Nursing Care Plan (NCP) for Endocarditis
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Outline
Lesson Objectives for Endocarditis
- Understanding Endocarditis:
- Define endocarditis, outlining the inflammatory condition affecting the endocardium and heart valves, and recognize its potential causes and risk factors.
- Pathophysiology of Endocarditis:
- Explore the underlying pathophysiology of endocarditis, including the mechanisms of infection, how microorganisms invade the endocardium, and the resulting impact on cardiac structures.
- Identification of Risk Factors:
- Identify and analyze the risk factors associated with endocarditis, such as pre-existing heart conditions, valve abnormalities, and intravenous drug use, to understand the predisposing factors for this condition.
- Clinical Manifestations:
- Explore the clinical manifestations of endocarditis, including signs and symptoms such as fever, heart murmurs, and vascular phenomena, to facilitate early recognition and timely intervention.
- Nursing Interventions and Prevention:
- Discuss nursing interventions for patients with endocarditis, emphasizing the importance of infection prevention strategies, patient education, and collaborative care to improve outcomes and prevent complications.
Pathophysiology of Endocarditis
- Microbial Invasion:
- Endocarditis typically begins when microorganisms, often bacteria, enter the bloodstream (bacteremia) from an external source, such as dental procedures, surgeries, or infections in other parts of the body.
- Attachment and Colonization:
- Microorganisms adhere to damaged areas on the heart’s endocardium or heart valves. Pre-existing heart conditions, congenital valve abnormalities, or artificial heart valves create susceptible sites.
- Formation of Vegetations:
- As microorganisms colonize, they trigger an inflammatory response. This immune response leads to the formation of vegetations, which are masses of platelets, fibrin, microorganisms, and inflammatory cells.
- Valve Damage and Dysfunction:
- The vegetations can cause structural damage to the heart valves, leading to valvular dysfunction. This can result in regurgitation or stenosis, affecting the heart’s ability to pump blood efficiently.
- Embolic Events:
- Fragments of vegetations, known as emboli, can break loose and travel through the bloodstream, causing blockages in smaller blood vessels. This can lead to systemic complications, such as stroke, organ infarction, or septic emboli.
Etiology of Endocarditis
- Bacterial Infections:
- Bacteria are the primary causative agents of infective endocarditis. Common bacteria involved include Streptococcus and Staphylococcus species. The specific strain can vary, and certain individuals may be more susceptible, especially those with pre-existing heart conditions.
- Fungal Infections:
- In addition to bacteria, fungal infections, particularly Candida species, can also cause endocarditis. Fungal endocarditis is more prevalent in individuals with compromised immune systems.
- Intravenous Drug Use:
- Individuals who engage in intravenous drug use are at an increased risk of developing endocarditis. Contaminated needles can introduce bacteria directly into the bloodstream, leading to infection of the heart valves.
- Structural Heart Abnormalities:
- Congenital heart defects, artificial heart valves, and other structural abnormalities increase the risk of endocarditis. Damaged heart tissue provides sites for bacterial attachment and colonization.
- Procedures and Surgeries:
- Certain medical procedures, such as dental work or surgeries involving the respiratory or gastrointestinal tracts, can introduce bacteria into the bloodstream. Individuals with predisposing conditions are more susceptible to developing endocarditis following such procedures.
Desired Outcome for Endocarditis
- Infection Control:
- Achieve resolution of the infectious process, ensuring the elimination of bacteria or fungi causing endocarditis.
- Restoration of Valve Function:
- Restore optimal functioning of the affected heart valve(s) to prevent complications such as valvular insufficiency or stenosis.
- Prevention of Systemic Complications:
- Prevent the spread of infection to other organs and tissues, reducing the risk of systemic complications such as emboli formation, septicemia, or organ damage.
- Normalization of Laboratory Values:
- Normalize laboratory parameters such as blood cultures, inflammatory markers, and cardiac biomarkers to indicate control of the infection and reduction of inflammation.
- Symptomatic Relief:
- Alleviate symptoms associated with endocarditis, such as fever, fatigue, and cardiac symptoms, enhancing the overall quality of life for the individual.
Endocarditis Nursing Care Plan
Subjective Data:
- Chest Pain
- Symptoms of Heart Failure
Objective Data:
- Temperature
- ↑ WBC
- Signs of Heart Failure
- Heart murmurs
- ↓ SpO2
- Embolic complications
- Splinter hemorrhages in nail beds
- Janeway lesions on fingers, toes, nose
- Clubbing of fingers
Nursing Assessment for Endocarditis
- Clinical History:
- Obtain a detailed medical history, including any recent infections, dental procedures, or intravenous drug use, which could contribute to the development of endocarditis.
