Infective

Endocarditis

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Infective Endocarditis (IE)
Infection of inner layer of heart,
including the cardiac valves
Improved prognosis with antibiotic
therapy

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Layers of the Heart

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Classification
Subacute form
Preexisting valve disease
Longer clinical course
Acute form
Healthy valves
Rapidly progressive
Also classified by cause or site of
involvement
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Causative Organisms
Bacterial most common
Streptococcus viridans
Staphylococcus aureus
Viruses
Fungi

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Etiology and Pathophysiology
Occurs when blood flow within
heart allows causative organism to
infect previously damaged valves
or other endothelial surfaces

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Risk Factors
Cardiac, noncardiac, procedural
Principal risk factors
Age
IV drug abuse (IVDA)
Prosthetic valves
Use of intravascular devices
Renal dialysis

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Etiology and Pathophysiology
Vegetation
Fibrin, leukocytes, platelets, and
microbes
Adhere to the valve or endocardium
Parts break off and enter circulation
(embolization)

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Bacterial Endocarditis of
Mitral Value

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Mitral Stenosis and Vegetation

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Pathogenesis of Infective Endocarditis

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Clinical Manifestations
Nonspecific Subacute form
Fever Arthralgias
Chills Myalgias

Weakness Back pain

Malaise Abdominal discomfort

Weight loss
Fatigue
Headache
Anorexia
Clubbing of fingers

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Clinical Manifestations
Vascular manifestations
Splinter
hemorrhages in nail
beds
Petechiae
Oslers nodes on
fingertips or toes
Janeways lesions on
pads of the fingers
and toes
Roths spots

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Janeway Lesion/Roth Spots

Hemorrhagic retinal
lesions called Roths spots.
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Clinical Manifestations
New or worsening systolic murmur in
most patients
Heart failure
Manifestations secondary to embolism
Spleen
Kidneys
Limbs
Brain
Lungs
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Diagnostic Studies
History
Laboratory tests
Blood cultures
CBC with differential
ESR, C-reactive protein (CRP)
Echocardiography
Chest x-ray
ECG
Heart catheterization
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Interprofessional Care
Prophylactic antibiotic treatment
for select patients having
Certain dental procedures
Respiratory tract incisions
Tonsillectomy and adenoidectomy
Surgical procedures involving
infected skin, skin structures, or
musculoskeletal tissue
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Interprofessional Care
Accurate identification of organism
IV antibiotics (long-term)
Repeat blood cultures
Valve replacement if needed
Antipyretics
Fluids
Rest

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Nursing Assessment
Subjective Data
Health history
Valvular, congenital, or syphilitic heart
disease
Previous endocarditis

Staph or strep infection

Drugs Immunosuppressive therapy

Recent surgeries and procedures

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Nursing Assessment
Subjective Data: Functional Health
Patterns
IVDA
Alcohol abuse
Weight changes
Chills
Hematuria
Exercise intolerance, weakness, fatigue
Cough, DOE, orthopnea, palpitations
Night sweats
Pain, headache, joint or muscle tenderness
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Nursing Assessment
Objective Data
Fever
Oslers nodes
Splinter hemorrhage
Janeways lesions
Petechiae, purpura
Peripheral edema, clubbing
Tachypnea, crackles
Dysrhythmia, tachycardia, murmurs, S3, S4
Retinal hemorrhages
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Nursing Diagnoses
Decreased cardiac output
Hyperthermia
Impaired comfort
Activity intolerance
Deficient knowledge

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Planning
Patient will
Have normal cardiac function
Perform ADLs without fatigue
Understand therapeutic regimen to
prevent recurrence

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Nursing Implementation
Health Promotion
Identify those at risk
Assess history and understanding of
disease process
Teach importance of adherence to
treatment regimen

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Nursing Implementation
Health Promotion
Patient teaching
Stress need to avoid infectious people
Avoidance of stress and fatigue
Rest
Hygiene
Prophylactic antibiotics
Drug rehabilitation
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Nursing Implementation
Ambulatory Care
Antibiotic therapy for 46 weeks
Assess home setting
Monitor laboratory data, including
blood cultures
Assess IV lines
Coping strategies

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Nursing Implementation
Ambulatory Care
Adequate rest
Moderate activity
Compression stockings
ROM exercises
Deep breath and cough every 2 hours

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Nursing Implementation
Patient teaching
Monitor body temperature
Signs and symptoms of complications
Nature of disease and reducing risk of
reinfection
Stress follow-up care, good nutrition,
early treatment of common infections
Signs and symptoms of infection
Need for prophylactic antibiotic therapy
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Evaluation
Adequate tissue and organ
perfusion
Normal body temperature
Activity tolerance
Comfort
Verbalizes understanding

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