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Nursing 172 > Week 8: Chp 30: Infective Endocarditis > Flashcards

Week 8: Chp 30: Infective Endocarditis Flashcards

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1
Q

IE can be classified as

A

native (own) or prosthetic or as right or left sided

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2
Q

What valves does IE affect?

A

mostly the native mitral or aortic valves

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3
Q

Risk Factors for Infective Endocarditis

A
  • age (>60)
  • immunodeficiency
  • IV drug use
  • diabetes mellitus
  • presence of prosthetic heart valves
  • prior history of endocarditis
  • congenital or structural heart disease
  • presence of an intravascular access or implanted cardiac device
  • poor oral hygiene or periodontal disease
  • patients on hemodialysis
  • patients with frequent exposure to the healthcare system or invasive procedures
  • rheumatic heart disease
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4
Q

What is Infective Endocarditis

A

infection of the innermost layer of the heart, the endocardium, most typically affecting the heart valves

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5
Q

How does IE begin?

A

begins with damage to the endocardial lining of the heart, which can occur as a result of turbulent blood flow; turbulent blood flow is often caused by valve dysfunction

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6
Q

Pathophysiology of IE; path of how it develops

A

begins with damage to the endocardial lining of the heart (due to turbulent flow)

  • platelet and fibrin deposit onto the injured area, forming what is known as a nonbacterial thrombotic endocardial lesion
  • microorganisms introduced into the bloodstream through patient exposures circulate and can become trapped under the layers of platelet and fibrin deposits
  • these microorganisms and deposits grow into clumps known as vegetation which can severely damage the valves of the heart
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7
Q

Most common causative organism of IE are

A
  • Staphylococcus and Streptococcus
  • can also be caused by other bacteria, viruses, and fungi
  • the source of exposure to microorganisms in the blood has been historically linked to dental and other invasive procedures; but repeated exposures to microorganisms are more likely to cause IE than a exposure during a single dental or other invasive procedure
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8
Q

Etiology of IE

A

generally bacterial origin

-Staphylococcus and Streptococcus

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9
Q

Vegetation

A

microorganisms and deposits grow into clumps known as vegetation
-which can severely damage the valves of the heart

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10
Q

Clinical Manifestations

A
  • Osler’s nodes: red, painful nodes in the pads of the fingers and toes
  • Janeway Lesions: red, painless spots on the palms and soles
  • splinter hemorrhages: tiny blood clots that run vertically under nails
  • heart murmur; the sound heard when there is turbulent blood flow across a heart valve
  • also experience HF, arrhythmias, weight loss, or night sweats
  • fever, fatigue, confusion (in older adults)
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11
Q

Diagnostic Tests

A

Tests used to confirm IE are blood cultures, two sets from different sites

  • transthoracic echocardiogram (TTE) or
  • transesophageal echocardiogram (TEE)
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12
Q

Diagnostic Tests: Echocardiography

A

can identify valve dysfunction, vegetative growth, abscesses, and changes in heart size and pumping ability that can occur with IE

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13
Q

Medication management

A

consists of IV antibiotic therapy

  • increasing trend of microbial resistance has led to the use of combination therapy
  • standard duration of treatment is 4 to 6 weeks; may be longer if you have prosthetic valves
  • often discharged home on IV antimicrobial therapy
  • Oral antimicrobial therapy are rarely used as initial treatment
  • repeated blood cultures may be obtained until results are negative, indicative of adequate bactericidal effects
  • prophylactic use of oral antibiotics is not routinely recommended but is used for patients at high risk
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14
Q

Safety Alert

A

to prevent IE and reduce valvular disease, prophylactic antibiotics are recommended before dental procedures, and meticulous oral hygiene should be encouraged for patients at highest risk, such as those with a history of IE, intracardiac prosthetic material such as valves and defect closure devices, cardiac transplant, and congenital heart disease

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15
Q

How to choose Antimicrobial Agents

A

complex and based on the organism cultured and the sensitivity report, right sided versus left sided IE, native versus prosthetic valve involvement, patient comorbidity, and other factors
-infectious disease specialists are often consulted

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16
Q

Various antimicrobials for the treatment of IE

A

-Penicillin G, ceftriaxone, vancomycin, nafcillin, and gentamicin may be considered in various combinations

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17
Q

Treatment of IE

A
  • medications
  • surgical management
  • supportive treatment for the common complications of IE, especially HF, is also indicated to optimize cardiac output and tissue perfusiom
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18
Q

Surgical Management

A
  • valve repair or replacement
  • surgery can remove infected tissue and reduce mortality and complications but has significant risks
  • timing of surgery is controversial, due to lack of definitive evidence but early surgery is recommended for cases in which antimicrobial therapy has been ineffective in controlling the infection or when complications such as embolic events or HF are observed
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19
Q

Complications

A
  • Embolic Events (often of left-sided IE)
  • Heart Failure and dysrhythmias
  • stroke
20
Q

Complications: Embolization

A

major complication of IE

  • occurs when fragments of vegetation break free from the valve and travel to other parts of the body through the bloodstream
  • the emboli can travel randomly to any organ or tissue, resulting in obstructed blood flow and potentially spreading infection
  • Emboli from left-sided IE travel to CNS but can also affect kidney, spleen, bowel, and extremities
  • Emboli traveling to the CNS can cause transient ischemic attacks or strokes
  • Right sided IE is associated with pulmonary emboli
21
Q

