A 38-year-old man with uncontrolled diabetes was admitted with 1 week of fevers, chills, and cough. He was diagnosed with infective endocarditis of the tricuspid valve caused by Staphylococcus aureus based on positive blood cultures, echocardiogram findings, and Duke criteria. He received IV antibiotic therapy and was monitored closely in the hospital. Nursing care involved administering antibiotics, monitoring for signs of heart failure, and providing patient education on preventing future infections and managing his diabetes.

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2. Infective Endocarditis Case
Study
Presented By
Yasmeen BB
Subject Faculty
Sir Adnan Yaqoob
Assistant Professor
MScN, BScN
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3. Objective Of Case
 Demographic data
 past and present medical history
 Clinical presentation: signs and symptoms,
 physical findings with rational
 Lab and diagnostic test findings with rational
 Differential diagnosis and current diagnosis with rational.
 Pharmacotherapeutic treatment (and any changes in it
during treatment)
 Nursing management: Integrate the theoretical and
conceptual model in selected patients.
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4. Patient Case
• A 38-year-old man with uncontrolled diabetes
mellitus type 2 was admitted with a 1-week
duration of fevers, chills, and a non-productive
cough.
• Physical examination
• Oriented
• caries on a left upper molar a
• well-healed scar on the left buttock,
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5. Patient Demographic Data
• Patient name ===== Hussain Khan
• Mr. No ===== 2021-37713
• Medical ward =====@ MIC, Multan
• Category ====== Poor
• Age ===== 38 years
• Gender ===== Male
• Address ====== H#32 St# 02 Gulstan
Colony Multan,
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9. Epidemiology
Endocarditis affected predominantly older age
Adult population
Rheumatic Heart Disease
• 20 – 25% of cases of IE till 1980
• 7 – 18% of cases in recent reported series
Mitral site more common in women
Aortic site more common in men
Congenital Heart Disease • 10 – 20% of cases in
young adults • 8% of cases in older adults
(Babeș et al.2021)
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10. Distribution in clinical series
• tricuspid – 46 – 78%
• – mitral24 – 32%
• – 8 – 19% aortic
• S. aureus is the predominant causative
microorganism for TVIE, occurring in 60–90%
of cases in some studies, irrespective of
associated risk factors (Hussain et al.2017).
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11. Present History
Patient has diabetes mellitus using oral glucophage
was perscribed to the patient one year ago.
Positive culture for s.aureus
Lethargic
Fatigue
Fever
Chills
In S. aureus endocarditis the first two
blood cultures are positive in 90% of cases
(Missiakas, & Schneewind,2013).
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12. Vitals Signs On Admission
Fever, temperature was 38.2°c,
Respiratory rate 20 breaths per minute,
Pulse was 101 beats per minute,
 Blood pressure was 134/96 mmhg,
Weight was 84 kg and height 6ft one month
ago but on admission weight was 78kg.
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13. Rational
• Acute bacterial endocarditis usually begins
suddenly with a high fever, fast heart rate,
fatigue, and rapid and extensive heart valve
damage.
• Subacute
bacterial endocarditis gradually causes such sy
mptoms as fatigue, mild fever, a moderately
fast heart rate, weight loss, sweating, and a
low red blood cell count
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14. Family History
• significant for diabetes mellitus type 2 in his
mother
• Denied to use of tobacco, alcohol, or
intravenous drug user in his family.
• His father has been died with metastatic
prostate cancer
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15. Past History
• Diagnosed diabetic at the age of 35 years
• He faced a road traffic accident at the age of
20years
• He has been treated from two local Hakeem
for diabetes 3years ago
• He has taken medicine from a dispensary for
the pain of his teeth a month ago.
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16. Laboratory Findings
• Hemoglobin of 10.4 g/dl;
• a serum potassium of 3.1 mmol/l, low
• and a serum creatinine of 0.9mg/dl.
• Liver function tests are normal on admission.
• The blood culture is positive for
Staphylococcus aureus
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18. Echocardiography
• An echocardiogram revealed a two mobile
mass in the right ventricle that attached to
tricuspid valve.
• Restricted VSD with left to right shunt.
• Tricuspid regurgitation.
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20. Infective Endocarditis
• Infective Endocarditis (IE) is a microbial
infection of the endocardial (endothelial)
surface of the heart.
• The vegetation is a variably sized amorphous
mass of platelets and fibrin in which abundant
micro-organisms and scant inflammatory cells
are enmeshed.
