infective endocarditis(acute, subacute) A+ 맞은 급성 심내막염 수술간호 사례간호 간호진단 3개, 간호과정 1개

문서 내 토픽

• 1. infective endocarditis

  감염성 심내막염은 주로 세균에 의해 발생하는데, 포도알균이나 사슬알균이 주요 원인균이다. 기존에 특정한 선천성 심장질환을 가지고 있거나, 판막 질환을 앓고 있는 환자들이 비뇨기계 수술이나 치과 치료(특히 발치)를 받는 과정에서 혈액 내로 들어온 세균들이 혈액을 타고 흐르다가, 심장 내 구조물, 특히 판막에 정착하여 염증을 일으키게 된다. 감염성 심내막염에 걸리면 심장의 수축기에 심 잡음이 들리고, 비 출혈(코피), 잇몸 출혈, 관절통, 열, 등의 증상이 생긴다. 이러한 염증은 결합조직을 침범하며, 신체의 모든 기관에 침범할 수 있다.

• 2. acute endocarditis

  급성 심내막염은 고열이 갑작스럽게 발생하며, 심장 손상 때문에 가슴 두근거림과 호흡 곤란이 나타날 수 있다.

• 3. subacute endocarditis

  감염성 심내막염의 증상은 대부분 수주 이내에 발생하며, 양상은 매우 다양하다. 보통 발열이 동반되는데, 급성이 아니라면 대개 체온이 39℃를 넘지 않는 것으로 알려져 있다. 발열 이외에는 식욕 감퇴, 체중 감소, 피로, 오한, 무력감, 오심, 구토, 야간 발한 등의 증상이 나타날 수 있다.

• 4. mitral valve insufficiency

  감염성 심내막염에 의해 심장판막에 심한 손상이 생겨 폐쇄 부전증이나 심부전 증상이 심해질 경우, 또는 약물 치료가 실패한 경우나 우종에 의해 반복적인 혈전증이 발생할 때는 흉부외과에 의뢰하여 심장판막 치환술에 대해 논의해야 한다.

• 5. septic embolic infarction

  판막에 생성된 세균 덩어리(우종, 혹, vegetation)가 떨어져 나가면, 혈관을 막아 손톱이나 피부 아래에 점상 출혈이 발생할 수 있고, 만약 뇌나 눈으로 가는 혈관을 막으면, 뇌졸중이나 시야 장애가 생길 수 있다. 또한 비장 혈관이 막히면 비장 경색이 생겨 복통이나 옆구리 통증이 발생할 수 있다.

• 6. mitral valve replacement

  감염성 심내막염에 의해 심장판막에 심한 손상이 생겨 폐쇄 부전증이나 심부전 증상이 심해질 경우, 또는 약물 치료가 실패한 경우나 우종에 의해 반복적인 혈전증이 발생할 때는 흉부외과에 의뢰하여 심장판막 치환술에 대해 논의해야 한다.

• 7. antibiotic treatment

  감염성 심내막염에 걸렸다면 보통 6주, 최소 4주 이상의 장기간에 걸친 정맥 내 항생제 치료가 필요하다. 혈액 배양 검사 결과에 따라 적절한 항생제를 선택해야 한다.

• 8. brain MRI findings

  MRI 검사 결과 양쪽 대뇌 반구에 작은 급성 경색이 흩어져 있고, 오른쪽 두정엽 병변에 작은 미세 출혈이 있어 패혈성 색전증을 시사한다.

• 9. chest CT findings

  흉부 CT 검사 결과 L2-L3와 L3-L4의 가벼운 팽윤 디스크, L4-L5의 경미한 중심판 탈출증, L-Spine의 퇴행성 변화, L4 바디의 오래된 압박골절, T12 본체의 schmorl node 등이 관찰되었다.

• 10. nursing diagnosis

  간호진단으로는 1) 수술 부위 감염의 위험성, 2) 심박출량 감소와 관련된 활동 지속성 장애, 3) 어지러움 호소와 저혈압으로 인한 낙상의 위험이 도출되었다.

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• 1. infective endocarditis

  Infective endocarditis is a serious and potentially life-threatening condition that requires prompt diagnosis and appropriate treatment. It is an infection of the inner lining of the heart, typically involving the heart valves. The most common causative organisms are Streptococcus and Staphylococcus species. Patients with underlying heart conditions, such as congenital heart defects, prosthetic heart valves, or a history of rheumatic fever, are at higher risk. Symptoms can include fever, chills, fatigue, heart murmurs, and embolic complications affecting various organs. Early recognition and initiation of appropriate antibiotic therapy are crucial to prevent complications and improve outcomes. Careful monitoring, echocardiographic evaluation, and, in some cases, surgical intervention may be necessary. Preventive measures, such as good dental hygiene and antibiotic prophylaxis in high-risk individuals, are important to reduce the incidence of this condition.

