ACKNOWLEDGEMENT

This case study would not have been possible without the guidance and the help of several individuals who in one way or another contributed and extended their valuable assistance in the preparation and completion of this study.

First and foremost, to the Almighty Father, for His unceasing love and blessings; for giving us enough power and fortitude to face all the hardships in the making of this work. To Him be all glory and praise!

To our Clinical Instructor Mr Hamed Leo Fabre, R.N., M.N., thank you for your invaluable time, knowledge and effort rendered to us.

The Staff and Personnel at Northern Mindanao Medical Center-Intensive care Unit for giving us the opportunity to complete this endeavor.

To our families, classmates and friends for giving us the inspiration to finished this seemingly impossible task. To the group, we would like to recognize each other for our own radical efforts in order to complete this case study; for sticking together through thick and thin and for simply being there. With this, we are proud to say that we are indeed the RLE50 Group 5.

Lastly, to each of us who helped realize this job into completion, may it be direct or indirect, no matter how minimal, the gratitude and pleasure for the achievement of this task is ours to share.

A Case Study on Rheumatic Heart Disease – RLE 50 Group 5

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ABSTRACT This is a case study of a 27-year old, Male who had a Rheumatic Heart Disease with Mitral Regurgitation admitted at Northern Mindanao Medical Center

INTRODUCTION “Getting your head in sync with your heart and harnessing the power of coherence gives you the energy efficiency you need to achieve changes that haven't been possible before”. --Doc Childre and Howard Martin, The HeartMath Solution

The heart is one of the most important organs in the entire human body. It is really nothing more than a pump, composed of muscle which pumps blood throughout the body, beating approximately 72 times per minute of our lives. The heart pumps the blood, which carries all the vital materials which help our bodies function and removes the waste products that we do not need. The walls of the heart are made up of three layers, while the cavity is divided into four parts. There are two upper chambers, called the right and left atria, and two lower chambers, called the right and left ventricles. Sometimes there are also some problems that can affect the heart like with this case of our patient that has rheumatic heart disease.

Rheumatic heart disease is a complication of rheumatic fever, which is also a complication of sore throat and mumps. So basically this disease is the end result of untreated common infections. The valves of the heart are damaged; they may not be opening and/or closing properly which then causes regurgitation of blood. The heart is inflamed and thus scarring may result, which then causes accumulation of blood on the scars, causing damage to the heart membranes. The heart gets damaged by the toxin of streptococcus (the bacteria that causes rheumatic fever) thus causing it to beat abnormally. Heart ventricles are also damaged causing it to dysfunction.

RHD does not always cause symptoms. When it does, symptoms may include: Chest pain, heart palpitations, breathlessness on exertion, breathing problems when lying down (orthopnea), waking from sleep with the need to sit or stand up (paroxysmal nocturnal dyspnea),swelling (edema), fainting (syncope), stroke, fever associated with infection of damaged heart valves.

Worldwide, rheumatic heart disease remains a major health problem. The mortality rate from this disease remains 1-10%. A comprehensive resource provided by the World Health Organization (WHO) addresses the diagnosis and treatment of this latter population. Estimations worldwide are that 5-30 million children and young adults have
A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 2

chronic rheumatic heart disease, and 90,000 patients die from this disease each year. (http://www.who.int/en/)

In the Philippines, about 2,389 Filipinos under all age groups die because of Chronic Rheumatic Heart Disease each year and 873 of that are young Filipinos under 10-24years old. (Philippine Health Statistics 2003, DOH) The Office of the Secretary under the Department of Health released an administrative order no. 23-B on July 1 1996 entitled Addendum To Manual Of Operation of Rheumatic Fever/ Rheumatic Heart Disease (RF/RHD); Guidelines on the Referral, Confirmation, Diagnosis, Registration and Management of RF-RHD Cases. This guideline is the answer of Philippine Government to address Rheumatic Heart Disease cases in the country.

(http://www.doh.gov.ph/)

Our major objective of this case study is to gain knowledge about rheumatic heart disease, the signs and symptoms of it and ways how to identify the early manifestations. We could as well lead them to the proper treatment to lessen their agony brought by the said disease, in anyhow. By having a wide understanding of the disease, we could impart teachings on how we could prevent the occurrence of the disease. It is our responsibility to render information and impart health teachings to improve the condition to our patients to the best of our abilities. One of the characteristics that we, student nurses, should have is to be informative and only through a keen of disease such as this way for us to gain all the information that we need to learn.

Scope and Limitation: This study is focused on one patient only who happened to have rheumatic heart disease admitted at Northern Mindanao Medical Center. Through the exposure of the students in the Intensive Care Unit and familiarity on the disease, we decided to choose him to be the patient in conducting the study.

