Infective endocarditis

PPT of Infective endocarditis

1. TOPIC: INFECTIVE ENDOCARDITIS Prepared by Asso.Prof, Mr. Vijayreddy Vandali M.Sc ( N ), PGDHA, PGCDE. Medical-Surgical Nursing dept.

2. DEFINITION : Definition: Endocarditis is an inflammatory processes of the endocardium especially

3. PATHOPHYSIOLOGY Due to etiological factor bacteria enter into blood stream Colonization, replication of bacteria on valve leaflets Bacteria get surrounds by fibrin and platelets   Forms vegetation and clots travel to other organs, forming abscesses. Damage heart valves by perforating and deforming valve leaflet Causes infarction of organs in heart, kidneys, spleen or lungs.

4. CLINICAL MANIFESTATIONS Findings are non- specific and can involve multiple organ systems 1)Fever- occurs in 90% patients 2)Non specific manifestations includes -fever with chills, malaise, weakness, fatigue, anorexia -arthralgias, myalgias, back pain, abdominal discomfort, weight loss, headache and clubbing of fingers

5. Contd… 3) Vascular manifestations includes a) Splinter hemorrhages in nail beds b) petechiae- bleeding in conjunctiva and lips, bucal mucosa, ankles and feet. c) Oster notes-painful, tender d) Janeways lesion- flat, painless, small red spots on palms and sole. e) Roths spots- hemorrhage in retinal lesions.

6. Splinter hemorrhages in nail beds

7. Petechiae- bleeding in conjunctiva

8. Petechiae in bucal mucosa

9. Oster nodes

10. Janeways lesion

11. Roths spots

12. Contd… 4) Cardiac manifestations- a) Heart murmur with aortic and mitral valve most commonly affected 5) Secondary to embolisation- *Embolisation in spleen- sharp, at upper quadrant pain and spleenomegaly, local tenderness * Kidney- pain in the flank, hematuria, glomeruli nephritis. * Brain- hemiplegia , ataxia, aphasia, visual changes and change in level of consciousness. * Pulmonary emboli.

13. MEDICAL MANAGEMENT The medical management includes *Organism with streptococci may be treated with -Penicillin G At 12-18 Million/d IV By in 6 equally divided doses for 4 weeks. -Patients with allergic to penicillin vancomycin at 30mg/kg/dl IV in 2 equally divided doses for 4 weeks. -Ceftriaxone at 2 g/d IV for 4 weeks. -Gentamycin at 1mg/kg every 8 hours for 2 weeks

14. Contd… *Organisms with fungal infections are treated with antifungal such as amphoterician Example- Abelect, Amphocin

15. NURSING MANAGEMENT The nursing management includes following aspects -The nurse monitors the patients temperature -Heart sounds assessed(A new or worsening murmur may indicate dehiscence of a prosthetic valve, rupture of an abscess or injury to valve leaflet.) -The nurse monitors for signs and symptoms of systemic embolisation.

16. Contd… -In addition the nurse assesses signs and symptoms of organ damage such as stroke (CVA) meningitis, heart failure, myocardial infarction, glomerulonephritis and spleenomegaly. -All invasive lines and wounds must be assessed daily for redness and swelling. -If the patient has undergone surgical treatment, the nurse provides postoperative care and instructions.

17. Contd… -After discharge the nurse supervises and monitors IV Antibiotics therapy delivered in the home setting and educates the patient and family about prevention and health promotion -The nurse provides the patient and family with emotional support and facilitates coping strategies during the prolonged course of the infection and antibiotic treatment.

18. NURSING PROCESS ASSESSEMENT - Subjective and objective data from patient -Assess for murmur -Assess for pain -Assess for joint tenderness - General assessment for typical signs and symptoms.

19. Contd… NURSING DIAGNOSIS 1) Fever releated to infection of cardiac tissue as manifested by increased temperature, diaphoresis, chills, headache and malaise.

20. NURSING INTERVENTIONS -Assess the level of temperature -provide cold compress -check temperature every half hourly -administer plenty of fluids -administer antipyretics according to physicians order -reduce physical activity to decrease cardiac workload.

21. 2) Decreased cardiac output releated to valvular insufficiency and fluid overload as manifested by heart murmur, tachycardia. N ursing interventions -Auscultate heart sound, rate and rhythm -monitor for new onset of murmurs -assess capillary refill, skin colour and temperature.

22. Contd… -Assess for jugular venous distention. - provide oxygen therapy to increase oxygen to promote comfort by relieving hypoxemia. -administer diuretics according to order. - assess for blood pressure.

23. 3) Activity intolerance Releated generalized weakness and alteration in oxygen transport secondary to valvular dysfunction. N ursing interventions -Monitor vital signs during activity to evaluate cardiac response -monitor for signs of activity intolerance

24. Contd… -reduce activity if systolic blood pressure goes down -plan rest periods between activities to reduce cardiac workload.

25. THANK YOU