The test may be ordered when you see your doctor Ior a
routine health exam.
http://labtestsonline.org/understanding/analytes/bmp/tab/glance


aLhophyslology
eneLlc auLolmmune deflclency
When the immune system within the body starts attacking blood vessels, red blood cells,
connective tissues, the endocrine system, the digestive system, nerves and muscle joints within
the body itselI mistaking them to be a threat to the body, this condition is said to exist. The
symptoms oI this disorder vary Irom person to person, as it is diIIicult to say with what intensity
the immune system will start attacking.

When this disorder sets in, the immune system is busy attacking its own cells and oIten lets the
other harmIul Iactors pass through unscathed. This Iurther weakens the body, as it now has to
deal with many more diseases and ailments as well. Due to this combination oI threats, a disorder
oI this nature can severely debilitate an individual, and cause a lot oI damage over the course oI
time.

The causes oI this disorder cannot be known accurately, and as such there are a variety oI causes
which medical experts say lead to the onset oI this disorder. It is not a disease in itselI, and
merely opens up the body to the risk oI many other harmIul diseases. Here are some oI the
causes that experts say may lead to this disorder.
O Hereditary or genetics
O Pregnancy
O Excessive iodine
O Anxiety and stress
O Environmental toxins
O External viruses
O Weakening oI the immune system due to excessive substance abuse
O Lack oI sleep, exercise and a proper diethLLp//wwwbuzzlecom/arLlcles/auLolmmune
deflclencyhLml
8acLerlal endocardlLls
What causes inIective endocarditis
The inIection that leads to endocarditis can be caused by bacteria, Iungi, or other
microorganisms that enter your bloodstream. (You may have heard the term bacterial
endocarditis, subacute bacterial endocarditis, or SBE. These terms are used Ior endocarditis
caused only by bacteriausually group A strepand not by other microorganisms.)
Normally, microorganisms live on your skin, in your mouth, in your intestines, and in your
urinary tract, but not in your blood. Sometimes, however, microorganisms can enter your
bloodstream (Ior example, during a surgical or dental procedure).
For most people, microorganisms in the bloodstream do not pose a problem. But iI one oI your
heart valves becomes damaged, your body sends immune cells, platelets, and Iibrin (a clotting
material) to heal the valve. This healing process can lead to endocarditis iI any microorganisms
in your bloodstream become trapped under the layers oI these cells. The trapping oI
microorganisms leads to the development oI "clumps" oI tissue within the heart and on the
heart's valves. These clumps are called vegetations.
Vegetations are dangerous because they can break oII and enter the bloodstream. This process is
called embolization. II the embolus (the clump that breaks oII) is large enough, it can block a
blood vessel. This blockage can slow the Ilow oI oxygen-rich blood to parts oI your body.
Who is at risk Ior developing inIective endocarditis
You are more likely to get endocarditis iI you already have other heart problems or you have
heart valve damage. Endocarditis is more common in people older than 50, and men are
aIIected more oIten than women.
Your risk Ior developing endocarditis is increased iI
O ou have valve dlsease
O ou have had a heart valve replaced
O ou have a congenlLal heart defecL (a heart defecL LhaL you were born wlLh)
O ou had rheumaLlc fever or rheumaLlc heart dlsease as a chlld whlch scarred your heart valves
O ou have hyperLrophlc cardlomyopaLhy (enlarged or Lhlckened heart walls)
O ou are an lnLravenous drug user

Cllnlcal leaLures and Course Acote endocardlLls ls rare loslJloos courses are more frequenL A general
feellng of malalse llldeflned llmb paln subfebrlle LemperaLures and nlghL sweaLs are Lhe earllesL
sympLoms lnlLlally chllls are unusual 1hey occur more frequenLly laLer ln Lhe course of Lhe dlsease
-oolofectloos eoJocotJltls (Llbman-Sacks syndrome ln sysLemlc lupus eryLhemaLosus rheumaLlc fever
carclnold syndrome) occurs wlLhouL chllls
O 1he alLeraLlon ln Lhe characLer of Lhe hearL murmur ls of declslve dlagnosLlc slgnlflcance ln
ausculLaLlon

