Last updated on May 16th, 2022 at 12:23 pm
Endocarditis Nursing Care Plans Diagnosis and Interventions
Endocarditis NCLEX Review and Nursing Care Plans
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:
- Fever
- Chills
- Heart murmur (new or changed)
- Fatigue
- 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
- Stroke
- 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
- Echocardiogram
- Electrocardiogram
- 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 Diagnosis for Endocarditis
Nursing Care Plan for Endocarditis 1
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.
| Endocarditis Nursing Interventions | Rationales |
| 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. |
Nursing Care Plan for Endocarditis 2
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.
| Endocarditis Nursing Interventions | Rationales |
| 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. |
Nursing Care Plan for Endocarditis 3
Impaired Gas Exchange
Nursing Diagnosis: Impaired Gas Exchange related to alveolar inflammation due to increased ventricular pressure secondary to endocarditis, as evidenced by productive cough, crackles heard on auscultation, shortness of breath, pallor noted on the conjunctiva, nailbeds, and buccal mucosa and reports of fatigue.
Desired Outcomes:
- The patient will be able to indicate improvement in gas exchange as evidenced by unremarkable breath sounds, pinkish nail beds, conjunctiva and buccal mucosa, presence of normal breathing or eupnea, heart rate of 100 bpm or less, and Sp02 level of 95% above.
- The patient will be able to demonstrate effective methods on how to manage difficulty in breathing.
| Endocarditis Nursing Interventions | Rationale |
| Assess the patient’s breathing pattern, respiratory rate, auxiliary muscle use, indications of air hunger, lung excursion, cyanosis, and any notable changes in the patient’s vital signs. | The following deviations from the normal are warning signals of deteriorating respiratory health that necessitate emergency medical intervention. |
| Auscultate the patient’s lung fields to check the presence of crackles with the use of a stethoscope. | Reduced breath sounds may indicate fluid overload or a change in ventilation. Alveolar fluid congestion and systolic dysfunctional heart failure are indicated by crackles. Wheezing, on the other hand, could suggest asthma or bronchitis. |
| Determine and monitor the patient’s oxygen saturation, WBC count, and ABG levels as indicated and report any deviation from the normal values. | Decreased oxygenation is indicated by a pulse oximetry value of 92 percent or below, decreased PaO2, and increased PaCO2. Infection is indicated by increased WBC count. |
| Assess the patient skin color, and observe the color of the mucous membranes, and nail beds to see if there is peripheral cyanosis. | Vasoconstriction is the body’s response to fever/chills and could cause cyanosis of the nail beds. |
| Place the patient in a high fowler’s position, with the bed’s head elevated to 90 degrees. | Putting the patient on a high Fowler’s position improves ventilation by promoting maximum inhalation and increasing the expectoration of secretions. |
| Advise the patient to maintain the back dry at all times. | A dry back will help to keep the patient from coughing. |
| Encourage the patient to have proper rest periods and to get a night of adequate sleep. | Rest will avoid fatigue and will lower metabolic needs for oxygen. |
| Keep the patient’s surroundings clean and free of allergens at all times. | A clean environment will help to lessen the effects of irritants on the airways |
| Perform suctioning to the patient’s secretions as needed. | When secretions obstruct the airway, it is necessary to clean it. |
| Administer supplemental oxygen therapy as indicated by the healthcare provider and discontinue if the SP02 level is above the target range. | If the condition improves, oxygen is titrated to keep pulse oximetry readings over 92 percent. |
| Advise the patient to consume all the medications given especially the anti-bacterial medications. | Stopping the medication abruptly can cause bacterial resistance. |
| Have airway emergency equipment at the ready at all times. | Patients with severe decompensated heart failure are at risk of cardiac arrest. |
| Educate the patient to understand the symptoms and indications of endocarditis. | It is advised that if there are any signs or symptoms, especially a persistent fever, unexplained lethargy, any form of skin infection, or open cuts or sores that don’t heal properly, to seek immediate consultation right away. |
| Educate the patient about deep breathing exercises, relaxation methods, and stress management. | Stress may lead to increased heart rate, respiratory rate, and blood sugar levels due to the increase in adrenaline levels. |
| Encourage the patient to eat small but frequent meals. | To avoid abdominal distention which may cause decreased lung capacity and to keep the patient’s nutritional balance. |
| Offer a tepid sponge bath if the patient has a fever. | A sponge bath will help the patient to feel better and more comfortable by cooling down the body. |
| Advise the patient to refrain from doing strenuous activities, such as heavy exercise, running, and lifting. | Strenuous activities will add to fatigue and will cause further difficulty in breathing. |
Nursing Care Plan for Endocarditis 4
Fatigue
Nursing Diagnosis: Fatigue related to decreased cardiac output secondary to endocarditis, as evidenced by extreme lack of energy, expression of tiredness, overwhelming body weakness, irregular heartbeat, heart rate of 130 bpm, and dyspnea.
