LESSON PLAN

IDENTIFICATION DATA:

NAME OF EVALUATOR :

NAME OF STUDENT TEACHER : Neha Parihar

SUBJECT : Medical Surgical Nursing

TOPIC : Endocarditis

DATE OF PRESENTATION : 23-12-2022;

DURATION : 10 minutes

VENUE :

GROUP :

METHOD OF TEACHING : Lecture & Discussion method

A.V. AIDS : PowerPoint presentation, Chart, Flashcards, Bibliography card and blackboard.

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GENERAL OBJECTIVE:

At the end of teaching the group will be able to comprehend the knowledge regarding endocarditis.

SPECIFIC OBJECTIVE: At the end of teaching, the group will be able to:

• explain about the introduction of endocarditis.

• describe about the definition of endocarditis.
• explain the etiological factors of endocarditis.
• discuss the pathophysiology of endocarditis.
• describe about clinical manifestations of endocarditis.
• discuss the diagnostic tests of endocarditis.
• explore the management of endocarditis.

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SR. SPECIFIC TIME CONTENT TEACHING- A.V. EVALUATIO
NO OBJECTIVE LEARNING N
ACTIVITY AIDS

1. To introduce ½ min SELF INTRODUCTION Introducing self to ---

self to the group.
group. Myself Neha Parihar, student of [Link]. Nursing 1st year of MHR DAV
Institute of nursing, Jalandhar.

2. To announce ½ min ANNOUNCEMENT OF THE TOPIC Students will actively ---

the topic to the listen to the teacher
group. Today we will discuss the topic – endocarditis. and will try to guess
the topic of
presentation.

3. To appraise the ½ min PREVIOUS KNOWLEDGE The student teacher --- Students will
previous will ask questions answer the
knowledge of Questions asked from students for assessing their previous from the group. questions.
the group. knowledge.

• Que. Have you ever seen a patient with endocarditis during

your clinical postings?
• Que. What are the different layers of heart?

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 ENDOCARDITIS
4. To introduce ½ min INTRODUCTION: Student teacher will C students will
about introduce about the H answer the
endocarditis.  Three layers (Endocardium, Myocardium, Pericardium) covering endocarditis & A questions.
the heart. Infectious process can occur in any of these layers. students listen R
• Endocarditis (Endocardium) carefully. Student T
• Myocarditis (Myocardium) teacher will ask
• Pericarditis (Pericardium) question from students

5. To define the ½ min DEFINITIONS Student teacher will P students will

endocarditis. define about the O answer the
Infective endocarditis is a microbial infection of endothelial surface endocarditis & W questions.
of heart. students listen E
It is a serious infection, that is associated with high degree of illness carefully. Student R
and death. teacher will ask -
question from P
students. O
I
N
T

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6. To describe the ½ min. CAUSES OF ENDOCARDITIS: Student teacher will P Students will
causes of describe the causes of O answer the
endocarditis. • Staphylococcus aureus endocarditis & W questions.
• Viridans streptococcus students listen
E
R
• Enterococci carefully. Student -
• Streptococci bovis teacher will ask P
• Fungi – e.g. Candida, aspasgallus question from O
students. I
N
T

7. To explain the 1 min PATHOPHYSIOLOGY OF ENDOCARDITIS Student teacher will P Students will
pathophysiolog explain O answer the
y of Due to etiological factors (deformity or injury to endocardium) pathophysiology of W questions.
endocarditis. endocarditis & E
Infectious organisms invade the clot and endocardial lesions students listen R
carefully. Student -
Results in platelets, fibrin, blood cells and micro-organisms teacher will ask P
activation question from O
students. I
Forms clusters on endocardium N
T
Vegetation/ clusters may embolize to other tissues

Infection may erode through endocardium to other underlying

structures (valve leaflets)

Causes tear or other deformities of valve leaflets.

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8. To enlist sign 1 min SIGNS AND SYMPTOMS OF ENDOCARDITIS Student teacher will F Students will
and symptoms • Fever explain sign and L answer the
of endocarditis. • Heart murmurs symptoms of A questions.
• Petechiae endocarditis & S
• Tachycardia students listen H
• Cardiomegaly carefully. Student C
• Splenomegaly teacher will ask A
question from R
• Chest pain and breathing difficulty
students. D
• ROTH SPOTS: Hemorrhages with pale centers which are
S
caused by emboli.
• SPLINTER HEMORRHAGES: May be under the
proximal half of the fingernails and toenails.
• OSLER NODES: Small and painful nodules may be present
on finger and toes.
• JANEWAY LESIONS: Irregular, red, purple,
painless flat macules). May be present on palms,
fingers, hands, soles and toes.