5pleoomeqoly ls parLlcularly found ln abouL 30 of advanced cases 5eptlc mlctoembollsms are of
paLhognomonlc slgnlflcance (approxlmaLely 30 of Lhe cases) whlch are predomlnanLly locaLed on Lhe
flngers and Loes (Csler nodes) palms and soles of Lhe feeL (!aneway leslons) buL also ln Lhe
con[uncLlvae or subungually Mlcroembollsms can sLlll develop durlng an adequaLe anLlbloLlc Lherapy
Larger embollsms also can cause cerebral deflclLs 1herefore lL ls always necessary Lo conslder
lnfecLlous endocardlLls ln younger paLlenLs experlenclng a febrlle apoplecLlc sLroke
What are the symptoms
Cardlnal SympLoms 1he mosL lmporLanL cllolcol symptomsof endocardlLls are
fever
chllls
paLhologlcal hearL ausculLaLlon flndlngs
mlcroembollsms
renal flndlng
splenomegaly
II you have acute endocarditis, meaning the inIection has happened recently, you may Ieel like
you have the Ilu, with a Iever, night sweats, muscle aches and pains, and decreased energy.
II you have chronic endocarditis, which may last Ior months, you may Ieel Ieverish and chilled,
be very tired, lose weight, and have joint pain, night sweats, or the symptoms oI heart Iailure.
Other symptoms may include red spots on the palms oI your hands and the soles oI your Ieet
(called Janeway lesions), or red, painIul sores on the tips oI your Iingers and toes (called Osler's
nodes).
aLhogens tloloqlcolly sLrepLococcl and sLaphylococcl remaln Lhe mosL frequenL potboqeos coosloq
eoJocotJltls ln endocardlLls whlch occurs on arLlflclal hearL valves an early form ls dlsLlngulshed whlch
develops slx Lo elghL weeks afLer surgery and ls mosL frequenLly caused by 5topbylococcos eplJetmlJls
5topbylococcos ooteos or ramnegaLlve nosocomlal paLhogens ln conLrasL Lhe laLe form exhlblLs a
bacLerlal specLrum comparable Lo LhaL of endocardlLls on naLural valves
1he mosL frequenL cause of oeqotlve blooJ coltotes ln endocardlLls ls prlor anLlbloLlc Lherapy Speclal
culLure medla and long lncubaLlon Llmes are requlred Lo deLecL paLhogens of Lhe nAc qtoop
(noemopbllos specles Actlooboclllos specles cotJloboctetlom specles lkeoello specles and loqello
specles) as well as tocello 8are endocardlLls paLhogens are leqlooello coxlello botoetll (C fever)
cblomyJlo and ottooello (earller kocbollmoeo specles) whlch can only be dlagnosed serologlcally
How is inIective endocarditis diagnosed
Most doctors will suspect inIective endocarditis iI you tell them your symptoms and iI you have
a history oI congenital heart disease, rheumatic Iever, or valve disease. Doctors may also look
Ior small, dark lines under your Iingernails that look like wood splinters (called splinter
hemorrhages) or burst blood vessels in the retina oI your eyes (called Roth's spots).
With a stethoscope, a doctor can listen to your chest Ior the distinct sound oI a new heart
murmur or a change in the sound oI an old heart murmur. Heart murmurs are caused by the
sound oI Iaulty heart valves and by certain deIects in your heart.
Blood samples Irom diIIerent areas oI your body can tell doctors iI you have microorganisms in
your bloodstream. The samples are placed on what is called a culture, where the organism can
grow so that it can be analyzed and identiIied.
Echocardiography can be used to see valve structure and Iunction, heart wall motion, and
overall heart size. This is by Iar the most reliable way to diagnose inIective endocarditis.
Other imaging techniques such as transesophageal echocardiography (TEE), computed
tomography (CT) scanning, and magnetic resonance imaging (MRI) may be used Ior a more
complete diagnosis or to Iind out iI you have other complications.
How is inIective endocarditis treated
Medicines called antibiotics, which kill the microorganisms, are the Iirst line oI treatment Ior
inIective endocarditis. II vegetations have damaged your heart valves, you may need surgery.

