Endocarditis Nursing Diagnosis Care Plan Pathophysiology and NCLEX review
There are two types of Endocarditis. Non-infective Endocarditis and Infective Endocarditis. Endocarditis is a medical condition that involves the inner lining of the heart.
Non infective endocarditis develops when sterile fibrous vegetations form on the heart valves.
Infective endocarditis is caused by a pathogen either bacterial, viral, or fungi. The microbes come from another body part, such as the mouth (strept throat), skin, intestines, or the urinary tract, and can spread through the bloodstream and reach the damaged cardiac tissues. A person with existing cardiac issues is more susceptible to endocarditis than someone who has a healthy heart.
Endocarditis is more common on the left side of the heart usually effecting the mitral and aortic valve.
The most common type of endocarditis that is tested on the NCLEX is infective endocarditis. Therefore, this article will concentrate on infective endocarditis.
The most common type of bacteria that causes infective endocarditis is:
Staphylococcus or streptococci.
Signs and Symptoms of Endocarditis
Common signs and symptoms of endocarditis include:
- Heart murmur (new or changed)
- Aching joints and muscles
- Night sweats
- Shortness of breath
- Chest pain when you breathe
- Peripheral Edema or Swelling in the feet and legs
- Ascites of the abdomen
Severe endocarditis signs and symptoms may also cause:
- Unexplained weight loss
- Hematuria or blood in the urine
- Tenderness in the spleen
- Splinter hemorrhages
- Roth Spots – retinal hemorrhages in the eye
- Small purplish or reddish spots on the skin, oral mucosa or whites of the eyes (Petechiae)
- Red spots on the palms or soles of the feet (Janeway lesions)
- Red tender spots on the toes or fingers (Osler’s nodes)
Causes of Endocarditis
The immune system normally destroys the bacteria or other microbes that enter the bloodstream. However, clumps of bacteria and cell fragments called “vegetations” may infect the endocardium. The following may cause the bacteria to enter the bloodstream:
- Poor oral health. Bleeding gums may cause the bacteria to enter the blood stream.
- Other medical conditions. Infected skin, sexually-transmitted infections (STIs), and intestinal disorders may also cause bacteria to spread and enter the bloodstream.
- Catheters and infected needles for body piercing and tattoo procedures
- Contaminated needles for IV drug use
- Certain dental procedures
- Existing heart problems. Having a diseased and/or faulty heart valve, having an artificial heart valve, and congenital heart defects can increase the risk for endocarditis.
- Marfans syndrome – Heart Disease
- Strept throat which can lead to Rheumatic Fever
Complications of Endocarditis
The vegetations of bacteria can travel from the heart to the other parts of the body, which may lead to the following complications:
- Paralysis – unable to move a part of the body or all of it
- Pulmonary embolism – the clump of bacteria blocks an artery of the lung
- Seizure attacks
- Enlarged spleen
- Kidney disorder
- Brain abscess
- Heart failure
Diagnostic Tests for Endocarditis
- Blood Tests – a complete blood count (CBC) may show anemia; blood culture will show the specific causative agent of the infection
- Imaging – chest X-ray, CT scan, or MRI may show enlargement of the heart and/or infection in the lungs, as well as possible spread in other organs
Treatment for Endocarditis
- Antibiotics. The blood culture and sensitivity test will help identify the specific bacteria or fungi that cause the endocarditis and will show the antibiotics to which the pathogen is sensitive. The course of antibiotics may last for several weeks.
- Surgery. If the endocarditis is related to faulty or damaged heart valves, surgery may be required. Heart valve repair or replacement with artificial valve is the particular surgical intervention associated with endocarditis.
- Proper oral hygiene. Brushing and flossing teeth as well as regular dental checkups are key to treat gum disease that is highly associated to a number of endocarditis cases.
Nursing Care Plan for Endocarditis
- Hyperthermia secondary to infective process of endocarditis as evidenced by temperature of 38.7 degrees Celsius, rapid breathing, profuse sweating, and chills
Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.
|Assess the patient’s vital signs at least every 4 hours.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs administered|
|Remove excessive clothing, blankets and linens. Adjust the room temperature.||To regulate the temperature of the environment and make it more comfortable for the patient.|
|Administer the prescribed antibiotic and anti-pyretic medications.||Use the antibiotic to treat bacterial infection (endocarditis), which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.|
|Offer a tepid sponge bath.||To facilitate the body in cooling down and to provide comfort.|
|Elevate the head of the bed.||Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.|
- Decreased cardiac output secondary to valvular dysfunction from infective process as evidenced by fatigue and inability to do ADLs as normal
Desired outcome: The patient will be able to maintain adequate cardiac output.
|Assess the patient’s vital signs and characteristics of heart beat at least every 4 hours. Assess heart sounds via auscultation. Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor, cyanosis, and cool, clammy skin.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment. Heart murmur sounds is an important sign of endocarditis. The presence of signs of decreasing peripheral tissue perfusion indicate deterioration of the patient’s status which require immediate referral to the physician.|
|Administer the antibiotics as prescribed.||Antibiotics will treat the bacterial infection that caused the endocarditis.|
|Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.||To increase the oxygen level and achieve an SpO2 value of at least 94%.|
|Educate patient on stress management, deep breathing exercises, and relaxation techniques.||Stress causes a persistent increase in cortisol levels, which has been linked to people with cardiac issues. Chronic stress may also cause an increase in adrenaline levels, which tend to increase the heart rate, respiratory rate, and blood sugar levels. Reducing stress is also an important aspect of dealing with fatigue.|
Other nursing diagnoses:
- Ineffective Breathing Pattern related to pulmonary embolism secondary to endocarditis
- Activity Intolerance