The nurse identifies which client histories below as at risk for infective endocarditis? (Select three that apply)

Infective endocarditis involves the microbial colonization of the endocardial surface or heart valves, typically following bacteremia. The presence of foreign material or previously damaged endothelial tissue provides a nidus for platelet and fibrin deposition, which serves as an ideal environment for bacteria to adhere and form vegetations. A. Post pericardiotomy syndrome is an inflammatory reaction involving the pericardium following cardiac surgery. While it involves the heart, it is primarily an autoimmune-mediated inflammatory process of the external sac rather than an infectious process of the internal lining or valves. It does not significantly increase the risk of endocardial infection. B. Systemic lupus erythematosus (SLE) can cause Libman-Sacks endocarditis, which involves sterile (non-infectious) vegetations. While SLE patients are often immunosuppressed due to medication, the condition itself is not a primary risk factor for the bacterial "infective" form of endocarditis compared to structural or prosthetic valvular issues. C. Implanted cardiac devices like pacemakers and ICDs involve permanent leads that traverse the heart chambers and valves. These components represent foreign bodies within the vascular system. Bacteria can adhere to these leads and form biofilms, making these patients significantly more susceptible to persistent and difficult-to-treat endocardial infections. D. Prosthetic cardiac valves are among the highest risk factors for infective endocarditis. Because these valves are non-biological or treated tissue, they lack the natural immune defenses of healthy endothelium. Once bacteria seed onto a prosthetic valve, the resulting infection is aggressive and often requires surgical replacement of the valve. E. A previous history of bacterial endocarditis indicates that the patient already has damaged endocardial tissue or scarred valves. These irregularities create turbulent blood flow and provide a ready surface for bacterial attachment during future episodes of bacteremia, making a recurrence much more likely than an initial infection in a healthy heart.