1 WhaL ls Lhe |gn|f|cance of Lhe orthotat|c hypoten|on Lhe w|de pu|e preure and Lhe
tachycard|a?
decreased cardlac ouLpuL ln aorLlc sLenosls

2 WhaL ls Lhe |gn|f|cance of Lhe abdomlnal Lenderness hemaLurla [olnL paln and peLechlae? lve Lhe
paLhophyslologlcal basls for each of Lhe four sympLoms
a Abdomlnal Lenderness may be due Lo lnLraabdomlnal mycoLlc aneurysms LhaL are formed from
bacLerlal lnvaslon embollc occluslon and lmmune complex deposlLlon of blood vessel
hLLp//[ournalnzmaorgnz/[ournal/1181208/1262/
b PemaLurla (glomurelonephrlLls) hemaLurla of glomerular orlgln may be Lhe resulL of a sLrucLural
dlsrupLlon ln Lhe lnLegrlLy of glomerular basemenL membrane caused by lnflammaLory or lmmunologlc
processes
c !olnL paln lnflammaLlon of Lhe [olnL due Lo lmmune complex deposlLlon of Lhe synovlum
wwwarLhrlLlsLreaLmenLandrellefcom/rapldonseL[olnL
palnhLml+paLhophyslology+of+[olnL+paln+ln+endocardlLlscd2hlLlcLclnkglph
d peLechlae sepLlc mlcroembollsms LhaL are of paLhognomonlc slgnlflcance ln endocardlLls (osler's
nodes [aneway leslons)

3 As you monlLor !l LhroughouL Lhe day whaL oLher slgns and sympLoms (S/S) of embollzaLlon wlll you
waLch for? LlsL Lhe four sysLems of Lhe body lnvolved ln Lhls case sLudy and glve Lhe slgns and sympLoms
you'd waLch for Lo deLecL embollzaLlon of each of Lhe four sysLems
enlLourlnary hemaLurla
8esplraLory pleurlLlc chesL paln
asLrolnLesLlnal lefL upper quadranL paln
neurologlcal paresls
hLLp//nurslngfllecom/nurslngcareplan/nurslnglnLervenLlons/nurslnglnLervenLlonsfor
endocardlLlshLml
4 1hree lmporLanL dlagnosLlc crlLerla for lnfecLlous endocardlLls are anemla fever and cardlac
murmurs Lxplaln Lhe cause for each slgn lve Lhe paLhophyslologlcal basls for each slgn seen ln Lhls
case sLudy
Anemla chronlc lnfecLlons |though the exact caue of anem|a of chron|c d|eae | not known |t |
re|ated to the effect of chron|c d|eae on the red b|ood ce|| 1hese condlLlons cause a number of
changes ln Lhe bodys red blood cells 1he llfespan of red blood cells becomes shorLer producLlon of
new red blood cells ln Lhe bone marrow slows down and lron ls wlLhheld so LhaL lL cannoL be used Lo
make new red blood cells normally Lhe body recycles lron from old red blood cells and uses lL Lo make
new ones ln anemla of chronlc dlsease Lhe body does noL recycle lron as easlly so lL ls held up ln Lhe
old red blood cells
hLLp//chealLhcanoeca/channel_condlLlon_lnfo_deLallsasp?dlsease_ld263channel_ld12relaLlon_l
d1619
lever classlc sympLom and may perslsL for days before any oLher sympLoms appear
wwwnlmnlhgov/medllneplus//000681hLm
Cardlac murmurs eart murmur are caused by Lhe sound of faulLy heart valves and by cerLaln defecLs
ln your heart hLLp//LexashearLorg/PlC/1oplcs/Cond/endocardcfm

3 Cn Lhe day afLer admlsslon you revlew !l's laboraLory LesL resulLs na 138 mmol/L (133143) k
39 mmol/L (33 3) Cl 103 mmol/L (97107) 8un 83 mg/dl (1020) creaLlnlne 39 mg/dl (0714)
glucose 183 mg/dl (fasLlng 60110) W8Cs 67 Lhou/cmm (4311) PcL 27 (M 4232 l 3347) Pgb 90
g/dl (M 1318 l 1216) ldenLlfy Lhe values LhaL are noL wlLhln normal ranges and explaln Lhe reason
for each abnormallLy SLaLe why each of Lhe lab values ls abnormal for Lhls pL
Abnormal blood values are ln 8un CreaLlnlne glucose hemaLocrlL and hemoglobln
8un elevaLed ln renal fallure
CreaLlnlne chronlc renal fallure
8un chronlc renal fallure
lucose chronlc renal fallure chronlc lnfecLlon
Pemoglobln and hemaLocrlL decreased eryLhropoleLln producLlon hemoconcenLraLlon or hemolysls

