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Chapter 2
•
Cardiovascular Care
47
PICTURING
PATHO
INFECTIVE ENDOCARDITIS
IE refers to infection of the
endocardial surface of the heart;
infection of one or more heart valves,
or infection of a cardiac device.
Risk Factors
•
History of prior IE
•
Presence of a prosthetic valve or
cardiac device
•
History of valvular or congenital
heart disease (CHD)
Noncardiac Factors
•
Intravenous drug use
•
Intravenous catheter
•
Immunosuppression, or a recent
dental or surgical procedure
•
Age
>
60, and men
Population at Risk for Infective
Endocarditis
Patients with:
•
Prosthetic valve or with prosthetic
material used for cardiac valve repair
•
Transcatheter-implanted
prostheses and homografts
•
Previous IE
•
Untreated cyanotic CHD and
those with CHD who have
postoperative palliative shunts,
conduits or other procedures
Clinical Manifestations
•
Malaise
•
Headache
•
Myalgia
•
Arthralgia
•
Night sweats
•
Loss of weight
•
Flu-like syndromes
•
Abdominal pain
•
Dyspnea
•
Cough
•
Splinter hemorrhages
•
Cardiac murmurs
•
Petechiae
•
Pleuritic pain
•
Low-grade fever and nonspecific
symptoms
Treatment
•
Bactericidal agents
•
Corrective surgery if refractory HF
develops or heart structures are
damaged
•
Replacement of infected
prosthetic valve
Nursing Considerations
•
Watch for signs and symptoms of
embolization such as hematuria,
pleuritic chest pain, left upper
quadrant pain, and paresis.
•
Monitor the patient’s renal status
including blood urea nitrogen
levels, creatinine clearance levels,
and urine output.
•
Assess cardiovascular status
frequently and watch for signs
of left ventricular failure such as
dyspnea, hypotension, tachycardia,
tachypnea, crackles, neck vein
distention, edema, and weight gain.
•
Check for changes in cardiac
rhythm or conduction.
•
Evaluate ABG values as needed to
ensure adequate oxygenation.
•
Observe for signs of infiltration or
inflammation at the venipuncture
site.
•
Stress the importance of taking
the medication and restricting
activities for as long as the doctor
orders.
•
Tell patient to watch closely for
fever, anorexia, and other signs
of relapse for about 2 weeks after
treatment stops.
•
Teach the patient how to
recognize symptoms of
endocarditis, and tell him to notify
the doctor immediately if such
symptoms occur.
•
Stress the importance of dental
hygiene to prevent caries and
possible recurrent endocarditis.
•
Before giving an antibiotic,
obtain a patient history of
allergies. Administer the
prescribed antibiotic on time to
maintain a consistent drug level in
the blood.
Libman–Sacks Endocarditis
From Rubin E, Farber
JL.
Pathology
. 3rd ed.
Philadelphia: Lippincott
Williams & Wilkins, 1999.
PICTURING
PATHO
Bacterial Endocarditis
From Rubin E, Farber JL.
Pathology
. 3rd ed. Philadelphia: Lippincott Williams
& Wilkins, 1999.