1. Encourage bed rest since it reduces myocardial oxygen demand and usually continues until the following criteria are met:

> Temperature remains normal without use of salicylates

> Resting pulse rate remains less than 100 beats/min

> ECG tracings show no manifestations of myocardial damage

> Pericardial friction rub is not present

2. Obtain a clear description of the pain or discomfort. Identify the source of greatest discomfort as a focus for intervention.
3. Administer analgesics as needed and use salicylates around the clock. Balance rest and activity according to the degree of pain and activity tolerance.
4. Provide psychosocial support while patient is confined to hospital or home with restrictive intravenous therapy.
5. If patient received surgical treatment, provide postsurgical care and instruction.
6. After surgery, monitor patient’s temperature; a fever may be present for weeks.
7. A high-protein, high-carbohydrate diet helps maintain adequate nutrition in the presence of fever and infection.
8. Oral hygiene every 4 hours; small, attractive meal servings and foods that are not overly rich, sweet or greasy stimulate the appetite.
9. Instruct the client about how to reduce exposure to infection as follows:
10. Advise patient to take good care of the teeth and gums, obtain prompt dental care for cavities and gingivitis
11. Prophylactic medication may be needed before invasive dental procedures, and individualized evaluation for prophylaxis medication is needed.
12. Instruct patient to Avoid people who have an upper respiratory tract infection
13. Assess for signs and symptoms of organ damage such as stroke (CVA, brain attack), meningitis, heart failure, myocardial infarction, glomerulonephritis, and splenomegaly.
14. Instruct patient and family about activity restrictions, medications, and signs and symptoms of infection.
15. Provide a quiet environment and comfort measures such as: change of position, rub his back, use warm compresses / cold, emotional support to reduce physical and emotional discomfort of the patient.
16. Refer to home care nurse to supervise and monitor intravenous antibiotic therapy in the home.