SPURTY COLLEGE OF NURSING

SUBJECT: Medical Surgical Nursing

ASSIGNMENT ON
ENDOCARDITIS

SUBMITTED TO:

SUBMITTED BY:
UMAR FIRDOUS
M.Sc. Nursing 1st year

SUBMITTED ON:

Endocarditis
Definition

Endocarditis is a life-threatening infection of the inner lining of the heart

(endocardium), particularly the heart valves. It occurs when bacteria, fungi, or
other microorganisms enter the bloodstream and colonize on the heart valves or
other areas of the endocardium.
Types
1. Acute endocarditis: A sudden and severe infection, often caused by virulent
organisms like Staphylococcus aureus.
2. Subacute endocarditis: A slower-developing infection, often caused by less
virulent organisms like Streptococcus viridians.
3. Chronic endocarditis: A long-standing infection, often caused by organisms
like Enterococcus or fungi.
4. Right-sided endocarditis: Infection of the tricuspid or pulmonary valves, often
associated with IV drug use.
5. Left-sided endocarditis: Infection of the mitral or aortic valves, often
associated with underlying heart disease.
Etiology
1. Bacterial endocarditis: Most common cause, with Staphylococcus aureus,
Streptococcus viridians, and Enterococcus being common culprits.
2. Fungal Endocarditis: Less common, but often associated with
immunocompromised patients or those with prosthetic valves.
3. Non-bacterial thrombotic endocarditis (NBTE): A rare form of endocarditis
characterized by the formation of sterile vegetations on the heart valves.

Risk Factors
1. Pre-existing heart disease: Valve disorders, congenital heart defects, or
previous heart surgery increase the risk.
2. Intravenous drug use: IV drug use is a significant risk factor for right-sided
endocarditis.
3. Poor dental hygiene: Bacteria from the mouth can enter the bloodstream and
cause endocarditis.
4. Immunocompromised state: Patients with weakened immune systems, such as
those with HIV/AIDS or undergoing chemotherapy, are more susceptible.
5. Age: Endocarditis can occur at any age, but it's more common among older
adults.

Pathophysiology

1. Bacterial colonization: Microorganisms enter the bloodstream and adhere to the

heart valves or other areas of the endocardium.
2. Vegetation formation: The bacteria multiply and form vegetations, which are
composed of platelets, fibrin, and microorganisms.
3. Valve damage: The vegetations can cause valve damage, leading to
regurgitation or stenosis.
4. Embolic events: Fragments of the vegetation can break off and travel to other
parts of the body, causing embolic events.

Signs and Symptoms

1. Fever: A persistent and recurring fever is a common symptom.

2. Fatigue: Patients may experience fatigue, weakness, and malaise.
3. Shortness of breath: Dyspnea can occur due to valve damage or heart failure.
4. Chest pain: Chest pain or discomfort can occur due to pericarditis or
myocardial infarction.
5. Neurological symptoms: Embolic events can cause neurological symptoms like
stroke, seizures, or confusion.

Diagnostic evaluation
Clinical Assessment
1. Medical history: Assess for risk factors, such as pre-existing heart disease, IV
drug use, or recent dental procedures.
2. Physical examination: Look for signs of infection, such as fever, chills, or
sweating, as well as cardiac abnormalities, like murmurs or arrhythmias.

Laboratory Tests
1. Blood cultures: Obtain multiple blood cultures to identify the causative
microorganism.
2. Complete blood count (CBC): Evaluate for signs of infection, such as
leukocytosis or anemia.
3. Erythrocyte sedimentation rate (ESR): Measure inflammation.
4. C-reactive protein (CRP): Assess for acute infection.
5. Rheumatoid factor: Evaluate for autoimmune disorders.

Imaging Studies
1. Echocardiography: Use transthoracic echocardiography (TTE) or
transesophageal echocardiography (TEE) to visualize the heart valves and detect
vegetations.
2. Cardiac magnetic resonance imaging (MRI): Use cardiac MRI to evaluate
cardiac function and detect complications.
3. Computed tomography (CT) scan: Use CT scans to detect complications, such
as emboli or abscesses.

Other Diagnostic Tests

1. Duke Criteria: Use the Duke Criteria to diagnose endocarditis, which includes
major and minor criteria.
2. Modified Duke Criteria: Use the modified Duke Criteria, which includes
additional criteria, such as positive blood cultures and echocardiographic findings.
Diagnostic Algorithm
1. Initial evaluation: Perform a thorough clinical assessment, obtain blood
cultures, and perform echocardiography.
2. Duke Criteria: Apply the Duke Criteria to determine the likelihood of
endocarditis.
3. Modified Duke Criteria: Use the modified Duke Criteria if the initial
evaluation is inconclusive.
4. Additional testing: Perform additional testing, such as cardiac MRI or CT
scans, to evaluate cardiac function and detect complications.

