infectious endocarditis, Notas de estudo de Medicina

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 Infective endocarditis  Myocarditis  pericarditis

 Advanced age  Heart defects  Intravenous drug abusers  Bacteremia  Invasive procedures  prosthetic heart valves,  a history of endocarditis,  complex cyanotic congenital malformations

Common signs and symptoms of endocarditis include:  Flu-like symptoms, such as fever and chills  heart murmur,  Fatigue  Aching joints and muscles  Night sweats  Shortness of breath  Chest pain when you breathe  Swelling in the feet, legs or abdomen

Uncommon signs  Unexplained weight loss  Microscopic hematuria  Spleen tenderness  Janeway lesions, which are red spots on the soles of the feet or the palms of the patients hands  Osler's nodes, which are red, tender spots under the skin of your fingers or toes  (^) Petechiae which are tiny purple or red spots on the skin, whites of your eyes, or inside your mouth

 The causative organism may be identified by serial blood cultures. The objective of treatment is to eradicate the invading organism through adequate doses of an appropriate antimicrobial agent.

 Antibiotic therapy is usually administered parenterally in a continuous intravenous infusion for 2 to 6 weeks.  Parenteral therapy is administered in doses that achieve a high serum concentration and for a significant duration to ensure eradication of the dormant bacteria within the dense vegetations.

 After the patient recovers from the infectious process, seriously damaged valves may need to be replaced. Surgical valve replacement greatly improves the prognosis for patients with severe symptoms from damaged heart valves

 The nurse monitors the patient’s temperature; the patient may have fever for weeks.  Heart sounds are assessed; a new murmur may indicate involvement of the valve leaflets.  The nurse monitors for signs and symptoms of systemic embolization, or for patients with right heart endocarditis, the nurse monitors for signs and symptoms of pulmonary infarction and infiltrates.

 (^) Patient care is directed toward management of infection. The patient is started on antibiotics as soon as blood cultures have been obtained.  (^) All invasive lines and wounds should be assessed daily for redness, tenderness, warmth, swelling, drainage, or other signs of infection.  (^) Patients and their families are instructed about any activity restrictions, medications, and signs and symptoms of infection.  (^) The nurse should instruct the patient and family about the need for prophylactic antibiotics before, and possibly after, dental, respiratory, gastrointestinal, or genitourinary procedures.

 (^) Antibiotic prophylaxis is recommended for highrisk patients immediately before and sometimes after the following procedures:

• Dental procedures that induce gingival or mucosal bleeding, including professional cleaning and placement of orthodontic bands (not brackets)
• Tonsillectomy or adenoidectomy
• Surgical procedures that involve intestinal or respiratory mucosa
• Bronchoscopy with a rigid bronchoscope
• Sclerotherapy for esophageal varices
• Esophageal dilation

 CCF  Stroke  Regurgitation  Valvular stenosis  Myocardial damage