University of San Jose


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 .

Pericarditis . These problems depend on the severity of the damage and on which heart valve is affected. The immune system reacts to the presence of bacteria by producing specific substances.T hebody simmunecellsareunabletodistinguishbetweenGroupAstreptococcusbacteria santigensand antigens present on the body s own cells. Most individuals who get treatment and those with strong immune systems usually recover from the infection without complications. The heart valve is damaged by a disease process that begins with a strep throat caused by streptococcus A bacteria. a complication of untreated strep throat. brain or skin.000 Americans. URTI caused by these bacteria are often contagious and spreads easily through oral and respiratory secretions. Statistics y y Rheumatic fever and rheumatic heart disease afflict about 1.800. In rheumatic heart disease. when your heart valves may be damaged. about 3% of them. headache. the result is myocarditis. body weakness. Symptoms of the inflammatory process usually manifest after two to four days of incubation period and these include high fever. and this often results in the manifestation of many RHD symptoms. Rheumatic fever is an immune response to an infection with group A streptococcus. sore throat. particularly if the disease strikes again. Rheumatic fever and rheumatic heart disease killed 5. they have not been linked to rheumatic fever. While streptococcal skin infections are fairly common. forcing it to work harder to pump blood. problems. When the heart muscles are affected by inflammation. some of them also attack or cross-react with the tissues in the heart. some people develop rheumatic fever that never had an obvious throat infection and test negative after a throat culture. But as these antibodies attack the bacteria. rheumatic fever scars the valves of the heart. Over a period of months or even years. However. Rheumatic heart disease is caused during the course of the rheumatic fever. Rheumatic fever can affect many connective tissues of the body especially those of the heart. The same bacteria causes strep throat and scarlet fever. to attack them and stop their spread inside the body. Some patients however. The greatest danger from rheumatic fever is the damage it can do to the heart. joints. the damaged heart valve either does not completely close or completely open. It is believed that certain proteins produced by the group A Streptococci are structually similar to those found in the heart. like carditis. pericarditis and myocarditis. The most advanced condition is congestive heart failure. may develop RF several weeks after the infection has resolved. that may eventually cause rheumatic fever. but it usually occurs in children five to 15 years old. but eventually damaged heart valves can cause serious. 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. called antibodies. In more than half of all cases. resulting in the immune cells attacking the body. It is a rare but potentially life-threatening disease. endocarditis. stroke or abnormal heart rhythm. You also have a higher risk of congestive heart failure. The valve may not open or close properly or becomes stiff and narrow. and increase in WBC count. If you had rheumatic fever you are at higher risk of recurring heart attacks. damage to the heart can lead to the serious condition of rheumatic heart disease. Sometimes damage to heart valves is not immediately noticeable. infections of your heart's lining or valves and further damage. Anyone can get acute rheumatic fever. Etiology Rheumaticfeveriscausedbythebody simmunesystemactinginappropriatelyasacomplicationofstrepthroat.Definition Rheumatic heart disease is a condition in which permanent damage to heart valves is caused from rheumatic fever. even disabling. The bacteria attach themselves to the epithelial cells of the respiratory tract and produce substances or enzymes that cause destruction to the surrounding tissues.014 Americans in 1997. A serious complication of RF is rheumatic heart disease.

and stability of blood pressure. Electrocardiogramchanges aren t diagnostic. or pericardial effusion). and palpate peripheral pulses. Antistreptolysin-O titer is elevated in 95% of patients within 2 months of onset. Laboratory data support the diagnosis: White blood cell count and erythrocyte sedimentation rate may be elevated (during the acute phase). is effective.Usually this can be accomplished with oral administration of penicillin. If heart failure develops. Risk for Ineffective Therapeutic regimen management related to a need for lifelong therapy. Imbalanced Nutrition: Less than Body requirements related to fever. treatment. . but PR interval is prolonged in 20% of patients. Assess baseline nutritional and hydration data. and endocarditis happens when the inner layer of the heart is involved in the inflammatory process. Eradicate infection. Cardiac catheterization evaluates valvular damage and left ventricular function in severe cardiac dysfunction. A baseline ECG is used to determine whether heart block is present. Cardiac enzyme levels may be increased in severe carditis. or subcutaneous nodules) and a detailed patient history. polyarthritis. Promote Comfort. C-reactive protein is positive (especially during acute phase). tachycardia. Chest X-rays show normal heart size (except with myocarditis. anorexia and fatigue. allergic client. Assess vital signs to reveal the presence of fever. Auscultate heart sounds for the presence of friction rub. erythema marginatum. Diagnostic and Laboratory Testing Diagnosis depends on recognition of one or more of the classic symptoms (carditis. Medical Interventions 1. 3. Activity Intolerance related to reduced cardiac reserve and enforced bed rest. rheumatic fever without carditis. . 2.Corticosteroids are used to treat carditis. For penicillin erythromycin is usually prescribed.Bed rest is usually prescribed to reduce cardiac effort until evidence of inflammation has subsided. 2. Nursing Intervention Nursing assessment involves gathering baseline and ongoing subjective and objective data. Echocardiographyhelps evaluate valvular damage. heart failure. 3. . chorea. chamber size.occurs when there is inflammation of the sac that surrounds the heart. Nursing Diagnosis 1. including cardiac glycosides and diuretics. and ventricular function. blood studies show slight anemia due to suppressed erythropoiesis during inflammation. Maximize Cardiac Output . inflammation. especially if heart failure is evident.

rheumatic fever. coping strategies.Assess psychosocial data about the client s feelings regarding restrictions of activity. and intervention for. level of discomfort. support system. Rheumatic Glomerulonephritis . and knowledge (both the client s and his/her family s) concerning the nature of.

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