The scope of this study would include:

Data collected via assessment, interviews with the patient, family members and clinical records, any health problems for 3 days including the initial assessment and its appropriate nursing intervention that would be applied within her stay in the hospital, developing a plan of care that will reduce identified predicaments and complications, coordinating and delegating interventions within the plan of care to assist the client to reach maximum
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It may open a new door in the practice of getting quality care. Through this study. the interaction.functional health. SIGNIFICANCE OF THE STUDY Nursing Education This study can be a useful learning guide in nursing education as this can be used by students as a reference for future studies regarding Rheumatic Heart Disease and related cases. This study might also inspire other individuals to come up with their own research about this disorder or any similar condition. They can apply these interventions in the real setting when they encounter the same or similar condition. Nursing Practice This case study can be used as a tool in nursing practice because it provides nursing interventions for patients with Rheumatic Heart Disease. they are acquiring more knowledge about the disease that they can use to further develop their skills as student nurses and future nurses. patient‘s chart and nurse on duty. the students will learn about the nursing interventions and have an idea of the rationale behind its actions. Further evaluations of the effectiveness of nursing interventions have been rendered to the client. This case study will enable the students to learn how to assess patient‗s with any signs of kidney disorders and be able to provide appropriate nursing care and management. Nursing Research The case can be used as a baseline data for further research of the current management of patients with Rheumatic Heart Disease. An array of factors influencing the limitations of this study includes: Data collected is limited only to assessment and interview to the patient‘s significant others. important information regarding this illness has been gathered which will be helpful on the researchers to have an in-depth understanding on the said disorder. In this way. There might be some information in this study that can be of good use for future research. This study can give a good introduction to the disorder so that an established nursing action can be quickly utilized. It is important to do A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 4 . assessment and care were only limited to a total of 8 hours (2 days clinical duty) with actual nursing intervention done. Furthermore.

Specific: 1. 2. 7. emphasize the importance of making appropriate action and to guide the patient towards recovery. 4. the researchers should have introduced the symptoms (for early detection). Describe and explain the disease together with the risk factors contributing to the occurrence of the condition. Therefore through this study. Analyze the client‘s disease process along with its signs and symp toms. comprehension and approach in the practice of nursing and be able to establish knowledge on the risk factors. Specific: 1. Patient Cantered: General: To be able for the client to fully understand and recognize the disease condition. 3. prognosis nursing management. To come up with a comprehensive presentation of the disease condition by means of correct presentation of the data gathered through the use of nursing process. To render proper nursing management and medical regimen needed by the patient. current trends and incidence of the disease condition that was chosen. To identify predisposing factors that aggregate the present condition of the patient. To impart knowledge about the importance of healthy lifestyle. 5. this study might serve as a guide for orienting people about the substance of the disease. Aside from being beneficial as a simple academic informative material. and the importance of the case study. with their significantly related nursing care plans as well as the discharge plan. 3. treatment (for information). 6. Review the anatomy and physiology of the organs involved. Interpret the results in the laboratory and diagnostic procedures done with the patient. and how this disease affects people. and management. Enumerate the different medications administered for the condition. the reason for choosing such case for presentation. better interventions and techniques to provide to the patients. their indications and specific nursing responsibilities. To present the current trends about the disease condition. OBJECTIVES OF THE STUDY: Nurse Cantered: General: To enhance skills. Formulate significant nursing diagnoses.research every now and then to gain new information. laboratory results and its complications. A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 5 . 2.

there was increase severity of shortness of breath where he had shortness of breath at rest. Chief complaint: According to his mother. patient had onset of tolerable shortness of breath. No consultation done but still taking his maintenance. Prior to admission. Patient’s Profile: Patient X. He had no allergies to any food and drugs. Thus client opt consultation. He was admitted at Northern Mindanao Medical Center Intensive Care Unit last May 26. was baptized to the nearest Philippine Independent Church from where they lived in. Nutritional and Metabolic Pattern: Patient is currently on low salt low fat diet. 2013. He used to urinate 4 times a day with urine amber in color. Activity-Exercises Patterns: Musculoskeletal are weak and could not perform activities of daily living except in feeding himself.ASSESSMENT Nursing Health History The following nursing health history includes the health history of the patient. The family. Family History of Illness: None of the members of the family were diagnosed of RHD. a 27 years old male from Zone 1 Cugman Cagayan De Oro City. The researchers deemed it important to include assessing factors which may have contributed to the patient‘s present condition. including the patient himself. Joints and muscles are sometimes painful as verbalized by the A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 6 . His last bowel movement was on last February 6. the patient was experiencing shortness of breath especially during supine position. Consumed full share with good appetite. Hence admission. 2013. He drinks coffee occasionally. History Of Present illness: Morning prior to admission. and tricuspid regurgitation. he is then diagnosed with Rheumatic Heart Disease with mitral regurgitation. for about 1 cup urine per urination. Functional Health Pattern: Patient never smoke nor drinks alcohol based beverages. Elimination Pattern: Patient X‘s usual elimination pattern is firm brownish stool once a day without drinking any laxatives.

