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