This is an NCLEX review for endocarditis. Patients who have endocarditis are experiencing inflammation of the endocardium layer of the heart. There are two types of endocarditis: infective and non-infective. This NCLEX review will focus on the the infective endocarditis (IE).
When taking care of a patient with endocarditis, it is very important the nurse knows how to recognize the typical signs and symptoms seen in this condition, the types of endocarditis, treatments, nursing interventions, and patient education .
Don’t forget to take the endocarditis quiz.
In this NCLEX review for endocarditis, you will learn the following:
- Definition of endocarditis
- Types of Endocarditis
- Patho of Endocarditis
- Signs and Symptoms of Endocarditis
- Nursing Interventions (treatments, patient education etc.)
NCLEX Lecture on Endocarditis
NCLEX Review Endocarditis
Definition: Inflammation of the endocardium layer of the heart.
What is the endocardium layer? The endocardium is a membrane that lines the inside of the heart chambers and the heart valves.
How many heart valves do you have? Four….Atrioventricular (tricuspid and mitral valve) and Semilunar (pulmonic and aortic valves)
Endocarditis mainly affects the heart valves but it can affect the:
- interventricular septum: this separates the right and left ventricles (perforation)
- chordae tendineae: fibrous cords of tendons that connect papillary muscle to the tricuspid and bicuspid valves (rupture)
Endocarditis is hard to treat because there is no blood flow to the valves so the body does NOT respond properly to the pathogen present (hence, WBCs can NOT get to the valves to fight the infection) and it is hard for antibiotics to get to it (so the patient will need weeks of IV antibiotics).
Types of Endocarditis:
- Infective (concentrated on in this lecture): bacteria, virus, or fungi gets into the bloodstream and grows on the valve. The heart valves are more susceptible (especially defected heart valves) to this because they don’t have a blood supply to help fight off infection (hence, white blood cells). Therefore, the body doesn’t fight it properly.
- Patients who have weak heart valves due to defects on them are most at risk for this (healthy valves are more resistant to the bacteria but can develop it as well).
- Examples of weak heart valves:
- Valve replacement (due to the increase risk of a thrombus forming on the valve is the patient is not anticoagulated properly)
- Mitral valve prolapse
- Rheumatic heart disease
- History of IV drug use
- Invasive procedures: implanted device pacemaker, dental work surgery, central line placement
- Congenital heart defects
Patients who have defective heart valves can experience complications of heart failure (valves are leaking or have stenosis, embolic events (strokes), erosion of valve leaflets, and abscesses of the heart tissue.
Non-effective: sterile platelets and fibrin (thrombus) form on the valve due to trauma or some other issue (hypercoagulated blood) but it isn’t pathogenic. However, it is a site of origin for possible infective endocarditis.
Patho of how a heart valve turns into Infective Endocarditis:
- A defect on the valve allows platelets and fibrin (aka a thrombus…clotting ingredient) to stick to the endothelial cells.
- A pathogen enters into the blood (from invasive procedure….dental work, central line placement, implantable device) and the pathogen sticks to the platelets and fibrin (thrombus).
- The pathogen is able to grow.
- As it grows, parts of the pathogen, platelets, and fibrin can break off. This can cause a stroke.
Type of Infective Endocarditis:
- Acute IE: affects patient who have healthy heart valves (high death rate). The onset is fast and symptoms are very severe.
- Subacute IE: affects people who have a pre-existing condition like rheumatic heart disease, valve problem. The symptoms are subtle and onset slower (several weeks to months to develop).
*IV drug uses are susceptible to both
Signs and Symptoms of Infective Endocarditis:
Remember the mnemonic: Pathogens
Petechiae (tiny purplish red spots on the skin….from emboli)
Anorexia (loss of appetite and enlarged spleen pushing on the stomach)
Tired and weak
High Fever & Heart Failure
Osler’s Nodes: tender, red lesions on the hands and feet
finGernail changes: splinter hemorrhages that are small, dark lines under the nails…like petechiae but found under the nails
Embolic events, Erythematous, non-tender nodular lesions on the palms or soles of feet (Janeway Lesions)…small, septic emboli that form abscesses
Night sweats, New cardiac heart murmur or worsening of one
Splenomegaly (helps fight infection so it becomes enlarged), Roth Spots (burst of blood vessels in the retinas with white centers)
TEE (transesophageal echocardiogram): an ultrasound probe is placed down through the patient throat and it looks at the back side of the heart which helps assess the heart valves.
Nursing Interventions for Infective Endocarditis:
- Embolic episodes of the spleen, renal, brain, pulmonary status:
- Spleen embolic: radiating abdominal pain that goes to the left shoulder
- Renal: flank pain in the groin with possible pus or blood in the urine
- Brain (stroke): changes in neuro status…confusion, speech difficulty
- Pulmonary: chest pain, shortness of breath, dyspnea, decreased oxygen saturation
- Signs and symptoms of heart failure
- Monitor vital signs especially temperature, heart rate, blood pressure, oxygen saturation
- Collecting blood cultures to find out what type of microorganism is infecting the patient…antibiotic treatment is based on this
- Administered IV antibiotics…type of antibiotics depends on the pathogen causing the problem
- Example: Vancomycin or Rocephin (strong…usually need a central line because patient will be on long term and go home on them…up to 4 weeks)
Educate the patient about:
- inform other healthcare practitioners about history of endocarditis because they are at risk for it again and will need prophylactic antibiotics prior to invasive procedures
- how to take or administer antibiotics (complete all doses)
- monitor central line site and how to care for it
- good oral care
You may be interested in more NCLEX Reviews.