general mobility (ADL=2). Legend: Level (0) . He is comfortable sleeping on a high-fowlers position.Full Self care Level (1) . He usually does not share his feelings with regards to the situation. Everything was in order and on time. Role-Relationship Pattern He lived with his family. and conversing with his family. andtotally dependent in meal preparation. He experienced a quality nurse-service experience. Patient is alert and well oriented to time and place except of the date.Requires assistance or supervision from another person or device Level (4) . He prefers displaying a flat affect expression when asked about how he feels on certain situations.dependent and does not participate Sleep-Rest Pattern Patient X is having sleep pattern disturbances due to his sleeping position available for his conditions. He managed stress by enjoying what television can offer. bed mobility. and cleaning (ADL=4). Sexuality-Reproductive Pattern He was never been to sexual activities. He doesn‘t have any problem with his family. A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 7 . Cognitive-Perceptual Pattern Patient X was not able to finish primary education due to his present illnesses. He is financially supported by his family. He asked support from his family which is always there. grooming and toileting (ADL=3). He is the oldest among the 5 children of his parents. assisted with person in bathing. At home.patient.Requires assistance or supervision from another person Level (3) . Self-Perception and Self-Concept Pattern He always feels exhausted.Requires use of equipment or device Level (2) . Coping-Stress Tolerance Pattern In the hospital. or sleeping while leaning on a pillow placed on a table in front of him. He usually sleeps 4 to 5 hours every night and sometimes sleeps in the morning. He was totally dependent in dressing.

More visible on the nail beds of the patient. Head. RESPIRATORY SYSTEM: Upon inspection. PHYSICAL ASSESSMENT Integumentary System General color of the skin is brown but the soles of the feet and the palms of his hands are pallor in color. Nose and Throat (HEENT) The head of the client is small for his age. His family went to church Sunday. Ears. Lips are dry and pallor.Value-Belief Pattern The family is Filipinista. Pitting edema grade 2 is noted on both feet. (diaphragm and intercostal muscles) orthopnea is manifested. Tongue is pink. Cardiovascular system: Upon inspection. The pinnas of the ears are flexible. Lesions are not noted. Pupils are equally round and reactive to light accommodation. Pupil measures 3 mm on both eyes. There is no presence of lesions noted. Eyes are jaundice in color with pale conjunctiva. pulsations of the veins on the neck. Eyes. Chest excurtion is normal. Uses sternocleidomastoid muscle as an accessory muscle for inspiration apart from the other major muscles used in breathing. Cyanosis on the upper and lower extremities are slightly noted. Resonance is heard over right and left lung during percussion.Distribution of vibrations are equal upon assessing for tactile fremitus. on the precordial area are visible. Clear lungs sound are auscultated. Respiratory rate and rhythm are abnormal as evidence by increased respiratory rate that ranges from 40 – 50 cycles per minute and a fluctuating oxygen saturation that ranges from 70% to 90%. Teeth are incomplete with presence of plaque on the upper and lower central and lateral incisors. (Percussion is not A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 8 . Skin turgor is firm when assessed. Skin in the lower extremities is dry accompanied with crusts. Skin hair is well distributed. This is very important to them because this is the only way to have them courage whenever aches and problems brought them down. With capillary refill of 4 seconds. without deformity and are aligned with the external cantus of eyes.

amplitude. Decreased muscle tone. Upon auscultation. The four quadrants of the abdomen are auscultated using the flat disc diaphragm for bowel sounds and the bell of the stethoscope for arterial and venous vascular sounds. Apical impulse is palpated in the mitral area which measures 2cm in size. The aortic.performed because patient verbalized discomfort during percussion)Pulsations are palpated at the precordial area for apical impulses noting its rate. tricuspid. Edematous feet . rhythm. Decreased range of motion. Bowel sounds are present in all four quadrants with 5 to 15 clicks per min. superficial veins noted at the 3 rd and 4th quadrants of the abdomen. dullness is heard over fluid and tympany over intestines. No dimpling is observed. mitral. Reproductive System The genitalia is normal and has no problem. Spine is slightly lordotic as a compensatory action of a protruding abdomen. pulmonic. There is an abnormal build up of fluid in the abdomen or ascites noted. Genitourinary System He has yellowish urine 3 times daily with no discomfort. contour. s1 and s2 are heard in all areas. Upon percussion. Arms and legs are symmetrical in size and decreased movement. Further percussion of organs was not performed due to patient‘s verbalization of discomfort when percussed. Musculoskeletal System He has a complete set of fingers and toes. no clicks in the joints. symmetry and elasticity. Because of this. Lesions are not noted at the anterioposterior aspect of the abdomen. Amplitude is small like gentle tap with brief duration lasting through the first two thirds of the systole and often less. There are no fractures or dislocations. Murmur noted in all areas except at apex. erb‘s point and the apex area of the precordium are auscultated using the diaphragm and the bell of the stethoscope noting for normal and abnormal heart sounds and any murmur. A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 9 . protruding contour of the abdomen is noted. Gastrointestinal System Upon inspection. there are equal gluteal folds.

