Endocarditis

Question 1

What layer of the heart is the endocardium?

Answer 1

Innermost, lining the chambers and valves.

Question 2

What parts of the heart are affected by infective endocarditis?

Answer 2

Heart chambers or valves

Infective endocarditis is an infection of the heart chambers or valves

Question 3

SUBACUTE endocarditis
Affects those with _______ and has a clinical course that can extend over months; MILDER in presentation; CHRONIC

Answer 3

Affects those with pre-existing valve disease and has a clinical course that can extend over months; MILDER in presentation; CHRONIC

Question 4

ACUTE endocarditis
Affects _________; manifests as a rapidly progressive illness; therapy must be prompt and vigorous

Answer 4

Affects healthy valves; manifests as a rapidly progressive illness; therapy must be prompt and vigorous

Question 5

Two factors required to get endocarditis?

Answer 5

1. A damaged epithelium (i.e., from valve replacements or defects)
2. A port of entry (i.e., wound, dental procedure, IVDU)

Question 6

Most common causative bacterial organisms of infective endocarditis

Answer 6

Staph aureus, strep viridans

Question 7

Aside from bacteria, what other pathogens can cause infective endocarditis?

Answer 7

Fungi, viruses

Question 8

When do clinical manifestations typically occur with endocarditis?

Answer 8

Typically occur within 2 weeks of bacteremia

Question 9

Endocarditis clinical manifestations
nonspecific
specific (6)

Answer 9

Nonspecific
Low-grade fever (90% of patients), chills, weakness, malaise, fatigue, anorexia, arthralgias, myalgias, back pain, abdominal discomfort, weight loss, headache, clubbing of fingers (late manifestation)

specific
- splinter hemorrhages – black/red/brown longitudinal streaks in nail bed
- petechiae – little bruises in conjunctiva, lips, buccal mucosa, ankles, feet, antecubital (elbows) and popliteal areas. d/t microembolization of vegetative valves (embolus in smaller vessels)
- osler nodes – tender papule and pustule lesions on finger tips and toes
- Janeway lesions – painless, flat/macular, small red spots on palms and soles of feet
- roth spots – hemorrhagic retinal lesions
- new onset murmur – murmurs are r/t opening/closing of valves so it makes since that with IE which involves damaged valves, there would be a murmur

Question 10

What are vegetations?

Answer 10

The primary lesions of infective endocarditis. They consist of different cell pieces and microbes that stick to the valve surface. The loss of these fragile vegetations into the circulation results in emboli.

Question 11

Where do left-sided vegetations move to?

Answer 11

Various organs (brain, kidneys, spleen) and extremities (causing limb infarction)

Question 12

Where do right-sided vegetations move to?

Answer 12

Lungs (PE)

Question 13

Two vascular manifestations of endocarditis

Answer 13

1. Splinter hemorrhages
2. Petechiae

Question 14

Black/reddish-brown longitudinal streaks in nail beds

Answer 14

Splinter hemorrhages
Black/reddish-brown longitudinal streaks in nail beds

Question 15

From micro-embolization of vegetative valves. Can occur in conjunctivae, lips, buccal mucosa, ankles/feet, antecubital, popliteal areas, fingers

Answer 15

Petechiae
From micro-embolization of vegetative valves. Can occur in conjunctivae, lips, buccal mucosa, ankles/feet, antecubital, popliteal areas, fingers

Question 16

Three clinical manifestations that are uncommon but very suggestive of infective endocarditis

Answer 16

1. Osler nodes
2. Janeway lesions
3. Roth spots

Question 17

Tender papulopustules on fingertips or toes

Answer 17

Osler nodes
Tender papulopustules on fingertips or toes

Question 18

Flat/macular, painless, small red spots on palms and soles of feet

Answer 18

Janeway lesions
Flat/macular, painless, small red spots on palms and soles of feet

Question 19

Hemorrhagic retinal lesions

Answer 19

Roth spots
Hemorrhagic retinal lesions

Question 20

Endocarditis clinical manifestations

New-onset ________ (85% of time)
________ (most common complication of infective endocarditis)

Answer 20

New-onset murmur (85% of time)
HF (most common complication of infective endocarditis)

Question 21

Endocarditis history and diagnostic tests (3)

Answer 21

1. History: recent (3-6 mo.) history of dental, urological, surgical, or gynecologic procedure; or IVDA
2. Positive blood cultures (3 blood cultures drawn over a period of 1 hour from 3 different sites will be positive in most patients with infective endocarditis)
3. Echocardiogram (evidence of endocardial enlargement)

Question 22

Who should be prophylactically treated for endocarditis? (4)

Answer 22

Patients with a history of a prosthetic heart valve, infective endocarditis, congenital heart disease, or heart transplant

Question 23

Under what situations should patients get prophylactic treatment for endocarditis?
(4)

Answer 23

1. Oral-dental work
2. biopsy of any kind -respiratory tract incision (biopsy)
3. procedures like tonsillectomy, adenoidectomy
4. GI & GU-wound infection, UTI

Question 24

Endocarditis drug therapy

Typically _______ initially and given IV ________
Complete eradication may take _______
Relapses are common

Answer 24

Typically hospitalized initially and given IV antibiotics
Complete eradication may take weeks
Relapses are common

Question 25

Endocarditis nursing care Identify and educate high-risk individuals to avoid _______, have adequate ______ periods, have good ____ hygiene notify HCP before ________. Refer patients with IVDA for rehab

Answer 25

Identify and educate high-risk individuals to avoid infections, have adequate rest periods, have good oral hygiene, and notify HCP before dental procedures. Refer patients with IVDA for rehab

Question 26

Endocarditis nursing care: home care May include IV _______ Have patient monitor for ________

Answer 26

May include IV antibiotics Have patient monitor for nonspecific s/s

Question 27

Patho 1. causative organism enters ______ 2. travels in blood to the ____ 3. infects previously damaged ______ or other endothelial surfaces 4. valve(s) or other endothelial surfaces are covered with large, irregular ______ (primary lesions of IE) 5. if the vegetations break off, they enter the ______ and circulate 6. if emboli gets lodged = ____ 7. left sided vegetations can lead to embolism in _______ causing ______infarction 8. right sided vegetations can lead to embolism in the _____

Answer 27

Patho 1. causative organism enters body 2. travels in blood to the heart 3. infects previously damaged valves or other endothelial surfaces 4. valve(s) or other endothelial surfaces are covered with large, irregular “vegetations” (primary lesions of IE) 5. if the vegetations break off, they enter the blood stream and circulate 6. if emboli gets lodged = embolism 7. left sided vegetations can lead to embolism in (body) brain, kidneys, spleen and extremities causing limb infarction 8. right sided vegetations can lead to embolism in the lungs (PE)