UNIT 2 AND 3 Chapter 32 Endocarditis Flashcards
What is Ineffective Endocarditis
bacterial infection and inflammation in the endocardium , can be e.g., viruses, bacteria, fungi
(Streptococcus viridans or Staphylococcus aureus.)
The most common causative agents are Staphylococcus aureus and viridans streptococci;
The most common causative agents are Staphylococcus aureus and viridans streptococci;
Invasive Cardiac surgery
Invasive Gastrointestinal surgery
Invasive Genuitory surgery
especially if synthetic material is used (valves, patches, conduits); or from long-term indwelling catheters.
Exposure to bacteria by brushing teeth
Dental work
How may someone get exposed to bacteria that can cause Endocarditis
- The oral cavity (especially if dental procedures have been performed)
- Skin rashes, lesions, or abscesses
- Infections (cutaneous, genitourinary, GI, systemic)
- Surgery or invasive procedures, including IV line placement
What is a common complication of Ineffective Endocarditis?
HEART FAILURE
Cardiac Valve Vegetation during Bactermia
During bacteremia, bacteria become trapped in the low-pressure “sinkhole” and are deposited in the vegetation. Additional platelets and fibrin are deposited, causing the vegetative lesion to grow.
THAT CAN CAUSE EMBOLI’S
-Risk for myocardial infarction or cerebral vascular accident
Splenic Infarction and Renal infarction
Splenic infarction with sudden abdominal pain and radiation to the left shoulder can also occur. When performing an abdominal assessment, note rebound tenderness on palpation. The classic symptom with Renal infarction is flank pain that radiates to the groin and is accompanied by hematuria (red blood cells in the urine) or pyuria (white blood cells in the urine). Mesenteric emboli cause diffuse abdominal pain, often after eating, and abdominal distention.
s/s of splenic infarction
rebound tenderness on palpation.
s/s renal infarction
-flank pain that radiates to the groin
-hematuria
-pyuria (white blood cells in the urine).
Mesenteric emboli cause diffuse abdominal pain, often after eating, and abdominal distention.
Where is the Endocardium?
THE MOST INNER LAYER OF THE HEART
- basically a infection inside your heart**
What are the Risk factor for Endocarditis?
RISK FACTORS
* IV drug users (IDU- Injection Drug use)
* Valve replacements
* Genetic anomalies like structural cardiac defects
Is Endocarditis fatal?
A. No
B. Yes
B. Yes
Because the mortality rate remains high, early detection of infective endocarditis is essential. Without treatment, infective endocarditis is fatal.
Can early detection of Endocarditis save apatients life?
A. Yes
B.No
A. Yes
Early detection of infective endocarditis is essential.
Are clinical manifestations of Ineffective Endocarditis slow or onset?
A. onset
B. slow
B. slow
Unfortunately, many patients (especially older adults) are misdiagnosed. Signs and symptoms typically occur within 2 weeks of a bacteremia.
Clinical Manifestations of Endocarditis?
Fever associated with chills, night sweats, malaise, and fatigue
* Anorexia and weight loss
Cardiac murmur (newly developed or changing heart murmurs in location)
Development of heart failure
Evidence of systemic embolization(blood clots)
Petechiae
Splinter hemorrhages(lines on nails)
Osler nodes (on palms of hands and soles of feet)
Janeway lesions (flat, reddened maculae on hands and feet)
* Roth spots (hemorrhagic lesions that appear as round or oval spots on the retina)
Positive blood cultures(due to bacteria , virus , or fungi in blood)
Dyspnea
*Peripheral edema
*Jugular Vein Distention**
Crackles in lungs
Pink frothy sputum
What is a clinical finding of a patient with Endocarditis?
A. heart murmur change
B. unsteady gait
C. hypoglycemia
D. hypotension
A. heart murmur change
Is it true that patient with Endocarditis will exhibit signs and symptoms of Heart failure?
A. Yes
B. NO
A. Yes
What are the s/s Left and Right sided heart failure?
HF is the most common complication of infective endocarditis. Assess for right-sided HF (as evidenced by peripheral edema, weight gain, and anorexia) and left-sided HF (as evidenced by fatigue, shortness of breath, and crackles on auscultation of breath sounds)
Arterial embolization
Arterial embolization is a major complication in up to half of patients with infective endocarditis.
