Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved....

transcript

(Relates to Chapter 37, “Nursing Management: Inflammatory and Structural

Heart Disorders,” in the textbook)

Infection of the inner layer of the heart that usually affects the cardiac valves

Was almost always fatal until development of penicillin

15,000 cases diagnosed in the United States each year

Fig. 37-1

Subacute form• Longer clinical course• Insidious onset•Caused by enterococci

Acute form•Shorter clinical course•Rapid onset

Causative organism more virulent

Streptococcus viridans Staphylococcus aureus Viruses Fungi

Occurs when blood turbulence within heart allows causative agent to infect previously damaged valves or other endothelial surfaces

Principal risk factors•Prior endocarditis•Prosthetic valves•Acquired valvular disease•Cardiac lesions

Vegetation • Fibrin, leukocytes, platelets, and microbes•Adhere to the valve or endocardium • Embolization of portions of vegetation into circulation

Fig. 37-2

Fig. 37-3

Nonspecific Fever occurs in 90% of patients

ChillsWeakness

Malaise FatigueAnorexia

Subacute form•Arthralgias•Myalgias •Back pain•Abdominal discomfort

Subacute form•Weight loss•Headache•Clubbing of fingers

Vascular manifestations•Splinter hemorrhages in nail beds•Petechiae•Osler’s nodes on fingers or toes• Janeway’s lesions on palms or soles•Roth’s spots

Murmur in most patientsHeart failure in up to 80% with aortic valve endocarditis

Manifestations secondary to embolism

History•Recent dental, urologic, surgical, or gynecologic procedures•Heart disease•Recent cardiac catheterization•Skin, respiratory, or urinary tract infection

Laboratory tests•Blood cultures•WBC with differential

EchocardiographyChest x-ray

Prophylactic treatment for patients having•Removal or drainage of infected tissue•Renal dialysis•Ventriculoatrial shunts

Antibiotic administration•Monitor antibiotic serum levels •Subsequent blood cultures•Renal function monitored

Fungal and prosthetic valve endocarditis•Responds poorly to antibiotics•Valve replacement is adjunct procedure

Subjective Data•History of valvular, congenital, or syphilitic cardiac disease•Previous endocarditis •Staph or strep infection• Immunosuppressive therapy•Recent surgeries and procedures

Functional health patterns• IV drug abuse•Alcohol abuse•Weight changes•Chills

•Diaphoresis•Bloody urine• Exercise intolerance •Generalized weakness• Fatigue •Cough

•Dyspnea on exertion •Night sweats •Chest, back, abdominal pain

Objective Data•Olser’s nodes•Splinter hemorrhage• Janeway’s lesions•Petechiae

Objective Data•Clubbing• Tachypnea•Crackles•Dysrhythmias • Tachycardia

Objective Data• Leukocytosis•Anemia•↑ ESR and cardiac enzymes•Positive cultures• ECG showing chamber enlargement

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

Identify those at riskAssessment of history and understanding of disease process

Teach importance of adherence to treatment regimen

Stress need to avoid infectious people

Avoidance of stress and fatigue

Rest HygieneNutrition

Assessment of nonspecific manifestations

Monitor laboratory dataMonitor patency of IV

Compression stockings with immobility

ROMTurn, cough, deep breathe

Teach signs and symptoms of infection

Teach reduction measures for risk for infection

Stress follow-up care

Vital signs WNLAbsence of chills, diaphoresis, headache

Sufficient cardiac output

Completion of ADLs with no fatigue or physiologic distress

Increased understanding of disease process and self-care management

Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved....

Documents