Endocarditis Eli — Infective Endocarditis
New murmur, fever, and tiny splinter hemorrhages under the nails — bacteria are colonizing his heart valves
Eli has had a low-grade fever and fatigue for two weeks, and now his nurse notices small dark streaks under his fingernails and a new murmur that wasn't there at his last visit.
Eli, an IV drug user with a history of a prosthetic valve, develops persistent fever and a new heart murmur as bacteria colonize his valve leaflets and form friable vegetations. Those vegetations can break off and embolize to the brain, spleen, kidneys, or skin, producing classic peripheral stigmata like Janeway lesions, Osler's nodes, splinter hemorrhages, and Roth spots. Blood cultures drawn before antibiotics are essential, and prolonged IV antibiotic therapy — often four to six weeks — is required to sterilize the vegetation.
Read Endocarditis Eli's full story →The story arc
The setup
Eli has a history of intravenous drug use and a prosthetic aortic valve placed two years ago after a prior valve infection.
The turn
He develops a persistent low-grade fever, night sweats, and fatigue for two weeks, and on exam the nurse hears a new systolic murmur.
The crisis
Splinter hemorrhages appear under his nails, tender red Osler's nodes form on his fingertips, and blood cultures grow Staphylococcus aureus in multiple sets.
The save
The nurse ensures three sets of blood cultures are drawn from different sites before the first antibiotic dose, and the client begins a prolonged course of IV antibiotics guided by sensitivities.
NCLEX study section — Infective Endocarditis
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Cardiovascular
Take this chapter into practice questions on the same topic.