- Symptom Assessment:
- Evaluate and document symptoms such as fever, fatigue, new or changed heart murmurs, and signs of emboli (e.g., petechiae, splinter hemorrhages).
- Cardiovascular Assessment:
- Perform a thorough cardiovascular assessment, including auscultation for murmurs, assessing heart sounds, and monitoring for signs of heart failure or embolic events.
- Peripheral Signs of Infection:
- Examine for peripheral signs of infection, such as clubbing, Janeway lesions, Osler nodes, or Roth spots, which may indicate systemic involvement.
- Laboratory Tests:
- Order and interpret laboratory tests, including blood cultures, complete blood count (CBC), inflammatory markers (e.g., erythrocyte sedimentation rate, C-reactive protein), and cardiac biomarkers.
- Imaging Studies:
- Consider imaging studies, such as echocardiography, to visualize heart valves, assess for vegetations, and determine the extent of cardiac involvement.
- Renal Function Assessment:
- Monitor renal function through assessments of serum creatinine and blood urea nitrogen, as endocarditis can lead to complications affecting renal perfusion.
- Neurological Assessment:
- Conduct a neurological assessment to identify signs of embolic events, such as changes in mental status, focal neurological deficits, or other neurological abnormalities.
Implementation for Endocarditis
- Antibiotic Therapy:
- Initiate prompt and appropriate antibiotic therapy based on blood culture results and susceptibility patterns. Administer intravenous antibiotics for an extended duration, guided by infectious disease specialists.
- Intravenous Fluids:
- Ensure adequate hydration with intravenous fluids to maintain cardiac output and perfusion. Monitor fluid balance and adjust the rate as needed, especially if the patient is at risk of heart failure.
- Pain Management:
- Manage pain and discomfort effectively with prescribed analgesics. Consider the patient’s pain threshold and choose medications that do not compromise cardiovascular stability.
- Monitoring and Support:
- Implement continuous monitoring of vital signs, cardiac function, and oxygen saturation. Provide respiratory support if necessary, including supplemental oxygen or mechanical ventilation.
- Surgical Intervention:
- Collaborate with the healthcare team to determine the need for surgical intervention, such as valve repair or replacement, in cases of severe valvular damage or persistent infection despite antibiotic therapy.
Nursing Interventions and Rationales
- Assess Heart Sounds
Patients with endocarditis may develop valve disorders – listen for heart murmurs or extra sounds.
- Assess and Address Oral Hygiene
There is a significant connection between oral health and pericarditis. Bacteria can travel to the heart easily from the oral cavity. Patients should brush their teeth twice daily to prevent complications.
- Administer IV Antibiotics
Endocarditis is almost always a bacterial source, therefore, IV antibiotics will be required to treat the infection. Be sure to obtain blood cultures prior to initiating antibiotics.
- Administer and Monitor Anticoagulant Therapy
The provider may order anticoagulant therapy to prevent further collection of platelets or clots around the valves and to prevent major complications from emboli.
Depending on the medication, the therapy may require monitoring. For example IV Heparin requires PTT monitoring.
- Apply SCDs or TED hose
Patients are at risk for embolic complications. SCD’s or TED hose can help prevent DVT’s from developing. This can help to prevent pulmonary embolism.
- Assess for s/s emboli
The vegetation on the valves is at risk for breaking off and becoming lodged in smaller vessels. This includes risk for Stroke, MI, Pulmonary Embolism, but also damage to the smaller vessels in the extremities, hands, and feet.
- Educate patient on s/s infection
Endocarditis is an infectious process, therefore infection control is imperative. They need to be taught hand hygiene as well as other infection precautions. They should also be taught s/s of infection to report to their provider.
- Educate patient to inform other providers before procedures
- May need prophylactic antibiotics
- No dental procedures for at least 6 months
Because the patient is at high risk for recurrence and complications, it’s important that they notify other providers of their history of endocarditis. They may require prophylactic antibiotics prior to any invasive procedures and they should avoid dental procedures for at least 6 months after their hospitalization.
Evaluation for Endocarditis
- Clinical Response:
- Assess the patient’s clinical response to antibiotic therapy by monitoring vital signs, laboratory results, and resolution of signs and symptoms of infection. Evaluate for any signs of persistent or recurrent infection.
- Complications Monitoring:
- Regularly evaluate for potential complications, such as embolic events, heart failure, or systemic complications. Conduct imaging studies and diagnostic tests as necessary to identify and manage complications promptly.
- Laboratory Parameters:
- Monitor laboratory parameters, including blood cultures, inflammatory markers (such as C-reactive protein and erythrocyte sedimentation rate), and complete blood count, to gauge the effectiveness of antibiotic therapy and resolution of inflammation.
