Endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves (native or prosthetic valves). Other structures that may be involved include the interventricular septum, the chordae tendineae, the mural endocardium, or even on intracardiac devices. Endocarditis is characterized by a prototypic lesion, the vegetation, which is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells. In the subacute form of infective endocarditis, the vegetation may also include a center of granulomatous tissue, which may fibrose or calcify.
Nursing Assessment for endocarditis
A. History or presence of risk factors:
- Congenital heart disease
- History of cardiac surgery
- The use of intravenous drugs are indiscriminate
- Previous cardiovascular diagnostic procedure is invasive previously.
B. Physical Examination of Cardiovascular Status Based Assessment
Possible Shows:
- The three major components: anemia, intermittent fever, and systolic murmur (with aortic stenoses, tricuspid insufficiency, or mitral insufficiency) or diastolic murmur (with aortic insufficiency, tricuspid stenosis or mitral stenosis).
- Arthralgia
- Anorexia and weight loss
- Tired
- Splenomegaly
- Vascular lesions
- Osler's nodes (painful, red nodules on the skin)
- Lychee Jeneway's (flat no pain, red spots found on the feet and slap palms become pale because of pressures).
- Petechiae
- Symptoms of heart failure
C. Diagnostic examination
- Positive blood cultures for infectious organisms
- Laboratory: show leukocytosis, and Hb, hemotokrit and red blood cells below normal limits.
- The rate of sediment erythrocytes (ESR) increase, which describes the presence of inflammation
- Rheumatoid factor positive.
- Chest X-ray detecting congestive heart failure and cardiac hypertrophy.
- ECG to assess heart failure and arrhythmias
- An echocardiogram to determine the extent of valve damage
Nursing Assessment Nursing Care Plan for Endocarditis
0 Komentar untuk "Nursing Assessment for Endocarditis"