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]
| Body System | Description |
|---|---|
| Cardiovascular | – New or changing heart murmurs (indicating valve involvement)
– Tachycardia (elevated heart rate) – Irregular heart rhythms (arrhythmias) – New signs of heart failure |
| Neurological | – Altered mental status
– Weakness, numbness, paralysis, or slurred speech |
| Respiratory | – Dyspnea
– Cough, fever, or respiratory distress |
| Integumentary | – Petechiae (small, red or purple spots)
– Splinter hemorrhages (linear hemorrhages under nails) – Osler's nodes (tender subcutaneous nodules, often on fingertips) – Janeway lesions (nontender, red or hemorrhagic macules, often on palms or soles) – Roth spots (retinal hemorrhages; visible on fundoscopy) |
| General | – Fever, chills, night sweats, fatigue, joint pain |
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 Diagnoses
Nursing diagnoses for clients with infective endocarditis guide nursing care. Examples of common nursing diagnoses are the following:
- Risk for Decreased Cardiac Output
- Risk for Infection
- Risk for Decreased Tissue Perfusion
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 eviden