The cure.” Nursing is participation in care. core and cure aspects of patient care. Quality professional nursing care requires the nurses to identify and solve overt and covert nursing problems. and value system. A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 10 . whereas the CORE and CURE are shared with other members of the health team. provision of patient teaching activities and helping the patient meet their needs where help is needed. The core has goals set by himself and not by any other person. and focused on performing that noble task of nurturing the patients. The model explains that the cure circle is shared by the nurse with other health professionals. These are the interventions or actions geared on treating or ―curing‖ the patient from whatever illness or disease he may be suffering from. which may include imited to provision of comfort measures. where CARE is the sole function of nurses. The core is the person or patient to whom nursing care is directed and needed. The core behaved according to his feelings. Her framework is efficient enough to address and meet the different requirements of the three aspects of her "pendulum model" which consists of client-oriented. The care explains the role of nurses. Hall “The student nurses are instruments by which certain nursing problems which are faced by the client and the client's family are addressed and met. This theory emphasizes a client-centered approach because it is the primary role of the nurse to alleviate the patient from whatever suffering he/she is in and help her/him meet the needs. meaning the component of this model is the ―motherly‖ care provided by nurses.DEVELOPMENTAL DATA 3C’s by Linda E. on the other hand is the attention given to patients by the medical professionals. nursing-centered and disease-centered approach.

shoulder area. including the presence of semilunar valves.Central Nervous System3.intestinal tract. Resemble vein in structure except it is thin and have more valves. 3) 3) Transporting Dietary lipids: Lymphatic vessels carry lipids and lipid soluble vitamins (ADEK) absorbed by gastro. The right lymph duct drains the right arm. Lacteals: Each Villi in the small intestine has centrally placed lymphatic vessels called Lacteal. Functions of the lymphatic system: 1) Draining interstitial fluid: To maintain the pressure and volume of the extracellular fluid by returning excess water and dissolved substances from the interstitial fluid to the circulation. When interstitial fluid passes in to lymphatic vessels. It transport lipids absorbed in the intestine. Interstitial fluid and lymph are basically same except for location. Bone marrow houses Stem cells that develop into lymphocytes and provide immunity. T lymphocytes rupture foreign cells or produce toxins while B lymphocytes differentiate in to plasma cells that secrete antibodies. Lymph capillaries containing lymph are found through out the body except in1.Avascular tissue2. 1. A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 11 . and the right side of the head and neck. Filtration forces water and dissolved substances from the capillaries into the interstitial fluid.Spleenic pulp4.ANATOMY AND PHYSIOLOGY A. From lymph capillaries fluid flows into lymph veins(lymphatic vessels) which virtually parallel the circulatory veins and are structurally very similar to them.e.Bone marrow Lymphatic Ducts: The lymphatic veins flow into one of two lymph ducts. Lymphatic System Lymphatic System consists of fluid called lymph flowing inside the lymphatic vessels. some structure and tissues that contain lymphatic tissue and bone marrow. It carries many pores which allow interstitial fluid including large lipids to get inside the lymphatic circulation but do not allow coming out. and excess fluid is picked up by lymph capillaries to become lymph. Clear water. It is half inch in length. Lymph capillaries: Close ended vessels lies in the space between cells. 2) 2) Protecting against invasion: Lymph nodes and other lymphoid tissues is the site for production of immuno-competent lymphocytes and macrophages in the specific immune response. Lymphatic Vessels: Lymph capillaries unite to form Lymphatic vessels. Not all of this water is returned to the blood by osmosis. it is called Lymph i.

