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RHEUMATIC HEART DISEASE

Introduction
Rheumatic fever is one of the complications associated with strep throat. Its
a relatively serious illness that can cause stroke, permanent damage to your
heart, and death if its left untreated. The condition usually appears in
children between the ages of 5 and 15, even though older children and
adults have been known to contract the fever as well. Its still common in
places like sub-Saharan Africa, south central Asia, and certain populations in
Australia and New Zealand. It is a disease of poverty caused by Acute
Rheumatic Fever (ARF). Rheumatic Fever is an illness that predominantly
affects children, with the highest rates occurring in the 5-14 year age group.
Rheumatic fever causes RHD and is the most common cause of cardiac
mortality in children and adults aged less than 40 years this often disabling
disease can cause mortality. RHD is the most common cause of childhood
cardiovascular death and illness in the developing world. A minimum of 15
million people worldwide have the disease, resulting in 300,000 deaths each
year. The cause is a Streptococcal A infection.
RHD is difficult to detect in its early stages, however all children and adults
who are suspected of having ARF should have an ultrasound of the heart,
known as echocardiography. This test greatly enhances the chances of an
accurate diagnosis.
Accurate diagnosis continues to be a problematic for health clinicians, where
over-diagnosis results in unnecessary treatment over a long time, while
underdiagnosis leads to further attacks of ARF, cardiac damage and
premature death. Diagnosis remains a clinical decision, as there is no specific
laboratory test.
The risk is increased with socioeconomic disadvantage such as overcrowding
in housing, poor nutrition, poor household sanitation and wastewater
management. RHD is preventable by improving living conditions and
introducing effective measures of prevention and control. Often RHD is
called the classic disease of social injustice.
These primary infrastructure related programs can be addressed in parallel
with the medical education, intervention, prevention, support and research
programs

Causes

Rheumatic fever is caused by group A streptococcus. This bacterium causes strep


throat or, in a small percentage of people, scarlet fever. Its an inflammatory
disorder.
Rheumatic fever causes the body to attack its own tissues after its been infected
with the bacteria that causes strep throat. This reaction causes widespread
inflammation throughout the body, which is the basis for all of the symptoms of
rheumatic fever

Symptoms
Rheumatic fever is caused by a reaction to the bacteria that causes strep
throat, group A streptococcus. Although not all cases of strep throat result in
rheumatic fever, this serious complication may be prevented with diagnosis
and treatment of strep throat. The following symptoms may be present:

a sore throat
a sore throat with tender and swollen lymph nodes
a red rash
difficulty swallowing
thick, bloody discharge from nose
a temperature of 101F or above
tonsils that are red and swollen
tonsils with white patches or pus
small, red spots on the roof of their mouth
a headache
nausea
vomiting

A wide variety of symptoms are associated with rheumatic fever. An


individual with the illness could experience a few, some, or most of the
following symptoms. Symptoms usually appear two to four weeks after your
child has been diagnosed with strep throat. Common symptoms of strep
throat include:

small, painless nodules, or bumps, under the skin


chest pain
rapid fluttering or pounding chest palpitations
lethargy or fatigue
nosebleeds
stomach pain
painful or sore joints in the wrists, elbows, knees, and ankles
pain in one joint that moves to another joint

red, hot, swollen joints


shortness of breath
a fever
sweating
vomiting
a flat, slightly raised, ragged rash
jerky, uncontrollable movements of their hands, feet, and face
a decrease in attention span
outbursts of crying or inappropriate laughter

Complications
Once they develop, the symptoms of rheumatic fever can last for months.
Rheumatic fever can cause long-term complications in certain situations.
One of the most prevalent complications is rheumatic heart disease. Other
heart conditions include:

valve stenosis, which is a narrowing of a valve


valve regurgitation, which is a leak in the valve that causes blood to
flow in the wrong direction
heart muscle damage, which is an inflammation that can weaken the
heart muscle and decrease the hearts ability to pump blood effectively
atrial fibrillation, which is an irregular heart beat in the upper chambers
of the heart
heart failure, which happens when the heart can no longer pump blood
to all parts of the body

Diagnosis
A physical exam will be given to determine a recent bout of strep throat
which includes the following:

looking for rash or skin nodules, which are hard bumps beneath the
skin
listening to their heart to check for abnormalities
performing movement tests to determine their nervous system
dysfunction
examining their joints for inflammation
testing their blood for strep bacteria
performing an electrocardiogram, which measures the electric waves
of their heart

performing an echocardiogram, which uses sound waves to produce


images of their heart

The first step in diagnosing rheumatic heart disease is establishing that one
recently had a strep infection. The doctor may order a throat culture, a blood
test, or both to check for the presence of strep antibodies.
The doctor will do a physical examination and check for signs of rheumatic
fever, including joint pain and inflammation. The doctor also will listen to the
heart to check for abnormal rhythms or murmurs that may signify that the
heart has been strained.
In addition, there are a couple of tests that may be used to check the heart
and assess damage, including:

