BACTERIAL BACTERIAL ENDOCARDITISENDOCARDITIS

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DefinitionDefinitionEndocarditis, inflammation of the Endocarditis, inflammation of the endocardium can involve any of the endocardium can involve any of the endothilial lining of the heart. The valves endothilial lining of the heart. The valves usually are affected.usually are affected.Usually infection in mature, characterized by Usually infection in mature, characterized by colonization or invasion of the endocardium colonization or invasion of the endocardium and heart valves by a pathogen.and heart valves by a pathogen.Inflamasi pada endokardium dan injap-injap Inflamasi pada endokardium dan injap-injap jantung. Kebanyakan seringkali adalah jantung. Kebanyakan seringkali adalah akibat demam reumatik atau jangkitan akibat demam reumatik atau jangkitan bakteria. Ciri-ciri utama termasuk demam, bakteria. Ciri-ciri utama termasuk demam, deruan jantung yang menukar, kegagalan deruan jantung yang menukar, kegagalan jantung dan embolisme.jantung dan embolisme.

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There are two bacterial endocarditis:There are two bacterial endocarditis:Sub acute bacterial endocarditisSub acute bacterial endocarditis-develop more slowly and usually -develop more slowly and usually occurs in people with pervious heart occurs in people with pervious heart valve damage.valve damage.Acute bacterial endocarditisAcute bacterial endocarditis -has on abrupt on set and typically -has on abrupt on set and typically affects people ith no pervious history affects people ith no pervious history of heart problemsof heart problems. .

Etiology Etiology

Previous heart damage. Previous heart damage. Intravenous drug. Intravenous drug. Invasive catheters (e.g. a central venous Invasive catheters (e.g. a central venous catheter, heomodynamic monitoring, or an catheter, heomodynamic monitoring, or an indwelling urinary catheters)indwelling urinary catheters)Prosthetic valve endocarditis (PVE).Prosthetic valve endocarditis (PVE).May occurs in clients with a mechanical or May occurs in clients with a mechanical or tissue vale replacement.tissue vale replacement.Develop in the early post operative period Develop in the early post operative period or late.or late.Usually affects males over the age.Usually affects males over the age.

ManifestationManifestation Chills and fever Chills and fever General malaise General malaise Cough Cough DyspneaDyspneaAnorexiaAnorexiaAbdominal painAbdominal painFatigue Fatigue Heart murmurHeart murmurPetechiae, splinter hemorrhages in nail bed.Petechiae, splinter hemorrhages in nail bed.SplenomegalySplenomegalyTachycardia- low CO Tachycardia- low CO Localised headache Localised headache Altered mental status.Altered mental status.

DIAGNOSTIC TEST:DIAGNOSTIC TEST:

Blood cultures – x 3Blood cultures – x 3-For positive for bacteria or other -For positive for bacteria or other pathogens.pathogens.EchocardiographyEchocardiography-to visualize vegetations can be diagnostic -to visualize vegetations can be diagnostic for infective endocarditic.for infective endocarditic.Serologic immune testing for circulating Serologic immune testing for circulating antigen to typical infective organisms may antigen to typical infective organisms may be done. be done. -CBC,ESR,SERUM CREATIRINE-CBC,ESR,SERUM CREATIRINE-CHEST X- RAY-CHEST X- RAY-ELECTROCARDIOGRAM.-ELECTROCARDIOGRAM.

MEDICATIONMEDICATIONAntibiotics commonly prescribed for clients (depends Antibiotics commonly prescribed for clients (depends on blood culture [4-6 weeks] RX).on blood culture [4-6 weeks] RX).Streptococcal and enterococcal infection are treated Streptococcal and enterococcal infection are treated with combination of penicillin and gentamycin.with combination of penicillin and gentamycin.Staphylococcal infection are treated with nafcillin or Staphylococcal infection are treated with nafcillin or oxacillin and gentamicin.oxacillin and gentamicin.Intravenous drug therapy is continued for 2 to 8 Intravenous drug therapy is continued for 2 to 8 weeks.weeks.-depending on the infecting organisms, the drugs used -depending on the infecting organisms, the drugs used and the result of repeat blood cultures.and the result of repeat blood cultures.The clients with PVE requires extended treatment The clients with PVE requires extended treatment using vancomycin, rifampin and gentamicin. using vancomycin, rifampin and gentamicin. Dental surgicalDental surgicalSurgical- valve replacement.Surgical- valve replacement.Supplement nutritionSupplement nutrition..