Braunwald – Heart Diseas
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21. Diagnosis:
• Duke Criteria
In 1994 a group at Duke University standardized
criteria for assessing patients with suspected
endocarditis
Include -Predisposing Factors -Blood culture
isolates or persistence of bacteremia -
Echocardiogram findings with other clinical,
laboratory findings
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22. • Duke Criteria
Definite
• 2 major criteria :
• 1 major and 3 minor criteria :
• 5 minor criteria : pathology/histology findings
Possible :
• 1 major and 1 minor criteria :
• 3 minor criteria
Rejected : firm alternate diagnosis or resolution of
manifestations of IE with 4 days antimicrobial therapy
or les
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24. The Duke Criteria was used for Clinical
Diagnosis of Infectious Endocarditis
Major criteria
Positive blood culture
Two separate blood cultures positive for
microorganism consistent with infectious
endocarditis, Staphylococcus aureus,
Echo showing vegetation of TV.
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25. Minor criteria
• Fever, temperature was 38.2°c,
• Lethargic, weight loss
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26. Treatment
• Successful treatment requires appropriate
antibiotic therapy. Initial empiric therapy may
include vancomycin plus an aminoglycoside.
• The choice of definitive antibiotic therapy is
based on the causative microorganism and its
antibiotic susceptibility, and whether the
involved valve is native or prosthetic(Jaggi, &
Sule, 2018).
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27. Cont….
• Tricuspid valve replacement Whilst the choice
of prosthesis for TV replacement remains
controversial, long-term survival is similar
regardless of prosthesis type used in many
series.
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28. Nursing intervention
• Provide supplemental oxygen at 2 to 4 L/min
to maintain or improve oxygenation.
• Minimize oxygen demand to decrease anxiety.
• Maintain patient on bed rest to maximize
comfort.
• Administer multi-I.V. antibiotic regimen as
ordered.
• Administer antipyretics as ordered and as
needed
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29. Patient Monitoring
• Monitor pulse pressure and central venous
pressure hourly or more frequently if titrating
pharmacologic agents.
• Obtain Bp hourly or more frequently if the
patient’s condition is unstable.
• Monitor hourly urine output to evaluate for
responses to pharmacologic interventions.
• Analyze ECG rhythm strip at least every 4
hours and note every rate.
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30. • Intravenous catheters should be removed
promptly after antibiotic therapy is complete.
• In patients with a history of infectious.
• Maintain and educate the patient about
personal hygiene.
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31. Rational
• Obtain HR, RR, and BP every hour or more
frequently if the patient is exhibiting signs and
symptoms of heart failure.
• Assess for changes in neurological function
hourly and as clinically indicated.
• Assess skin for warmth, color, and capillary
refill time. Assess distal pulses bilaterally for
strength, regularity, and symmetry.
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32. Family support and Follow up
instructions
• instructions before leaving the hospital.
• Make sure to ask any questions if patient have
• Always healthcare team will determine how long
you should be on antibiotics and how often you
should have follow up testing do not skip any
dose.
• Take the antibiotics until they are all gone. Take
them even if you feel better. They treat the
infection and prevent it from returning.
• Do not drive.
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33. Education And Prevention
• Take good care of teeth and mouth. Brush teeth before and after
every meals meal.
• Visit dentist every 6 months. Dental infection is a risk factor for
bacterial endocarditis.
• See dentist immediately if have a toothache or abscess.
• Must need to take an antibiotic before dental visits.
• Take good care of yourself. Get regular exercise and eat a healthy
diet.
• Ask healthcare provider for help as needed.
• Stop going to Hakeem
• Maintain glucose monitoring and keeping glucose level normal
• Always be happy by spending life according to religion and avoid
anxiety by helping others as much as anyone can.
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35. References
• Babeș, E. E., Lucuța, D. A., Petcheși, C. D., Zaha, A. A., Ilyes,
C., Jurca, A. D., ... & Babeș, V. V. (2021). Clinical Features
and Outcome of Infective Endocarditis in a University
Hospital in Romania. Medicina, 57(2), 158.
• Hussain, S. T., Witten, J., Shrestha, N. K., Blackstone, E. H., &
Pettersson, G. B. (2017). Tricuspid valve
endocarditis. Annals of cardiothoracic surgery, 6(3), 255.
• Missiakas, D. M., & Schneewind, O. (2013). Growth and
laboratory maintenance of Staphylococcus aureus. Current
protocols in microbiology, 28(1), 9C-1.
• Jaggi, A., & Sule, A. A. (2018). Case Series and Review: 3
cases of Clostridium Ramosum infections leading to organ
abscess or sepsis.
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