9. To describe the 2 min. DIAGNOSTIC EVALUATION OF ENDOCARDITIS Student teacher will P Students will
diagnostic ➢ HISTORY TAKING explain diagnostic O answer the
evaluation of ➢ PHYSICAL ASSESSMENT evaluation of W questions.
endocarditis.  Roth spots endocarditis & E
 Splinter hemorrhages students listen R
 Osler nodes carefully. Student -
 Janeway lesions teacher will ask P
➢ ECHOCARDIOGRAPHY: to relieve heart failure. O
I

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➢ CMR – (Cardiovascular magnetic resonance imaging) detection question from N
of inflammation and adhesion. students. T
➢ TEE (Transesophageal echocardiogram)
➢ CHEST X-RAY:
➢ Chest X-rays may reveal malignancies, sarcoidosis, or several
infections, which may be the cause of acute pericarditis.
➢ BLOOD TESTS:
o ESR
o CRP
o Troponin levels
o CBC
o Urea & creatinine
➢ Duke’s Criteria for Infective Endocarditis
Mnemonic - BE FIVER
➢ Major Criteria
o B – Blood culture positive (Two positive for typical
microorganisms)
o E – Echocardiogram shows:
o Valve regurgitation
o Abscess
➢ Minor Criteria
o F – Fever >38℃
o I – Imunological phenomena
o (Roth spots, Osler nodes, Glomerulonephritis)
o V – Vascular phenomena (intra arterial emboli/ Janemay
Lesions or conjuctivital hemorrhage)
o E – Echocardiogram/ Blood cultures
o R – Risk factors (IV drug abusers, valve replacement.

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 DEFINITE INFECTIVE ENDOCARDITIS:
• 2 major OR 1 major + 3 minor criteria
POSSIBLE INFECTIVE ENDOCARDITIS:
• 1 major + 1 minor OR 3 minor criteria
10. To explain the 1 min ❖ NON-PHARMACOLOGICAL MEASURES: Student teacher will P Students will
management of ❖ Counseling and education of patients. explain management O answer the
endocarditis. ❖ Life style measures. of endocarditis & W questions.
❖ Smoking cessation. students listen E
❖ Avoid Alcohol intake. carefully. Student R
❖ Diet and nutrition. teacher will ask -
❖ Salt restriction. question from P
Objective of management is to: students. O
❖ Eradicate invading organism through appropriate doses of an I
antimicrobial agent. N
❖ Antibiotic therapy: 2-6 weeks every four hours or continuously T
by IV infusion or once daily by intramuscular injection.
• Vancomycin 500-1000 mg, IV
• Gentamicin – 5-7 mg/kg body weight, IV/IM
• Cefepime – 500 – 1000mg, IV
❖ Antifungal therapy: In case of fungal infection
• Amphotericin B - 0.25mg / kg body weight
SURGICAL MANAGEMENT
❖ May be required if
• Infection does not respond to medications.
• Patient having prosthetic heart valve endocarditis.
• Vegetation larger than 1 cm.
• Development of complications: Septal perforation
❖ Surgical interventions include:

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 • Valve debridement/ excision
• Debridement of vegetation
• Debridement or closure of an abscess
• Aortic or mitral valve debridement/ excision/
replacement
11. To explain the ½ min NURSING MANAGEMENT OF ENDOCARDITIS Student teacher will P Students will
nursing ❑ History & physical examination. explain the nursing O answer the
management of ❑ Assess fever of the patient. management of W questions.
endocarditis. ❑ Rest period should be planned. endocarditis & E
❑ Infection control and good hand hygiene is necessary by students listen R
both patient and care givers. carefully. Student -
❑ Assess heart sounds. teacher will ask P
❑ Nurse monitors for signs and symptoms of: question from O
❑ Systematic embolism students. I
❑ Pulmonary infarction N
❑ Stroke T
❑ Meningitis
❑ Heart failure, MI, and splenomegaly
NURSING INTERVENTIONS
❑ Relieving pain and other symptoms.
❑ Improving respiratory function.
❑ Promote adequate tissue perfusion.
❑ Reducing anxiety.
❑ Monitoring and managing potential problems.
12. To ½ min SUMMARIZATION
summarizing ➢ Introduction and definition of endocarditis.
➢ Causes & risk factors of endocarditis.
➢ Clinical manifestation of endocarditis.

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 the topic to the ➢ Diagnostic evaluation of endocarditis.
group. ➢ Management of endocarditis.
➢ Nursing diagnosis of endocarditis.
13 To ask various ½ min RECAPTUALIZATION Student teacher will --- ---
question about What do you mean by endocarditis? ask various questions
the topic. Explain the pathophysiology of endocarditis? about the topic and the
Describe the management of endocarditis? class will answer to the
questions

14 To describe the ½ min BIBLIOGRAPHY ---- --- ---

bibliography to 1) Brunner & Suddarth. Textbook of Medical Surgical
the class Nursing. Volume 1. 13th edition. New delhi. Wolter
Kluwer Publishers. Page no. 458 to 463
2) Black Joyce M. Medical Surgical Nursing Clinical
Management of positive outcome. 8th ed. New Delhi:
Mosby Elsevier Publishers; 2009. Page no. 348-359
3) Heitkemper, O’Brien and Chintamani. Lewis’s Medical
Surgical Nursing Assessment and Management of
Clinical Problems. New Delhi: Mosby Elsevier
Publishers; 2011. Page no. 1234-1236

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