Afferent lymph veins enter each node. about 3 lit/ day drains in to the lymphatic vessels and become lymph. and tonsils. cecum. they are diffuse) and are found in connective tissue beneath the epithelial mucosa. with large concentrations occurring in the areas of convergence of lymph vessels. Other lymphoid tissue: 1. including the legs. 2. They serve as filters throughwhich lymph percolates on its way to the blood. 2) Muscular and respiratory pumps push lymph forward due to function of the semilunar valves. Lymphokinetic motion (flow of the lymph) due to: 1) Lymph flows down the pressure gradient.2.e. Local concentrations of lymphocytes in these systems and other areas are called lymphatic nodules . They vary from about 1 mm to 1 to 2 cmin diameter and are widely distributed throughout the body. thoracic organs. A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 12 . Formation and flow of lymph: The excess fluids in the interstitial space i. GI tract and other abdominal organs. These cells intercept foreign antigens and then travel to lymph nodes to undergo differentiation and proliferation. Lymph nodes: Lymph nodes are small encapsulated organs located along the pathway of lymphatic vessels. Diffuse Lymphatic Tissue and Lymphatic nodules: The alimentary canal. and genitourinary tract are guarded by accumulations of lymphatic tissue that are not enclosed by a capsule (i. and the left side of the head and neck and left arm and shoulder. The left lymph duct (thoracic duct). Antigen-activated lymphocytes differentiate and proliferate bycloning in the lymph nodes.e. Arteries (blood plasma)Blood capillaries Interstitial space Lymph capillaries (Lymph)Lymphatic Vessels Lymphatic Ducts Subclavian vein .  These ducts then drain into the subclavian veins on each side where they join the internal jugular veins to form the brachiocephalic veins.Heart Lymph nodes lie along the lymph veins successively filtering lymph.In general these are single and random but are more concentrated in the GI tract in the ileum. efferent veins lead to the next node becoming afferent veins upon reaching it. respiratory passages. appendix. It is 15-18 inches in length and is a major vessel of the system. drains everything else.

Immune functions include: proliferation of lymphocytes. retrieval of iron from hemoglobin degradation. production of antibodies. 4. removal and destruction of aged. The transformation of primitive or immature lymphocytes into T-lymphocytes and their proliferation in the lymph nodes is promoted by a thymic hormone called thymosin . IMMUNE SYSTEM I. and removal of antigens from the blood. Hematopoietic functions include: formation of blood cells during fetal life. Mucous membranes a.3.The Thymus gland: The thymus is bilobed organ which is located in between the lungs. Occasionally the thymus persists and may become cancerous after puberty and and the continued secretion of thymosin and the production of abnormal T-cells may contribute to some autoimmune disorders. Keratinization protects unbroken skin against acids and bases of bacterial enzymes and toxins. storage of red blood cells. The spleen functions in both immune and hematopoietic systems. a meshwork of reticular cells and fibers. 2. The spleen The spleen oval and largest lymphatic mass which filters the blood and reacts immunologically to blood-borne antigens. while red pulp contains large numbers of red blood cells that it filters and degrades. denatures proteins A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 13 . The thymus is fully formed and functional at birth. These are the first line of defense against invasion by pathogens. but it has the capacity for contraction to release this blood into the circulation during anoxic stress. and a rich supply of macrophages which monitor the blood. White pulp in the spleen contains lymphocytes and is equivalent to other lymph tissue. HCl in the stomach kills many pathogens. Non-specific responses General mechanisms for discouraging pathogens which donot require the identity of the pathogen's antigenic nature. damaged and abnormal red cells and platelets. posterior to the sternum. The human spleen holds relatively little blood compared to other mammals. acidic pH b. Characteristic features of thym ic structure persist until about puberty. The thymus is where immature lymphocytes differentiate into Tlymphocytes. Surface Membrane Barriers 1. In addition to large numbers of lymphocytes the spleen contains specialized vascular spaces. Skin a. A.

Natural killer cells. Secondary response. Disrupts metabolism of pathogens II.Clonal selection. Interleukin I. 2. caused by histamine and prostaglandins released by basophils and other cells. Inflammation a.these large lymphocytes lyseand kill tumor and virus-infected cells before activation of a specific immune response.engulf particulates. increases disposal of cell debris and pathogens c. Phagocytes . which pass through the external barriers."non-self" antigen binds to antigen-specific surface receptors on generic B-cell. Due to pyrogens secreted by leucocytes b. Specific Responses This second line of defense responses are activated by. Antigen . including microorganisms.b. Humoral Immunity. Interferons. a.a protein or other substance which elicits immune system activation in a "foreign" host. 4. a bactericide c.multiplication of B-cells produces cells which all contain the same antigen-specificsurface receptor. A. 2.stimulates the immune response 5. Fever a. Non-Specific complement activation b. Lacrimal fluid contains lysozyme d. Saliva contains lysozyme. Anti-microbial proteins a.plasma cells secrete free antibodies of the same structure as the antigen-specific surface receptor. Cellular And Chemical Defenses 1. 3. b. and directed against. Primary response.the B-cell response 1. a specific antigen. Mucus traps organisms B. Antigen challenge. reduces spread of damaging agents to nearby tissues b.block tumor and viral reproduction c. The primary response takes 7 to 10 days to reach maximum antibody levels.memory cells which retain the ability to quickly clone to produce more plasma cells should the antigen be A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 14 . facilitates repair processes d.

