Nursing management of patient with cardiac problems.

1. INFECTIVE ENDOCARDITIS
Mr.Veerabhadra .B B
Asst Lecturer
Medical-Surgical Nursing dept.

2. DEFINITION:
Endocarditis is an inflammatory processes of
the endocardium , heart valves, or cardiac
prosthesis .
Causative agent:
*Bacterial (eg, streptococci, enterococci,
pneumococci, staphylococci).
*Fungal & rickettsiae
Endocarditis (also known as infective or
bacterial endocarditis)

3. RISK FACTORS
 Dental Procedure.
 Genito urinal Procedure.
 Intra venous injection.
 Aging.
 Altered immunity.
 Systemic infection.
 Drug induced : Immunosuppressive medications or
corticosteroids

4. PATHOPHYSIOLOGY
Due to etiological factor bacteria enter into blood stream
Colonization, replication of bacteria on valve leaflets
Bacteria get surrounds by fibrin and platelets
Forms vegetation and clots travel to other organs, forming abscesses.
Damage heart valves by perforating and deforming valve leaflet
Causes infarction of organs in heart, kidneys, spleen or lungs.

5. CLINICALMANIFESTATIONS
Findings are non- specific and can involve multiple
organ systems
1)Fever- occurs in 90% patients
2)Non specific manifestations includes -fever
with chills, malaise, weakness, fatigue,
anorexia
-arthralgias, myalgias, back pain, abdominal discomfort,
weight loss, headache and clubbing of fingers

6. CONTD…
3) Vascular manifestations includes
a. Splinter hemorrhages in nail beds
b. petechiae- bleeding in conjunctiva and lips, bucal
mucosa, ankles and feet.
c. Oster notes-painful, tender
d. Janeways lesion- flat, painless, small red spots on
palms and sole.
e. Roths spots- hemorrhage in retinal lesions.

7. PETECHIAE- BLEEDING IN
CONJUNCTIVA
Splinter hemorrhages in
nail beds
Petechiae in bucal mucosa

8. ROTHS SPOTS
Janeways lesion
Fundoscopic examination of
eye showing Roths Spot

9. CONTD…
4) Cardiacmanifestations-
a) Heart murmur with aortic and mitral valve most
commonly affected
5) Secondary toembolisation-
*Embolisation in spleen- sharp, at upper quadrant pain
and spleenomegaly, local tenderness
* Kidney- pain in the flank, hematuria, glomeruli
nephritis.
* Brain- hemiplegia, ataxia, aphasia, visual changes and
change in level of consciousness.
* Pulmonaryemboli.

10. DIAGNOSTIC STUDIES:
 History collection: H/o any invasive procedure.
 Physical Examination : Sign & symptoms
 Blood culture , RFT, LFT & complete Hemogram.
 ECG To rule out any other H/o of MI, Arrhythmia
 Echocadiogram. (To check valve function)
 Chest X-ray.

11. MEDICALMANAGEMENT
The medical management includes
For bacterial infection treated with
 Penicillin G (At 12-18 Million/d IV By in 6 equally divided
doses for 4 weeks.)
 vancomycin (at 30mg/kg/dl IV in 2 equally divided doses for 4
weeks.)
 Ceftriaxone at 2 g/d IV for 4 weeks.
 Gentamycin at 1mg/kg every 8 hours for 2 weeks

12. CONT……
 For fungal infections
Antifungal :Amphoterician-B , Abelect,Amphocin
 Fever: Aspirin or acetaminophen.
 Adequate rest
 Sufficient fluid intake.
 Prophylactic treatment for high-risk
individuals.

13. SURGICAL MANGEMENT
 Replacement of diseased valve.
Aortic or mitral valve Replacement.
 Corrective surgery if refractory heart
failure develops or heart structures
are damaged .

14. NURSING MANAGEMENT
 Provide Adequate rest.
 Provide assistant in physically demanding
activities.
 To reduce anxiety, allow the patient to express his
concerns .
 Before giving an antibiotic, obtain a patient history
of allergies.
 Assess cardiovascular status( Murmur, ECG)
frequently,
 Administer oxygen to ensure adequate
oxygenation.
 Monitor the patient’s renal status .

15. THANK YOU
Take Care of Your Heart