Endocarditis is an inflammatory process of the inner lining of the heart. Bacteria enter the bloodstream and colonize on heart valves, forming clots and vegetations that can damage valves and embolize to other organs. Symptoms are non-specific but may include fever, heart murmur, petechiae, splinter hemorrhages, and signs of infection in other organs. Treatment involves intravenous antibiotics for 4 weeks or more. Nursing care focuses on monitoring for signs of infection, complications affecting organs, and managing symptoms like fever while the patient completes the long antibiotic regimen.

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