Complement protein binds to a site on the constant (Fc) portion of the antibody. Activated Helper cells release A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 15 . Helper T-cells a. respond to antigens complexed by MHC I proteins from infected body cells. 1. Opsonization. Identification of these cells and their antigens is by means of MHC proteins. responses IgA . respond to antigens complexed with MHC II proteins on antigen presenting cells b. They are displayed together with part of the antigen from invading viruses to be recognized by T-cell lymphocytes.antibody complexes which have the following affects: a. B. clone to produce mature cytotoxic cells and cyt otoxic memory cells 2. Agglutination.(dimer) antibody found in secretions IgE .(pentamer) first antibody released by plasma cells during primary response IgG .labeling of antigens or foreign cells b. There are several types of T cells. Antibodies form antigen.(monomer) antigen receptor on B-cell IgM . Cell Mediated Immunity. Precipitation. Complement fixation. attack and kill virus or bacteria-infected cells and tumor cells c. Neutralization.removes soluble antigen from solution e. Generic cytotoxic T-cells a. act as co-stimulator cells for B-cells and other T-cells and.the T-cell response -requires an intermediary cell to be stimulated. 3. mediates inflammation in allergic reaction. There are two classes of MHC antigens: Class I is present on all body cells.encountered again.inactivation of bacterial toxins c. Maintain immunologic surveillance d.which causes cell lysis.(monomer) secreted in mucosa. b. 4. Classes of antibodies:      IgD .(monomer) comprises most circulating antibodies. The secondary response takes from 1 to 2 days to reachmaximum antibody levels. These intermediary cells can be infected body cells or macrophages as below. MHC (Major Histocompatibility Complex) antigens are recognition proteins which identify a cell as being "self". Class II is present only on cells of the immune system.clumping of cell-bound antigens d.

chemical mediators involved in cellular immunity. a. the left atrium and the left ventricle. Interleukin II.stimulates both B and T-cell proliferation B. Interleukin I.regulatory cells which tend toshut down B and T-cell responses. Cardiovascular System Four compartments The heart is divided into 4 chambers: 2 on the right hand side and 2 on the left.c. Blood comes into the heart via the atria. 3. The 4 compartments are known as: the right atrium. the right ventricle. Cytokines. 4. Each upper chamber is known as an atrium and each lower chamber as a ventricle. and is pumped out via the larger ones the ventricles A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 16 . Interleukin II and act as a co-stimulator for an effective B-cell response. Suppressor T-cells. which are the smaller chambers.co-stimulator for activated T-cells b.

Muscle that separates two ventricle from each other. The superior (top) vena cava brings in blood from the head and arms and upper body.Cardiac Muscle that separates two atrium from each other. simultaneously and analogously with those of the right ventricle. the left ventricle is larger and its walls are thicker than those of the right ventricle. the aorta. Interatrial septum.  Superior and inferior vena cava These are the 2 large veins which enter the heart on the right hand side and bring blood low in oxygen into the right atrium.marks the junction of the atria and ventricles. made up of a layer of muscle and elastic tissue. They are the thickest blood vessels. into a large artery. Arterial walls have three layers:  The endothelium Is on the inside and provides a smooth lining for blood to flow over as it moves through the artery.  Arteries Carry blood away from the heart. Coronary sulcus (artioventricular groove). Coronary arteries A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 17 .mark the junction of the ventricles on the front and back of the heart. the inferior (lower) vena cava brings in blood from the trunk and legs the lower body. When the left ventricle contracts.  The media Is the middle part of the artery.  The adventitia Is the tough covering that protects the outside of the artery. respectively. Because a greater blood pressure is required to pump blood through the much more extensive systemic circulation than through the pulmonary circulation. Types of arteries: a. Anterior interventricular sulcus and posterior interventricular sulcus. it pumps oxygenated blood through the aortic semilunar valve.     Interventricular septum. The following events occur in the left ventricle. and throughout the body. The Left Ventricle is the pumping chamber for the systemic circulation. with muscular walls that contract to keep the blood moving away from the heart and through the body.

