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Flashcards in infectious diseases of the heart and valve disorders Deck (46)
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1

what is endocarditis

caused by bacteria, fungi or virus
effects ventricular and vavle functions
mortality 20-40%
staph aureus is the most common cause

2

pt with increased rf endocarditis

men >60
pt with poor dentition
hx of IV drugs
type 2 diabetics
hemodialysis patientns
implanted CVP devices, pacemakers, defibs, LVADs
prosthetic heart valves

3

clinical manifestations of infective endocarditis

different organisms can cause different symptoms/decline example, S. aureus is rapid and progressive
S. Viridian has a subtler presentation
acute onset of fever appears in 90% of cases
subsides 2-3 days after onset of antibiotics
fever in more than 14 days may indicate the infection has penetrated the myocardium or metastasized

4

presenting symptoms of infective endocarditis

chilld, night sweats, anorexia, myalgia, arthaligia, extreme fatigue and maliase, nausea, vomiting, SOB, CP, glomerulonephritis (from emobilization), heart murmur (90% of time and get worse with destruction)

5

what can accidentally be diagnosed instead of endocarditis?

CHF, sepsis, meningitis, vasculitis, osteomyelitis.

6

dermatological clues for endocarditis
"VIP"

Osler's nodes, Roth spots, Janeway leisons, splinter hemmorhage on nail beds
petechiae

7

Osler nodes
"VIP"

painful purple nodes on the fingertips, palm of hand and toes, dorsal aspect of the feet and earlobes, caused by septic emboli and are frequently seen caused by infective emboli

8

Roth spots
"VIP"

exudative edematous hemorrhagic lesions on the retina

9

Janeway leisons
"VIP"

small non painful lesions, typically red, found on the palm of the hands and soles of the

10

complications of emolization

sites include
lungs
liver
spleen
kidneys
bowels
extremities
illac, mensintary, coronary and middle cerebral arteries

11

consider possible emobilization when what?

CP, dyspnea, tachypnea, diminished pulses, abd pain, oliguria, hematuria, TIA, or change in LOC

12

how does endocarditis lead to glomulernephritis

emobilization

13

diagnosing infective endocarditis

exam
cxr
2 positive blood cultures 24hrs apart
echocardiogram confirms where the vegetation is taking place, may be used through treatment to monitor progression

14

what drug is used to treat fungal endocarditis?

amphotericin B

15

what to do through trx of endocarditis

monitor peaks and troughs of antibiotics to be sure proper trx is happening

16

indications for surgery in a patient with infective endocarditis

prosthetic valve
vegetation larger than 1cm
develops complications with a septal perferation

17

types of surgical interventiosn with infective enocarditits

valve debridement or excision
valve debridement/ closure of abscess
debridement
valve replacement

18

valve replacement surgery

patients with mechanical valve present a special challenge
their infection requires valve replacement to clear the infection
both prosthetic and native valve endocarditis should not be delayed

19

complications of valve replacement surgery

CHF
Cardiogenic shock
Aortic abscess
AV block
systemic embolization
infection resistant to antibiotic trx

20

nursing care management of infective endocarditis

temp
antibiotic/fungals/virals
administer fluids
planned rest periods
Administer NSAIDs
tempid bath water and fan, dont let pt shiver
assess heart sounds for worsening murmur
assess for signs and symptoms of systemic emobilization
assess for signs and symptoms of pulmonary infarction and infiltrates
manage infection (PICC line)

21

pediatric considersations of bacterial endocarditis
"VIP slide" chart in wongs book

prophylaxisis for high risk children
dentist should be informed of childs diagnosis
SBE prophylaxisis is now reserved for very high risk pts
parents should suspect and monitor for infection
nurse stresses any unexplained fever, weight loss, change in behavior must be brought to the practitioners attention immediately

22

what is pericarditis

inflammation of the pericardium the membranous sac surrounding the heart

23

pathophysiology of pericarditis

idiopathic
normally viral, rarely bacterial
disorder of connective tissues
sarcoidosis
disorder of adjacent structures
ex. MI, Dissecting aneurism, plueral and pulmonary disease, neoplasic disease, hypersensitivity issues, trauma, radiation therapy, renal failure and uremia

24

what happens to the heart in pericarditis

heart is restricted and cannot fill, pericardium becomes calcified, further restricting ventricular filling, restricted ventricular filling can cause increased vascular pressure leading to peripheral edema and hepatic failure

25

clinical manifestations of pericarditis

may be asymptomatic
chest pain is a characteristic symptom
May have pain beneath clavical, neck or scapula
pain is constant and may worsen on inspiration
creaky/scratchy friction is heart and most commonly at the LL sternal border
mild fever, elevated WBC, Anemia, elevated ESR
elevated c-reactive proteins

26

medical management of pericarditis

-determine cause
-administer therapy for trx and relief
-anaglesics and NSAIDS and steriods
-periocardiocentisis
-pericardial window allows continious drainage into the chest cavity
-surgical removal of drainage into chest cavity
-surgical removal of tough encasing pericardium may be necessary to release both ventricles from restrictive inflammation and scaring
-pain management
-sitting or leaning forward may help
-reassure chest pain is not a MI
- watch for cardiac tapomade
-monitor for HF
-monitor and manage cardiac function

27

myocarditis what is it?

Inflammatory process of the myocardium causes heart dilation and mural thrombi
mortality is based on severity of symptoms
most people with mild symptoms recover completely
most patients may recover completely

28

what can cause myocarditis?

Microorganisms
immune related agours after a systemic infection
in patients receiving immunosuppressive therapy such as infective endocarditis, systemic lupus, and Chron's disease
pharmacological trx like ethanol or radiation

29

clinical manifestations of myocarditis

depends on the type of infection and degree of myocardial damage
some patients may be a symptomatic or develop chest pain, syncope, palpitations, shortness of breath, flu like symptoms
CHF or sudden cardiac death can occur

30

management of myocarditis

undetectable abnormalities, so illness can go undetected
tachy, chest pain, cardiac enlargement
changed T and ST waves
S1 mumur, gallop, systolic mumur
treat w abx (PCN)
elevated ESR and WBC
place on best rest
limit activity- no sports