- Cardiac Function:
- Assess cardiac function through echocardiography and other cardiac imaging studies. Evaluate for any persistent valvular damage or development of new cardiac issues that may require further intervention.
- Patient Education and Compliance:
- Evaluate the patient’s understanding of the prescribed treatment plan and ensure compliance with medications and follow-up appointments. Address any concerns or barriers to adherence to optimize long-term outcomes.
References
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Example Nursing Diagnosis For Nursing Care Plan (NCP) for Endocarditis
- Risk for Infection: Endocarditis is an infectious condition involving the heart valves. This diagnosis focuses on the potential for systemic infection.
- Altered Cardiac Output: Endocarditis can impair cardiac function by affecting heart valves. This diagnosis addresses alterations in cardiac output.
- Risk for Embolic Events: Endocarditis can lead to vegetation formation on heart valves, increasing the risk of embolic events. This diagnosis emphasizes the potential for embolism formation.
Transcript
Hey guys, in this lesson, we’re going to take a look at the care plan for endocarditis. We’re briefly going to take a look at the pathophysiology and etiology of endocarditis. We’re going to also take a look at additional things that would be included in the endocarditis care plan like subjective and objective data, what a patient with this issue might present with, and also necessary nursing interventions and rationales.
So, endocarditis is inflammation of the lining of the valves of the heart, often from an infectious source, which can cause disorders of the valve and also life-threatening arrhythmias. Because vegetations can form from bacteria, heart attacks and strokes are also extremely possible. So, the two most common causes of endocarditis are IV drug use because of the introduction of bacteria into the vascular system, and also artificial valve replacement as bacteria tends to adhere to artificial devices. The desired outcome is to treat the cause and remove the source of infection while preserving cardiac output and preventing any major or even minor complications.
Okay. So let’s take a look at some of the subjective and objective data that your patient with endocarditis may present with. Remember, subjective data is going to be things that are based on your patient’s opinions or feelings. These things for endocarditis might include chest pain or symptoms of heart failure.
So objective data for endocarditis includes possibly a temperature, increased white blood cells, signs of heart failure, heart murmurs, decreased SATs, and also embolic complications, including splintering hemorrhage in the nail beds, janeway lesions on the fingers, toes and nose, and clubbing of the fingers.
Okay, let’s take a look at some nursing interventions necessary for endocarditis. Assess heart sounds as patients with endocarditis may develop valve disorders. Listen for heart murmurs or extra sounds. Next, assess and address oral hygiene. This is super important as there’s a significant connection between oral health and pericarditis. Bacteria can actually travel from the mouth to the heart, super easily, so patients should brush their teeth twice daily. With endocarditis, there is almost always a bacterial source involved. IV antibiotics will be required to treat this infection. Be sure to obtain blood cultures prior to initiating antibiotics. The provider may also order anticoagulant therapy to prevent further collection of platelets or clots around the valves and to prevent major complications from an emboli. Depending on the medication, the therapy may require monitoring. For example, with IV heparin, you’ll need to do PTT’s. Because of the risk of embolic complications, patients with endocarditis should have SCD’s and Ted hose. Be sure to assess for signs of an emboli because of the possible vegetations on the valves. There’s a risk of MI, PE, stroke, even damage to the smaller vessels in the hands, feet and extremities. Be sure that you educate your patients on the signs of infections and also report these to the provider. Also, teaching hand hygiene is critical. Teach the patient to inform other providers of their endocarditis history before any procedure, as the patient may need prophylactic antibiotics, and they should not have any dental procedures for six months.
Okay guys, here is a look at the completed care plan for endocarditis. Let’s do a quick review of endocarditis. This is the inflammation of the lining of the heart valves, usually from an infectious source, which can cause vascular disorders and arrhythmias. The causes are usually from IV drug use or from artificial valves. Subjective data includes chest pain and symptoms of heart failure. Objective data includes a temperature, having elevated white blood cells, signs of heart failure, heart murmurs, and embolic complications like splintering, hemorrhagic nail beds, finger clubbing and janeway lesions. Assess the patient’s heart sounds. Listening for murmurs, assess their oral hygiene and have them brush their teeth twice daily. Assess for signs and symptoms of emboli to prevent MI, strokes or PE’s. Apply SCDs and Ted hose, and administer IV antibiotics or anticoagulant therapy to prevent embolic complications. Educate the patient to report any signs of infection to their provider. Tell the provider of endocarditis for any procedures that they may have as they may need antibiotic prophylaxis, and they should not have any dental procedures for six months.
Okay guys, that is it on this care plan for endocarditis. We love you guys. Go out and be your best self today and as always, happy nursing!
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