Nursing Care Plan for Endocarditis

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

  1. Assess Heart Sounds

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

  3. Assess and Address Oral Hygiene

  4. 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.

  5. Administer IV Antibiotics

  6. 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.

  7. Administer and Monitor Anticoagulant Therapy

  8. 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.

  9. Apply SCDs or TED hose

  10. 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.

  11. Assess for s/s emboli

  12. 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.

  13. Educate patient on s/s infection

  14. 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.

  15. Educate patient to inform other providers before procedures

    • May need prophylactic antibiotics
    • No dental procedures for at least 6 months
  16. 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.


References

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