Endocarditis

Question 1

What is Endocarditis?

Answer 1

• Inflammation of the inner lining of the heart chamber and heart valves (endocardium).
• This condition usually occurs when an invading organism (bacteria, virus, fungi, etc.) from other parts of the body, such as the mouth, spread through blood circulation and then attach themselves to the damaged regions in the heart.

Question 2

How does injury to tissue lead to inflammation?

Answer 2

• Injury to tissue will initiate the inflammatory response
  
  • WBCs (macrophage & neutrophils) come in through increased capillary permeability to protect the body
  • this causes swelling and redness because more blood and fluid come in too

Question 3

Endocarditis non-specific manifestations?

Answer 3

• Fever due to the inflammatory response
• Flu-like symptoms
• Arthralgia (joint pain) and myalgias are common
  
  • Assess the patient for joint or muscle tenderness and decreased range of motion (ROM)

Question 4

Endocarditis heart manifestations?

Answer 4

Heart murmurs

• faulty valves → altered blood flow → causes extra sounds

Dysrhythmias

• altered rhythm due to faulty valves

Heart failure

• valves affected → blood not flowing forward → backup of blood → heart gets weaker as it works harder

Decreased cardiac output

• Normal CO: 5-7 L/min

Emboli

• backflow of blood → blood slows down → clots can form (can lead to MI and stroke)

Endocarditis vegetations

• masses of bacteria (can be any microorganism) that form on the heart valves
• can break off and travel to other organs (emboli)

Question 5

Endocarditis vascular manifestations?

Answer 5

• Splinter hemorrhages (black longitudinal streaks) in the nail beds
• Petechiae from microembolization of vegetative lesions can occur on mouth, feet, antecubital, and behind the knees (small dots of blood)
• Osler’s nodes
• Janeway’s lesions
• Roth’s spots (hemorrhagic retinal lesions)
  
  • eyes have red area with pale center

Question 6

Describe Osler’s nodes.

Answer 6

• painful
• tender
• red or purple, pea-size lesions found on the fingertips or toes

Question 7

Describe Janeway’s lesions.

Answer 7

• painless
• flat
• small, red spots seen on the palms of the hands and soles of the feet

Question 8

How are blood cultures obtained in a patient with endocarditis?

Answer 8

• Obtained frequently, regularly, and at different sites
• Culture FIRST before antibiotics

Question 9

Diagnostic tests for endocarditis?

Answer 9

• Echocardiogram: allows visualization and evaluation of valve function
  
  • can also show vegetations
• Electrocardiogram (ECG/EKG)
• Chest x-ray

Question 10

If a patient asked you about an echocardiogram, what would you say?

Answer 10

• Echocardiogram = uses sound to take pictures of what your heart looks like
• Can see the inside and outside of the heart
• See if the chambers and valves are working normally

Question 11

If a patient asked you about an electrocardiogram, what would you say?

Answer 11

• We’re going to put probes on your body and see how the normal electricity in your body flows through your heart
• It will show if your heart is beating correctly
• No, you will not feel the electricity
• No, it won’t hurt.

Question 12

How does a chest x-ray work?

Answer 12

• Doesn’t show the inside of the heart
• It will show if there’s enlargement (cardiomegaly) or hypertrophy of a chamber of the heart

Question 13

What changes in labs would you expect with Endocarditis?

Answer 13

• Leukocytosis = elevated WBCs
  
  • Normal WBCs: 5,000-10,000
• Elevated erythrocyte sedimentation rate (ESR)
  
  • increases with inflammation
• Elevated C-reactive protein (CRP) levels
  
  • increases with inflammation

Question 14

What is the significance of blood cultures and medication therapy?

Answer 14

• Accurately identifying the causative organism is the key to successful treatment of IE.
• Antibiotic therapy is based on blood culture results.
• Long-term treatment is needed to kill dormant bacteria within the valvular vegetations.
• Complete removal of the organism generally takes 4-6 weeks.

Question 15

What can continued positive blood cultures indicate?

Answer 15

• Inadequate or inappropriate antibiotics
• An aortic root or myocardial abscess
• Wrong diagnosis

Question 16

Why would a patient with Endocarditis require a valve replacement?

Answer 16

• Valve dysfunction causing heart failure
• To prevent embolization
• Uncontrolled infection

Question 17

Nursing considerations for Endocarditis?

Answer 17

Avoid risk of infection!

• Tell patient to avoid people with infections, especially upper respiratory tract infections, and to report cold, flu, and cough symptoms.
• Tell the patient to inform providers scheduling invasive procedures about the history of IE.
• Patients are at risk for life-threatening complications, such as stroke, pulmonary edema, and heart failure (teach them to recognize s/s)
• Promote rest to decrease work of the heart
• To prevent problems related to decreased mobility:
  • Encourage elastic compression stockings
  • Perform ROM exercises
  • Deep breathing
• Stress the importance of good oral hygiene.
  
  • Bacteria can get into blood system quick through mucous membranes