Understanding Medical Conditions And Their Treatment Options

Orthostatic Hypotension

Orthostatic hypotension is a condition of low blood pressure in which occurs during the time of standing up from a position of sitting or lying down. The condition is considered as the reduction in systolic pressure of 20 mmHg or reduction in diastolic pressure of 10 mmHg. According to Topol and Teirstein (2015) it happens due to physiological repercussion to the postural changes in BP. Some heart disease such as heart attack, bradycardia and heart valve issue may lead to the consequence of orthostatic hypotension as it restricts the body to pump enough blood when standing up.

Trachycardia is defined as the condition in which the heart rate exceeds the normal resting rate. The normal heart rate for an adult is 60 to 100 bpm and when the heart rate exceeds 100 bpm the condition is considered as trachycardia. Such consequence may be normal during the time of exercise, but such increase in heart rate is considered as serious issue when it occurs due to electrical problem in heart (Topol and Teirstein 2015).

Abdominal tenderness, also known as point tenderness is a condition in which pain occurs due to the pressure on an area of abdomen. A person feels pain when the pressure is taken off the abdomen. The issue may occur due to problem in multiple organs such as abdomen, intestine, kidney and digestive tract (Pasricha 2015).

Himaturia is the condition in which red blood cells are found in the urine. In this case, blood may be leaked by any part of kidney or urinary tract and such condition mainly occur due to urinary tract infection, bladder cancer or kidney stones (Pivkin et al. 2016).

Flank pain is described as the unpleasant sensation in the upper abdomen, back and sides. Flank pain is mainly associated with kidney problem, however, other causes are also possible, but if someone experience flank pain with fever, urination with blood and frequent urination it indicates the consequence of kidney problem like kidney stone (Pasricha 2015).

Petechiae is the condition in which small, non-raised and circular patches develop on skin or in the mucous membrane. It is the consequence of bleeding under the skin and the patches occur on the skin surface or inside the mouth and eyelids (Pivkin et al. 2016).

Splinter hemorrahages is commonly known as the small blood clots that appears vertically under the nails. Hence, it is important to have in-depth understanding about the anatomy of nails in order to assess the disorder and a nurse should inspect the localized abnormalities in nails and identify excessive keratinaceous material under the nail bed for the assessment of splinter hemorrahages (Haber et al. 2016).

Tachycardia

In case of J.F, the signs such as patches on skin, arms, legs and chest has been found. In addition, it is important to identify further signs and symptoms of embolization. Such signs may include, decreased pulse rate in arm or leg. Lack of movement of arm and leg, muscle pain and spasm in the affected areas, pale colour, legs, arms and fingers feel cool and numbness and tingling of affected parts (Brinjikji et al. 2016). Such signs and symptoms may help the nurse to detect the areas where blood flow has been blocked due to embolization.

The diagnosis criteria for endocarditis include-

• Body temperature greater than 38 degree Celsius.
• Positive blood culture for the presence of infective organism that causes endocartitis.
• ECG that indicates oscillating intracardiac mass on valve.
• Use of intravenous drugs administered to the patient and consideration of predisposing heart condition (Millar et al. 2016).

According to the study of Sun et al. (2018) total parenteral nutrition is considered as a nutrition support therapy that is provided to address the issue of malnutrition. The therapy contains nutrients such as dextrose, amino acid, lipid, vitamins and minerals. Due to continuous infusion of dextrose to the bloodstream, the blood glucose level of the patient may increase, hence, the patient associated with total parenteral nutrition has a high risk of developing hyperglycaemia. Thus, it is important to monitor the fasting blood glucose level in order to identify whether the nutrition therapy has elevated the blood glucose level of the patient. Therefore, in case of J.F, order for fasting blood glucose level is appropriate as she was administered with four months course of TPN.

The six things that the patient, J.F along with her family required to know before her discharge from the health care centre involves the following:

• The patient should regularly intake the antibiotics until the medication are all over.
• The patient should not be allowed to drive unless the healthcare provider allows the patient to do so.
• The patient should take good care of the teeth and mouth. Brushing of teeth is mandatory after every meal.
• The patient as well as the family members must report to the healthcare provider about any infection the patient might have.
• Regular exercise is important along with intake of healthy diet
• Care should be taken before any proper treatment of any open cuts that has developed (Habib et al. 2015).

Oral infections is most of the time associated with heart disease, therefore it is important to reduce the risk of oral infections. As recommended by the American Diabetes Association, use of soft-bristled toothbrush with rounded ends is beneficial for the patients. Any damage to the gum might allow the organisms to get into the bloodstream which could lead to endocarditis, therefore use of extra-soft bristled brush is important. Therefore this patient must be taught more about use of soft toothbrush in order to take better care (Naik et al. 2015).

While the patient asked that how she will be able to receive IVPB antibiotics when the TPN is continuously running, I responded by saying that antibiotics through IV and TPN are not compatible because bot cannot be run in the same lumenor infection control purposes. This is because the TPN line cannot be broken at any time. Therefore there is a need for starting another lock for the antibiotics or one can also get a provided to start the 2 or 3 lumen line. Therefore while the patient is on TPN, it is not possible to provide IVPB at the same time (Bally and Railwah 2017).

Abdominal Tenderness

For a patient suffering from endocarditis, it is generally recommended that there should be a minimum of 4 weeks therapy. Some evidences have showed that the patients who have enterococcal endocarditis and the patients who show the symptoms for a period of more than 3 months often tend to benefit from 6 weeks of penicillin (Thornhill et al. 2016).

