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37 Cards in this Set

  • Front
  • Back
What is infective endocarditis (previously called bacterial endocarditis)?
refers to a microbial infection
ex: virus
involves endocardium...
a healthy, defective, or prosthetic valve can be affected, but infection may also occur in apparently healthy endocardium or in septal defects
Who gets infective endocarditis?
IV drug abusers
valve replacement patients
systemic infection patients
structural cardiac defects
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 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
Possible ports of entry for infecting organisms are?
oral cavity (esp if dental
procedures have been done)
skin rashes
infections (cutaneous, GU,
GI, systemic)
surgery or invasive
procedures, including IV
line placement
The incidence of infective endocarditis is estimated to be 1 in ?
1000 hospital admissions...males and females equally affected
How long is it before clinical manifestations occur following onset of bacteremia?
2 weeks
What does assessment reveal a recurrence of?
fever...ranging from 99 to 103F...elders may be afebrile...severity of symptoms based on type of infecting organism
More than 90% of clients with IC will develop what heart condition?
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
What is the most common complication of IC?
heart failure
What symptoms would a right-sided heart failure patient have?
peripheral edema
weight gain
What symptoms would a left-sided heart failure patient have?
crackles on auscultation
What are key features of infective endocarditis?
fever associated with chills,
night sweats, malaise, and
anorexia and weight loss
cardiac murmur (newly
developed or change in
development of heart failure
evidence of systemic
splinter hemorrhages
Osler's nodes
Janeway's lesions
positive blood cultures
What is a major complication in 50% of clients with IE?
arterial embolization due to fragmentation of vegetation
Where do the fragments travel in left-sided HF?
GI tract
brain extremities
Where do the fragments travel in right-sided HF?
pulmonary circulation
_________ infection with sudden _________ pain and radiation to left _______ can also occur?
When assessing abdomen, what should be noted on palpation?
rebound tenderness
What is the classic pain described with renal infarction?

flank pain that radiates to groin and is accompanied by? (2)
What emboli may result in client complaining of diffuse abdominal pain, often after eating, and abdominal distention?
If a third of clients are demonstrating neurologic changes, what are the others experiencing?
pulmonary problems
What 2 life-threatening conditions may appear if emboli make it to CNS?
symptoms include:
reduced concentration
What symptoms of pulmonary infarction are related to embolization?
pleuritic chest pain
What are petechiae?

mucous membranes
skin above clavicles
pinpint red spots...these can occur in 40% of clients with endocarditis...what anatomical parts should be checked for petechiae?
What are splinter hemorrhages?
black longitudinal lines or small red streaks...look at distal third of the nail bed for these
How is IE diagnosed by blood culture?
positive blood culture...may take 3 weeks for aerobic and anaerobic organisms to grow in culture
What two blood tests might indicate IE?
low hematocrit and hemoglobin
What radiographic studies are performed to diagnose IE?
transesophageal echocardiography (TEE)
What are the MOST RELIABLE ways to diagnose IE?
positive blood cultures
evidence of endocardial
involvement by echocardio-
What does care of the IE client involve?
rest balanced with activity
supportive therapy for HF
What is the mainstay drug therapy for IE?
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
What's the scoop on anticoagulants...are the given or not?
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
Complete bedrest is not necessarily needed unless?
patient is hemodynamically unstable...balance activities with'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
Nursing assessment for signs of HF include?
rapid pulse
new heart murmurs
early signs of embolization
When is the cardiac surgeon called in? (4)
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
Current surgical interventions for infective endocarditis include the following? (4)
removing infected valve (either biologic or prosthetic)....
repairing or removing congenital shunts...
repairing injured valves and
chordae tendinae...
draining abscesses in heart or elsewhere
How would home care nurse and pharmacist help patient?
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
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
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
What self-monitoring techniques should be taught to patient?
HF symptoms
embolic phenomena
record daily temperature for
up to 6 weeks
weight loss
increased fatigue
sudden weight gain