Endocarditis

  1. General information
    1. Inflammation of the endocardium; platelets and fibrin deposit on the mitral and/or aortic valves causing deformity, insufficiency, or stenosis.
    2. Caused by bacterial infection: commonly S. aureus, S. viridans, B-hemolytic streptococcus, gonococcus
    3. Precipitating factors: rheumatic heart disease, open-heart surgery procedures, GU/Ob-Gyn instrumentation/surgery, dental extractions, invasive monitoring, septic thrombophlebitis
  2. Medical management
    1. Drug therapy
      1. Antibiotics specific to sensitivity of organism cultured
      2. Penicillin G and streptomycin if organism not known
      3. Antipyretics
    2. Cardiac surgery to replace affected valve
  3. Assessment findings
    1. Fever, malaise, fatigue, dyspnea and cough (if extensive valvular damage), acute upper quadrant pain (if splenic involvement), joint pain
    2. Petechiae, murmurs, edema (if extensive valvular damage), splenomegaly, hemiplegia and confusion (if cerebral infarction), hematuria (if renal infarction)
    3. Elevated WBC and ESR, decreased Hgb and Hct
    4. Diagnostic tests: positive blood culture for causative organism
  4. Nursing interventions
    1. Administer antibiotics as ordered to control the infectious process.
    2. Control temperature elevation by administration of antipyretics.
    3. Assess for vascular complications (see Thrombophlebitis, and Pulmonary Embolism).
    4. Provide client teaching and discharge planning concerning
      1. Types of procedures/treatments (e.g., tooth extractions, GU instrumentation) that increase the chances of recurrences
      2. Antibiotic therapy, including name, purpose, dose, frequency, side effects
      3. Signs and symptoms of recurrent endocarditis (persistent fever, fatigue, chills, anorexia, joint pain)
      4. Avoidance of individuals with known infections.

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