Desired Outcomes:
- The patient will be able to restore strength and bodily function.
- The patient will be able to maintain an acceptable cardiac output in order to decrease fatigue.
- The patient will be able to demonstrate alternative therapeutic management to alleviate fatigue.
- The patient will be able to perform normal daily activities with minimal to no help from significant others.
| Endocarditis Nursing Interventions | Rationale |
| Assess the patient’s understanding of fatigue for severity, variations in severity over time, and aggravating or relieving factors. | Using a quantitative scoring system, such as 1 to 10, might help the patient define the degree of fatigue they are experiencing. Using graphics or descriptive words for more scoring scales. The nurse can use this technique to account for changes in the patient’s fatigue level over time. It’s crucial to determine whether the patient’s level of fatigue is continuous or fluctuating over time. |
| Determine the patient’s capacity to carry out activities of daily living and demands of daily living. | Fatigue can limit a patient’s capacity to participate in self-care and fulfill family and societal responsibilities, such as working outside the home. |
| Determine the patient’s dietary intake to ensure that the patient is getting enough energy to meet the required metabolic needs. | Fatigue might be a sign of protein-calorie deficiency, vitamin deficiency, or iron deficiency. |
| Assess the patient’s likelihood of experiencing relief from fatigue, willingness to participate in fatigue-reduction techniques, and level of family and social support. | These will encourage active participation in the planning, implementation, and evaluation of fatigue-relieving therapy management. Social support will be critical in assisting the patient in implementing adjustments that will reduce weariness. |
| Determine and monitor the patient’s oxygen saturation, WBC count, and ABG levels as indicated and report any deviation from the normal values. | Decreased oxygenation is indicated by a pulse oximetry value of 92 percent or below, decreased PaO2, and increased PaCO2. Infection is indicated by increased WBC count. |
| Examine the patient’s usual degree of physical activity and movement. | Increased physical exertion will require additional oxygen demand. However, decreased exercise may lead to fatigue, the two should be balanced. |
| Examine the patient’s sleeping patterns for quality, amount, time it takes to fall asleep, and how the feeling upon waking up, as well as any changes in the mental processes or actions. | Changes in the patient’s sleep pattern could be a factor in the emergence of fatigue. Fatigue can be exacerbated by a variety of reasons, including sleep loss, mental discomfort, pharmacological side effects, and the progression of CNS disease. |
| Limit the patient’s exposure to ambient stimuli, especially at times when the patient is supposed to be resting or sleeping. | In the patient’s physical environment, bright lighting, noise, visitors, numerous distractions, and litter can inhibit relaxation, disrupt rest or sleep, and lead to fatigue. |
| Assist the patient in creating a daily exercise and rest regimen. Stress the need of taking frequent breaks in between activities. | A schedule that alternates periods of activity with periods of relaxation can let the patient do their preferred activities without becoming fatigued and the patient will be able to restore adequate oxygen levels. |
| Assist the patient in prioritizing daily activities and role responsibilities. | Setting priorities is an example of an energy conservation technique that allows the patient to focus available energy on the most important tasks. The patient’s mood and sense of emotional wellness can improve as a result of achieving targeted goals. |
| Determine the patient nutritional status and encourage the patient to take an adequate dietary requirements. | To offer energy resources, the patient will require a well-balanced diet of fats, carbohydrates, proteins, vitamins, and minerals. |
| Encourage the patient to express feelings regarding the effects of fatigue. | Recognizing that living with fatigue is physically and emotionally difficult for the patient, thus, aids in coping. |
| Provide relaxing diversional activities for the patient like listening to music, watching television, and therapeutic massage. | This strategy makes beneficial use of nervous energy and may help to reduce anxiety. |
| Plan with the patient on how to save energy by sitting and splitting activities of daily living into manageable tasks. As needed, advise the significant other to assist the patient with movement or self-care tasks. | Weakness might make it nearly impossible for a patient to complete activities of daily living. It is important that someone will be with the patient to protect them from injury during activities. |
Nursing Care Plan for Endocarditis 5
Knowledge Deficit
Nursing Diagnosis: Knowledge Deficit related to a lack of understanding and misconceptions about the disease secondary to endocarditis, as evidenced by repetitive questioning, statements of misunderstanding, and recurrence of the disease when preventable.
