Week 4 - Endocarditis

Question 1

what is infective endocarditis

Answer 1

• infection of the heart valves and/or the endocardial surface of the heart with formation of vegetations

Question 2

what is infective endocarditis most commonly caused by

Answer 2

• bacteria –> staph and strep

Question 3

what are other possible causes of infective endocarditis (2)

Answer 3

• fungi

- viruses

Question 4

what are predisposing factors for infective endocarditis (4)

Answer 4

• prior endocarditis
• conditions that damage the valves
• IV drug use
• hospital acquired bacteremia (ex. dialysis, CVAD)

Question 5

what are the “vegetations” seen in infective endocarditis

Answer 5

• primary lesions of IE

- consist of fibrin, leukocytes, patelets, and bacteria that adhere to the valves and endocardium

Question 6

IE occurs when…

Answer 6

• blood flow turbelence within the heart allows the causative organisms to infect previously damaged valves or other endothelial surfaces and cause vegetations

Question 7

what is a potential complication that can arise due to the vegetations in IE

Answer 7

• fragmentation and migration of the vegetations into the circulation causing embolization

Question 8

emboli arising from a left sided heart vegetation will cause? (2)

Answer 8

• organ embolization

- vascular embolization

Question 9

what organs can be affected by vegetations in the left side of the heart (3)

Answer 9

• kidney
• spleen
• brain

Question 10

what can vascular embolization cause (5)

Answer 10

• limb infarction
• splinter hemorrages
• petichia
• janeaway’s lesions
• roth’s spots
• oslers nodes

Question 11

where might you see petechiae from vascular embolization (4)

Answer 11

• feet
• ankles
• lips
• buccal mucosa

Question 12

what are splinter hemorrhages

Answer 12

• black streaks in nail beds

Question 13

what are roth’s spots

Answer 13

• lesions on the retina

Question 14

what are janeaway lesions

Answer 14

• flat, painless red spots on the palm of the palm or soles of feet

Question 15

what are osler nodes

Answer 15

• red/purple, painful, pea sized lesions on fingers or toes

Question 16

what sign may indicate organ embolization to the brain (5)

Answer 16

• decreased LOC
• hemiplegia
• ataxia
• aphasia
• visual changes

Question 17

what sign may indicate organ embolization to the kidneys (3)

Answer 17

• decreased UO
• flank pain
• hematuria

Question 18

right sided vegetations in IE may embolize to…

Answer 18

• the lungs

Question 19

what is a side of organ embolization to the lungs

Answer 19

SOB

Question 20

what are other complications of IE (6)

Answer 20

• dysrhythmias
• valvular incompetence
• invasion of the myocardium
• HF
• sepsis
• heart block

Question 21

what is the primary cause of right sided endocarditis

Answer 21

• IV drug use

Question 22

describe the S&S of IE

Answer 22

• nonspecific

- involve multiple organ systems

Question 23

what are some S&S of IE (14)

Answer 23

• low grade fever
• chills
• weakness
• malaise
• fatigue
• anorexia
• weightloss
• arthralgia & myalgia
• back pain
• abdominal discomfort
• headache
• finger clubbing
• murmurs
• Sx secondary to embolization

Question 24

what Sx may indicate embolization to the spleen (4)

Answer 24

• sharp, LUQ pain
• splenomegaly
• local tenderness
• abdom rigidity

Question 25

how can IE be diagnosed (6)

Answer 25

- health history - blood cultures - CBC (esp. leukocytes) - echo - ECG (for heart block) - cardiac catheterization

Question 26

what should you assess regarding history for someone who may have IE (4)

Answer 26

- recent procedures - history of IV drug use - previous valvular heart disease - congenital heart disease

Question 27

what is important in collaborative care for a pt with IE (7)

Answer 27

- drug therapy - monitor and treat fever - physical and emotional rest - monitor for complications from the vegetations - avoid excessive fatigue - plan rest period before and after therapy

Question 28

what kind of drug therapy is used in treatment for a pt wirt IE

Answer 28

- long term IV ab for 4-6 weeks | - antipyretics

Question 29

what do pts with IE need for treatment

Answer 29

- long term IV catheter or CVAD

Question 30

what is important to teach a pt with IE (5)

Answer 30

- avoid people w infection - adhere to planned treatment regimen - teach S&S of embolization - maintain good oral hygeine - must take prophylactic antibiotics before dentist or procedures for rest of life

Question 31

why is decreased CO a nursing diagnosis for IE (3)

Answer 31

- altered rhythm - valvular incompetence - fluid overload (heart murmur)

Question 32

a nursing diagnosis for IE is hyperthermia. nursing interventions can be done for this? (6)

Answer 32

- monitor temp & VS - admin antipyretics - monitor I&O - monitor signs of dehydration - encourage fluid consumption - monitor for fever-related complications (seizure, decreased LOC, electrolytes, etc.)

Question 33

a nursing diagnosis r/t IE is impaired comfort. what nursing interventions can be done for this? (6)

Answer 33

- prompt attention to call bells - determine sources of discomfort - avoid unnecessary exposure, drafts, overheating, or chilling - facilitate hygeine measures - position pt - reduce anxiety

Question 34

what nursing interventions can help reduce anxiety in a pt with IE (3)

Answer 34

- provide factual info concerning diagnosis, treatment, and prognosis - encourage verbalization of feelings, perceptions, and fears - instruct pt on use of relaxation techniques

Question 35

a nursing diagnosis r/t endocarditis is deficient knowledge. what teaching of the disease process can be done (3)

Answer 35

- assess pts currently lvl of knowledge - describe common S&S - discuss lifestyle changes that may be required to prevent future complication and/or control the disease

Question 36

what teaching regarding the meds can be done to the pt?

Answer 36

- provide pt and caregiver w written info about the action, purpose, and s/e of meds