The nurse is caring for a client with newly diagnosed infective endocarditis (IE). Which assessment finding by the nurse is the highest priority to report to the health care provider (HCP)?

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11ecbb05_c933_36fe_b433_b51650b5a7ff_MD0009_00 In IE, the vegetations over the valves can break off and embolize to various organs, resulting in life-threatening complications. These include the following: Stroke - paralysis on one sideSpinal cord ischemia - paralysis of both legsIschemia to the extremities - pain, pallor, and cold foot or armIntestinal infarction - abdominal painSplenic infarction - left upper-quadrant pain Stroke - paralysis on one side Spinal cord ischemia - paralysis of both legs Ischemia to the extremities - pain, pallor, and cold foot or arm Intestinal infarction - abdominal pain Splenic infarction - left upper-quadrant pain The nurse or the client (if at home) should report these manifestations immediately to the HCP. (Options B and D) IE commonly presents with fever, arthralgias (multiple joints pains), weakness, and fatigue. These are expected and do not need to be reported during the initial stages of treatment. IE clients typically require intravenous antibiotics for 4-6 weeks. Fever may persist for several days after treatment is started. If the client is persistently febrile after 1-2 weeks of antibiotics, this must be reported as it may indicate ineffective antibiotic therapy. (Option C) Splinter hemorrhages can occur with infection of the heart valves (endocarditis). They may be caused by vessel damage from swelling of the blood vessels (vasculitis) or tiny clots that damage the small capillaries (microemboli). The presence of splinter hemorrhages is not as critical as the macroemboli causing stroke or painful cold leg. Educational objective: IE causes the formation of vegetations on valve and endocardial surfaces. Embolization to various organ sites can occur. The onset of hemiplegia or painful, pale, cold foot/leg could indicate embolization and should be reported to the HCP immediately.

The Nurse Is Caring for a Client with Newly Diagnosed