Endocarditis Nursing Care Plan

Endocarditis is an inflammation of the endocardium; it is usually limited to the memrane lining and the valves. The cause of endocarditis may be viral, fungal, or most commonly, bacterial. The most common organism is Streptococcus viridans. Vegetations (growths or lesion) may cause vulvular dysfunction, with mortality from endocarditis being as high as 25%.

Risk factors include any high-risk individual as a patient with valvular disese or mitral valve prolapse; undergoing any type of invasive procedure, especially dental surgery; any chronically ill individual, especially one who is immunosuppressed; any individual with previously damaged or congenitally malformed valves; any individual with prosthetic valves; and illicit drug users.

Signs and Symptoms

• Nonspecific
• Fever and flu like symptoms
• Fatigue
• Weight loss
• Malaise
• Night sweats

Physical Examination

• Physical findings are not specific
• The hallmark of endocarditis is a fever and a new murmur.
• Signs and symptoms of heart failure may be present.

Acute Care Management

Nursing Diagnosis: Decreased cardiac output secondary to valvular dysfunction from infective process.

Outcome Criteria

• Patient alert and oriented
• Skin warm and dry
• Pulses strong and equal bilaterally
• O2 sat ? 95%

Nursing Interventions

Patient Monitoring

1. Monitor pulse pressure and central venous pressure hourly or more frequently if titrating pharmacologic agents.
2. Obtain Bp hourly or more frequently if the patient’s condition is unstable.
3. Monitor hourly urine output to evaluate for responses to pharmacologic interventions.
4. Analyze ECG rhythm strip at least every 4 hours and note every rate.

Patient Assessment

1. Obtain HR, RR, and BP every hour or more frequently if the patient is exhibiting signs and symptoms of heart failure.
2. Assess for changes in neurological function hourly and as clinically indicated.
3. Assess skin for warmth, color, and capillary refill time. Assess distal pulses bilaterally for strength, regularity, and symmetry.

Diagnostic Assessment

1. Review BUN and creatinine levels to evaluate renal function.
2. Review endocardiography finding if available for valvular and ventricular function and presence of vegetation.
3. Review WBC counts to evaluate course if infection.

Patient Management

1. Provide supplemental oxygen at 2 to 4 L/min to maintain or improve oxygenation.
2. Minimize oxygen demand to decrease anxiety.
3. Maintain patient on bed rest if in acute hear failure.
4. Administer multi-I.V. antibiotic regimen as ordered.
5. Administer antipyretics as ordered and as needed.
6. Prepare the patient for anticipated surgical intervention to repair or replace affected valves.

Complications

In endocarditis, clumps of bacteria and cell fragments form in your heart at the site of the infection. These clumps, called vegetations, can break loose and travel to your brain, lungs, abdominal organs, kidneys or limbs. As a result, endocarditis can cause several major complications, including:

• Heart problems, such as heart murmur, heart valve damage and heart failure
• Stroke
• Seizure
• Loss of the ability to move part of all of your body (paralysis)
• Pockets of collected pus (abscesses) that develop in the heart, brain, lungs and other organs
• Pulmonary embolism — an infected vegetation that travels to the lungs and blocks a lung artery
• Kidney damage
• Enlarged spleen

Prevention

You can help prevent endocarditis in several ways, including:

• Know the signs and symptoms of endocarditis. See your doctor immediately if you develop any signs or symptoms, especially a fever that won't go away, unexplained fatigue, any type of skin infection, or open cuts or sores that don't heal properly.
• Pay special attention to your dental health — brush and floss your teeth and gums often, and have regular dental checkups.
• Avoid procedures that may lead to skin infections, such as body piercings or tattoos.