endocarditis Flashcards
infective endocarditis
Is an infection of the innermost layer of the heart where the valves are.
Prognosis of IE has improved with use of antibiotics. Untreated will cause death.
15,000 cases are diagnosed per year.
acute endocarditis
¨Affects those with healthy valves and is
rapidly progressive.
sub acute endocarditis
¨Typically affects those with pre-
existing valve disease. Clinical course
may extend over months. Usually
responds well to treatment.
classified by cause of site (endocarditis)
Intravenous drug abuse infective
endocarditis (IE IVDA)
b. Fungal endocarditis
c. Prosthetic valve endocarditis (PVE)
organisms that cause endocarditis
¨Bartonella quintana, Chlamydia
¨Coag. negative staphlococcus, enterococcus
¨MRSA, streptococcus, trophenyma whipple,
¨Rickettsiae, staph aureus, HACEK group
¨Viruses—coxsackie B virus
¨Fungi—Candida
¨
¨Most common cause is staph aureus and steptococcus viradans. Bartonella & trophenyma are new organisms that are difficult to cultivate. MRSA is hard to treat.
predisposing cardiac conditions for endocarditis
¨Prior endocarditis, prosthetic valves
¨Acquired valve disease, cardiomyopathy
¨Pacemakers, Marfan’s syndrome
¨Asymmetrical septal hypertrophy
¨Rheumatic Heart Disease
if you receive any procedure with endocarditis
any dental procedures or anything. Like murmurs
need to be on an antibiotcs
non cardiac conditions that predispose you to endocarditis
¨IV drug abuse
¨Nosocomial infections
procedures that predispose you to endocarditis
¨Intravascular devices, cardiac catherization
¨Oropharyngeal procedures
¨Bronchoscopy, esophageal dilation, endoscopy
¨Surgical procedures
pathophysiology of endocarditis
¨Turbulent blood flow from damaged cardiac valves allows bacteria to settle on low pressure side of valve or defect.
¨Hallmark of IE is platelet-fibrin-bacteria mass on valve called vegetation. Organisms surround valve matrix, scarring and perforating leaflets.
¨Emboli can occur if vegetative growths break free and enter blood. 22% to 50% will experience systemic embolization with left sided vegetation. Right sided embolization goes to lungs.
¨Infection can spread from valve to supporting structures causing arrhythmias, valvular incompetence and possible heart failure.
endocarditis in the mitral valve
affects organs
causes emboli to be pushed out into the system
endocarditis in the tricuspid valve
causes emboli to go into the lungs
symptoms of endocarditis
¨In acute type the onset is swift with septicemia and a fever over 38 degrees. The sub-acute is more insidious with vague complaints of malaise & aches & pains with low grade fever.
¨Chills, weakness, malaise, anorexia, fatigue.
¨Back pain, arthralgias, abdominal discomfort, headache, night sweats, and weight loss. May see clubbing of fingers in sub-acute.
acute symptoms of endocarditis
come on strong. worst
sub acute endocarditis symptoms
take longers to come on. not as stong. low grade fever
vascular symptoms of endocarditis
¨Splinter hemorrhages on nail beds
¨Petechiae
¨Osler’s nodes-painful, tender, red or purple, pea size lesions on fingertips and toes
¨Janeway’s lesions-flat, painless, small red spots on palms and soles of feet.
¨Roth’s spots-hemorrhagic retinal lesions.
¨Onset of new or changing murmur is noted in most patients with aortic and mitral valve problems.
embolization that comes of the left side (endocarditis)
¨Spleen—sharp LUQ pain and increased size of spleen
¨Kidneys—flank pain, hematuria, azotemia
¨Brain—neurological damage like ataxia, hemiplegia, aphasia, visual changes, changes in levels of consciousness.
¨Peripheral vessels to extremities–gangrene
diagnostic studies for endocarditis
¨History of procedures in last 6months, IVDA(IV drug abuse), heart disease, intravascular devices, renal dialysis, infections.
¨Blood cultures
¨Elevated WBC, ESR, & C-reactive protein
¨Vegetative growth on echocardiogram
¨ECG
¨Chest Xray to check for cardiomegaly
¨Cardiac cath to evaluate valve.
treatment for endocarditis
¨Long term antibiotic therapy
¨Valve replacement
¨Initially hospitalized for IV antibiotics . Then can get IV antibiotics on outpatient basis.
¨Will need prophylactic antibiotic therapy for any invasive procedures in the future.
nursing care for endocarditis
¨Assess for history and subjective/objective symptoms of endocarditis.
¨Possible nursing diagnoses:
a. Decreased cardiac output
b. Hyperthermia
c. Activity intolerance
d. Knowledge deficit
nursing interventions for endocarditis
¨Monitor vital signs, cardiovascular status, respiratory status and for complications
¨Administer medications as ordered
¨Give oxygen as needed, I&O, daily weight, keep HOB elevated.
¨Monitor labs/diagnostic procedures
¨Evaluate activity tolerance. Encourage balance between rest and activity to decrease cardiac workload.
teaching a patient with endocarditis
¨Review patient’s knowledge about this condition
¨Review signs & symptoms of the disease and when to notify doctor.
¨Patient should avoid contact with people who have infections.
¨Patient should take prophylactic antibiotics prior to any invasive procedure.
¨Action of medications
¨Need for medical follow-up.
¨Avoid excessive fatigue.
pericarditis
¨Is an inflammatory process of the visceral or parietal layer of the pericardium (membranous sac that encloses the heart)
¨Can be acute or chronic.
¨Acute pericarditis is commonly associated with:
¡Infective organisms ( bacteria, viruses, fungi)
¡Malignant neoplasms
¡Post MI syndrome ( Dressler’s Syndrome )
¡Post-pericardiotomy syndrome after cardiac surgery
¡Systemic connective tissue disease like Lupus
¡Renal disease with uremia
acute pericarditis
¡Infective organisms ( bacteria, viruses, fungi)
¡Malignant neoplasms
¡Post MI syndrome ( Dressler’s Syndrome )
¡Post-pericardiotomy syndrome after cardiac surgery
¡Systemic connective tissue disease like Lupus
¡Renal disease with uremia
