ENDOCARDITIS

INTRODUCTION
The heart is a vital organ that pumps blood and
it has three layers which are Endocardium,
Myocardium and Pericardium.
 DEFINITION
1. Endocarditis is an inflammation of the inner layer
of the heart, the endocardium. it usually involves
the valves and other structures like the septum.

2. It is an infection of valves and endothelial surface

of the heart
ETIOLOGY
• Fungus- e.g. Candida, Aspergillus
• Gram Negative Organisms- e.g. Pseudomonas
• Bacteria- e.g. Staphylococci, Streptococci, Pneumococci
• Acute Rheumatic Fever
• Congenital Heart Disease
 RISK FACTORS
• IV drug users --- Rt heart valve infections
• Older People --- low immunity
• Invasive Procedure involve mucosal surfaces
• Dental Procedures, Intubation, Bronchoscopy, Cystoscopy,
Colonoscopy, Catheterization, Surgery
• Prosthetic Heart Valves
• History of Bacterial Endocarditis
 PATHOPHYSIOLOGY
Causative agents enter the blood stream

They accumulate on the valves of the heart or endocardium

Form vegetations or Clusters

Vegetations causes damage to heart valves by perforating

and deforming the valves leaflets

Valvular Heart Disease

 CLINICAL MANIFESTIONS
Onset is sudden
• Fever
• Dysrhythmias
• Heart Murmurs
• S/S of valvular heart disease depends on which valve is
affected
 CLINICAL MANIFESTIONS
• Malaise
• Anorexia
• Weight loss
• Cough
• Splinter hemorrhage (reddish –brown line /streaks) under
fingernails & toenails
 CLINICAL MANIFESTIONS
• Petechiae in Conjunctiva and Mucus Membrane

• Osler’s nodes - Small, painful nodule in pads of

fingers and toes
• Janeway Lesion- Irregular red painless flat macule
• Roth’s spot - Hemorrhage with pale center in fundus
of eye due to emboli in nerve fiber of eye
• CVS: Cardiac Murmur, Cardiomegaly
• CNS: Headache, Transient Cerebral Ischemia,
Strokes due to emboli in cerebral arteries
 DIAGNOSTIC EVALUATION
• History Collection
• Physical Examination
• Blood Cultures To know the organism
• White blood cell count, ESR
• Echocardiogram - Valve Structure, Regurgitation, Presence of
Vegetation, Ventricular Function
 MANAGEMENT
• ANTIBIOTICS – Inj.Penicillin , IV , 2-6 WKS or Ampicillin +
Flucloxacillin +Gentamicin
• AMPHOTERICIN-B - Fungal Endocarditis
• Administer PCM 1g tds p.o
• Monitor Temperature
• Psychological Support
 SURGICAL MANAGEMENT

Valve Replacement
 NURSING MANAGEMENT
NURSING DIAGNOSIS:

1.Acute pain related to systemic effects of infection.

2.Risk for decreased cardiac output related to disorders of the heart valves and the endothelium.

3.Altered body temperature related to the infection process.

4.Risk for Ineffective tissue perfusion related to embolization

 NURSING MANAGEMENT
INTERVENTIONS
• Assess the complaint of chest pain. Pay attention to nonverbal cues of
discomfort.
• Monitor frequency / rhythm, heart sounds.
• Provide a quiet environment and comfort measures, such as: changes
in position, back rub
• Provide diversional activities.
 NURSING MANAGEMENT
INTERVENTIONS
• Assess for dehydration, diaphoresis, poor skin turgor, dry mucous
membranes.
• Measure the body temperature 4-8 hours.
• Monitor the input and output of fluids every 8 hours.
• Monitor the IV presence of redness and swelling, change places every
24 hours
• Administer antibiotics ,antipyretic
 NURSING MANAGEMENT
• Assess for signs of embolization, report any signs of embolization
to the doctor immediately.
• Perform a neurological examination
• Instruct the client about the need to continue anticoagulation, if
ordered for further prevent embolic period.
• Encourage active with range of motion exercises as tolerated.
• Administer anticoagulant therapy
 NURSING MANAGEMENT

• Assess all invasive lines and wounds for Redness,

Swelling
• Assess Heart Sounds /Murmurs
• Psychological Support
Congenital Heart Disease- Blood moves at high velocity
across defects such as VSD's, stenotic or leaky valves, and
PDA's. This high velocity flow facilitates the sticking of the
blood's clotting elements to these defects. If bacteria are in the
blood stream, they become enveloped in the clot adhering to the
defect and endocarditis may develop ther