Nursing Care Plan (NCP) for Endocarditis

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Outline

Pathophysiology

Endocarditis is inflammation of the lining and valves of the heart. It is often from an infectious source and can cause disorders of the valves and life threatening arrhythmias. Vegetations can form because of bacteria adhering to valves, which can then become embolic – causing heart attacks or strokes.

Etiology

The two most common causes are IV drug use (because of the introduction of bacteria into the vascular system) and artificial valve replacement (because the bacteria tend to adhere to the artificial device).

Desired Outcome

To treat the cause and remove the source of infection while preserving cardiac output and preventing any major (or minor) complications.

Endocarditis Nursing Care Plan

Subjective Data:

  • Chest Pain
  • Symptoms of Heart Failure

Objective Data:

  • Temperature
  • ↑ WBC
  • Signs of Heart Failure
  • Heart murmurs
  • ↓ SpO2
  • Embolic complications
    • Splinter hemorrhages in nail beds
    • Janeway lesions on fingers, toes, nose
    • Clubbing of fingers

Nursing Interventions and Rationales

  • Assess Heart Sounds

 

Patients with endocarditis may develop valve disorders – listen for heart murmurs or extra sounds.

 

  • Assess and Address Oral Hygiene

 

There is a significant connection between oral health and pericarditis. Bacteria can travel to the heart easily from the oral cavity. Patients should brush their teeth twice daily to prevent complications.

 

  • Administer IV Antibiotics

 

Endocarditis is almost always a bacterial source, therefore, IV antibiotics will be required to treat the infection. Be sure to obtain  blood cultures prior to initiating antibiotics.

 

  • Administer and Monitor Anticoagulant Therapy

 

The provider may order anticoagulant therapy to prevent further collection of platelets or clots around the valves and to prevent major complications from emboli.

Depending on the medication, the therapy may require monitoring. For example IV Heparin requires PTT monitoring.

 

  • Apply SCDs or TED hose

 

Patients are at risk for embolic complications. SCD’s or TED hose can help prevent DVT’s from developing. This can help to prevent pulmonary embolism.

 

  • Assess for s/s emboli

 

The vegetation on the valves is at risk for breaking off and becoming lodged in smaller vessels. This includes risk for Stroke, MI, Pulmonary Embolism, but also damage to the smaller vessels in the extremities, hands, and feet.

 

  • Educate patient on s/s infection

 

Endocarditis is an infectious process, therefore infection control is imperative. They need to be taught hand hygiene as well as other infection precautions. They should also be taught s/s of infection to report to their provider.

 

  • Educate patient to inform other providers before procedures
    • May need prophylactic antibiotics
    • No dental procedures for at least 6 months

 

Because the patient is at high risk for recurrence and complications, it’s important that they notify other providers of their history of endocarditis. They may require prophylactic antibiotics prior to any invasive procedures and they should avoid dental procedures for at least 6 months after their hospitalization.

 

Writing a Nursing Care Plan (NCP) for Endocarditis

A Nursing Care Plan (NCP) for Endocarditis starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Hey guys, in this lesson, we’re going to take a look at the care plan for endocarditis. We’re briefly going to take a look at the pathophysiology and etiology of endocarditis. We’re going to also take a look at additional things that would be included in the endocarditis care plan like subjective and objective data, what a patient with this issue might present with, and also necessary nursing interventions and rationales. 

 

So, endocarditis is inflammation of the lining of the valves of the heart, often from an infectious source, which can cause disorders of the valve and also life-threatening arrhythmias. Because vegetations can form from bacteria, heart attacks and strokes are also extremely possible. So, the two most common causes of endocarditis are IV drug use because of the introduction of bacteria into the vascular system, and also artificial valve replacement as bacteria tends to adhere to artificial devices. The desired outcome is to treat the cause and remove the source of infection while preserving cardiac output and preventing any major or even minor complications.

 

Okay. So let’s take a look at some of the subjective and objective data that your patient with endocarditis may present with. Remember, subjective data is going to be things that are based on your patient’s opinions or feelings. These things for endocarditis might include chest pain or symptoms of heart failure. 

 

So objective data for endocarditis includes possibly a temperature, increased white blood cells, signs of heart failure, heart murmurs, decreased SATs, and also embolic complications, including splintering hemorrhage in the nail beds, janeway lesions on the fingers, toes and nose, and clubbing of the fingers. 

 

Okay, let’s take a look at some nursing interventions necessary for endocarditis. Assess heart sounds as patients with endocarditis may develop valve disorders. Listen for heart murmurs or extra sounds. Next, assess and address oral hygiene. This is super important as there’s a significant connection between oral health and pericarditis. Bacteria can actually travel from the mouth to the heart, super easily, so patients should brush their teeth twice daily. With endocarditis, there is almost always a bacterial source involved. IV antibiotics will be required to treat this infection. Be sure to obtain blood cultures prior to initiating antibiotics. The provider may also order anticoagulant therapy to prevent further collection of platelets or clots around the valves and to prevent major complications from an emboli. Depending on the medication, the therapy may require monitoring. For example, with IV heparin, you’ll need to do PTT’s. Because of the risk of embolic complications, patients with endocarditis should have SCD’s and Ted hose. Be sure to assess for signs of an emboli because of the possible vegetations on the valves. There’s a risk of MI, PE, stroke, even damage to the smaller vessels in the hands, feet and extremities. Be sure that you educate your patients on the signs of infections and also report these to the provider. Also, teaching hand hygiene is critical. Teach the patient to inform other providers of their endocarditis history before any procedure, as the patient may need prophylactic antibiotics, and they should not have any dental procedures for six months. 

 

Okay guys, here is a look at the completed care plan for endocarditis. Let’s do a quick review of endocarditis. This is the inflammation of the lining of the heart valves, usually from an infectious source, which can cause vascular disorders and arrhythmias. The causes are usually from IV drug use or from artificial valves. Subjective data includes chest pain and symptoms of heart failure. Objective data includes a temperature, having elevated white blood cells, signs of heart failure, heart murmurs, and embolic complications like splintering, hemorrhagic nail beds, finger clubbing and janeway lesions. Assess the patient’s heart sounds. Listening for murmurs, assess their oral hygiene and have them brush their teeth twice daily. Assess for signs and symptoms of emboli to prevent MI, strokes or PE’s.  Apply SCDs and Ted hose, and administer IV antibiotics or anticoagulant therapy to prevent embolic complications. Educate the patient to report any signs of infection to their provider. Tell the provider of endocarditis for any procedures that they may have as they may need antibiotic prophylaxis, and they should not have any dental procedures for six months. 

 

Okay guys, that is it on this care plan for endocarditis. We love you guys. Go out and be your best self today and as always, happy nursing!

 

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