| Abstract | Infektivni endokarditis upalna je bolest endokarda izazvana naseljavanjem mikroorganizama na prethodno oštećen endokard,a li može nastat i u zdravih ljudi.
Endokarditis nativnih valvula može biti akutan i subakutan. Akutni se očituje naglim razvojem kliničke slike, već unutar nekoliko dana, a praćen je visokom temperaturom, tresavicom, brzim oštećenjem struktura srca i hematogenim širenjem infekcije na ekstrakardijalne strukture. Kod subakutnog oblika klinička slika se razvija unutar nekoliko tjedana ili mjeseci, a obilježen je blažim porastom temperature, umorom, gubitkom teka, bolovima u mišićima, tahikardijom, povećanjem slezene...
Endokarditis umjetnih valvula podijeljen je na rani, koji nastaje u prvih godinu dana od implantacije i kasni koji nastaje nakon tog vremena.
Postavljanje dijagnoze je često puta otežano zbog atipične kliničke slike, umjetnih valvula ili drugih intrakardijalnih naprava. Ehokardiografija i hemokulture temelj su dijagnoze IE.
Terapija IE provodi se produženom terapijom baktericidnim lijekovima, a kod polovice pacijenata potrebno je kirurški odstraniti inficirano tkivo.
Kod bolesnika koji nisu alergični na penicilin lijek izbora za profilaksu IE je amoksicilin, dok se onima kod kojih je zabilježena alergija na penicilin preporučuje eritromicin ili klindamicin per os ili vankomicin intravenski.
Antibiotsku profilaksu potrebno je provesti kod pacijenata s visokim rizik od nastanka IE, a tu spadaju pacijenti s umjetnim srčanim valvulama, ranijim IE, složenim kongenitalnim bolestima srca s cijanozom, ductus arteriosus persistents, koarktacijama aorte, s kirurški izrađenim sistemski – pulmonalnim spojem.
Antibiotska profilaksa provodi se prije slijedećih dentalnih zahvata:ekstrakcije zuba, periodontalnih postupaka, ugradnje implantata, reimplantacije zuba, endodontalnih zahvata, incizije i drenaţe,intraligamentarne primjene injekcije lokalnog anestetika.
Uloga medicinske sestre je da svakodnevno radi na poboljšanju oralnog zdravlja svojih pacijenata i samim time smanji potrebu za dentalnim zahvatima koji mogu izazvat bakterijemiju i nastanak IE. |
| Abstract (english) | Infective endocarditis is an inflammation of the endocardium caused by microorganisms settling on a previously damaged endocardium, but it can also develop in healthy people.
Native valve endocarditis can be acute and subacute. The acute one manifests itself with a rapid development of the clinical picture, within a few days already. It is accompanied by a high temperature, shaking, fast damaging of the heart's structures and a hematogenous spread of the infection to extracardiac structures. With the subacute form the clinical picture develops within a few weeks or months and it is characterized by a slight fever, fatigue, loss of appetite, muscle pain, tachycardia, spleen enlargement...
Early prosthetic valve endocarditis, which develops during the first year after the implantation, is distinguished from the late prosthetic valve endocarditis, which develops after one year.
An atypical clinical picture, prosthetic valves and other intracardiac devices often make it difficult to make the diagnosis. Echocardiography and hemocultures are the basis for the diagnosis of IE.
Treatment for IE involves a prolonged bactericidal medication therapy and half of all patients need to have the infected tissue surgically removed.
Amoxicillin is the preferred medication for IE prophylaxis for patients who are not allergic to penicillin, whereas it is recommended to treat patients who have had allergic reactions to penicillin with erythromycin or clindamycin per os or vancomycin intravenous.
Patients at a high risk of developing IE should receive antibiotic prophylaxis. Among them are patients with prosthetic heart valves, those who had already had IE, patients with complex congenital heart diseases with cyanosis, ductus arteriosus persistents, aortic coarctation, surgically made systemic - pulmonary shunts.
Antibiotic prophylaxis is carried out prior to the following dental procedures: tooth extraction, periodontal procedures, putting dental implants, tooth replantation, endodontic treatments, incisions, drainage, intraligamentary injection of local anesthetic.
The role of the nurse is to work on the improvement of oral health of the patients on a daily basis and so reduce the need for dental procedures which can cause bacteriemia and development of IE. |
