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What is Endocarditis?
- Inflammation of the lining of the heart and valves
- Previously damaged valve surface seeded with bacteria released during invasive prodcedures
- Infection (through bloodstream) causes valve damage; can infect myocardium and/or result in sepsis
- Valve damage can lead to CHF
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What are vegetation?
Clumps of bacteria, fibrin, platelets, and leukocytes that effects valvular function and can embolize to brain, kidneys, lungs, limbs, etc.
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Types of invasive procedures that can promote endocarditis
- Dental procedures
- Cystoscopy
- Endoscopy
- GYN procedures
- Surgery
- IV drug abuse
- Cardiac cath
- IV therapy
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Clinical manifestations of endocarditis
- Fever, chills, weakness (immune response)
- Myalgias, arthralgias (inflammatory cytokines released in reaction to infection)
- New onset murmur (caused by valvular damage from infection and bacteria)
- Splinter hemorrhage and petechiae (vegetations lodge in peripheral vessels)
- Osler's Nodes (painful tender red or purple pea sized lesions on finger tips or toes)
- Janeway's Lesions (bruising areas; flat painless small red spots on palms and soles)
- Embolic complications (strokes, embolism in kidneys)
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Diagnosing endocarditis
- CBC (elevated WBCs)
- Blood cultures (want to know organism so know how to treat; usually strep, staph or enterococci)
- 2D echo or TEE (to visualize valves; TEE better visualize vegetation)
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Treatment of endocarditis
- IV antibiotics for weeks (usually PCN, cephalosporin, or vancomycin)
- May be discharged with PICC
- May require valve replacement (if damage is severe)
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Nursing care of endocarditis
- Assessment (vitals, heart sounds, fever, lack of cardiac flow due to valve damage, skin lesions)
- Cardiac monitoring
- Draw labs and evaluate results (draw culture prior to 1st dose of antibiotics)
- IV antibiotics (maintain IV access, review allergy history, observe for response to therapy and adverse reactions)
- Acetaminophen for fever (control fever to decrease cardiac workload)
- Patient education (explain diagnosis and treatment)
- Psychosocial support
- Discharge planning (home health follow up; PICC line; teach patient to do treatment themselves, maintenance of PICC line, signs and symptoms of infection, and what to do if there is a problem)
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Endocarditis prophylaxis
- Patient's with pre-existing valve disease are more prone to endocarditis because they already have valves that are calcified
- Required for patients with prosthetic heart valves, pacemakers, ICDs, some heart murmurs (does not include functional murmurs or MVP without regurgitation), rheumatic fever and prior history of endocarditis
- Usually single dose of PCN or erythromycin 1 hour prior to procedure
- Educate patient (inform dentist and other healthcare providers)
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