Preoperative nursing care in patient with endocarditis
ABSTRACT
In our cardiology service we attend to a significant number of patients with the diagnosis of endocarditis, they are patients who, due to their pathology, are many days admitted for antibiotic treatment and in many cases these patients have to go through the operating room for replacement of a heart valve,In our unit we attend them before only in their phase prior to surgery;That is why we will deal only with preoperative care.
Endocarditis definition:
Infectious endocarditis is the inflammation of the internal coating of cardiac valves and cavities (endocardium), produced by the infection of a microorganism, usually bacteria that grow forming structures known as vegetations. Although it may appear in healthy patients, it is more frequent in patients with: prosthetic valves, congenital heart disease, valvulopathies and previous endocarditis. It is also more frequent in intravenous drug addicts.
Causes
Infectious endocarditis is produced by the arrival of microorganisms to the heart through the bloodstream. These microorganisms bind to the endocardium, usually in a heart valve, they multiply and form vegetations. The growth of microorganisms and the response of the immune system to control infection can cause alterations in the function of the valve giving rise to endocarditis. Abscesses can also be formed and embolisms when a fragment of vegetation and migrate from the bloodstream.
Microorganisms can enter the bloodstream as long as the integrity of the skin or mucous membranes are affected, as occurs in numerous procedures: dental procedures that involve bleeding, respiratory tract procedures, gastrointestinal tract procedures or urological procedures that are carried out with infection.
In parenteral drug addicts, endocarditis on tricuspid and pulmonary valves is more frequent.
The most frequent microorganisms in endocarditis are bacteria, especially streptococci and staphylococci. According to the aggressiveness of the causative bacteria, endocarditis can be:
- Acute: they evolve in a very short time from days to weeks and are caused by very aggressive germs.
- Subacute: they evolve more slowly, caused by less aggressive germs.
Plant nursing care for patients with endocarditis:
- Temperature control per shift: Once in turn and whenever the patient presents chills.
- Surveillance of venous pathways: Check the venous tracks in each nursing shift by watching the appearance of phlebitis making change of dressing every 48h or whenever necessary. Registering the last change of dressing.
- Perform serial hemocultures: To detect blood microorganisms, blood cultures are performed, which are blood crops of the sick person in special conditions that favor the growth of the microorganism. In addition to detecting the causal microorganism of endocarditis, blood cultures also serve to select the most appropriate treatment for this particular microorganism.
- Indications of the blood culture: There is no universal recommendation on what are the indications of the taking of blood cultures, its extraction is normally recommended in the presence of chills, fever (body temperature ≥38ºC) or hypothermia in neonates and elderly patients. Also before leukopenia, leukocytosis or thrombopenia not related to hematological processes, other signs of focal infection or sepsis, as well as in the case of suspicion of endocarditis.
- Sample extraction: blood samples for blood culture should be obtained through a venous puncture, avoiding extraction from intravascular devices as recommended by the American College of Physicans, changing equipment and anatomical location in the extraction of eachblood culture. Extractions will only be carried out through the catheter if it is intended to diagnose an infection of it and it must be accompanied by another peripheral extraction.
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