In this post, we continue with our series about Endocarditis with a discussion of Non-Infective Endocarditis and the Nursing Interventions for the patient with Endocarditis.

CAUSES OF NON-INFECTIVE ENDOCARDITIS

Non-Infective Endocarditis occurs when fibrous blood clots without bacteria form on damaged heart valves. Damage may be due to a birth defect, rheumatic fever, or an autoimmune disorder (where antibodies attack the heart valves); and rarely, from insertion of a catheter into the heart. People most at risk include those with the following conditions:

• Systemic Lupus Erythematosus 
• Antiphospholipid Syndrome 
• Lung, stomach, or pancreatic cancer
• Tuberculosis
• Pneumonia
• Uremia
• Sepsis 
• Burns 

Like Infective Endocarditis, Non-Infective Endocarditis may cause heart valves to not open normally or leak. Arteries may get blocked if vegetations break loose, become emboli, and travel through the bloodstream to other parts of the body, where they occlude an artery.  These emboli can cause stroke, heart attack, pulmonary embolism, and abscess.  Larger emboli may cause stomach pain, blood in the urine, or pain or numbness in an arm or a leg.  Heart murmurs may develop, or preexisting ones may change.  Heart failure may occur as a result of the defective valves, the signs of which include cough, shortness of breath, and lower extremity edema.

DIAGNOSIS OF NON-INFECTIVE ENDOCARDITIS

It is important to diagnose not only the endocarditis, but its etiology, as soon as possible because treatment differs.  

The diagnosis of Non-Infective Endocarditis begins when an echocardiogram identifies vegetations on the heart valves. Because an echocardiogram cannot determine whether the vegetations are infected, blood cultures must then be obtained. If no bacteria or other microorganisms are detected by blood culture, it is more likely that the endocarditis is non-infective. 

TREATMENT of Non-Infective Endocarditis

Treatment of Non-Infectious Endocarditis includes anticoagulants, like heparin and warfarin, but their effectiveness has not been proven.  The new oral anticoagulants (NOACs) are not regarded as effective. Treatment should include the underlying disease that contributed to the development of the Non-Infective Endocarditis.

Nursing Interventions for the Patient with Endocarditis

There are nursing interventions for the patient with endocarditis, regardless of its etiology. These include the following:

• Report abnormal findings to the provider and prepare to send out to the hospital for further diagnostics, treatments, and care.

• Be prepared to draw blood tests – Complete Blood Count, Comprehensive Metabolic Panel, blood cultures.

• Prepare the patient for any diagnostic testing ordered – Electrocardiogram, Echocardiogram, Chest x-ray – including the rationale for obtaining and how the test in general will be conducted.

• Administer medications as ordered and conduct patient education about potential side effects and reportable signs and symptoms. 

• Conduct any prescribed post-op care if the patient has cardiac surgery.

• If providing Infirmary care, assess the patient’s vital signs at least every four hours; auscultate  lungs and heart and assess the abdomen – report any abnormalities or remarkable findings to the provider.
• Observe the patient for signs of decreasing peripheral tissue perfusion like slowed capillary refill, pale skin, cyanosis and cool, clammy skin, and report them immediately to a provider.

The information in this post is based on The Correctional Nurse Educator class entitled Endocarditis for the Correctional Nurse.

Have you had a patient with endocarditis in your Correctional Nursing practice? Share your experiences in the comments section of this post.