Gulpany, Jynrose Kaye L.

BSN 4A

Infective Endocarditis - microbial infection of the endolethial surface of the heart -usually develops in people with prosthetic heart valves or structural cardiac defects - more common in older people, who are more likely to have degenerative or calcific valve lesions, reduced immunologic response to infection, and metabolic alterations associated with aging PATHOPHYSIOLOGY deformity/injury to the endocardium

clot expands
vegetations may embolize to other tissues throughout the body

body's normal defenses does not recognize new clots

clot formation

infection erode through the endocardium and underlying structures

infectious organisms invade the clot and endocardial lesion

platelets, fibrin, and microorganisms cluster as vegetations on the endocardium

tears/deformities to other valvular leaflets, dehiscence of prosthetic valves, deformity of chordae tendonae, mural abscesses

CLINICAL MANIFESTATIONS fever heart murmur clusters of petechiae small, painful nodules in the pads of fingers or toes (Osler nodes) irregular, red or purple, painless, flat macules may be present on the palms, fingers, hands, soles, and toes (Janeway lesions) hemorrhages with pale centers caused by emboli may be observed in the fundi of the eyes (Roth spots) reddish brown lines and streaks (Splinter hemorrhages) cardiomegaly, heart failure, tachycardia, or splenomegaly may occur headache temporary or transient cerebral ischemia strokes

ASSESSMENT AND DIAGNOSTIC FINDINGS definitive diagnosis is made when a microorganism is found in two separate blood culture, in a vegetation or in an abscess 3 sets of blood cultures drawn over a 24hour period should be obtained Elevated WBC Anemic Positive rheumatoid factor

Elevated erythrocyte sedimentation rate (ESR) or C-reactive protein Microscopic hematuria Echocardiogram to view a mass

PREVENTION: Antibiotic prophylaxis for high risk patients Good oral hygiene Avoid nail biting Minimize outbreaks of acne and psoriasis Female patients must not use intrauterine devices Avoid body piercing Aseptic technique in caring for patients with IV catheters and also during invasive procedures

MEDICAL MANAGEMENT: - Antibiotic therapy for 2-6weeks - Monitor serum levels of antibiotic - Blood cultures are taken periodically - Temperature is regularly monitored SURGICAL MANAGEMENT - Valve debridement or excision - Debridement of vegetations - Debridement and closure of abscess - Closure of fistula NURSING MANAGEMENT Monitor pts temp Assess heart sounds WOF s/sx of systemic embolization, pulmonary infarction and infiltrates WOF s/sx of organ damage Management of infection Invasive lines must be assessed regularly Activity restriction Supervise and monitor antibiotic treatment