Desired Outcomes:
- The patient will be able to determine the association between the ongoing treatment program and the prevention of repeated episodes and problems.
- The patient will be able to understand the disease process.
- The patient will be able to make a list of any signs or symptoms that require prompt attention.
- The patient will be able to determine individual stressors and risk factors, as well as demonstrate appropriate coping strategies.
- The patient will be able to make the appropriate lifestyle or behavioral adjustments.
| Endocarditis Nursing Interventions | Rationale |
| Educate the patient about how the heart works normally. Include details about the patient’s deviation from normal function. | Understanding illness processes and expectations can make it easier for the patient to stick to treatment plans. |
| Discuss to the patient the treatment goal. Include significant others in the discussion when needed, especially for complex therapeutic regimens. | When patients are feeling well and symptom-free, they may believe it is appropriate to change their routine, which might raise the risk of worsening symptoms. Understanding the regimen, drugs, and restrictions can help with symptom management. |
| Discuss with the patient the significance of being active without developing fatigue and taking breaks in between exercise and daily activities. | Excessive physical activity or overexertion can weaken the heart, worsening the condition and necessitating a change in the exercise routine. |
| Explain to the patient and significant other the medications, the purpose, and any potential side effects. Instruct the patient both orally and in writing. | Drug-related complications can be avoided by understanding therapeutic needs and the need of promptly report side effects. Anxiety can make it difficult to understand input or specifics, therefore the patient or significant other may need to refer to written material later to refresh the memory. |
| Instruct and get a return demonstration of the patient’s ability to determine and record daily pulse and blood pressure readings, as well as when to contact a healthcare provider about the readings that are above or below the normal rate, rhythm variations, and regularity. | Self-monitoring of medication effects is encouraged. Early diagnosis of alterations allows for prompt action and may help to avoid further complications. |
| Advise the patient to report immediately any signs and symptoms that require emergency medical attention such as chills, fever, headaches, joint discomfort, diarrhea, and skin rash. | Self-monitoring empowers the patient to take charge of the health and helps to avoid further complications. |
| Allow the patient and the significant other to ask questions, voice concerns, and make required lifestyle changes. | Because of lack of information, both the patient’s and significant other’s coping capacities and supportive capacity are frequently exhausted, resulting in depression. |
| Explain to the patient the possible causes of the disease like improper dental care and illegal use of IV drugs, and demonstrate ways how to prevent the recurrence of the disease. | Allowing the patient to understand the cause and determine the solution will help the patient to prevent the disease from recurring in the future. |
| Advise the patient to maintain proper dental hygiene by brushing and flossing the teeth often and to visit the dentist regularly. | One of the most common causes of endocarditis is poor dental health, it may cause the bacteria to inside the mouth and enter the bloodstream through a cut on the gums. |
| Educate the patient about the importance of consuming all the prescribed medications. | Abruptly stopping the prescribed medications can lead to bacterial resistance that may delay healing and cause further complications. |
More Nursing Diagnosis for Endocarditis
- Ineffective Breathing Pattern related to pulmonary embolism secondary to endocarditis
- Activity Intolerance
- Anxiety
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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