Emboli traveling from Left-sided IE travel to

A

CNS but can also affect kidney, spleen, bowel, and extremities
-Traveling to the CNS can cause transient ischemic attacks or stroke

22
Q

Emboli traveling from the right-sided IE

A

pulmonary emboli

23
Q

Nursing Management: Assessment and Analysis

A
  • clinical manifestations of IE such as, positive blood cultures combined with fever, fatigue, and the lesions typically seen in the hands and feet are due to infection
  • Sepsis can occur in conjunction with IE
  • Septic Emboli can alter CNS and systemic perfusion
  • the damage to the heart valves can cause a new murmur and heart failure (HF)
24
Q

What can occur in conjunction with IE

A

Sepsis

-septic emboli can alter CNS and systemic perfusion

25
Q

Nursing Diagnosis

A
  • Infection r/t an invading organism secondary to IE
  • Ineffective tissue perfusion r/t emboli
  • Decreased cardiac output r/t valve dysfunction, altered rhythm, and/or altered stroke volume
26
Q

Nursing Interventions: Assessments

A

Assess:

  • Vital Signs
  • Auscultate Breath Sounds
  • Auscultate Heart Sounds
  • Assess neurological function
  • extremities
  • skin assessment
  • monitor diagnostic test results
  • history of drug use, invasive procedures, implanted vascular or cardiac devices, or valve replacement surgery
27
Q

Assessment: Vital Signs

A

fever is indicative of ongoing acute infection

-hypotension, tachycardia, tachypnea, and low Sp02 can be signs of sepsis and HF

28
Q

Assessment: Auscultate Breath Sounds

A

crackles may be a sign of heart failure related to valve dysfunction

29
Q

Assessment: Auscultate Heart Sounds

A

new or worsening murmur may occur due to valve damage

30
Q

Assessment: neurological function

A

neurological changes or deficits in pupils, grips, foot pushes, facial droop, and speech may be signs of CNS embolization

31
Q

Assessment: Extremities

A

cyanosis or pallor, delayed capillary refill, and decreased peripheral pulses may indicate peripheral embolization
-edema can be a sign of HF related to valve dysfunction

32
Q

Assessment: Skin

A

Osler’s Nodes, Janeway lesions, and splinter hemorrhages are indicative of IE

33
Q

Assessment: Monitor diagnostic test results

A

repeated culture reports are used to evaluate the effective treatment of IE

  • WBC counts can indicate responsiveness to infection
  • echocardiograms can evaluate the size of vegetation and valve function and can be used to predict the risk of complications
34
Q

Assessment: History of drug use, invasive procedures, or valve replacement surgery

A

common risk factors for IE

35
Q

Nursing Interventions: Action

A
  • administer antibiotics as prescribed
  • maintain IV access for antibiotics prescribed
  • administer HF medications as needed
  • provide social support during prolonged hospitalization
  • refer patient to addiction counseling services if drug use has caused the disease
36
Q

Nursing Actions: Administer antibiotics as prescribed

A

treatment for IE is long-term antibiotic treatment

37
Q

Nursing Actions: Maintain IV access for antibitoic administration

A

intravenous access is essential for antibiotic administration
-long-term venous access, such as a peripherally inserted central catheter (PICC), may be considered

38
Q

Nursing Actions: Administer heart failure medications as needed

A

heart failure treatment optimizes cardiac output and tissue perfusion

39
Q

Nursing Actions: Provide social support during prolonged hospitalization

A

social isolation due to hospitalization may contribute to depression, anxiety, and anger

40
Q

Nursing Actions: Refer patient to addiction counseling services if drug use has caused the disease

A

stopping recreational IV drug use may help limit the reoccurrence of IE and lead to a better quality of life

41
Q

Teaching

A
  • good hygiene utilizing a soft tooth brush (bleeding gums provide a portal of entry for bacteria into the bloodstream. Poor dental hygiene may increase recurrence of IE)
  • inform healthcare provider about IE history prior to any dental or invasive procedure (prophylactic antibiotics may be prescribed to decrease risk of IE)
  • completion of prolonged antibiotic regimen (completing the full course of antibiotics is critical to eradicating the infection and preventing recurrence and complications)
42
Q

Goals of Care

A

to control the infectious process through antibiotic administration and minimizing complications

43
Q

Patient education should focus on?

A

risk control, early detection, and prevention

44
Q

A well-managed patient looks like?

A

free from infection and understands the signs of IE and when the healthcare provider should be contacted

45
Q

Who is at higher risk for getting IE?

A

older people/ geriatric

  • due to comorbidities, increasing numbers of invasive procedures, and greater use of implanted cardiac devices such as pacemakers and artificial valves
  • the required prolonged hospitalization and treatment can contribute to rapid functional decline
  • evaluation for early discharge and home infusion therapy should be considered to maintain functional capabilities
  • an increase in fat mass, reduced renal function, and lower albumin levels require careful antimicrobial adjustments to optimize outcomes and reduce adverse effects
  • serum medication levels, renal function, and culture reports should be routinely monitored
  • confusion and agitation can challenge maintenance of continuous IV access; alternate medication routes my need to be considered
  • aging is not a contraindication for surgery but, comorbidities and clinical status should be evaluated

Nursing 172 (120 decks)

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