16.4
心内膜炎 IV：护理管理
感染性心内膜炎（IE）是心脏内膜的慢性感染，主要影响心脏瓣膜。对于感染性心内膜炎患者的护理评估，需要收集主观和客观数据，以确保准确诊断和及时干预。
主观数据
在主观评估过程中，护士收集患者的症状和主诉信息。感染性心内膜炎患者会常常报告一些非特异性症状，这些症状可能与其他疾病的症状相似。常见的主观症状…
感染性心内膜炎的护理评估包括主观和客观数据。
患者主观上可能报告胸痛、呼吸困难、疲劳以及腿部沉重感。客观上，护士可能发现发热、低氧饱和度、瘀点、甲下线状出血、奥斯勒结节和贾尼韦病变。
主要护理目标包括维持正常的心脏功能并预防复发。
为实现这些目标，必须采取以下干预措施：
给予处方退热药，并用温水擦浴以降低体温。
定期听诊心音，观察有无变化，尤其注意新出现或加重的杂音。
对患者进行感染控制教育，重点强调手卫生和口腔护理，包括清晨醒来后和睡前刷牙。
鼓励进行适度运动，并穿插短暂休息。
出院后，患者可能留置经外周静脉置入的中心静脉导管（PICC）以用于长期静脉输注抗生素。居家护理护士需监测导管及伤口是否出现感染迹象，包括穿刺部位发红、肿胀、疼痛或有渗出液。
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Q1: What subjective symptoms should nurses assess in patients with infective endocarditis?
Nurses should assess for chest pain, dyspnea (shortness of breath), fatigue, and heaviness in the legs. These non-specific symptoms occur because the heart cannot pump blood efficiently, causing pulmonary congestion and systemic fatigue from the body's inflammatory response to infection.
Q2: What are the key objective clinical signs of infective endocarditis?
Objective findings include fever, low oxygen saturation, petechiae (small red spots on skin), splinter hemorrhages (dark streaks under nails), Osler's nodes (painful lesions on finger pads), and Janeway lesions (non-tender lesions on palms and soles). These signs result from microvascular emboli and immune complex deposition caused by the infection.
Q3: How should nurses manage fever in patients with infective endocarditis?
Nurses should administer prescribed antipyretics such as acetaminophen and provide tepid water baths to reduce body temperature. These interventions address fever, a hallmark sign of the ongoing inflammatory infection process in the heart.
Q4: What cardiac monitoring is essential for infective endocarditis patients?
Nurses must regularly auscultate heart sounds to detect new or worsening murmurs, which indicate valve damage or disease progression. Continuous monitoring is critical for identifying early signs of heart failure or embolic events that require immediate intervention.
Q5: What infection control education should nurses provide to endocarditis patients?
Nurses should emphasize proper hand hygiene and oral care, including brushing after waking and before bed. Poor dental hygiene can cause bacteremia leading to recurrent endocarditis, so preventive oral practices are essential for reducing infection risk and disease recurrence.
Q6: How do home health nurses monitor patients after discharge from endocarditis treatment?
Home health nurses assess peripherally inserted central catheters (PICC lines) used for long-term IV antibiotics and monitor for infection signs including redness, swelling, pain, or drainage at the insertion site. They also educate patients and families about potential complications and ensure adherence to prescribed antimicrobial therapy.
Q7: What physical activity recommendations should nurses give to endocarditis patients?
Nurses should encourage moderate exercise with short breaks to improve circulation and maintain muscle tone while avoiding fatigue. Balancing activity with adequate rest helps patients maintain quality of life and perform daily activities without excessive exertion during recovery.