copyright © 2010, 2007, 2004, 2000, mosby, inc., an affiliate of elsevier inc. all rights reserved....

Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.

(Relates to Chapter 37, “Nursing Management: Inflammatory and Structural

Heart Disorders,” in the textbook)


Infection of the inner layer of the heart that usually affects the cardiac valves

Was almost always fatal until development of penicillin

15,000 cases diagnosed in the United States each year

Fig. 37-1


Subacute form• Longer clinical course• Insidious onset•Caused by enterococci


Acute form•Shorter clinical course•Rapid onset


Causative organism more virulent

Streptococcus viridans Staphylococcus aureus Viruses Fungi


Occurs when blood turbulence within heart allows causative agent to infect previously damaged valves or other endothelial surfaces


Principal risk factors•Prior endocarditis•Prosthetic valves•Acquired valvular disease•Cardiac lesions


Vegetation • Fibrin, leukocytes, platelets, and microbes•Adhere to the valve or endocardium • Embolization of portions of vegetation into circulation


Fig. 37-2

Fig. 37-3


Nonspecific Fever occurs in 90% of patients

ChillsWeakness


Malaise FatigueAnorexia


Subacute form•Arthralgias•Myalgias •Back pain•Abdominal discomfort


Subacute form•Weight loss•Headache•Clubbing of fingers


Vascular manifestations•Splinter hemorrhages in nail beds•Petechiae•Osler’s nodes on fingers or toes• Janeway’s lesions on palms or soles•Roth’s spots


Murmur in most patientsHeart failure in up to 80% with aortic valve endocarditis

Manifestations secondary to embolism


History•Recent dental, urologic, surgical, or gynecologic procedures•Heart disease•Recent cardiac catheterization•Skin, respiratory, or urinary tract infection


Laboratory tests•Blood cultures•WBC with differential

EchocardiographyChest x-ray


Prophylactic treatment for patients having•Removal or drainage of infected tissue•Renal dialysis•Ventriculoatrial shunts


Antibiotic administration•Monitor antibiotic serum levels •Subsequent blood cultures•Renal function monitored


Fungal and prosthetic valve endocarditis•Responds poorly to antibiotics•Valve replacement is adjunct procedure


Subjective Data•History of valvular, congenital, or syphilitic cardiac disease•Previous endocarditis •Staph or strep infection• Immunosuppressive therapy•Recent surgeries and procedures


Functional health patterns• IV drug abuse•Alcohol abuse•Weight changes•Chills


•Diaphoresis•Bloody urine• Exercise intolerance •Generalized weakness• Fatigue •Cough


•Dyspnea on exertion •Night sweats •Chest, back, abdominal pain


Objective Data•Olser’s nodes•Splinter hemorrhage• Janeway’s lesions•Petechiae


Objective Data•Clubbing• Tachypnea•Crackles•Dysrhythmias • Tachycardia


Objective Data• Leukocytosis•Anemia•↑ ESR and cardiac enzymes•Positive cultures• ECG showing chamber enlargement


Patient will•Have normal cardiac function•Perform ADLs without fatigue•Understand therapeutic regimen to prevent recurrence


Identify those at riskAssessment of history and understanding of disease process

Teach importance of adherence to treatment regimen


Stress need to avoid infectious people

Avoidance of stress and fatigue

Rest HygieneNutrition


Assessment of nonspecific manifestations

Monitor laboratory dataMonitor patency of IV


Compression stockings with immobility

ROMTurn, cough, deep breathe


Teach signs and symptoms of infection

Teach reduction measures for risk for infection

Stress follow-up care


Vital signs WNLAbsence of chills, diaphoresis, headache

Sufficient cardiac output


Completion of ADLs with no fatigue or physiologic distress

Increased understanding of disease process and self-care management

copyright © 2010, 2007, 2004, 2000, mosby, inc., an affiliate of elsevier inc. all rights reserved....

Documents

affiliate of elsevier

embolism slide

circulation slide

textbook slide

year slide

endothelial surfaces

patients chills weakness

malaise fatigue anorexia