Week 4 - Endocarditis Flashcards
what is infective endocarditis
- infection of the heart valves and/or the endocardial surface of the heart with formation of vegetations
what is infective endocarditis most commonly caused by
- bacteria –> staph and strep
what are other possible causes of infective endocarditis (2)
- fungi
- viruses
what are predisposing factors for infective endocarditis (4)
- prior endocarditis
- conditions that damage the valves
- IV drug use
- hospital acquired bacteremia (ex. dialysis, CVAD)
what are the “vegetations” seen in infective endocarditis
- primary lesions of IE
- consist of fibrin, leukocytes, patelets, and bacteria that adhere to the valves and endocardium
IE occurs when…
- blood flow turbelence within the heart allows the causative organisms to infect previously damaged valves or other endothelial surfaces and cause vegetations
what is a potential complication that can arise due to the vegetations in IE
- fragmentation and migration of the vegetations into the circulation causing embolization
emboli arising from a left sided heart vegetation will cause? (2)
- organ embolization
- vascular embolization
what organs can be affected by vegetations in the left side of the heart (3)
- kidney
- spleen
- brain
what can vascular embolization cause (5)
- limb infarction
- splinter hemorrages
- petichia
- janeaway’s lesions
- roth’s spots
- oslers nodes
where might you see petechiae from vascular embolization (4)
- feet
- ankles
- lips
- buccal mucosa
what are splinter hemorrhages
- black streaks in nail beds
what are roth’s spots
- lesions on the retina
what are janeaway lesions
- flat, painless red spots on the palm of the palm or soles of feet
what are osler nodes
- red/purple, painful, pea sized lesions on fingers or toes
what sign may indicate organ embolization to the brain (5)
- decreased LOC
- hemiplegia
- ataxia
- aphasia
- visual changes
what sign may indicate organ embolization to the kidneys (3)
- decreased UO
- flank pain
- hematuria
right sided vegetations in IE may embolize to…
- the lungs
what is a side of organ embolization to the lungs
SOB
what are other complications of IE (6)
- dysrhythmias
- valvular incompetence
- invasion of the myocardium
- HF
- sepsis
- heart block
what is the primary cause of right sided endocarditis
- IV drug use
describe the S&S of IE
- nonspecific
- involve multiple organ systems
what are some S&S of IE (14)
- low grade fever
- chills
- weakness
- malaise
- fatigue
- anorexia
- weightloss
- arthralgia & myalgia
- back pain
- abdominal discomfort
- headache
- finger clubbing
- murmurs
- Sx secondary to embolization
what Sx may indicate embolization to the spleen (4)
- sharp, LUQ pain
- splenomegaly
- local tenderness
- abdom rigidity
how can IE be diagnosed (6)
- health history
- blood cultures
- CBC (esp. leukocytes)
- echo
- ECG (for heart block)
- cardiac catheterization
what should you assess regarding history for someone who may have IE (4)
- recent procedures
- history of IV drug use
- previous valvular heart disease
- congenital heart disease
what is important in collaborative care for a pt with IE (7)
- drug therapy
- monitor and treat fever
- physical and emotional rest
- monitor for complications from the vegetations
- avoid excessive fatigue
- plan rest period before and after therapy
what kind of drug therapy is used in treatment for a pt wirt IE
- long term IV ab for 4-6 weeks
- antipyretics
what do pts with IE need for treatment
- long term IV catheter or CVAD
what is important to teach a pt with IE (5)
- avoid people w infection
- adhere to planned treatment regimen
- teach S&S of embolization
- maintain good oral hygeine
- must take prophylactic antibiotics before dentist or procedures for rest of life
why is decreased CO a nursing diagnosis for IE (3)
- altered rhythm
- valvular incompetence
- fluid overload (heart murmur)
a nursing diagnosis for IE is hyperthermia. nursing interventions can be done for this? (6)
- monitor temp & VS
- admin antipyretics
- monitor I&O
- monitor signs of dehydration
- encourage fluid consumption
- monitor for fever-related complications (seizure, decreased LOC, electrolytes, etc.)
a nursing diagnosis r/t IE is impaired comfort. what nursing interventions can be done for this? (6)
- prompt attention to call bells
- determine sources of discomfort
- avoid unnecessary exposure, drafts, overheating, or chilling
- facilitate hygeine measures
- position pt
- reduce anxiety
what nursing interventions can help reduce anxiety in a pt with IE (3)
- provide factual info concerning diagnosis, treatment, and prognosis
- encourage verbalization of feelings, perceptions, and fears
- instruct pt on use of relaxation techniques
a nursing diagnosis r/t endocarditis is deficient knowledge. what teaching of the disease process can be done (3)
- assess pts currently lvl of knowledge
- describe common S&S
- discuss lifestyle changes that may be required to prevent future complication and/or control the disease
what teaching regarding the meds can be done to the pt?
- provide pt and caregiver w written info about the action, purpose, and s/e of meds
