Heart Infections: Endocarditis

 Definition and Related Terms

• An infection of the endocardium, heart valves,  or cardiac prosthesis resulting from bacterial or fungal invasion
• Endocarditis can be classified as:

1. Native valve endocarditis
2. Endocarditis in IV drug users
3. Prosthetic valve endocarditis

Epidemiology

• With proper treatment, about 70% of clients recover
• The prognosis is worse when endocarditis damages valve severely or involves a prosthetic valve
• Infective endocarditis occurs in 50-60% of clients with previous valvular disorders
• Systemic Lupus Erythematosus (SLE) often leads to nonbacterial endocarditis
• In 12-35% of clients, with subacute endocarditis, lesions produce clots that show the findings of splenic, renal, cerebral or pulmonary infarction, or peripheral vascular occlusion

Findings of Endocarditis

• Cardiac murmurs in 85-90% of clients
• Fever
• Especially, a murmur that changes suddenly, or a new murmur that develops in the presence of a fever
• Pericardial friction rub
• Anorexia
• Malaise
• Clubbing of fingers
• Neurologic sequelae of embolus
• Petechia of the skin (especially on the chest)
• Splinter hemorrhage under the nails
• Infarction of the Spleen: pain in the upper-left quadrant radiating to the left shoulder and abdominal rigidity
• Infarction in the Kidney: hematuria, pyuria, flank pain, and decreased urine output
• Infarction in the Brain: hemiparesis, apahasia, and other neurologic deficits
• Infarction in the Lung: cough, pleuritic pain, pleural friction rub, , dyspnea and hemoptysis
• Peripheral Vascular Occlusion: numbness and tingling in an arm, leg, finger, or toe, or signs of impending peripheral gangrene

SIGNS OF VENOUS INSUFFICIENCY IN THE EXTREMITIES

1. Skin color reddish brown or cyanotic if extremely lowered
2. Normal temperature
3. Normal pulse
4. Often marked edema, usually foot to calf
5. Brown pigmentation around ankles

SIGNS OF ARTERIAL INSUFFICIENCY IN THE EXTREMITIES

1. Pale color on elevation, dusky red color when lowered
2. Cool to touch
3. Decreased or absent peripheral pulses
4. Little or no edema
5. Thin, shiny skin and decreased growth of hair
6. Thickened nails
7. Pain unrelieved by rest and/or activity
8. Chronic pain may be either steady or intermittent
9. Claudication pain as tight feeling, burning, fatigue, ache or cramping

Management

: clients at risk for prosthesis valves

• Prophylaxis - to prevent endocarditis, eg. MVP, cardiac lesions
• Antibiotics - to treat underlying infection
• Antipyretics - to control fever
• Anticoagulants - to prevent embolization
• Oxygen - to prevent tissue hypoxia
• Surgical - possible valve replacement

Nursing Interventions

• Cardio-Care Six
• Observe for findings of infiltration or inflammation at venipuncture site; rotate sites often
• Client and family teaching:

1. Explain all procedures in a simple and culturally sensitive manner
2. Involve the client and family in scheduling the daily routine activities. Allow client and family to participate in care.
3. Teach client relaxation techniques (medication, visualization, or guided imagery) to cope with stress, pain, or insomnia
4. Explain endocarditis and the need for long-term therapy
5. Explain the need for prophylactic antibiotics before dental work and other invasive procedures
6. Teach client to report fever, tachycardia, dyspnea and shortness of breath

Diagnostic Studies

• Health history
• Lab data:

1. CBC
2. Blood cultures
3. ESR
4. CXR - to detect chronic heart failure (CHF)
5. ECG (EKG) - transesophageal echocardiogram to detect vegetation and abscess on valves

Blogsite Owner's Note: PDF copy of this article is available for an affordable fee. Email the site owner at jpherreramd.rn@gmail.com for details.