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37 Cards in this Set
- Front
- Back
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What is infective endocarditis (previously called bacterial endocarditis)?
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refers to a microbial infection
ex: virus bacteria fungi involves endocardium... a healthy, defective, or prosthetic valve can be affected, but infection may also occur in apparently healthy endocardium or in septal defects |
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Who gets infective endocarditis?
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IV drug abusers
valve replacement patients systemic infection patients structural cardiac defects patients |
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How do cardiac defects cause endocardium erosion and what is the pathophysiology of endocarditis?
bacteria become trapped in the low-pressure "sinkhole" and are deposited in the vegetation...what is then deposited? valvular insufficiency...at some point, the vegetation may become so large that the blood flow through the valve is obstructed...this is a form of? |
blood flows rapidly from a high-pressure area to a low-pressure zone...platelets and fibrin adhere to the denuded endocardium which forms a vegetative lesion...what happens during bacteremia?
additional platelets and fibrin which causes the vegetative lesion to grow...this destroys theh endocarium and valve...what is the condition called when the lesion interferes with normal alignment of the valve? stenosis...and it may very likely embolize |
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Possible ports of entry for infecting organisms are?
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oral cavity (esp if dental
procedures have been done) skin rashes lesions abscesses infections (cutaneous, GU, GI, systemic) surgery or invasive procedures, including IV line placement |
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The incidence of infective endocarditis is estimated to be 1 in ?
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1000 hospital admissions...males and females equally affected
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How long is it before clinical manifestations occur following onset of bacteremia?
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2 weeks
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What does assessment reveal a recurrence of?
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fever...ranging from 99 to 103F...elders may be afebrile...severity of symptoms based on type of infecting organism
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More than 90% of clients with IC will develop what heart condition?
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murmur (usually regurgitant in nature)...may be changes in intensity if an old murmur already charted or reported...S3 or S4 heart sound may be heard
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What is the most common complication of IC?
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heart failure
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What symptoms would a right-sided heart failure patient have?
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peripheral edema
weight gain anorexia |
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What symptoms would a left-sided heart failure patient have?
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fatigue
SOB crackles on auscultation |
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What are key features of infective endocarditis?
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fever associated with chills,
night sweats, malaise, and fatigue anorexia and weight loss cardiac murmur (newly developed or change in existing) development of heart failure evidence of systemic embolization petechiae splinter hemorrhages Osler's nodes Janeway's lesions positive blood cultures |
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What is a major complication in 50% of clients with IE?
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arterial embolization due to fragmentation of vegetation
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Where do the fragments travel in left-sided HF?
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spleen
kidneys GI tract brain extremities |
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Where do the fragments travel in right-sided HF?
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pulmonary circulation
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_________ infection with sudden _________ pain and radiation to left _______ can also occur?
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splenic
abdominal shoulder |
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When assessing abdomen, what should be noted on palpation?
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rebound tenderness
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What is the classic pain described with renal infarction?
hematuria pyuria |
flank pain that radiates to groin and is accompanied by? (2)
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What emboli may result in client complaining of diffuse abdominal pain, often after eating, and abdominal distention?
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mesenteric
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If a third of clients are demonstrating neurologic changes, what are the others experiencing?
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pulmonary problems
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What 2 life-threatening conditions may appear if emboli make it to CNS?
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TIAs
stroke... symptoms include: confusion reduced concentration aphasia dysphagia |
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What symptoms of pulmonary infarction are related to embolization?
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pleuritic chest pain
dyspnea cough |
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What are petechiae?
mucous membranes palate conjunctivae skin above clavicles |
pinpint red spots...these can occur in 40% of clients with endocarditis...what anatomical parts should be checked for petechiae?
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What are splinter hemorrhages?
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black longitudinal lines or small red streaks...look at distal third of the nail bed for these
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How is IE diagnosed by blood culture?
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positive blood culture...may take 3 weeks for aerobic and anaerobic organisms to grow in culture
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What two blood tests might indicate IE?
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low hematocrit and hemoglobin
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What radiographic studies are performed to diagnose IE?
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echocardiography
transesophageal echocardiography (TEE) transthoracic echocardiography |
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What are the MOST RELIABLE ways to diagnose IE?
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positive blood cultures
a NEW REGURGITANT murmur evidence of endocardial involvement by echocardio- graphy |
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What does care of the IE client involve?
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antimicrobials
rest balanced with activity supportive therapy for HF |
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What is the mainstay drug therapy for IE?
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antimicrobials for up to 4-6 weeks IV that are strong enough to penetrate the vegetation protecting the microorganism...penicillin and cephalosporins are preferred
IV therapy is started at hospital for a few days and then patient can continue IV therapy at home after they show evidence of no fever, have negative blood cultures, and have no signs of HF or emoblization |
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What's the scoop on anticoagulants...are the given or not?
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Avoid use of anticoagulants...they're ineffective at preventing embolization of vegetation...they may result in bleeding...only recommended if they are required to prevent thrombus formation on a prosthetic valve
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Complete bedrest is not necessarily needed unless?
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patient is hemodynamically unstable...balance activities with rest...it's important to have proper oral treatment and general body hygeine and consistently use appropriate aseptic technique to protect client from contact with infective organisms
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Nursing assessment for signs of HF include?
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rapid pulse
fatigue cough dyspnea new heart murmurs early signs of embolization |
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When is the cardiac surgeon called in? (4)
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if antibiotic therapy is ineffective in sterilizing a valve...
if refractory HF develops secondary to a defective valve... if refractory HF develops secondary to a defective valve... if large valvular vegetations are present... if multiple embolic events occur |
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Current surgical interventions for infective endocarditis include the following? (4)
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removing infected valve (either biologic or prosthetic)....
repairing or removing congenital shunts... repairing injured valves and chordae tendinae... draining abscesses in heart or elsewhere |
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How would home care nurse and pharmacist help patient?
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supplies on hand?
prepared antibiotic IV pump with tubing alcohol wipes IV access device normal saline solution heparin and saline lock flush solution drawn up in syringes saline lock, peripherally inserted central catheter (PICC line), or central catheter is positioned at a venous site tht is easily accessible teach patient how to administer antibiotic and care for infusion site contact patient every 3-7 days to see how he's doing encourage proper hygeine.. use a soft toothbrush.. brush teeth twice per day.. don't use irrigation devices or floss teeth because bacteremia may result instruct patient to cleanse lacerations well and apply an antibiotic ointment tell dentist and other doctors about IE and start antibiotics before every invasive procedure |
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What self-monitoring techniques should be taught to patient?
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HF symptoms
embolic phenomena record daily temperature for up to 6 weeks report: fever chills malaise weight loss increased fatigue sudden weight gain dyspnea |