Chest X-ray to check the size of the heart and to see if there is excess
fluid in the heart or lungs
Echocardiogram, a non-invasive test that uses sound waves to create a
moving image of the heart and to measure its size and shape

Treatment
Treatment will involve getting rid of all of the residual group A strep bacteria
and treating and controlling the symptoms. This can include any of the
following:

Antibiotics
The doctor will prescribe antibiotics and might prescribe a long-term
treatment to prevent it from occurring again. This treatment can last
up to five years.

Anti-Inflammatory Treatment
Anti-inflammatory treatments include pain medications that are also
anti-inflammatory, such as aspirin or naproxen. Doctors may also
prescribe a corticosteroid to reduce inflammation.

Anticonvulsant Medications

They might prescribe an anticonvulsant if involuntary movements


become too severe.

Bed Rest
Bed rest is recommended and restricted activities until the major
symptoms like pain and inflammation have passed. Strict bed rest will
be recommended for a few weeks to a few months if the fever has
caused heart problems.

Risk Factors
Factors that increase chances of developing rheumatic fever include:

a family history because certain genes make you more likely to


develop rheumatic fever
the type of strep bacteria present because certain strains are more
likely to lead to rheumatic fever than others
environmental factors present in developing countries, such as poor
sanitation, overcrowding, and a lack of clean water

Nursing assessment is done in providing nursing care in rheumatic heart


disease beginning to collect data on the following matters:

About heart function.


Nutritional status of patients.
Tolerance to the activities and attitudes of patients toward limiting the
activities undertaken.
Disturbances in sleep patterns.
Level of discomfort felt by rheumatic fever patients.
Ability of the patient in terms of troubleshooting.
Knowledge of patients and families will be suffered by rheumatic heart
disease.

Assessment of the above are generally aware of what is known by the


patient and the family of rheumatic heart disease. Now the next step in the

assessment in terms of nursing as one of the nursing process. Next


examined the nursing care in rheumatic heart disease are:

History of rheumatic heart disease.


Monitor cardiac complications in the event.
Auscultation of heart sounds, usually typical in patients with rheumatic
heart was weakened heart sounds with the rhythm of galloping
diastole.
Assessment of the patient's vital signs.
Assessment of pain.
Assessment of the presence of markers of inflammation in the joints.
Assessment of the presence of lesions on the skin.
Nursing Care Plan for Rheumatic Heart Disease

Next is the nursing diagnosis of rheumatic heart disease. Some nursing


diagnoses that may arise in providing nursing care in rheumatic heart
disease, among which are:
1. Decreased cardiac output related to valvular stenosis
Goals to be achieved is to increase cardiac output.
Expected outcomes are:

Patients showed reduced levels of dyspnoe experienced.


Patients participating in participating in the activity and demonstrate
increased tolerance.
Nursing interventions:
Monitor vital signs such as: blood pressure, apical pulse and peripheral
pulse.
Monitor cardiac rhythm and frequency.
Semifowler bed rest in a position that is 45 degrees.
Encourage the patient to stress management techniques (quiet
environment, meditation).
Bantu patient activity as indicated when the patient is able.
Medical collaboration in terms of oxygen delivery and therapy.

2. Activity intolerance related to decreased cardiac output, oxygen supply


and demand imbalance.

Goals to be achieved is an optimal patient can tolerate the activity does.


Expected outcomes are:

Verbal response to reduced fatigue


Conducting activities within the limits of his ability (pulse activity
should not be more than 90X/mnt, no chest pain).
Nursing interventions:
Energy saving during the acute patients.
Maintain bed rest until the results of laboratory and clinical status of
patients improved.
In line with the good general condition, monitor the gradual increase in
the level of activity undertaken.
Teach to participate in activities of daily necessities.
Create a schedule of activities and also the breaks.

Prevention
The most effective way to make sure that one doesnt develop rheumatic
fever is to treat strep throat infection quickly and thoroughly. This means
making sure one completes all prescribed doses of medication.

Practicing proper hygiene methods can help prevent strep throat.


These include:
covering your mouth when coughing or sneezing
washing your hands
avoiding contact with people who are sick
avoiding sharing personal items with people who are sick

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