Case Study 15 Autoimmune Genetic Deficiency Scenario Jane Feliciano is a SO-year-old married homemaker with an autoimmune, genetic deficiency; she has suffered from recurrent infective endocarditis. The most recent episodes were a Staphylococcus aureus infection of the mitral valve 16 months ago and a Streptococcus viridans infection of the aortic valve one month ago. An echocardiogram showed moderate aortic stenosis, moderate aortic insufficiency, chronic valvular vegetations, and moderate left atrial enlargement during this latter hospitalization. Two years ago, Jane Feliciano received an 18-month course of parenteral nutrition (PN) for malnutrition caused by idiopathic, relentless nausea, and vomiting {N/V). She has also had coronary artery disease for several years and, 2 years ago, suffered an acute anterior wall myocardial infarction (Ml). In addition, she has a history of chronic joint pain. Now, after being home for only a week, Jane Feliciano has been readmitted to your floor with endocarditis, N/V, and renal failure. Since yesterday, she has been vomiting and retching constantly; she also has had chills, fever, fatigue, joint pain, and headache. As you go through the admission process with her, you note that she wears glasses and has a dental bridge. Intravenous access is obtained with a double lumen peripherally inserted central catheter (PICC) line, and other orders are written below. Your assessment is also documented. Admission Orders ? STAT blood cultures (aerobic and anaerobic) x 2? STAT electrolytes & CBC? Begin parenteral nutrition (PN) at 85 ml/hr? Penicillin 2 million units IV piggyback q4h? Furosemide (Lasix) 80 mg/day PO? Amlodipine (Norvasc) 5 mg/day PO? Potassium chloride (K-Dur) 40 mEq/day PO? Metoprolol (Lopressor) 25 mg PO bid? Prochlorperazine (Compazine) 5 mg IV push prn for N/V? Transesophageal echocardiogram ASAP? Blood pressure 152/48 (supine) and 100/40 (sitting)? Pulse rate 116 beats/min Respiratory rate 22 breaths/min? Temperature 100.2° F (37.9° C)? Oriented x 3 but drowsy? Grade II/VI holosystolic murmur and a grade Ill/VI diastolic murmur noted on auscultation? Lungs clear bilaterally? Abdomen soft with slight left upper quadrant (LUQ) tenderness? Multiple petechiae on skin of arms, legs, and chest; and splinter hemorrhages under the fingernails? Hematuria noted in voided urineWhat is the significance of the orthostatic hypotension and the tachycardia?2. What is the significance of the abdominal tenderness, hematuria, joint pain, and petechiae?3. What are splinter hemorrhages, and what is their significance?Health ScienceScienceNursing NURSING MEDSURG250

Don't use plagiarized sources. Get Your Custom Essay on
Case Study 15 Autoimmune Genetic Deficiency Scenario Jane Fe
Just from $10/Page
Order Essay

Order your essay today and save 10% with the discount code ESSAYHELP