Assessment 

Infective endocarditis  is characterised  by insidious onset of fever, malaise, night- sweats and weight loss. Other signs include vomiting, fatigue, headache, myalagia and arthralgia,  splenomegaly, and Petechia. There will be a characteristic  heart murmur because of destruction of valves, damage to myocardium or congesive  heart failure,

In  the later course of  disease  there may be small  erythematous  lesions on  the palm and soles. There will be splinter haemorhage (these are darkened lines under the nails) and tender small dermal nodules in pads of  the fingers and toes called ostenodes. Nursing Management Diagnostic evaluation includes laboratory examination of blood which shows elevated of Children with erythrocyte sedimentation rate (ESR) and anaeinia, mild to moderate leukocytosis. X- Medical  and Surgical ray shows cardiomegaly, ECG shows prolonged PR interval. Echocardiography reveals presence of  vegetation and ultrasound demonstrates  the effects of  valvular incompetence. Blood is also obtained for culture and sensitivity.