1. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. (Relates to Chapter 37, “Nursing Management: Inflammatory and Structural Heart Disorders,” in the textbook)

2. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Infection of the inner layer of the heart that usually affects the cardiac valves  Was almost always fatal until development of penicillin  15,000 cases diagnosed in the United States each year

3. Fig. 37-1

4. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Subacute form Longer clinical course Insidious onset Caused by enterococci

5. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Acute form Shorter clinical course Rapid onset

6. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Causative organism more virulent  Streptococcus viridans  Staphylococcus aureus  Viruses  Fungi

7. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Occurs when blood turbulence within heart allows causative agent to infect previously damaged valves or other endothelial surfaces

8. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Principal risk factors Prior endocarditis Prosthetic valves Acquired valvular disease Cardiac lesions

9. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Vegetation Fibrin, leukocytes, platelets, and microbes Adhere to the valve or endocardium Embolization of portions of vegetation into circulation

10. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Fig. 37-2

11. Fig. 37-3

12. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Nonspecific  Fever occurs in 90% of patients  Chills  Weakness

13. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Malaise  Fatigue  Anorexia

14. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Subacute form Arthralgias Myalgias Back pain Abdominal discomfort

15. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Subacute form Weight loss Headache Clubbing of fingers

16. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Vascular manifestations Splinter hemorrhages in nail beds Petechiae Osler’s nodes on fingers or toes Janeway’s lesions on palms or soles Roth’s spots

17. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Murmur in most patients  Heart failure in up to 80% with aortic valve endocarditis  Manifestations secondary to embolism

18. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  History Recent dental, urologic, surgical, or gynecologic procedures Heart disease Recent cardiac catheterization Skin, respiratory, or urinary tract infection

19. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Laboratory tests Blood cultures WBC with differential  Echocardiography  Chest x-ray

20. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Prophylactic treatment for patients having Removal or drainage of infected tissue Renal dialysis Ventriculoatrial shunts

21. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Antibiotic administration Monitor antibiotic serum levels Subsequent blood cultures Renal function monitored

22. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Fungal and prosthetic valve endocarditis Responds poorly to antibiotics Valve replacement is adjunct procedure

23. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Subjective Data History of valvular, congenital, or syphilitic cardiac disease Previous endocarditis Staph or strep infection Immunosuppressive therapy Recent surgeries and procedures

24. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Functional health patterns IV drug abuse Alcohol abuse Weight changes Chills

25. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Diaphoresis Bloody urine Exercise intolerance Generalized weakness Fatigue Cough

26. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved. Dyspnea on exertion Night sweats Chest, back, abdominal pain

27. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Objective Data Olser’s nodes Splinter hemorrhage Janeway’s lesions Petechiae

28. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Objective Data Clubbing Tachypnea Crackles Dysrhythmias Tachycardia

29. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Objective Data Leukocytosis Anemia ↑ ESR and cardiac enzymes Positive cultures ECG showing chamber enlargement

30. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Patient will Have normal cardiac function Perform ADLs without fatigue Understand therapeutic regimen to prevent recurrence

31. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Identify those at risk  Assessment of history and understanding of disease process  Teach importance of adherence to treatment regimen

32. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Stress need to avoid infectious people  Avoidance of stress and fatigue  Rest  Hygiene  Nutrition

33. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Assessment of nonspecific manifestations  Monitor laboratory data  Monitor patency of IV

34. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Compression stockings with immobility  ROM  Turn, cough, deep breathe

35. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Teach signs and symptoms of infection  Teach reduction measures for risk for infection  Stress follow-up care

36. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Vital signs WNL  Absence of chills, diaphoresis, headache  Sufficient cardiac output

37. Copyright © 2010, 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.  Completion of ADLs with no fatigue or physiologic distress  Increased understanding of disease process and self-care management