The two largest veins are the superior and inferior vena cava. Blood that needs oxygen is pumped into them from the right ventricle and they take it to the lungs where it is loaded up with oxygen. while the visceral pericardium is actually a part of the epicardium. They're not as muscular as arteries. but they contain valves that prevent blood from flowing backward. b. The serous pericardium is further divided into two layers. Veins have the same three layers that arteries do. The visceral layer extends into the starting point of great vessels. but are thinner and less flexible. The parietal pericardium is inseparably fused to the fibrous pericardium. This oxygen is brought to the heart by the coronary arteries.  Pulmonary veins The right and left pulmonary veins bring the oxygen-rich blood back from the lungs to the heart into the left atrium. which are the fibrous pericardium and the serous pericardium.  Veins Carry blood back to the heart. Fresh blood full of oxygen is pumped by the left ventricle into the aorta. There are two layers of the pericardial sac. thus. the valves open and blood is pumped from one chamber to another chamber.  Aorta The aorta is the largest artery in the body. Layers of the heart  Pericardium The pericardium is the double walled sac that contains the heart and the roots of the great vessels that leave from or enter the heart. trunk and lower body via the descending aorta. Pulmonary arteries The right and left pulmonary arteries branch off the main pulmonary trunk. becoming one with the parietal layer of the serous pericardium. There are valves separating the chambers of the heart. As the heart beats. which is the outermost single layer of the pericardium. round the aortic arch and out into the upper body via the 3 main arteries branching off the aortic arch and into the thorax.The heart is just a big muscle which pumps blood around the body.  Myocardium A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 18 . The right and left coronary arteries branch off the aorta the large main blood vessel which leaves the heart with fresh oxygen-rich blood so they are ensured of a good blood supply rich in oxygen.  Valves Valves are one-way doors. which are the parietal pericardium and the visceral pericardium.

A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 19 . The cardiac muscle structure consists of basic units of cardiac muscle cells known as myocytes. this is striated in nature. This muscle is involuntary and. Coordinated contraction of the cardiac muscles is what makes the heart propel blood to various parts of the body.The myocardium is the basic muscle that makes up the heart. thin and smooth layer of epithelial tissue that lines the inner surface of all the heart chambers and valves. Each heart valve is formed by a fold of endocardium with connective tissue between the two layers. This layer is made of thin and flat cells that are in direct contact with the blood that flows in and out of the heart.  Endocardium The endocarium is the innermost.

A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 20 . Increased numbers are indicative of chronic inflammation of the urethra and bladder.DIAGNOSTIC LABORATORY RESULTS LABORATORY & HEMATOLOGY RESULTS URINALYSIS REPORT June 12.0 1.2013 INTERPRETATION PHYSICAL PROPERTIES: Color Clarity pH Specific gravity yellow clear 7.030 CHEMICAL PROPERTIES: Normal Normal Normal Normal proteins Glucose negative negative Normal Normal SEDIMENT/MICROSCOPIC EXAMINATION Pus cells (WBC) Red blood cells Coarsely granular Mucus threads 0-2 Normal few Mucus threads are usually present in small numbers.

0 150 . Normal Normal Normal Beginning stages of a decrease in vitamin B12 or folic acid (a type of vitamin) in the body.0 – 10.9 30.5 fL 9.9 fL 8.2 – 5. folate).0 1.0 PDW 7. vitamin B12.0 – 16.0 – 12.5 0.0 – 47.8 0.1 21.8 14.0 – 2.2 43. Conditions in which platelets are used up (consumed) or destroyed faster than normal Normal HEMATOCRIT 27.TEST WHITE BLOOD CELS RED BLOOD CELLS HEMOGLOBIN RESULT 5.2 % MCV MCH MCHC RDW-CV 86.0 27.0 31.5 % % % % % % 17.0 – 3.0 4.1 25.400 Normal Normal infection Normal Normal --Normal 274 10^3/uL A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 21 .0 MPV DIFFERENTIAL COUNT Lymphocyte (%) Neutrophil (%) Monocyte (%) Eusinophils (%) Basophils (%) Bands/scabs (%) PLATELET 7.5 – 35.4 65.5 1.2 4.0 – 31.2 g/dL poor diet/nutrition or malabsorption nutritional deficiency (iron.0 37.0 12.9 fL Pg g/dL % 82.6 UNIT 10^3/uL REFERENCE 5.16 10^6/uL Anemic 8.0 18.0 – 16.0 INTERPRETATION Normal 3.4 12.5 – 10.0 0.0 – 17.4 – 48.0 – 2.4 – 76.0 – 98.

18 5.74 21.73 Orifice VTI Area RATIO Jet Area Cm2 1+ 32% 28% + Grading AORTIC MITRAL TRICUSPID PULMONIC PA PRESSURE 1. moderate to massive pleural effusion suggest follow up check up.49 0.30 / 1.X-RAY REPORT Chest APT here is opacification of the right hemithorax spacing the upper lung with obscuration of the right heart border bilateral hemidiaphragm. True cardiac size is difficult to assess but appears enlarge.39 2.13 / 0.24 1. Aorta is unremarkable Left costophrenic sulcus is intact No other remarkable finding Analysis: Chest Xray suggest that the patient has pleural effusion.13 / 0. The test also suggests that the heart isquite enlarge and could be possibly because of the congestion.21 / 6. 2D ECHO VALVE MAX.08 / 1.66 54mm PAT 97 TRJ QPQS A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 22 .95 1.VELOCITY M/SEC PEAK GRADIEN T mmHg 4.65 / 7. The inability of the heart to pump normallyand allow normal flow of the blood is impaired and tries to accommodate those extra volumes of blood.

