Signs and symptoms Book Based

Client Based

Chest pain Heart palpitations Breathlessness exertion on

Easy fatigability Heart palpitations

Breathing problems when lying down (orthopnea) Walking from sleep with the need to sit or stand up (paroxysmal nocturnal dyspnea) Swelling (edema) Fainting (syncope) Stroke Fever associated with infection of damage heart valves

The signs and symptoms that may be observed to the client with RHD are easy fatigability and heart palpitations. The client wasnt able to finish half of his work due to his easy fatigability. Risk Factors Book Based Poverty Overcrowding Reduced access medical care to Client Based Reduced access medical care to

The factor that may contribute the development of RHD is reduced access to medical care. As a result, the

treatment for the disease was delayed and some discomforts were experienced by the client. Diagnostic test You may notice the signs of RHD and decide to visit your doctor. The earlier the condition is diagnosed the lower the risk of complications. If a doctor suspects the patient has RHD they may refer them to a specialist cardiologist. Tests will be carried out to reach a diagnosis and

determine the appropriate course of treatment. The doctor may order Physical examination while a heart murmur may suggest RHD, many patients with RHD do not have a murmur; Medical history including evidence of past ARF or strep infection; Chest x-ray to check for enlargement of the heart or fluid on the lungs; Electrocardiogram (ECG) to check if the chambers of the heart have enlarged or if there is an abnormal heart rhythm (arrhythmia);

Echocardiogram to check the heart valves for any damage or infection and assessing if there is heart failure. This is the most useful test for finding out if RHD is present.

Complication Rheumative complications. heart

When it

failure
does, these

(RHD)

rarely

has

complications

include:

Arrhythmia (An irregular heartbeat is an arrhythmia (also called dysrhythmia). Heart rates can also be irregular), Infective endocarditis ( an infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium, or a septal defect,

Congestive heart failure ( blood moves through the heart and body at a slower rate, and pressure in the heart

increases. As a result, the heart cannot pump enough oxygen and nutrients to meet the body's needs. The chambers of the heart may respond by stretching to hold more blood to pump through the body or by becoming stiff and thickened), of certain

Recurrent

pulmonary

infections

(restraining

organism in the respiratory system) ,Death (the cessation of all biological functions that sustain a living organism) Prevention The Rheumative heart disease cab be prevented. Some people believe: Regular check-up with a cardiologist to monitor the heart; Up-to-date Regular flu (influenza and pneumococcal) to prevent

vaccinations;

(preventive)

antibiotic

group A streptococcus throat infection and recurring ARF;

Early

presentation,

diagnosis,

and

where

appropriate,

antibiotic treatment of sore throats; Good dental hygiene (tooth brushing and flossing, dental check-ups)as oral

bacteria entering the bloodstream can increase the risk of complications such as inflammation of the inner lining of the heart; Antibiotics- may be given to some people before some dental or surgical procedures to prevent bacterial

infection of the damaged areas of the heart; Good prenatal care, as pregnancy can make rheumatic heart disease worse (www.emedicinehealth.com)

Nursing Management The following are the nursing management that can be done for a client with rheumatic heart Disease: for for

ineffective dyspnea,

breathing and

pattern: confusion

Observe

cyanosis, worsening

hypoxia

indicating

condition; place patient in an upright position to obtain greater lung expansion and improve aeration. Frequent

turning and increased activity (up in chair, ambulate as tolerated) should be employed; administer oxygen at

concentration to maintain Pao2 at acceptable level i.e. 4 to 6; follow ABG levels/Sa02 to determine oxygen need and response to oxygen therapy. For reducing fever: do tepid

sponging

to

reduce and

fever

through

conduction

and

evaporation

administer

antipyretic;

administer

penicillin therapy as prescribed to eradicate hemolytic streptococcus; give salicylates or NSAIDs as prescribed to suppress rheumatic to activity fever by and controlling to relieve toxic joint

manifestations,

reduce

pain. Maintaining cardiac output: assess for signs and symptoms of acute rheumatic carditis; be alert to

patients complains of chest pain, palpitations, and/or precordial tightness; monitor for tachycardia (usually

persistent when patient sleeps) or bradycardia, be alert to development of second-degree (acute heart block or

wenckebachs pulse rate

disease interval

rheumatic

carditis auscultate

causes heart

prolongation),

sounds every 4hours. Medical Management Treatment of acute rheumatic fever includes

antibiotics to treat the strep infection and additional medications to ease the inflammation of the heart and other symptoms. Usually aspirin is given in large doses until the joint inflammation goes away; rarely, steroids are needed. need Once to the take acute illness or has an gone away,

patients

penicillin,

equivalent

antibiotic, for many years to prevent recurrences. This is a very important treatment because the risk of heart valve damage increases if rheumatic fever recurs. Surgical Management Most often the valve leak caused by the disease is mild and does not need treatment. If the leak is severe enough to strain and enlarge the heart, surgery may be needed to eliminate the leak. This surgery may involve repair of the damaged valve. Sometimes the valve is too badly damaged to repair, in which case it must be

replaced by an artificial valve.