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(Relates to Chapter 37, “Nursing Management:
Inflammatory and Structural Heart Disorders,” in the
textbook)
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 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
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Fig. 37-1
 Subacute
form
• Longer clinical course
• Insidious onset
• Caused by enterococci
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 Acute
form
• Shorter clinical course
• Rapid onset
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 Causative
organism more virulent
 Streptococcus viridans
 Staphylococcus aureus
 Viruses
 Fungi
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 Occurs
when blood turbulence within
heart allows causative agent to infect
previously damaged valves or other
endothelial surfaces
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 Principal
risk factors
• Prior endocarditis
• Prosthetic valves
• Acquired valvular disease
• Cardiac lesions
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 Vegetation
• Fibrin, leukocytes, platelets, and microbes
• Adhere to the valve or endocardium
• Embolization of portions of vegetation
into circulation
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Fig. 37-2
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Fig. 37-3
 Nonspecific
 Fever
occurs in 90% of patients
 Chills
 Weakness
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 Malaise
 Fatigue
 Anorexia
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 Subacute
form
• Arthralgias
• Myalgias
• Back pain
• Abdominal discomfort
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 Subacute
form
• Weight loss
• Headache
• Clubbing of fingers
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 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
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 Murmur
in most patients
 Heart failure in up to 80% with aortic
valve endocarditis
 Manifestations secondary to embolism
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 History
• Recent dental, urologic, surgical, or
gynecologic procedures
• Heart disease
• Recent cardiac catheterization
• Skin, respiratory, or urinary tract infection
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 Laboratory
tests
• Blood cultures
• WBC with differential
 Echocardiography
 Chest
x-ray
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 Prophylactic
treatment for patients
having
• Removal or drainage of infected tissue
• Renal dialysis
• Ventriculoatrial shunts
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 Antibiotic
administration
• Monitor antibiotic serum levels
• Subsequent blood cultures
• Renal function monitored
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 Fungal
and prosthetic valve
endocarditis
• Responds poorly to antibiotics
• Valve replacement is adjunct procedure
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 Subjective
Data
• History of valvular, congenital, or
syphilitic cardiac disease
• Previous endocarditis
• Staph or strep infection
• Immunosuppressive therapy
• Recent surgeries and procedures
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 Functional
health patterns
• IV drug abuse
• Alcohol abuse
• Weight changes
• Chills
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• Diaphoresis
• Bloody urine
• Exercise intolerance
• Generalized weakness
• Fatigue
• Cough
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• Dyspnea on exertion
• Night sweats
• Chest, back, abdominal pain
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 Objective
Data
• Olser’s nodes
• Splinter hemorrhage
• Janeway’s lesions
• Petechiae
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 Objective
Data
• Clubbing
• Tachypnea
• Crackles
• Dysrhythmias
• Tachycardia
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 Objective
Data
• Leukocytosis
• Anemia
• ↑ ESR and cardiac enzymes
• Positive cultures
• ECG showing chamber enlargement
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 Patient
will
• Have normal cardiac function
• Perform ADLs without fatigue
• Understand therapeutic regimen to
prevent recurrence
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 Identify
those at risk
 Assessment of history and
understanding of disease process
 Teach importance of adherence to
treatment regimen
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 Stress
need to avoid infectious people
 Avoidance of stress and fatigue
 Rest
 Hygiene
 Nutrition
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 Assessment
of nonspecific
manifestations
 Monitor laboratory data
 Monitor patency of IV
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 Compression
stockings with
immobility
 ROM
 Turn, cough, deep breathe
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 Teach
signs and symptoms of infection
 Teach reduction measures for risk for
infection
 Stress follow-up care
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 Vital
signs WNL
 Absence of chills, diaphoresis,
headache
 Sufficient cardiac output
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 Completion of ADLs
with no fatigue or
physiologic distress
 Increased understanding of disease
process and self-care management
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