Acquired Cardiovascular Disease - NURSING LIJAN

Acquired Cardiovascular Disease

(Bacterial (Infective)Endocarditis

Dr. Omayah Nassar

https://www.google.jo/search?hl=en&biw=1366&bih=662&tbm=isch&sa=1&ei=-kEgWrCtD4LFwQLH6aGACw&q=child+with+Bacterial+endocarditis&oq=child+with+Bacterial+endocarditis&gs_l=psy-ab.3...37029.41567.0.42063.11.11.0.0.0.0.150.1438.0j11.11.0....0...1c.1.64.psy-ab..0.2.286...0i13k1.0.hZc8lEL-maE#imgrc=BdoTv-yQUAqr_M:

Objectives

By the end of this lecture, the student will be able to:

• Define Infective Endocarditis (IE)

• Explain the pathophysiology of IE

• Analyze the Diagnostic evaluation of IE

• Evaluate the therapeutic management of IE

• Discuss the nursing care management of IE

• Bacterial endocarditis(BE), infective endocarditis(IE), and sub acute bacterial endocarditis (SBE)

• Its an infection of the valves and inner lining of the heart

• It can occur without underlying heart diseases

• Most often complication of bacteremia in the children with:

- Acquired or congenital anomalies of the heart

(Valvular abnormalities)

- Prosthetic valves

- Rheumatic heart disease with valve involvement

The most common causative agent are Staphylococcus aureus and Streptococcus viridans

• Gram-negative bacteria, and fungi such as Candida albicans

Pathophysiology

The organisms may enter the bloodstream from any site of localized infection.

The most common portals of entry are:

• Oral (from dental work) (S. viridans)

• The microorganisms grow on the endocardium, forming vegetation , deposits of fibrin, and platelet thrombi.

Pathophysiology

The lesion may invade neighboring tissues, such as aortic and mitral valves,

• May break off and embolizeelsewhere, especially in the spleen, kidney, and central nervous system


Clinical Manifestations (BOX 25-8)

• Onset usually insidious

• Unexplained fever (low grade and intermittent)

• Anorexia

• Splenomegaly

• Malaise, headache

• Myalgia, arthralgia

• New murmur

• Weight loss, diaphorisi


• Characteristic findings caused by extra cardiac emboli formation:

• Osler nodes (red, painful intradermal nodes found on pads of phalanges)



• Splinter hemorrhages (thin black lines) under the nails

https://www.healthline.com/health/splinter-hemorrhages


https://www.slideshare.net/rahulkshirsagar85/endocarditis-41686750

Janeway lesions (painless hemorrhagic areas on palms and soles)


http://nationaldoc11.blogspot.com/2014/12/mangement-of-infective-endocarditis.html


• Petechiae on oral mucous membranes

• Neonates may have:

• Feeding difficulties

• Respiratory distress

• Hf

• Tachycardia

• Symptoms of septicemia

https://www.google.jo/search?hl=en&biw=1366&bih=662&tbm=isch&sa=1&ei=TkggWr-HLsr5wQL_jIqgDg&q=child+with+Petechiae+on+oral+mucous+membranes++&oq=child+with+Petechiae+on+oral+mucous+membranes++&gs_l=psy-ab.3...59506.73844.0.74847.26.26.0.0.0.0.222.3570.0j24j2.26.0....0...1c.1.64.psy-ab..0.0.0....0.gj4mnyBlUBs#imgrc=LVc8hiF8COw5QM:

Diagnostic Evaluation

• Clinical manifestations (Box 23-8)

• Duke criteria (major and minor clinical criteria)

• Major criteria:

- Positive blood culture results for IE

- Evidence of endocardial involvement from echocardiography


• Minor criteria: (Fever, predisposing cardiac condition,…)

• Definitive diagnosis rests on growth and identification of the causative agent in the blood

• Vegetation on the valve and abnormal valve function can often be visualized by echocardiography.


• Radiographic evidence of cardiomegaly

• Anemia

• Elevated erythrocyte sedimentation rate, leukocytosis, microscopic hematuria).

Therapeutic Management

• It requires long-term parenteral drug therapy.

• Administration of high doses of antibiotics intravenously between 2 to 8 weeks.

• Blood cultures are taken periodically to evaluate response to antibiotic therapy.

Prevention of Infective Endocarditis• Administration of prophylactic antibiotic therapy 1 hour before

procedures (dental) for high risk children

• Early treatment is important in preventing further cardiac damage, embolic complications, and growth of resistant organisms.

Nursing Considerations

The objective of nursing care is:

• to counsel parents of high-risk children concerning the need for prophylactic antibiotic therapy before procedures such as dental work.

• These children should maintain the highest level of oral health


The nurse educate parents about the signs that need practitioner's attention that include:

• Unexplained fever

• Weight loss

• Change in behavior (lethargy, malaise, anorexia)

• Such symptoms should not be self-diagnosed as a cold or flu.


(1) preparation of the child for IV infusion, usually with an intermittent-infusion device, and several venipunctures for blood cultures

2) Use sterile technique when administering IV antibiotic

(3) Observation for side effects of antibiotics, especially inflammation along venipuncture sites

• IV antibiotics may be administered at home with nursing supervision


(3) Observation for complications, including embolism and CHF

(4) Education regarding the importance of follow-up visits for cardiac evaluation, echocardiographic monitoring, and blood cultures

References

• Hockenberry, M. J., & Wilson, D. (2018). Wong's nursing care of

infants and children. (11th ed.)Elsevier Health Sciences.

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Acquired Cardiovascular Disease - NURSING LIJAN