Unit 1 Cardiac Nursing – Infectious Endocarditis – Flashcards

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• Infection of the endocardial layer of the heart - Most commonly involves valve leaflets, chordae tendonae, & papillary muscles - May also invade the lining of the heart chambers & large vessels - Mitral valve most common effected

Pt. Hx. - Rheumatic fever (untreated strep throat) /previous endocarditis - Valve disease/damage/prosthetic valve replacement - Heart surgery/cath/pacemaker insertion - Cardiomyopathy - Congenital heart disease - Gu/bowel procedures/foleys - Endotracheal tubes r/t resp. infection - IV therapy - esp. if IV sites not changed Q72H (grows bugs/clots that dislodge and go to the heart - Central lines - IV drug abuse*** - Dental work*** •Elderly r/t more procedures

• Infection - tissue injury - inflammation - thrombus formed which covers infection - pathogens grow & are protected from antibx by thrombus - vegetation forms - hard to treat with antibx -vegetation erodes - valve dysfunction - heart failure & dysrhythmias

Vegetations on the valves can break off and travel as emboli - R side goes to the lungs - L side goes to the head, spleen & arteries

•Strep - 55% cases - Strep throat, dental work, •Staph - 30 % cases - Staph epi - IVs, central lines & devices, IV drug abuse, dental work, resp. •Fungus - heart surgery, IVs, central lines & devices, IV drug abuse, abx/steroids •Enterococcus, klebsiella, pseudomonas - GI/GU procedures, elderly

Insidious onset - Fever, headache, malaise, weakness, fatigue, anorexia, wt. loss, night sweats - New or changed murmur (murmur = damage to heart valve) Acute onset - Decreased BP, increase HR, T > 103°F, shaking chills, - New or changed murmur

•May also have S/S heart failure •If embolization occurs may have S/S - CVA, MI, renal failure, infarcted spleen/bowel, PE

Petechiae - Conjunctiva, mucous membranes, wrists, ankles, shoulders, clavicles - Flat red lesions usu. In groups - Fade in a few days Splenomegaly - usu. after 6 weeks

Splinter hemorrhages - Fingernails, toenails - Longitudinal dark line usu. on distal 1/3 of nail Osler's nodes - Pads of fingers & toes - Purplish with white center - Painful Janeway lesions - Fingers, toes, earlobes, & nose - Nontender, hemorrhagic

Atypical presentation - Confusion, renal failure, neuro changes, pulmonary edema

•Echocardiogram - Vegetations & valve function •Tee for mitral •Blood culture & sensitivity •Sed rate/WBC - Elevated •EKG - Heart failure & dysrhythmias •Heart cath - Assess valve & function

•Antibiotics/antifungals - most important intervention - Usu. receive 2 or 3 types for 4-6 weeks - PICC line - Check & maintain blood levels •Often need valve replacement surgery •Abx prophylaxis for invasive procedures (for life) - Wallet Card for abx prophylaxis

• Alteration in comfort r/t fever, chills, diaphoresis, arthralgias • Risk for decreased cardiac output r/t valve damage • Decreased activity tolerance r/t decreased pumping action of heart • Knowledge deficit • Risk for alteration in nutrition (less than body requirements) r/t anorexia & hypermetabolic state

• Give antibiotics on time (most important intervention) • Monitor blood cultures & drug levels & labs, vital signs, & QD wt. • Monitor temperature & for complications • Maintain adequate nutrition & hydration • PICC line care • Home health for home antibiotics • Activity as tolerated • Assist with general hygiene & comfort measures & oral care

• Abx prophylaxis for all invasive procedures • Tell all health care providers about hx. Endocarditis • Home iv care & antibiotics • Importance of personal & esp. Oral hygiene & dental care • Disease process S/S • S/S of complications • When to seek help