46

Cardiovascular system

Antibiotics are
a key treatment
for endocarditis. Be
sure to administer
antibiotics on
time to maintain
consistent antibiotic
blood levels.

(macrophages), elevated ESR, normocytic

normochromic anemia (in 70% to 90% of
endocarditis cases), and positive serum
rheumatoid factor (in about one-half of all
clients with endocarditis after the disease is
present for 3 to 6 weeks).
Echocardiography may identify valvular
damage.
ECG may show AF and other arrhythmias
that accompany valvular disease.
Three or more blood cultures in a 24to 48-hour period identify the causative
organism in up to 90% of clients.

NURSING DIAGNOSES
Activity intolerance
Decreased cardiac output
Risk for injury

TREATMENT
Bed rest
Maintaining sufficient fluid intake
Surgery (in cases of severe valvular
damage) to replace defective valve

Drug therapy
Antibiotics: based on infective organism
Aspirin

INTERVENTIONS AND RATIONALES

Before giving antibiotics, obtain a client
history of allergies to prevent anaphylaxis.
Observe for signs of infiltration and inflammation, possible complications of long-term
I.V. drug administration, at the venipuncture
site. Rotate venous access sites to reduce the
risk of these complications.
Watch for signs of embolization (hematuria, pleuritic chest pain, left upper quadrant
pain, and paresis), a common occurrence
during the first 3 months of treatment. These
signs may indicate impending peripheral
vascular occlusion or splenic, renal, cerebral,
or pulmonary infarction.
Monitor the clients renal status (BUN
levels, serum creatinine, creatinine clearance,
and urine output) to check for signs of renal
emboli or evidence of drug toxicity.
Observe for signs of heart failure, such as
dyspnea, tachypnea, tachycardia, crackles,
jugular vein distention, edema, and weight
gain. Detecting heart failure early ensures

313419NCLEX-RN_Chap03.indd 46

prompt intervention and treatment and

decreases the risk of heart failure progressing to
pulmonary edema.
Provide reassurance by teaching the
client and his family about this disease
and the need for prolonged treatment. Tell
them to watch closely for fever, anorexia,
and other signs of relapse about 2 weeks
after treatment stops. Suggest quiet diversionary activities to prevent excessive
physical exertion. Having the client and his
family involved in care gives them a feeling
of control and promotes compliance with
long-term therapy.
Make sure a susceptible client understands the need for prophylactic antibiotics before, during, and after dental work,
childbirth, and genitourinary, GI, or gynecologic procedures to prevent further episodes of
endocarditis.

Teaching topics
Explanation of the disorder and treatment
plan
Medications and possible adverse effects
Recognizing symptoms of endocarditis;
notifying the physician immediately if symptoms occur
Need for prophylactic antibiotics before,
during, and after dental work, childbirth, and
genitourinary, GI, or gynecologic procedures

Heart failure
Heart failure occurs when the heart cant
pump enough blood to meet the bodys metabolic needs.
Heart failure can occur as left-sided failure
or right-sided failure. Left-sided heart failure
causes mostly pulmonary symptoms, such as
shortness of breath, dyspnea on exertion, and
a moist cough.
Right-sided heart failure causes systemic
symptoms, such as peripheral edema
and swelling, jugular vein distention, and
hepatomegaly.

CAUSES
Atherosclerosis
Cardiac conduction defects (in left-sided
failure)

4/8/2010 7:01:44 PM