		Regimen: single dose 30 to 60 min before procedure
Situation	Agent	adults	Children
Oral	Amoxicillin	2 g	50 mg/kg
Allergic to penicillins or ampicillinoral	Cephalexin OR clindamycin	2 g 600 mg	50 mg/kg 20 mg/kg
Unable to take oral medication	Ampicillin OR cefazolin or ceftriaxone	2 g IM or IV	50 mg/kg IM or IV
Allergic to penicillins or ampicillin and unable to take oral medication	Cefazolin or ceftriaxone OR clindamycin	1 g IM or IV 600 mg IM or IV	20 mg/kg IM or IV

In most of the cases of infective endocarditis (IE) it can be fully cured either with medical therapy or through use of combined medical and surgical therapy. However some patients who recover tend to remain at risk for an additional episode of IE. Therefore continuous monitoring is required. The event of recurrence of fever mainly after initial defervescence recommends a septic or non-septic embolic event. This might be a hypersensitivity reaction of drug or the any resistant strain emergence. Therefore the patient must try to report the difference between type of infection as it might be relapse or reinfection. The site of infection must also be reported for better detection (Millar et al. 2013).

	Endocarditis	Pericarditis
Common causes	The most common cause of endocarditis is bacterial infections. In most cases it is Staphylococcus aureus. This is followed by Streptococci of the viridans group and also by coagulase negative Staphylococci. These are the most common organisms which are responsible for infective endocarditis. Additionally the other Streptococci and Enterococci also are responsible for the frequent cause of infective endocarditis.	The common causes are the conditions of infections which include the viral, the bacterial as well as the tuberculosis infections. There are also inflammatory disorders such as the RA, SLE, and scleroderma along with rheumatic fever. Additionally the cause might be Metabolic disorders like renal failure and hypothyroidism
Common assessment findings	There are Flu-like symptoms, with fever and chills. There is a new or changed heart murmur. This is the heart sounds that is made by blood rushing through your heart and fatigue.	The main clinical manifestations of acute pericarditis like pleuritic chest pain followed by pericardial friction rub, and ECG changes.

The treatment option for pericarditis include use of includes anti-inflammatory drugs to control symptoms and inflammation. 

This diagram shows the occurrence of Restrictive Cardiomyopathy.

This diagram shows the occurrence of Dilated Cardiomyopathy

References

Bally, K. and Railwah, D., 2017. A Rare Case Of Candida Albicans Acalculous Cholecystitis In A Patient Being Treated For Severe Clostridium Difficile. In A52. CRITICAL CARE CASE REPORTS: ADULT AND PEDIATRIC SEPSIS AND ICU INFECTIONS (pp. A1828-A1828). American Thoracic Society.

Brinjikji, W., Lanzino, G., Cloft, H.J., Siddiqui, A.H., Boccardi, E., Cekirge, S., Fiorella, D., Hanel, R., Jabbour, P., Levy, E. and Lopes, D., 2016. Risk factors for ischemic complications following pipeline embolization device treatment of intracranial aneurysms: results from the IntrePED study. American Journal of Neuroradiology, 13(3), pp. 20-35.

Haber, R., Khoury, R., Kechichian, E. and Tomb, R., 2016. Splinter hemorrhages of the nails: a systematic review of clinical features and associated conditions. International journal of dermatology, 55(12), pp.1304-1310.

Habib, G., Lancellotti, P., Antunes, M.J., Bongiorni, M.G., Casalta, J.P., Del Zotti, F., Dulgheru, R., El Khoury, G., Erba, P.A., Iung, B. and Miro, J.M., 2015. 2015 ESC guidelinesfor the management of infective endocarditis: the task force for the management of infective endocarditis of the European Society of Cardiology (ESC) endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). European heart journal, 36(44), pp.3075-3128.

Millar, B.C., Prendergast, B.D., Alavi, A. and Moore, J.E., 2013. 18FDG-positron emission tomography (PET) has a role to play in the diagnosis and therapy of infective endocarditis and cardiac device infection. International journal of cardiology, 167(5), pp.1724-1736.

Naik, R., Mujib, B.A., Telagi, N., Anil, B.S. and Spoorthi, B.R., 2015. Contaminated tooth brushes–potential threat to oral and general health. Journal of family medicine and primary care, 4(3), p.444.

Pasricha, P.J., 2015. Approach to the patient with abdominal pain. Yamada’s Textbook of Gastroenterology, pp.695-722.

Pivkin, I.V., Peng, Z., Karniadakis, G.E., Buffet, P.A., Dao, M. and Suresh, S., 2016. Biomechanics of red blood cells in human spleen and consequences for physiology and disease. Proceedings of the National Academy of Sciences, 113(28), pp.7804-7809.

Sun, H., Wan, S., Wang, X., Xuejin, G., Li, Z., Jiwei, W., Peng, W. and Jianbo, Y., 2018. Total parenteral nutrition induces glycometabolic disorders via systemic insulin resistance and hepatic glycogen suppression. Clinical Nutrition, 37, pp.S146-S147.

Thornhill, M.H., Dayer, M., Lockhart, P.B., McGurk, M., Shanson, D., Prendergast, B. and Chambers, J.B., 2016. Guidelines on prophylaxis to prevent infective endocarditis. British dental journal, 220(2), p.51.

Topol, E.J. and Teirstein, P.S., 2015. Textbook of Interventional Cardiology E-Book. Elsevier Health Sciences. 2^nd edition. pp. 3-256.