Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

Chapter 2 • Cardiovascular Care  47

Libman–Sacks Endocarditis

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

PICTURING PATHO

From Rubin E, Farber JL. Pathology . 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 1999.

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. Bacterial Endocarditis

• 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.

PICTURING PATHO

From Rubin E, Farber JL. Pathology . 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 1999.