Ariane Waters is 21 years of age and is a female patient who is admitted to the hospital with the diagnosis of infective endocarditis. Ariane had her tongue and nose pierced 6 weeks ago. The drug screen is negative. She presents with tricuspid insufficiency murmur grade II, and a temperature of 104°F. The patient complains of extreme fatigue, and anorexia. The echocardiogram reveals vegetations on the tricuspid valve. What risk factors predisposed Ms. Waters to develop infective endocarditis?
Body piercings can be major risk factors for infected endocarditis, especially the tongue piercing since the oral cavity is a main port of entry for the infective endocarditis organisms. Explain the pathophysiology of infective endocarditis as it relates to this case. Endocarditis is a noncontagious chronic infection of the valves or lining of the heart chambers, mainly caused by bacteria, although fungi can also be associated with this infection. To develop this infection, you need to have some bacteria or fungi in the bloodstream. The blood usually does not contain any bacteria or fungi.
However, some may get into the blood if you have an infection or wound in another part of the body. In particular, dental and mouth infections are situations where bacteria can quite easily get into the bloodstream. In this case, an infection with tongue piercing would be an easy portal. In time, small clumps of material called vegetations may develop on infected valves. The vegetations contain bacteria or fungi, small blood clots, and other debris from the infection. The vegetations may prevent affected valves from opening and closing properly. What additional clinical manifestations should the nurse include in the assessment of the patient?
The nursing assessment will include monitoring for s/s of heart failure which would include: crackles in the lungs, edema, SOB, cough, changes in VS, & jugular vein distention. Small bits may break off from the vegetations on the infected heart valves. These are called infected emboli and get carried in the bloodstream, and lodge in other parts of the body. This can cause various symptoms – for example: • Small spots may appear under fingernails, in the eyes, or on other parts of the body. • Infections may develop in other parts of the body.
• The spleen may enlarge, as it is the main organ that fights off blood infections. • If a larger chunk of vegetation breaks off then it can block the blood flow in a main artery. For example, if it gets stuck in an artery in the brain it can cause a stroke or sudden loss of vision in one eye. What medical management should the nurse anticipate for the patient? This patient will most likely be prescribed IV antibiotics for the first 4-6 weeks (assuming the infection is caused by bacteria). The most common drug therapy would include Penicillin or Cephalosporin.
In most cases, the patient is hospitalized for the first few days, and then discharged home for the remainder of treatment. However, if complications to the heart or to other parts of the body develop, the patient may require additional drug therapy – for example, medicines to counter heart failure, or erratic heartbeats, should they develop. In only a few cases, surgical intervention is needed. Some operations may include: • Replacing a damaged valve with an artificial valve. • Valve repair if the damage is less severe and repair is possible.
• Drainage of any abscesses (collections of pus) that may develop in the heart muscle or in other parts of the body. Assessments for infection and heart failure should be continuous. Blood cultures should be negative, VS should be within normal limits and the patient should not be showing s/s of heart failure at the time of discharge. Proper home care teachings will be provided. What nursing management should be provided for the patient and family? The patient and her family should be taught to monitor for s/s of heart failure (stated above).
They should be able to check for heart murmurs and assess VS for sign of infection-especially temperature. She will need adequate rest. The patient and her family should both be educated on aseptic technique to prevent an opportunity for more organisms to enter her body, especially during treatment. Teaching should also include how to administer IV antibiotics safely and care of the infusion site. The patient should be informed on proper oral care –such as brushing twice per day with a soft tooth brush staying away from devices that could contain bacterium.