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The theory of unpleasant symptoms (TUS), as described by Blakeman (2019), provides an essential framework for evaluating symptoms, their causes, and their impacts on patients' functioning. Applying this theory to the assessment of infective endocarditis (IE) in elderly patients is particularly relevant, given the complex presentation and multifactorial causation of symptoms in this population. Bea et al. (2022) highlight that, among older adults, IE often presents with nonspecific symptoms such as fever, muscle aches, and edema, which can easily be mistaken for other age-related conditions. This underscores the importance of a comprehensive assessment incorporating clinical presentation, diagnostics, and underlying causes to ensure accurate diagnosis and effective treatment.
Focusing on the clinical presentations, as you propose, is crucial in differentiating IE from other geriatric conditions with overlapping symptoms. Identifying signs such as heart murmurs and ulcer nodes, which are more specific indicators of IE, enhances diagnostic accuracy. Furthermore, understanding microbial etiology, as noted by Bea et al. (2022), reveals that Enterococcus spp. is predominant in elderly patients and influences antibiotic choices. The recognition that Gram-positive cocci are common in this demographic can guide targeted antimicrobial therapy, improving outcomes.
Assessing the severity of symptoms through tools that measure functional performance aligns with the TUS's emphasis on the symptom-performance relationship. Lebeaux et al. (2019) discuss that the mutation and resistance of bacteria like Staphylococcus aureus impede effective treatment, highlighting the necessity to evaluate the severity and potential impact of the infection on physical and psychomotor functions. Incorporating such assessments into a clinical tool would facilitate individualized treatment plans, optimizing intervention efficacy and minimizing adverse effects.
In conclusion, integrating the principles of the TUS with clinical and microbiological data enhances diagnostic precision and therapeutic decision-making in elderly patients with IE. Developing assessment tools that evaluate symptom severity, causality, and functional impact can significantly improve patient management and outcomes in this vulnerable population.
References
- Blakeman, J. R. (2019). An integrative review of the theory of unpleasant symptoms. Journal of Advanced Nursing, 75(5), 946–961.
- Bea, C., Vela, S., Garcàa-Blas, S., Perez-Rivera, J.-A., Dàez-Villanueva, P., de Gracia, A. I., Fuertes, E., Oltra, M. R., Ferrer, A., Belmonte, A., Santas, E., Pellicer, M., Colomina, J., Doménech, A., Bodi, V., Forner, M. J., Chorro, F. J., & Bonanad, C. (2022). Infective Endocarditis in the Elderly: Challenges and Strategies. Journal of Cardiovascular Development and Disease, 9(6), 192.
- Lebeaux, D., Fernández-Hidalgo, N., Pilmis, B., Tattevin, P., & Mainardi, J.-L. (2019). Aminoglycosides for infective endocarditis: time to say goodbye? Clinical Microbiology and Infection.