Endocarditis for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Endocarditis for Certified Emergency Nursing (CEN)
Outline
Endocarditis
Definition/Etiology:
Endocarditis occurs when a patient has bacteria in the blood that begin to stick to a heart valve (vegetate).
Risk factors include: male, >60 years old, injection drug use, and poor dentition.
Common comorbid conditions include: indwelling medical device, prosthetic heart valve, congenital heart disease, and hemodialysis.
Top four pathogens are: Staph aureus, Viridians group streptococci, Enterococci, and Coagulase-negative staphylococci.
Pathophysiology:
Some bacteria have sticky coatings and adhere to heart valves. Valves should open and close fully and easily; however, when they don’t, because of damage or calcification, then turbulent blood flow occurs. This turbulence creates an area where bacteria can begin to stick to the heart valve. Rheumatic, stenotic, prolapsing, prosthetic, or regurgitant valves are at risk, as well as valves with a prior history of endocarditis.
Clinical Presentation:
- Fever is present in ~90% of patients
- Janeway lesions: red or dark spots on palms/soles
- Osler nodes: tender nodules on the pads of the fingers
- Petechiae
- New cardiac murmur
- Septic emboli can cause multi-organ failure, septic arthritis, and stroke
- Heart failure due to valve damage
- New heart blocks due to infection entering the heart muscle and conduction system.
Collaborative Management:
- Blood cultures from 2 sites prior to empiric antibiotic treatment.
- Transthoracic echocardiogram to look for vegetation on valves, and paravalvular abscess. If negative, or if a better view is needed, can do transesophageal echocardiogram.
- CXR to look for septic pulmonary emboli, infiltrates (with or without cavitation), congestive heart failure, and potential alternative causes of fever and systemic symptoms.
- CT chest/abdomen/pelvis to look for metastatic infection.
- Dental evaluation.
- Typical IV antibiotic treatment is 4-6 weeks in duration.
Evaluation | Patient Monitoring | Education:
- Monitor for septic emboli
- Monitor for new murmurs
- Teach patient the signs and symptoms of heart failure
- If patient injects drugs and wants to quit, refer to social worker to coordinate a drug treatment counseling program
Linchpins: (Key Points)
- Infective endocarditis should be suspected in febrile patients with risk factors and common comorbid conditions.
- Delay in diagnosis and treatment may be associated with complications, including valvular regurgitation, heart failure (HF), embolic events, and sepsis.
- A damaged or dysfunctional valve is at risk for endocarditis due to turbulent flow.
- Skin lesions and murmurs can indicate a much larger problem.
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Chu, V. H. (2022, September 27). Native valve endocarditis: Epidemiology, risk factors, and microbiology. UpToDate. https://www.uptodate.com/contents/native-valve-endocarditis-epidemiology-risk-factors-and-microbiology
- Wang, A. (2022, September 7). Overview of management of infective endocarditis in adults. UpToDate. https://www.uptodate.com/contents/overview-of-management-of-infective-endocarditis-in-adults
- Chu, V. H. (2022, June 27). Clinical manifestations and evaluation of adults with suspected left-sided native valve endocarditis. UpToDate. https://www.uptodate.com/contents/clinical-manifestations-and-evaluation-of-adults-with-suspected-left-sided-native-valve-endocarditis
Tiona RN
Concepts Covered:
- Studying
- Medication Administration
- Adult
- Emergency Care of the Cardiac Patient
- Intraoperative Nursing
- Microbiology
- Cardiac Disorders
- Vascular Disorders
- Nervous System
- Upper GI Disorders
- Central Nervous System Disorders – Brain
- Immunological Disorders
- Fundamentals of Emergency Nursing
- Dosage Calculations
- Understanding Society
- Circulatory System
- Concepts of Pharmacology
- Hematologic Disorders
- Newborn Care
- Adulthood Growth and Development
- Disorders of Pancreas
- Postoperative Nursing
- Pregnancy Risks
- Neurological
- Postpartum Complications
- Noninfectious Respiratory Disorder
- Peripheral Nervous System Disorders
- Learning Pharmacology
- Prenatal Concepts
- Tissues and Glands
- Developmental Considerations
- Factors Influencing Community Health
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Developmental Theories
- Basic
- Neonatal
- Pediatric
- Gastrointestinal
- Newborn Complications
- Labor Complications
- Fetal Development
- Terminology
- Labor and Delivery
- Postpartum Care
- Communication
- Basics of Mathematics
- Statistics
- Basics of Sociology
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of the Thyroid & Parathyroid Glands
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Respiratory
- Delegation
- Perioperative Nursing Roles
- Acute & Chronic Renal Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Documentation and Communication
- Preoperative Nursing
- Legal and Ethical Issues
- Oncology Disorders
- Female Reproductive Disorders
- Musculoskeletal Trauma
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Integumentary Disorders
- Emergency Care of the Trauma Patient
- Urinary Disorders
- Musculoskeletal Disorders
- EENT Disorders
- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Urinary System
- Emergency Care of the Neurological Patient
- Central Nervous System Disorders – Spinal Cord
- Respiratory System
- Emergency Care of the Respiratory Patient
- Cognitive Disorders
- Anxiety Disorders
- Depressive Disorders
- Trauma-Stress Disorders
- Substance Abuse Disorders
- Bipolar Disorders
- Psychotic Disorders
- Concepts of Mental Health
- Eating Disorders
- Personality Disorders
- Health & Stress
- Psychological Emergencies
- Somatoform Disorders
- Prioritization
- Community Health Overview
- Gastrointestinal Disorders
- Integumentary Disorders
- Respiratory Disorders
- Neurologic and Cognitive Disorders
- Renal and Urinary Disorders
- Infectious Disease Disorders
- EENT Disorders
- Hematologic Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Endocrine and Metabolic Disorders
- Oncologic Disorders
- Behavior
- Emotions and Motivation
- Growth & Development
- Intelligence and Language
- Psychological Disorders
- State of Consciousness
- Note Taking
- Concepts of Population Health
- Basics of Human Biology