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
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System