When the left side of the heart is involved, vegetation fragments are carried to the spleen, kidneys, GI tract, brain, and extremities.
When the right side of the heart is involved, emboli enter the pulmonary circulation.
Complication of emboli
About a third of patients have neurologic changes; others have signs and symptoms of pulmonary problems. Emboli to the central nervous system cause either transient ischemic a acks (TIAs) or a stroke. Confusion, reduced concentration, and aphasia or dysphagia may occur. Pleuritic chest pain, dyspnea, and cough are symptoms of pulmonary infarction related to embolization.
What is the tx for Endocarditis?
Antimicrobials are usually given IV, with the course of treatment lasting 4 to 6 weeks. For most bacterial cases, the ideal antibiotic is one of the penicillins or cephalosporins.
The patient’s activities are balanced with adequate rest. Consistently use appropriate aseptic technique to protect the patient from contact with potentially infective organisms.
The nurse is caring for a hospitalized client with infective endocarditis who has been receiving antibiotics for 2 days. The client is now experiencing flank pain with hematuria. What complication will the nurse suspect?
A. Pulmonary embolus
B. Renal infarction
C. Transient ischemic a ttack
D. Splenic infarction
B. Renal infarction
Should you provide rest for a patient with endocarditis
Care of the patient with endocarditis usually includes antimicrobials, rest balanced with activity, and supportive therapy for HF. If these interventions are successful, surgery is usually not required.
for long-term IV therapy, what type of line would be inserted
A. peripherally inserted central catheter
B.pereipheral line
C. fistula
D. Ped tube
A. peripherally inserted central catheter
A saline lock, peripherally inserted central catheter (PICC) line, or central catheter is positioned at a venous site that is easily accessible to the patient or a family member.
Patient and family teaching for IV long-term therapy
- Teach the patient and family how to administer the antibiotic and care for the infusion site while maintaining aseptic technique.
- l. Emphasize the importance of maintaining a blood level of the antibiotic by administering the antibiotics as scheduled.
- After stabilization at home, the case manager or other nurse contacts the patient every week to determine whether he or she is adhering to the antibiotic therapy and whether any problems have been encountered.
- Encourage proper oral hygiene.
- No flossing
- no irrigation devices
- Clean open skin and apply antibiotic cream
- Self administer prophylaxis before dental work
- Self administer prophylaxis before dental work
- Note any indications of recurring endocarditis such as fever.
- Monitor and record their temperature daily for up to 6 weeks.
- Report fever, chills, malaise, weight loss, increased fatigue, sudden weight gain, or dyspnea to their primary care provider.
Nursing Considerations for Long Term IV therapy
- After stabilization at home, the case manager or other nurse contacts the patient every week to determine whether he or she is adhering to the antibiotic therapy and whether any problems have been encountered.MONITOR PEAK AND THROUGH
- Advise patients to use a soft toothbrush, to brush their teeth at least twice per day, and to rinse the mouth with water after brushing.
- They should not use irrigation devices or floss the teeth because bacteremia may result.
- Teach them to clean any open skin areas well and apply an antibiotic ointment.
- Self administer prophylaxis before dental work
- Note any indications of recurring endocarditis such as fever.
- Remind them to monitor and record their temperature daily for up to 6 weeks.
- Teach them to report fever, chills, malaise, weight loss, increased fatigue, sudden weight gain, or dyspnea to their primary care provider.
Should patients notify their Dental HCP that they have Endocarditis?
A. yes
B. no
A. yes
Patients must remind health care providers (including their dentists) of their endocarditis.
How do you measure the Peak of a medication?
HIGHEST CONCENTRATION OF MED
30 to 60 minutes after med administration
How do you measure the through of a medication?
Right before the next dose of medication
Should patients with ENndocarditis floss?
A. no
B. yes
Advise patients to use a soft toothbrush, to brush their teeth at least twice per day, and to rinse their mouth with water after brushing.
** They should NOT use irrigation devices or floss the teeth because bacteremia may result.**
What is the best way to prevent endocarditis?
A. brush teeth twice a day and after eating
B. floss teeth
C. Use peroxide oral swish
D. Brush teeth for 5 minutes
A. brush teeth twice a day and after eating
Should you use anticoagulants with Endocarditis?
A. yes
B.no
B.no
-your blood is thin due to the strepinfection which petechia.
