IE_Grp 4.pptx

Infective
Endocarditis
Chapter 37
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Infective Endocarditis (IE)
 Infection of the inner layer of heart,
including the cardiac valves
 Improved prognosis with antibiotic
therapy
 10,000–15,000 new cases
diagnosed in the U.S. each year

Layers of the Heart

Classification
 Subacute form
 Preexisting valve disease
 Longer clinical course
 Acute form
 Healthy valves
 Rapidly progressive
 Also classified by cause or site of
involvement

Causative Organisms
 Bacterial most common
 Streptococcus viridans
 Staphylococcus aureus
 Viruses
 Fungi

Etiology and Pathophysiology
 Occurs when blood turbulence
within heart allows causative
organism to infect previously
damaged valves or other
endothelial surfaces

Case Study
 E.F. is a 72-year-old man who
comes to the clinic with “flulike”
symptoms.
 He has a history of hypertension,
past MRSA infection, and a recently
implanted pacemaker.
iStockphoto/Thinkstock

Case Study
 What risk factors for IE does E.F.
have?
 What other risk factors would you
assess E.F. for?

Risk Factors
 Cardiac, noncardiac, procedural
 Principal risk factors
 Age
 IV drug abuse (IVDA)
 Prosthetic valves
 Use of intravascular devices
 Renal dialysis

Etiology and Pathophysiology
 Vegetation
 Fibrin, leukocytes, platelets, and
microbes
 Adhere to the valve or endocardium
 Parts break off and enter circulation
(embolization)

Bacterial Endocarditis of
MitralValue

Pathogenesis of IE

Case Study
 What clinical manifestations of IE
does E.F. present with?
 What other clinical manifestations
of IE would you assess him for?

Clinical Manifestations
 Nonspecific
 Low-grade fever occurs in 90% of
patients
 Chills
 Weakness
 Malaise
 Fatigue
 Anorexia

 Subacute form
 Arthralgias
 Myalgias
 Back pain
 Abdominal discomfort
 Weight loss
 Headache
 Clubbing of fingers

 Vascular manifestations
 Splinter hemorrhages in nail beds
 Petechiae
 Osler’s nodes on fingers or toes
 Janeway’s lesions on palms or soles
 Roth’s spots

Osler’s Nodes
From: Marrie, T. J., (2008). Osler’s Nodes and Janeway Lesions . American
Journal of Medicine, 121(2), 105-106.

Janeway Lesion
From: Zitelli, Basil, et al. (2007).
Zitelli and Davis' Atlas of Pediatric Physical
Diagnosis. Mosby.
From: Marrie, T. J., (2008). Osler’s Nodes and
Janeway Lesions . American Journal
of Medicine, 121(2), 105-106.

Roth Spots
From: Swartz, M. H..
Textbook of Physical
Diagnosis: History and
Examination, 6th Edition.
W.B. Saunders Company

 Murmur in most patients
 Heart failure
 Manifestations secondary to embolism
 Spleen
 Kidneys
 Limbs
 Brain
 Lungs

Case Study
 E.F. has petechiae in the conjunctivae
and splinter hemorrhages in his nail beds.
 His blood pressure is 138/64, heart rate
80, respiratory rate 18, and temperature
99.5° F (37.5° C).
 A heart murmur is noted.

Case Study
The health care provider suspects
infective endocarditis.
E.F. is sent to the hospital for further
workup and treatment.
What diagnostic studies would you
expect the admitting health care provider
to order for E.F.?

Diagnostic Studies
 History
 Laboratory tests
 Blood cultures
 CBC with differential
 ESR, C-reactive protein (CRP)
 Echocardiography
 Chest x-ray
 ECG
 Cardiac catheterization

Collaborative Care
 Prophylactic antibiotic treatment
for select patients having
 Certain dental procedures
 Respiratory tract incisions
 Tonsillectomy and adenoidectomy
 GI wound infection
 Urinary tract infection

Case Study
 E.F.’s blood culture results are
positive for Staphylococcus aureus
 Echocardiogram demonstrates
vegetations on his mitral valve.
 What treatment would you expect
the health care provider to order
for E.F.?

Collaborative Care
 Accurate identification of organism
 IV antibiotics (long-term)
 Repeat blood cultures
 Valve replacement if needed
 Antipyretics
 Fluids
 Rest

Nursing Assessment
 Subjective data
 Health history
 Valvular, congenital, or syphilitic cardiac
disease
 Previous endocarditis
 Staph or strep infection
 Drugs
 Recent surgeries and procedures

Nursing Assessment
 Subjective data: functional health patterns
 IVDA
 Alcohol abuse
 Weight changes
 Chills
 Hematuria
 Exercise intolerance, weakness, fatigue
 Cough, DOE, orthopnea, palpitations
 Night sweats
 Pain, headache, joint or muscle tenderness

Nursing Assessment
 Objective data
 Fever
 Osler’s nodes
 Splinter hemorrhage
 Janeway’s lesions
 Petechiae, purpura
 Peripheral edema, clubbing
 Tachypnea, crackles
 Dysrhythmia, tachycardia, murmurs, S3, S4
 Retinal hemorrhages

Case Study
E.F. is started on IV antibiotics and
seems to be resting comfortably.
He occasionally requests PRN drugs
for “achiness” and continues to
have a low-grade fever.

Case Study
He is not demonstrating any
symptoms of heart failure at this
time.
Identify appropriate nursing
diagnoses and goals for E.F.

Nursing Diagnoses
 Decreased cardiac output
 Hyperthermia
 Impaired comfort
 Activity intolerance
 Deficient knowledge

Planning
 Patient will
 Have normal cardiac function
 Perform ADLs without fatigue
 Understand therapeutic regimen to
prevent recurrence

Nursing Implementation
 Health promotion
 Identify those at risk
 Assess history and understanding of
disease process
 Teach importance of adherence to
treatment regimen

 Health promotion
 Patient teaching
 Stress need to avoid infectious people
 Avoidance of stress and fatigue
 Rest
 Hygiene
 Prophylactic antibiotics
 Drug rehabilitation

 Ambulatory and home care
 Antibiotic therapy for 4–6 weeks
 Assess home setting
 Monitor laboratory data, including
blood cultures
 Assess IV lines
 Coping strategies

 Ambulatory and home care
 Adequate rest
 Moderate activity
 Compression stockings
 ROM exercises
 Deep breath and cough every 2 hours

Case Study
 E.F. has completed a week of IV
antibiotic therapy in the hospital
setting.
 He is afebrile and feeling better.

Case Study
 Social service has arranged home
IV antibiotic therapy in anticipation
of discharge to home.
 What important patient and
caregiver teaching should you
provide E.F. and his family?

 Patient teaching
 Monitor body temperature
 Signs and symptoms of complications
 Nature of disease and reducing risk of
reinfection
 Stress follow-up care, good nutrition,
early treatment of common infections
 Signs and symptoms of infection
 Need for prophylactic antibiotic therapy

Evaluation
 Adequate tissue and organ
perfusion
 Normal body temperature
 Activity tolerance
 Comfort
 Verbalizes understanding

IE_Grp 4.pptx

Recommended

Recommended

More Related Content

Similar to IE_Grp 4.pptx

Similar to IE_Grp 4.pptx (20)

Recently uploaded

Recently uploaded (20)

IE_Grp 4.pptx

Editor's Notes