Overview.
Infective endocarditis is an inflammation of the heart valves or the lining of the ventricular wall resulting from direct infection by bacteria, fungi and other microorganisms (e.g., viruses, chlamydia, rickettsiae, spirochetes, etc.). According to the course of the disease, the presence or absence of systemic toxic symptoms and other clinical manifestations are often divided into acute and subacute, mainly subacute endocarditis is common. Clinical manifestations include fever, heart murmur, embolization and positive blood cultures. Infective endocarditis is a serious threat to the life and health of patients, and reasonable care can effectively reduce its mortality.
Main nursing problems
1. fever.
2. Nutritional disorders.
3. potential complications, such as arrhythmia, embolism, heart failure, renal failure, bacterial arterial rupture and bleeding.
Nursing measures
1.Psychological care
Due to the patients’ serious condition, long hospitalization time and high medical cost, they are often emotionally restless and unwilling to accept treatment. Therefore, nursing staff should patiently communicate with patients, explain the purpose of examination and precautions, so that patients can be hospitalized at ease and actively cooperate. Encourage patients to speak out their inner feelings, relieve psychological pressure, and avoid aggravating their pain due to psychological factors. Care for the patient, help the patient to establish confidence in overcoming the disease.
2. Temperature care
Instruct patients and their family members to measure body temperature accurately, measure and record once every 4 hours, and closely observe body temperature changes. If the body temperature is ≥38℃, then physical cooling should be taken immediately, placing ice packs or rubbing baths at the head and aorta. If the body temperature > 39 ℃, apply medication to lower the temperature. Do not measure body temperature within 30 minutes after meal, when sweating or drinking hot water. Pay attention to replenish water and electrolytes, and keep warm to prevent cold when chilling. Cooperate with the doctor to choose the best time to collect blood for blood culture. It is preferable to collect blood when chills or body temperature is rising and before applying antibiotics, which can improve the positive rate of blood culture.
3.Dietary care
Instruct patients to eat high-calorie, high-protein, easy-to-digest food, such as eggs, yogurt, meat, etc., and have small and frequent meals. For patients with heart failure, sodium and water intake should be limited, but attention should be paid to maintaining water, electrolyte and acid-base balance, especially the regulation of blood potassium. Also quit smoking and drinking, avoid drinking coffee, strong tea and other stimulating beverages.
4. Medication care
Antibiotic treatment should be administered in strict accordance with the time point to ensure the maintenance of effective blood concentration. During the process of medication, pay attention to the observation of drug efficacy and adverse reactions. If heart failure occurs suddenly, the patient should take the sitting position with the lower limbs hanging down, and be given vasodilating, cardiotonic and diuretic drugs as prescribed by the doctor. Pay attention to the protection of the veins, can use intravenous needle to reduce the number of puncture.
5.Complications care
When the patient appears hemiparesis, aphasia, sensory impairment, consider cerebral embolism; lumbago, proteinuria, hematuria, consider renal embolism; severe pain in the limbs, local skin temperature drop, arterial pulsation disappearance, consider peripheral artery embolism; sudden severe chest pain, dyspnea, cyanosis, hemoptysis and other manifestations, consider pulmonary embolism. Patients should communicate with doctors for emergency treatment once embolism occurs.
Health promotion
1. Stay away from environments that may induce infections, pay attention to warmth, and prevent colds.
2. Take medication as prescribed by the doctor and have regular follow-ups.
3. Pay attention to regular diet, balanced nutrition, moderate activity and reasonable rest to strengthen the body’s resistance.
4. Keep the mouth and skin clean.
5. Pay attention to the presence of dyspnea, oliguria and other signs of heart failure, and the presence of local pain and other signs of embolism.