PPT of Infective endocarditis

1. TOPIC: INFECTIVE
ENDOCARDITIS
Prepared by
Asso.Prof, Mr. Vijayreddy Vandali
M.Sc (N), PGDHA, PGCDE.
Medical-Surgical Nursing dept.

2. DEFINITION :
 Definition:
Endocarditis is an inflammatory
processes of the endocardium especially

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. CLINICAL MANIFESTATIONS
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

7. 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.

8. Splinter hemorrhages in nail beds

9. Petechiae- bleeding in
conjunctiva

10. Petechiae in bucal
mucosa

11. Oster nodes

12. Janeways lesion

13. Roths spots

14. Contd…
 4) Cardiac manifestations-
 a) Heart murmur with aortic and mitral valve most
commonly affected
 5) Secondary to embolisation-
 *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.
 * Pulmonary emboli.

15. MEDICAL MANAGEMENT
 The medical management includes
 *Organism with streptococci may be treated with
 -Penicillin G At 12-18 Million/d IV By in 6 equally
divided doses for 4 weeks.
 -Patients with allergic to penicillin 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

16. Contd…
*Organisms with fungal infections are
treated with antifungal such as
amphoterician
Example- Abelect, Amphocin

17. NURSING MANAGEMENT
 The nursing management includes following
aspects
 -The nurse monitors the patients temperature
 -Heart sounds assessed(A new or worsening
murmur may indicate dehiscence of a
prosthetic valve, rupture of an abscess or
injury to valve leaflet.)
 -The nurse monitors for signs and symptoms
of systemic embolisation.

18. Contd…
-In addition the nurse assesses signs
and symptoms of organ damage such as
stroke (CVA) meningitis, heart failure,
myocardial infarction,
glomerulonephritis and spleenomegaly.
-All invasive lines and wounds must be
assessed daily for redness and swelling.
-If the patient has undergone surgical
treatment, the nurse provides
postoperative care and instructions.

19. Contd…
-After discharge the nurse supervises and
monitors IV Antibiotics therapy delivered
in the home setting and educates the
patient and family about prevention and
health promotion
-The nurse provides the patient and
family with emotional support and
facilitates coping strategies during the
prolonged course of the infection and
antibiotic treatment.

20. NURSING PROCESS
ASSESSEMENT
- Subjective and objective data from
patient
-Assess for murmur
-Assess for pain
-Assess for joint tenderness
- General assessment for typical
signs and symptoms.

21. Contd…
NURSING DIAGNOSIS
1) Fever releated to
infection of cardiac tissue
as manifested by increased
temperature, diaphoresis,
chills, headache and
malaise.

22. NURSING INTERVENTIONS
 -Assess the level of temperature
 -provide cold compress
 -check temperature every half hourly
 -administer plenty of fluids
 -administer antipyretics according to physicians order
 -reduce physical activity to decrease cardiac workload.

23. 2) Decreased cardiac output
releated to valvular insufficiency
and fluid overload as manifested
by heart murmur, tachycardia.
Nursing interventions
-Auscultate heart sound, rate and
rhythm
-monitor for new onset of murmurs
-assess capillary refill, skin colour
and temperature.

24. Contd…
-Assess for jugular venous
distention.
- provide oxygen therapy to
increase oxygen to promote
comfort by relieving hypoxemia.
-administer diuretics according to
order.
- assess for blood pressure.

25. 3) Activity intolerance Releated
generalized weakness and
alteration in oxygen transport
secondary to valvular dysfunction.
Nursing interventions
-Monitor vital signs during activity to
evaluate cardiac response
-monitor for signs of activity
intolerance

26. Contd…
-reduce activity if systolic blood
pressure goes down
-plan rest periods between activities
to reduce cardiac workload.

27. THANK YOU