6 Whlch laboraLory value(s) reflecL(s) caLabollsm of muscle and why does muscle caLabollsm
occur? name Lhe correcL lab value and sLaLlng why muscle caLabollsm occurs ln Lhls case sLudy
CreaLlnlne (0714 mg/dl) 8ecause of caLabollc dlseases such as renal fallure

7 lf arenLeral nuLrlLlon (n) ls scheduled on a 24hour basls when would blood glucose be drawn and
why? WhaL ls your faclllLys proLocol for a pL geLLlng n and glve Lhe raLlonale for Lhe proLocol

every 6 hours 1o monlLor lf Lhe glucose levels have gone sLable
aLlenL selecLlon for n lnablllLy Lo use guL aL goal feeds wlLhln 3 days
LLp//wwwmcvanderbllLedu/surgery/Lrauma/roLocols/nuLrlLlonproLocolpdf

8 Why would blood glucose monlLorlng be lmporLanL?
8ecause he ls recelvlng 1n and hls glucose level ls hlgh


9 WhaL ls Lhe greaLesL rlsk for !l durlng Lhe process of rehydraLlon and whaL would you
monlLor Lo deLecL lLs developmenL? SLaLe whlch compllcaLlon would be Lhe greaLesL rlsk llsL aL leasL
four sympLoms LhaL you help deLermlne lf Lhe pL were developlng LhaL parLlcular compllcaLlon
8acLerlal conLamlnaLlon or lnfuslon of parLlculaLe maLLer lnfecLlon

CASL S1uu 8C8LSS
As you admlLLed !l you were aware LhaL as soon as she became sLable she would be golng home
ln a few days on n and lv anLlbloLlcs 1he home care agency LhaL wlll be supervlslng her care ls
conLacLed
Lo coordlnaLe dlscharge preparaLlons and Leachlng ASA



10 LlsL flve lmporLanL quesLlons ln assesslng her home healLh care needs


CASL S1uu 8C8LSS
lorLunaLely !l has a supporLlve husband and 2 daughLers who llve nearby who can funcLlon as
careglvers
when !l ls dlscharged 1hey along wlLh Lhe paLlenL wlll need Leachlng abouL endocardlLls
AlLhough !l has been lll for several years you dlscover LhaL she and her famlly have recelved llLLle
educaLlon abouL Lhe dlsease ou prepare a Leachlng plan for Lhe famlly 1he home care agency has
a parenLeralenLeral nuLrlLlon (Ln) Leam Lo address her nuLrlLlonal needs whlch wlll also lnclude
vlLamlns mlnerals and llplds n formulaLlons requlre complex calculaLlons 1he Ln Leam Lakes care of
Lhe formulaLlon of Lhe n Lhrough Lhe pharmacy or dleLary sLaff (dependlng on local arrangemenLs)

11 LlsL Lwo predlsposlng causes of bacLeremla Lxplaln 1ry Lo Lhlnk of Lwo dlsLlncLly separaLe casuses
whlch have noL been dlscussed ln prevlous quesLlons/answers
atheters
The use oI catethers in medical practice enables easy Iluid transIer to diIIerent areas oI the body.
In some cases, built up Iluid may need to removed. In other situations, adding Iluids is necessary.
The catheter is typically inserted directly into the skin, through a hole. The entrance oI the
catheter becomes a prime spot Ior bacterial multiplication. BioIilms, communities oI bacteria that
adhere to a surIace, Iorm on the tube. II bacterial growth goes unchecked and untreated, bacteria
can enter the bloodstream and cause problems. The bacteria can even multiply and become a
worse problem in the blood, Ieeding on sugars in the blood plasma. According to Dr. Issam Raad
at the M. D. Anderson Cancer Center in Houston, Texas, patients with catheters that were
retained between treatments had greatly increased odds oI a recurrent Iorm oI -acteremia.

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uenLal procedures 1he mouLh ls home Lo many dlfferenL klnds of bacLerla When skln ls broken ln Lhe
mouLh as ls Lhe case ln many common denLal procedures bacLerla can lnvade Lhe bloodsLream and
cause problems especlally ln Lhe lmmunocompromlsed When flosslng many people can be
overamblLlous wlLh Lhe floss and break Lhe gum surface ln beLween Lhe LeeLh Slnce much bacLerla
accumulaLes ln beLween Lhe LeeLh a cuL by Lhe floss can provlde an easy way for bacLerla Lo enLer Lhe
blood sLream on a dally basls

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