5.13 Infective Endocarditis

Overview

Infective endocarditis (IE) is an infection of the inner lining of the heart chambers and valves caused by bacteria or fungi. IE can lead to the formation of vegetations (clumps of infected material) on heart valves, causing damage to the valves that can impair cardiac function. Risk factors for IE include congenital heart disease, prosthetic heart valves, intravenous drug use, and dental procedures that result in transmission of bacteria into the bloodstream.^[1] See Figure 5.35^[2] for an illustration of IE.

Assessment

Physical assessment findings for infective endocarditis (IE) can vary depending on the stage of the infection, causative microorganism, and the presence of complications. See Table 5.13 for potential clinical manifestations of IE.

Table 5.13. Potential Clinical Manifestations of Infective Endocarditis^[3],[4]

Diagnostic Testing`

The diagnosis of infective endocarditis (IE) typically involves a combination of clinical evaluation, laboratory tests, and imaging studies. These tests help confirm the presence of IE, identify the causative microorganism, and guide treatment.^[5],[6]

• Blood cultures are collected from individuals suspected of having IE to identify the causative microorganism.
• Echocardiography is also used to examine cardiac structures and look for the presence of vegetation on heart values.
• Complete blood cell count and C-reactive protein blood tests may be used to detect systemic infection and inflammation.

Nursing Problems & Diagnoses

Nursing problems and nursing diagnoses for clients with infective endocarditis (IE) guide nursing care. Examples of NANDA diagnoses related to IE are the following:

• Risk for Decreased Cardiac Output. Risk factor: presence of vegetation on heart valves
• Risk for Infection: Risk factor: potential for systemic infection
• Risk for Decreased Tissue Perfusion. Risk factor: potential embolism formation from vegetation

Outcome Identification

Outcome identification involves setting short- and long-term goals and creating expected outcome statements tailored to the client’s specific needs. These outcomes should be measurable and responsive to nursing interventions.

• The client will maintain cardiac output within normal limits as evidenced by systolic blood pressure in normal range.
• The client will remain free from sepsis.
• The client will maintain effective tissue perfusion as evidenced by capillary refill less than three seconds.

Medical Interventions

Medical interventions for infective endocarditis aim to effectively resolve the infection and kill the causative microorganism.

Medication Therapy

Antibiotics are the cornerstone of treatment for IE. They are typically administered intravenously for several weeks to eradicate the infecting microorganism.

Surgical Intervention

Surgeries (such as valve repair, valve replacement, or debridement of the lesion) address complications of IE and remove infected tissue.^[7],[8]

Nursing Interventions

Nursing interventions focus on safely administering prescribed medications, monitoring for complications, and managing pain. Nurses closely monitor for complications such as embolic events caused by vegetation, acute heart failure, and sepsis. Prescribed analgesics are safely administered if IE causes pain in locations such as the chest and joints. Nurses provide health teaching regarding the purpose of prescribed medications and signs of complications to promptly report to the health care provider.

Evaluation

During the evaluation stage, nurses determine the effectiveness of nursing interventions for a specific client. The previously identified expected outcomes are reviewed to determine if they were met, partially met, or not met by the time frames indicated. If outcomes are not met or only partially met by the time frame indicated, the nursing care plan is revised. Evaluation should occur every time the nurse implements interventions with a client, reviews updated laboratory or diagnostic test results, or discusses the care plan with other members of the interprofessional team.