• 2. acute endocarditis

  Acute endocarditis is a rapidly progressing form of infective endocarditis that can lead to severe complications and even death if not promptly recognized and treated. It is typically caused by highly virulent organisms, such as Staphylococcus aureus, and can progress within days or weeks. Patients may present with fever, chills, heart murmurs, and signs of systemic infection or embolic events. Rapid diagnosis through blood cultures, echocardiography, and other imaging modalities is essential. Immediate initiation of appropriate intravenous antibiotic therapy, often in combination with surgical intervention, is the mainstay of treatment. Close monitoring and management of complications, such as heart failure, sepsis, and embolic events, are crucial. Timely and aggressive treatment is necessary to improve the prognosis, as acute endocarditis can be a medical emergency.

• 3. subacute endocarditis

  Subacute endocarditis is a form of infective endocarditis that progresses more slowly compared to the acute form. It is typically caused by less virulent organisms, such as Streptococcus viridans, and can have a more insidious onset. Patients may present with nonspecific symptoms, including low-grade fever, fatigue, weight loss, and anemia, which can make diagnosis challenging. Echocardiography and blood cultures are essential for diagnosis. While the progression is slower, subacute endocarditis can still lead to serious complications, such as heart valve damage, heart failure, and embolic events, if left untreated. Prolonged antibiotic therapy, often for several weeks, is the mainstay of treatment. In some cases, surgical intervention may be necessary to address valve damage or other complications. Careful monitoring and management are crucial to prevent adverse outcomes.

• 4. mitral valve insufficiency

  Mitral valve insufficiency, also known as mitral regurgitation, is a condition in which the mitral valve, located between the left atrium and left ventricle, does not close properly, allowing blood to flow back (regurgitate) into the left atrium. This can lead to volume overload and strain on the left ventricle, potentially causing symptoms such as shortness of breath, fatigue, and heart palpitations. Causes can include degenerative changes, rheumatic heart disease, infective endocarditis, or other underlying conditions. Mild cases may be asymptomatic and managed conservatively, but severe or progressive mitral valve insufficiency may require surgical intervention, such as mitral valve repair or replacement, to prevent further complications and improve outcomes. Careful monitoring, echocardiographic evaluation, and timely treatment are essential in managing this condition.

• 5. septic embolic infarction

  Septic embolic infarction is a serious complication that can occur in patients with infective endocarditis. It involves the formation of infected blood clots (septic emboli) that break off from the infected heart valve and travel to various organs, causing localized tissue damage and infarction (cell death due to lack of blood supply). The most common sites affected are the brain, spleen, kidneys, and limbs. Patients may present with symptoms related to the affected organ, such as stroke, splenic infarction, or limb ischemia. Prompt recognition and treatment are crucial, as septic embolic infarction can lead to significant morbidity and mortality. Management typically involves appropriate antibiotic therapy, anticoagulation, and, in some cases, surgical intervention to remove the infected vegetation or address the underlying valve pathology. Careful monitoring and management of complications are essential to improve outcomes in these patients.

• 6. mitral valve replacement

  Mitral valve replacement is a surgical procedure performed to treat severe mitral valve disease, such as mitral valve stenosis or severe mitral regurgitation, when the valve cannot be adequately repaired. In this procedure, the damaged or diseased mitral valve is removed and replaced with a prosthetic valve, either mechanical or bioprosthetic (made from animal tissue). Mitral valve replacement is often necessary in cases of infective endocarditis, rheumatic heart disease, or other conditions that have caused irreversible damage to the valve. The surgery aims to restore normal valve function, improve symptoms, and prevent further complications, such as heart failure or embolic events. Careful patient selection, surgical expertise, and postoperative management are crucial to ensure successful outcomes and minimize the risks associated with the procedure, such as bleeding, thromboembolism, and prosthetic valve-related complications.

• 7. antibiotic treatment

  Appropriate antibiotic treatment is the cornerstone of managing infective endocarditis. The choice of antibiotics depends on the causative organism, the severity of the infection, and the patient's clinical condition. In general, initial empiric antibiotic therapy is started based on the most common causative organisms, such as Streptococcus or Staphylococcus species, while awaiting the results of blood cultures and antimicrobial susceptibility testing. Once the specific pathogen is identified, the antibiotic regimen is tailored accordingly. Intravenous antibiotics are typically administered for several weeks, often in combination, to effectively eradicate the infection and prevent complications. Careful monitoring of the patient's response, antibiotic levels, and potential side effects is crucial. In some cases, antibiotic therapy may need to be adjusted based on the patient's clinical course or the development of antibiotic resistance. Appropriate antibiotic management is essential to improve outcomes and reduce the risk of complications in patients with infective endocarditis.

