endocarditis (inflammation of endocardium )

1. ENDOCARDITIS
Prepared by : Arpana Bhusal
Level : BNS

2. CONTENT
 Endocarditis
 Definition
 Incidence
 Risk Factor
 Causes
 Pathophysiology
 Sign and symptoms

3. CONT..
 Diagnosis
 Treatment
 Medical management
 Surgical management.
 Nursing management
 Complication
 Reference

4. ENDOCARDITIS
 Endocarditis is a rare and potentially fatal infection
of the inner lining of the heart (the endocardium)
most often involving the valves . It's most commonly
caused by bacteria entering the blood and travelling
to the heart

5.  If it's not treated quickly, endocarditis can damage
or destroy heart valves.
 Endocarditis is usually caused by an infection.
Bacteria, fungi or other germs from another part of
our body, such as mouth, spread through your
bloodstream and attach to damaged areas in heart.

7. INCIDENTS
 Infective endocarditis (IE) is a relatively rare
disorder with an estimated incidence of 3–10 cases
per 100 000 per year. Despite diagnostic and
therapeutic advances, prognosis remains poor, as
reflected by hospital mortality of about 22%, rising
to 40% at 5 years. Morbidity rates are also high;
50% of patients require operative management in
the acute phase of the disease, often with ongoing
consequences for quality of life.

8. RISK FACTOR
 Previous heart damage
 Dental procedure which leads into the introduction
of bacteria's
 Heart surgery
 Intubation
 Procedure involving gastro intestinal and
genitourinary tracts egg . Barium enema,
sigmoidoscopy, catherization and cystoscopy .

9. CAUSES
a. Organism
 Bacteria's e.g. Streptococci, Staphylococci,
Enterococci
 Fungus e.g. candida, aspergillus
 Gram negative organism pseudomonas
b. Cardiac pathological condition:
 Rheumatic valvular disease
 Acute rheumatic fever
 Congenital heart disease
 Cardiac surgery

10. CONT…
c. Intrusive procedures:
 Dental procedure
 Minor surgery
 Insertion of indwelling catheter
 Vaginal Operation/surgery
d. Immunosuppression related to:
 Diabetes
 Burns
 Cancer
 Hepatitis

11. PATHOPHYSIOLOGY

12. SIGN AND SYMPTOMS
Infective endocarditis is s rapidly progressing
infection associated with :
 High fever
 Fatigue
 Dyspnea
 Rapid pulse
 Finger clubbing

13. CONT.
 Weight loss
 Anemia
 Myocardial infraction
 Heart murmur
 Splenomegaly

14. MORE SPECIFIC SIGN
 Osler's nodes: painful red nodes on palm of
fingers and toes, usually late sign of endocardial
infection.
 Janeway's lesion-light pink macules on palms or
sole, non tender or fade in 1 or 2 weeks: usually an
early sign of endocardial infection

16. DIAGNOSIS ( DUKE CRITERIA )
 The Duke criteria are a set of clinical criteria set
forward for the diagnosis of infective endocarditis
 For diagnosis the requirement is:
• 2 major and 1 minor criterion or
• 1 major and 3 minor criteria or
• 5 minor criteria

17.  Major criteria
• positive blood cultures for infective endocarditis
• typical microorganism for infective endocarditis
from 2 separate blood cultures
• Viridans streptococci, Streptococcus bovis, and
HACEK group or
• community-acquired Staphylococcus
aureus or enterococci in the absence of a
primary focus or
• persistently positive blood cultures, defined as
recovery of a microorganism consistent with
infective endocarditis from:

18.  evidence of endocardial involvement
 positive echocardiogram for infective endocarditis
 oscillating intracardiac mass on valve or supporting
structures or in the path of regurgitant jets or on
implanted material in the absence of an alternative
anatomical explanation or
 abscess or
 new partial dehiscence of prosthetic valve or
 new valvular regurgitation

19.  Minor criteria
• predisposing heart condition or intravenous drug
• fever: 38°C
• vascular phenomena: major arterial emboli, septic
pulmonary infarcts, mycotic aneurysm, intracranial
haemorrhage, conjunctival haemorrhages, and
Janeway lesions

20. • immunologic phenomena:
• glomerulonephritis
• Osler nodes
• Roth spots
• rheumatoid factor