By following this diagnostic algorithm, healthcare providers can accurately

diagnose endocarditis and initiate prompt treatment.

Medical Management

1. Antibiotic therapy: Prompt antibiotic treatment is crucial to prevent further

damage and complications.
2. Antifungal therapy: For fungal endocarditis, antifungal medications like
amphotericin B or fluconazole may be used.
3. Anti-coagulation: Anticoagulation therapy may be necessary to prevent
embolic events.
4. Pain management: Pain relief medications like acetaminophen or ibuprofen
may be prescribed.

Surgical Management
1. Valve repair or replacement: Surgery may be necessary to repair or replace
damaged heart valves.
2. Debridement: Surgical removal of infected tissue or vegetations may be
required.
3. Pacemaker implantation: In some cases, a pacemaker may be implanted to
regulate the heartbeat.

Nursing Management

1. Monitoring: Close monitoring of vital signs, cardiac function, and neurological

status.
2. Pain management: Administering pain relief medications and using non-
pharmacological interventions.
3. Infection control: Implementing infection control measures to prevent the
spread of infection.
4. Education: Educating patients and families about endocarditis, its treatment,
and prevention.

Nursing Diagnoses

1. Risk for Infection

Related to: Bacterial colonization of heart valves
Defining characteristics: Fever, chills, sweating, and positive blood cultures

2. Activity Intolerance
Related to: Fatigue, weakness, and shortness of breath
Defining characteristics: Decreased endurance, decreased stamina, and increased
fatigue

3. Acute Pain
Related to: Chest pain, headache, and myalgias
Defining characteristics: Verbal reports of pain, guarding behavior, and decreased
mobility

4. Anxiety
Related to: Fear of death, fear of disability, and uncertainty about the future
Defining characteristics: Restlessness, agitation, and verbal reports of anxiety

5. Impaired Gas Exchange

Related to: Respiratory failure, hypoxia, and hypercapnia
Defining characteristics: Shortness of breath, coughing, and decreased oxygen
saturation

6. Decreased Cardiac Output

Related to: Heart failure, decreased cardiac function, and decreased perfusion
Defining characteristics: Decreased blood pressure, decreased urine output, and
decreased peripheral pulses
7. Risk for Embolism
Related to: Embolic events, stroke, and peripheral embolism Defining
characteristics: Decreased mobility, decreased circulation, and presence of emboli.

Health Education

1. Prevention: Educating patients about the importance of good oral hygiene,

avoiding IV drug use, and seeking medical attention promptly if symptoms occur.
2. Signs and symptoms: Teaching patients to recognize the signs and symptoms of
endocarditis and seek medical attention immediately.
3. Treatment adherence: Emphasizing the importance of adhering to antibiotic
regimens and attending follow-up appointments.

Short-term goals (within 24-48 hours)

1. Temperature reduction: The patient's temperature will decrease to less than
100.4°F (38°C) within 24 hours.
2. Pain management: The patient will report a decrease in pain to a level of 3 or
less on the pain scale within 24 hours.
3. Hemodynamic stability: The patient's blood pressure, heart rate, and oxygen
saturation will remain within normal limits for 24 hours.
4. Infection control: The patient will show no signs of worsening infection, such
as increased white blood cell count or positive blood cultures, within 24 hours.

Long-term goals (within 1-2 weeks or at discharge)

1. Infection resolution: The patient's infection will be resolved, as evidenced by

negative blood cultures and normalization of white blood cell count.
2. Cardiac function improvement: The patient's cardiac function will improve, as
evidenced by increased ejection fraction and decreased symptoms of heart failure.
3. Pain-free status: The patient will report being pain-free, with a pain level of 0
on the pain scale.
4. Return to baseline function: The patient will return to their baseline level of
functioning, including activities of daily living and mobility.
5. Prevention of future episodes: The patient will demonstrate understanding of
measures to prevent future episodes of endocarditis, such as antibiotic prophylaxis
and good oral hygiene.

These goals should be tailored to the individual patient's needs and circumstances.
Bibliography

1. Bonow RO, et al. (2019). Braun Wald’s Heart Disease: A Textbook of

Cardiovascular Medicine. Philadelphia, PA: Elsevier.
2. Libby P, et al. (2019). Braun Wald’s Heart Disease: A Textbook of
Cardiovascular Medicine. Philadelphia, PA: Elsevier.
3. Mayo Clinic. (2020). Endocarditis.