Inflam Heart Disease

  1. 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
  2. What are vegetation?
    Clumps of bacteria, fibrin, platelets, and leukocytes that effects valvular function and can embolize to brain, kidneys, lungs, limbs, etc.
  3. Types of invasive procedures that can promote endocarditis
    • Dental procedures
    • Cystoscopy
    • Endoscopy
    • GYN procedures
    • Surgery
    • IV drug abuse
    • Cardiac cath
    • IV therapy
  4. 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)
  5. 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)
  6. 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)
  7. 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)
  8. 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)
Card Set
Inflam Heart Disease
Med Surg I - Inflam Heart Disease