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Summary

disease concept map...

Description

Education PICC line care Medications S/S HF S/S recurrent endocarditis Good oral hygiene Follow up Monitor/record temps. Report changes in condition: Fever, chills, wt. loss, fatigue, dyspnea

Medications -IV Antibiotics BroadSpectrum (Ex: Ampicillin, Azithromycin)

Surgical -Replace, repair if antibiotics are not effective -Remove vegetations -Draining abscesses in the heart

Risk Factors *IV drug *Poor dental *Systemic infections (bloodstream) *Structural defects (congenital) *Infection (valve deformed) *Valve replacement

Disorder/Disease Description Infective Endocarditis (Bacertial endocarditis) This is a microbial infection involving endocardium and valves. There is an entry of bacteria into bloodstream where it colonizes on valve leaflets. Platelets and fibrin then cover and prolong life of bacteria (why antibiotics take so long). Vegetation may embolize (ischemia, infarction, hemorrhage of tissues, abscesses). Often the patient is started on a broad- spectrum antibiotic and then changed to a different antibiotic once bacteria has been identified Most common organism: Streptococcus viridian or Staphylococcus aureus

Treatment *IV antibiotics 4-6 weeks (started with broad-spectrum usually) can be sent home w/ PICC line *Surgery (replace, repair valve, drain abscesses)

Subjective *Report flank pain (could indicate vegetation broke off and traveled to kidneys (renal infarction) *Neuro changes Assessment *CV assess/abdominal assessment/Vitals S/S (usually occur within 2 weeks) *Flu-like (fever) *Note rebound tenderness during abdominal assessment *Murmurs *Micro emboli *Neuro changes (decreased LOC) *Pulmonary infarction s/s (chest pain, dyspnea)

Objective *Report hematuria *Micro emboli (petechiae, lesions, nodes) *Neuro changes *HF s/s (wt. gain, crackles)

Lab Results Low H&H High WBC Positive blood cultures

Diagnostics *Assessment: Fever *s/s of HF (rapid pulse, fatigue, dyspnea, cough) *Positive blood cultures *Murmur (turbulent blood flow heard on auscultation) *Echocardiography *TEE (3D) vegetation seen Nursing Interventions -Fever control -Rest -Monitor blood cultures -Antibiotic therapy -Treat s/s of HF, observe for s/s of L and R side -PICC dressing changes and patient education -Abdominal assessments (flank pain) Activity as tolerated by individual Teaching *PICC line care *Medication *s/s of HF and recurrent endocarditis *Notify providers of hx *Good oral hygiene *Follow up care and report any flu-like symptoms, dyspnea, or sudden increase in fatigue or weight gain *Connect with care coordination to ensure patient has supplies

Potential Complications Without treatment=high death rate *HF (most common) *Embolization of vegetation fragments, plaques break off and travel via circulation. The valve effected determines where it goes… L side: kidneys, GI tract, brain, extremities R side: pulmonary circulation...