University of San Jose Recoletos College of Nursing

A Very Lengthy Assignment

Prepared By: Doguiles, Neil Elmo C. BSN 3 Block 2 Prepared For: Kirk Odrey O. Jimenez, RN Clinical Instructor

Table of Contents

Rheumatic Heart Disease

Definition
Rheumatic heart disease is a condition in which permanent damage to heart valves is caused from rheumatic fever. The heart valve is damaged by a disease process that begins with a strep throat caused by streptococcus A bacteria, that may eventually cause rheumatic fever. Rheumatic fever can affect many connective tissues of the body especially those of the heart, joints, brain or skin. Anyone can get acute rheumatic fever, but it usually occurs in children five to 15 years old. It is a rare but potentially life-threatening disease, a complication of untreated strep throat. The greatest danger from rheumatic fever is the damage it can do to the heart. In more than half of all cases, rheumatic fever scars the valves of the heart, forcing it to work harder to pump blood. Over a period of months or even years, particularly if the disease strikes again, damage to the heart can lead to the serious condition of rheumatic heart disease. In rheumatic heart disease, the damaged heart valve either does not completely close or completely open. Sometimes damage to heart valves is not immediately noticeable, but eventually damaged heart valves can cause serious, even disabling, problems. These problems depend on the severity of the damage and on which heart valve is affected. The most advanced condition is congestive heart failure.

Statistics
Rheumatic fever and rheumatic heart disease afflict about 1,800,000 Americans. Rheumatic fever and rheumatic heart disease killed 5,014 Americans in 1997.

Etiology
Rheumatic fever is caused by the bodys immune system acting inappropriately as a complication of strep throat. The bodys immune cells are unable to distinguish between Group A streptococcus bacterias antigens and antigens present on the bodys own cells, resulting in the immune cells attacking the body. However, some people develop rheumatic fever that never had an obvious throat infection and test negative after a throat culture. Rheumatic fever is an immune response to an infection with group A streptococcus. The same bacteria causes strep throat and scarlet fever. While streptococcal skin infections are fairly common, they have not been linked to rheumatic fever. Rheumatic heart disease is caused during the course of the rheumatic fever, when your heart valves may be damaged. The valve may not open or close properly or becomes stiff and narrow. If you had rheumatic fever you are at higher risk of recurring heart attacks, infections of your heart's lining or valves and further damage. You also have a higher risk of congestive heart failure, stroke or abnormal heart rhythm.

Pathophysiology
RF generally occurs in children and adolescents after an episode of upper respiratory tract infection (URTI) caused by the group A beta-hemolytic Streptococcus bacteria. The bacteria attach themselves to the epithelial cells of the respiratory tract and produce substances or enzymes that cause destruction to the surrounding tissues. Symptoms of the inflammatory process usually manifest after two to four days of incubation period and these include high fever, sore throat, headache, body weakness, and increase in WBC count. URTI caused by these bacteria are often contagious and spreads easily through oral and respiratory secretions. Most individuals who get treatment and those with strong immune systems usually recover from the infection without complications. Some patients however, about 3% of them, may develop RF several weeks after the infection has resolved. A serious complication of RF is rheumatic heart disease. It is believed that certain proteins produced by the group A Streptococci are structually similar to those found in the heart. The immune system reacts to the presence of bacteria by producing specific substances, called antibodies, to attack them and stop their spread inside the body. But as these antibodies attack the bacteria, some of them also attack or cross-react with the tissues in the heart, and this often results in the manifestation of many RHD symptoms, like carditis, endocarditis, pericarditis and myocarditis. When the heart muscles are affected by inflammation, the result is myocarditis. Pericarditis

occurs when there is inflammation of the sac that surrounds the heart, and endocarditis happens when the inner layer of the heart is involved in the inflammatory process.

Diagnostic and Laboratory Testing

Diagnosis depends on recognition of one or more of the classic symptoms (carditis, rheumatic fever without carditis, polyarthritis, chorea, erythema marginatum, or subcutaneous nodules) and a detailed patient history. Laboratory data support the diagnosis: White blood cell count and erythrocyte sedimentation rate may be elevated (during the acute phase); blood studies show slight anemia due to suppressed erythropoiesis during inflammation. C-reactive protein is positive (especially during acute phase). Cardiac enzyme levels may be increased in severe carditis. Antistreptolysin-O titer is elevated in 95% of patients within 2 months of onset. Electrocardiogram changes arent diagnostic; but PR interval is prolonged in 20% of patients. Chest X-rays show normal heart size (except with myocarditis, heart failure, or pericardial effusion). Echocardiography helps evaluate valvular damage, chamber size, and ventricular function. Cardiac catheterization evaluates valvular damage and left ventricular function in severe cardiac dysfunction.

Nursing Diagnosis
1. Activity Intolerance related to reduced cardiac reserve and enforced bed rest. 2. Imbalanced Nutrition: Less than Body requirements related to fever, inflammation, anorexia and fatigue. 3. Risk for Ineffective Therapeutic regimen management related to a need for lifelong therapy.

Medical Interventions
1. Eradicate infection. - Usually this can be accomplished with oral administration of penicillin. For penicillin allergic client, erythromycin is usually prescribed. 2. Maximize Cardiac Output - Corticosteroids are used to treat carditis, especially if heart failure is evident. If heart failure develops, treatment, including cardiac glycosides and diuretics, is effective. 3. Promote Comfort. - Bed rest is usually prescribed to reduce cardiac effort until evidence of inflammation has subsided.

Nursing Intervention
Nursing assessment involves gathering baseline and ongoing subjective and objective data. Assess vital signs to reveal the presence of fever, tachycardia, and stability of blood pressure. Auscultate heart sounds for the presence of friction rub, and palpate peripheral pulses. A baseline ECG is used to determine whether heart block is present. Assess baseline nutritional and hydration data. Assess psychosocial data about the clients feelings regarding restrictions of activity, support system, coping strategies, level of discomfort, and knowledge (both the clients and his/her familys) concerning the nature of, and intervention for, rheumatic fever.

Rheumatic Glomerulonephritis