COMPLICATIONCOMPLICATION

Embolization of vegetation fragments may Embolization of vegetation fragments may affect lung, brain, kidneys and the skin affect lung, brain, kidneys and the skin and mucous membranes with resulting and mucous membranes with resulting organ infarctions.organ infarctions.Ineffective endocarditic include heart Ineffective endocarditic include heart failure, abscess and aneurysm due to failure, abscess and aneurysm due to infiltration of the arterial wall by infiltration of the arterial wall by organisms.organisms.Heart failure due to valvular insufficiency.Heart failure due to valvular insufficiency.Uncontrolled infection. Uncontrolled infection. Embolic episodes- ischemic/ necrosis of Embolic episodes- ischemic/ necrosis of extremities/ organ. extremities/ organ.

NURSING ASSESSMENTNURSING ASSESSMENTIdentify patient at risk- heart murmur (heart Identify patient at risk- heart murmur (heart disease). Ineffective endocarditisdisease). Ineffective endocarditis Healthy history:Healthy history:-complaints of persistent flu like symptoms:-complaints of persistent flu like symptoms:-Fatigue, shortness of breath and activity intolerance, -Fatigue, shortness of breath and activity intolerance, history of recent dental work or other invasive history of recent dental work or other invasive procedure known heart disorder recent intravenous procedure known heart disorder recent intravenous drug use.drug use.Physical examination: Physical examination: -vital sign including apical pulse and heart sounds, -vital sign including apical pulse and heart sounds, rate and ease of respiration, lung sounds, skin color, rate and ease of respiration, lung sounds, skin color, temperature and presence of petechiae or splinter temperature and presence of petechiae or splinter hemorrhage.hemorrhage.Diagnostic test:Diagnostic test:-WBC and differential, ESR, blood culture and -WBC and differential, ESR, blood culture and sensitivity results, echocardiogram reports. sensitivity results, echocardiogram reports.

NURSING DIAGNOSIS & NURSING DIAGNOSIS & INTERVENTIONINTERVENTION

Risk for imbalanced body Risk for imbalanced body temperature related to fever. temperature related to fever.

-Record temperature every 2 to 4 hours.-Record temperature every 2 to 4 hours.

-Obtain blood culture as ordered, before -Obtain blood culture as ordered, before initial antibiotic dose.initial antibiotic dose.

-Provide anti-inflammatory or antipyretic -Provide anti-inflammatory or antipyretic agents as prescribed.agents as prescribed.

-Administer antibiotic as ordered; obtain -Administer antibiotic as ordered; obtain peak though drug level as indicated.peak though drug level as indicated.

continuecontinueRisk for ineffective tissue perfusion related to Risk for ineffective tissue perfusion related to embolization or vegetative lesion due to left embolization or vegetative lesion due to left heart infarction heart infarction -Assess for document and report manifestation of -Assess for document and report manifestation of described organ system perfusion.described organ system perfusion.-Neurologic; level consciousness, numbness, -Neurologic; level consciousness, numbness, tingling, inextremities, hemiplegia visual tingling, inextremities, hemiplegia visual disturbance and stroke.disturbance and stroke.

-Pulmonary dyspnea, haemoptysis, shortness of -Pulmonary dyspnea, haemoptysis, shortness of breath, diminished breath sound, restlessness, breath, diminished breath sound, restlessness, sudden chest or shoulder pain.sudden chest or shoulder pain.-Cardiovascular; chest pain radiating to jaw or arms, -Cardiovascular; chest pain radiating to jaw or arms, tachycardia, anxiety, tachypnea, hypotension.tachycardia, anxiety, tachypnea, hypotension.Assess and document skin color and temperature, Assess and document skin color and temperature, quality of peripheral pulse and capillary refill. quality of peripheral pulse and capillary refill.

continuecontinueIneffective health maintenance related to deficit of Ineffective health maintenance related to deficit of knowledge. knowledge.

Demonstrate intravenous catheter site care and Demonstrate intravenous catheter site care and intermittent antibiotic administration if the client and intermittent antibiotic administration if the client and family ill manage therapy. Have the client or significant family ill manage therapy. Have the client or significant other redemonstrate appropriate techniques.other redemonstrate appropriate techniques.Explain the actions, doses, administration and desired Explain the actions, doses, administration and desired and adverse effects of prescribed drugs. and adverse effects of prescribed drugs. Teach about the function of heart valves and the effects Teach about the function of heart valves and the effects of endocarditis,and explain the risk for its recurrence.of endocarditis,and explain the risk for its recurrence.Describe the manifestations of heart failure to be Describe the manifestations of heart failure to be reported to the physician.reported to the physician.Encourage good dental hygiene and mouth care and Encourage good dental hygiene and mouth care and require dental checkups. Teach how to prevent bleeding require dental checkups. Teach how to prevent bleeding from the gums and avoid developing mouth ulcers. Flow from the gums and avoid developing mouth ulcers. Flow water devices.water devices.

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QUESTION ?

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