• 8. brain MRI findings

  Brain MRI (Magnetic Resonance Imaging) can be a valuable tool in the evaluation of patients with infective endocarditis, particularly when neurological complications are suspected. Common MRI findings in infective endocarditis include: 1. Ischemic infarcts: These are areas of brain tissue damage due to interrupted blood supply, often caused by septic emboli originating from the infected heart valve. 2. Hemorrhagic infarcts: Bleeding into the areas of infarction can occur, leading to a mixed ischemic and hemorrhagic pattern. 3. Cerebral abscesses: Localized collections of pus within the brain parenchyma, resulting from septic emboli. 4. Meningeal enhancement: Inflammation and enhancement of the meninges, the protective membranes surrounding the brain and spinal cord, can be seen in cases of concomitant meningitis. 5. Mycotic aneurysms: Weakening and dilation of cerebral blood vessels, which can lead to the formation of aneurysms and increased risk of rupture. These MRI findings can help guide the diagnosis, management, and monitoring of neurological complications associated with infective endocarditis. Early recognition of these imaging features, along with appropriate clinical correlation, is crucial for timely intervention and improved patient outcomes.

• 9. chest CT findings

  Chest CT (Computed Tomography) can provide valuable information in the evaluation of patients with infective endocarditis, particularly when pulmonary complications are suspected. Some common chest CT findings associated with infective endocarditis include: 1. Septic emboli: Focal areas of lung parenchymal infarction or hemorrhage caused by infected emboli originating from the heart valve. 2. Pulmonary abscesses: Localized collections of pus within the lung tissue, often as a result of septic emboli. 3. Pleural effusions: Accumulation of fluid in the pleural space, which can be a sign of underlying infection or inflammation. 4. Pneumonia: Lung inflammation and consolidation, which can be a complication of infective endocarditis or a predisposing factor. 5. Cavitary lesions: Thin-walled, air-filled cavities within the lung parenchyma, which can develop due to necrosis and tissue destruction. 6. Lymphadenopathy: Enlargement of mediastinal or hilar lymph nodes, which can be a nonspecific finding associated with the underlying infection. These chest CT findings, in conjunction with clinical presentation and other diagnostic tests, can help guide the diagnosis, management, and monitoring of patients with infective endocarditis and its potential pulmonary complications. Early recognition of these imaging features is crucial for timely intervention and improved patient outcomes.

• 10. nursing diagnosis

  Nursing diagnosis is a crucial component in the comprehensive care of patients with infective endocarditis. Some common nursing diagnoses that may be relevant in these patients include: 1. Impaired Gas Exchange: Patients with infective endocarditis may develop respiratory complications, such as pneumonia or pulmonary emboli, leading to impaired gas exchange and the need for close monitoring and respiratory support. 2. Fluid Volume Excess: Patients may experience fluid overload due to heart failure or the body's inflammatory response, requiring careful fluid management and monitoring. 3. Infection Risk: Patients with infective endocarditis are at high risk of developing secondary infections, such as sepsis, which requires vigilant monitoring, infection control measures, and prompt intervention. 4. Acute Pain: Patients may experience pain related to the underlying infection, embolic events, or complications, necessitating effective pain management strategies. 5. Impaired Tissue Perfusion: Septic emboli or other vascular complications can lead to impaired tissue perfusion, requiring close monitoring and interventions to maintain adequate organ function. 6. Impaired Cardiac Output: The heart's ability to pump blood effectively may be compromised, leading to the need for hemodynamic monitoring and potential interventions to support cardiac function. Nursing diagnoses guide the development of a comprehensive care plan, including appropriate nursing interventions, patient education, and close collaboration with the multidisciplinary healthcare team. Effective nursing care is crucial in optimizing patient outcomes and preventing complications in individuals with infective endocarditis.

• 11. septic embolic infarction

  Septic embolic infarction is a serious complication that can occur in patients with infective endocarditis. It involves the formation of infected blood clots (septic emboli) that break off from the infected heart valve and travel to various organs, causing localized tissue damage and infarction (cell death due to lack of blood supply). The most common sites affected are the brain, spleen, kidneys, and limbs. Patients may present with symptoms related to the affected organ, such as stroke, splenic infarction, or limb ischemia. Prompt recognition and treatment are crucial, as septic embolic infarction can lead to significant morbidity and mortality. Management typically involves appropriate antibiotic therapy, anticoagulation, and, in some cases, surgical intervention to remove the infected vegetation or address the underlying valve pathology. Careful monitoring and management of complications are essential to improve outcomes in these patients.