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
Care plan
Concepts Covered:
- Basics of NCLEX
- Test Taking Strategies
- Integumentary Disorders
- Postoperative Nursing
- Musculoskeletal Disorders
- Musculoskeletal Trauma
- Emergency Care of the Trauma Patient
- Shock
- Acute & Chronic Renal Disorders
- Vascular Disorders
- Communication
- Perioperative Nursing Roles
- Hematologic Disorders
- Disorders of the Thyroid & Parathyroid Glands
- Cardiac Disorders
- Emergency Care of the Cardiac Patient
- Disorders of the Posterior Pituitary Gland
- Male Reproductive Disorders
- Infectious Disease Disorders
- Infectious Respiratory Disorder
- Intraoperative Nursing
- Medication Administration
- Urinary Disorders
- Urinary System
- Upper GI Disorders
- Preoperative Nursing
- Lower GI Disorders
- Neurological Trauma
- Neurological Emergencies
- Noninfectious Respiratory Disorder
- Respiratory System
- Oncology Disorders
- Respiratory Emergencies
- Immunological Disorders
- Central Nervous System Disorders – Brain
- Renal Disorders
- EENT Disorders
- Emergency Care of the Neurological Patient
- EENT Disorders
- Liver & Gallbladder Disorders
- Shock
- Studying
- Disorders of Pancreas
- Respiratory
- Emergency Care of the Respiratory Patient
- Legal and Ethical Issues
- Documentation and Communication
- Fundamentals of Emergency Nursing
- Female Reproductive Disorders
- Sexually Transmitted Infections
- Peripheral Nervous System Disorders
- Microbiology
- Central Nervous System Disorders – Spinal Cord
- Integumentary Disorders
- Disorders of Thermoregulation
- Neurologic and Cognitive Disorders
- Renal and Urinary Disorders
- Disorders of the Adrenal Gland
- Respiratory Disorders
- Nervous System
- Integumentary Important Points
- Tissues and Glands
- Delegation
- Factors Influencing Community Health
- Multisystem
- Cardiovascular
- Circulatory System
- Newborn Complications
- Gastrointestinal Disorders
- Cognitive Disorders
- Neurological
- Gastrointestinal
- Endocrine