21. MEDICAL MANAGEMENT
Antibiotic Prophylaxis for Patients with Previous
Infectious Endocarditis Undergoing Dental or
Other Procedures
 Amoxicillin (adults: 2 g; children: 50 mg per kg) taken orally
one hour before procedure
 If Unable to take oral medication, Ampicillin (adults: 2 g;
children: 50 mg per kg) IM or IV within 30 minutes of procedure
 Penicillin allergy and unable to take oral medications,
Clindamycin (adults: 600 mg; children: 20 mg per kg) IV within
30 minutes of procedure

22. CONT..
 Penicillin-susceptible viridans Streptococcus or Streptococcus
bovis;
 Penicillin G or ceftriaxone (Rocephin) for four weeks or
 Penicillin G plus gentamicin for two weeks or
 Ceftriaxone plus gentamicin for two weeks or
 Vancomycin for four weeks

23. CONT..
 penicillin-resistant viridans Streptococcus or S. bovis ;
 Penicillin G or ceftriaxone for four weeks, plus gentamicin for
two weeks or
 Vancomycin for four weeks or

24. CONT..
 Analgesic to reduce pain
 Antipyretic to reduce fever
 Appropriative antibiotic therapy for long time
depending on the infective organisms
 Digoxin I/V or oral in the case of congestive
cardiac failure
 Diuretic in the case of right sided heart failure

25. CONT..
 Rest in comfortable position
 Steroid of reduction of inflammation in the heart.
 Anticoagulant therapy
 low salt diet

26. SURGICAL MANAGEMENT
 Angioplasty stent placement .
 Surgical replacement of deteriorated valve.

27. NURSING MANAGEMENT
Nursing assessment :
It includes history taking like ;
Subjective Data
 Past medical history ; asked for sign of the
disease and the onset of the disease and review
with patients history of risk factor like cardiac failure
, shock
 Medication history
 Family history
 Social history
 Surgical history

28. Objective data
 Assess for temperature elevation , heart murmur,
evidence of cough, peripheral edema an embolism,
, auscultate for heart sound dyspnea, restlessness,
and manifestation of heart failure .

29. NURSING DIAGNOSIS
 Ineffective breathing pattern related to inflammation
of heart muscles as evidenced by use of accessory
muscle , dyspnea
 Impaired gas exchange related to fluid
accumulation in the lungs as evidenced by
shortness of breath
 Decreased cardiac output related to valvular
dysfunction as evidenced by poor tissue perfusion
 Impaired physical mobility related to fatigue
 Altered thermoregulation related to infection as
evidenced by increased body temperature

30. NURSING MANAGEMENT
1. Pain and comfort management
 Complete bed rest to reduce oxygen demand
 Place the patient in upright position to relieve dyspnea
and chest pain.
 Provide analgesics to relieve pain and oxygen to
prevent tissue hypoxia.
 Assess the patient’s cardiovascular status frequently.
 Monitor the patient’s pain level and the effectiveness of
analgesics
 Limiting activities
 Providing calm and quiet environment
 Offering support to reduce anxiety.

31. CONT..
2. Administering medications & IV fluids:
 Monitor vitals before and after administering
medications & IV fluids.
 Give drugs as indicated (Aspirin, Steroids).
 Give antipyretic drug if fever present.
 Administer prescribed medications & fluids
accurately (Follow10 Rights).
 Assess IV infusion site for bleeding or any allergic
response.

32. CONT...
3. Prevent complication
 Check vital sign and record it carefully.
 Carefully monitor intake output.
 Closely monitor sign for cardiac tamponade
4. Nutrition
 Ensure high protein, high carbohydrate,
 Low sodium diet.
 Serve attractive meals that stimulate appetite

33. CONT..
6. Prevent infection
 Apply infection prevention measures such as
hand washing, linen changes and sterility
during procedures.
 Encourage short stay to prevent nosocomial
infections
 Maintain skin and mucosal integrity:
 Provide primary care such as bathing, frequent
nappy changes, mouthcare.
 Use a soft toothbrush to prevent gum mucosal
breakdown.

34. COMPLICATION
• Heart problems, such as heart murmur, heart valve
damage and heart failure
• Stroke
• Pockets of collected pus (abscesses) that develop
in the heart, brain, lungs and other organs
• pulmonary embolism
• Kidney damage
• Enlarged spleen

36. REFERENCE
 MandalG.N.,“Text book of adult nursing” Makalu
publication house (P) Ltd, Dili bazar, Kathmandu
 R.N. Wilma J. phipps “Shafer’s Medical Surgical
Nursing”B.I. Publications PVT LTD, New Delhi
 Datta BN, (1992). “Text book of Pathology” 2nd
edition, Jaypee brothers (p). Ltd, New Delhi
 Mosby,( 2009 ),Medical surgical Nursing (5th edition)