Endocarditis Flashcards

1
Q

What layer of the heart is the endocardium?

A

Innermost, lining the chambers and valves.

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2
Q

What parts of the heart are affected by infective endocarditis?

A

Heart chambers or valves

Infective endocarditis is an infection of the heart chambers or valves

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3
Q

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

A

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

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4
Q

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

A

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

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5
Q

Two factors required to get endocarditis?

A
  1. A damaged epithelium (i.e., from valve replacements or defects)
  2. A port of entry (i.e., wound, dental procedure, IVDU)
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6
Q

Most common causative bacterial organisms of infective endocarditis

A

Staph aureus, strep viridans

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7
Q

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

A

Fungi, viruses

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8
Q

When do clinical manifestations typically occur with endocarditis?

A

Typically occur within 2 weeks of bacteremia

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9
Q

Endocarditis clinical manifestations
nonspecific
specific (6)

A

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

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10
Q

What are vegetations?

A

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.

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11
Q

Where do left-sided vegetations move to?

A

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

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12
Q

Where do right-sided vegetations move to?

A

Lungs (PE)

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13
Q

Two vascular manifestations of endocarditis

A
  1. Splinter hemorrhages
  2. Petechiae
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14
Q

Black/reddish-brown longitudinal streaks in nail beds

A

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

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15
Q

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

A

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

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16
Q

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

A
  1. Osler nodes
  2. Janeway lesions
  3. Roth spots
17
Q

Tender papulopustules on fingertips or toes

A

Osler nodes
Tender papulopustules on fingertips or toes

18
Q

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

A

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

19
Q

Hemorrhagic retinal lesions

A

Roth spots
Hemorrhagic retinal lesions

20
Q

Endocarditis clinical manifestations

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

A

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

21
Q

Endocarditis history and diagnostic tests (3)

A
  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)
22
Q

Who should be prophylactically treated for endocarditis? (4)

A

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

23
Q

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

A
  1. Oral-dental work
  2. biopsy of any kind -respiratory tract incision (biopsy)
  3. procedures like tonsillectomy, adenoidectomy
  4. GI & GU-wound infection, UTI
24
Q

Endocarditis drug therapy

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

A

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

25
Q

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

A

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

26
Q

Endocarditis nursing care: home care

May include IV _______
Have patient monitor for ________

A

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

27
Q

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 _____

A

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)