PATHOPHYSIOLOGY Predisposing Factors:  Male  Progression from rheumatic heart disease  Genetics Precipitating Factors:  Poverty  Lifestyle  Improper food handling  Uncompliance to medication Presence of Group-A hemolyrtic streptococcus Attach to epithelial cells of the upper respiratory tract Increase production of antigen Binds to receptors in joints. brain and other connective tissue Autoimmune response Attacks the heart valves Inflammation of the layers of the heart Difficulty of the heart to pump Increase cardiac workload Scarring of the heart valves that damages the mitral valve A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 23 . skin.

Restriction of leaflets motion Deformed leaflets resulting to valve failing to close completely Regurgitation of blood with streptococcus Ventricular dilation Left side of the heart fails Right side of the heart fails Increase workload of the heart Increase blood volume in the right ventricle right atrium Left ventricle is weak progressis Impaired gas exchange Decrease lung expansion Blood backs up from the left ventricle to left atrium Blood backs up going back to… Hepatic vein Congestion in the pulmonary vein Hepatomegaly Cardiac cirrhosis Movement of fluid to the alveoli Ascites resulting to abdominal pain. orthopnea. nausea and anorexia Portal vein Liver Pulmonary edema dyspnea.crackles. coughing A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 24 . restless. cyanosis. cheyne stroke respiration.

A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 25 .NURSING CARE PLAN 1. decreased respiratory rate. the patient will be able to demonstrate improved ventilation and adequate oxygenation of tissues. in a semi-Fowler's position as tolerated to allow increased lung expansion because the abdominal contents are not crowding the lungs.  Demonstrate and encourage the client to use pursed-lip breathing to increased use of intercostal muscles. Impaired gas exchange related to fluid shift on alveoli secondary to pulmonary edema Assessment Subjective Cues: ―Ga lisud ko hinga‖ as verbalized Objective Cues:  Use of accessory muscles when breathing  Dyspnea  Orthopnea  Crackles  Cyanosis  Oxygen saturation: 70-90% Goals and Objectives: Short-term:  After 15-30 minutes of nursing intervention. and improved oxygen saturation levels. the patielt will have improve respiration. increased tidal volume. Long-term:  After 8 hours of nursing interventions.  Minimize activities andenergy expenditures byassisting ADL‘s to reduce oxygen and energy demand Evaluation Short-term: After 15-30 minutes of nursing intervention. the patient was able to demonstrate improved ventilation and adequate oxygenation of tissues. Nursing Intervention  Elevated head of bed/position client‘s head appropriately.  Demonstrated and encouraged frequent deep breathing/coughing exercises to promote optimal chest expansion.

the patient has an improved respiration. Goals met.leg exercises when lying down to decrease peripheral venous pooling that may be potentiated by vasodilators. Long-term: After 8 hours of nursing interventions. 2. patient will maintain adequate cardiac output and cardiac index. 3. On low-salt. NURSING INTERVENTIONS AND RATIONALE: Independent: 1. Placed on a moderate high back rest to decreases oxygen consumption and risk of decomposition. 2. low-fat diet to prevent hypertension. Stress importance of accomplishing daily rest periods. alternating rest and activity increases tolerance to activity progression. Decrease cardiac output related to altered stroke volume. Frequent position changes. Administered Digoxin as ordered by the physician to help reduce heart rate.Goals met. ASSESSMENT Objective:  Vital Signs: BP: 100/62 mmhg PR: 112 bpm O2 Sat: 70%-90%  Capillary refill time: 4 seconds  Clammy skin noted GOALS AND OBJECTIVES Short Term  After 2 hours of nursing intervention. A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 26 . Dependent: 1. 4. patient blood pressure will be normalized Long Term:  After 3 days of nursing intervention.

Edema formation.Evaluation: Short Term  After 2 hours of nursing intervention. keep dry. A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 27 . altered nutritional intake. Excess fluid volume related to increased ADH production and sodium/water retention ASSESSMENT Objective:  Edema  Abdominal girth of 30cm  Urine output of 400cc per day GOALS AND OBJECTIVES  After 8hrs of continuous nursing intervention the patient will be able to reduce recurrence of fluid excess as manifested by decrease abdominal girth. Dependent: 2. patient maintained adequate cardiac output and cardiac index as evidence by stable signs. GOALS MET. Administered Furosemide as ordered by the physician to help increase urine output. and prolonged immobility/bedrest are cumulative stressors that affect skin integrity and require close supervision/preventive interventions. Inspect skin surface. patient heart rate is lowered down to 100 GOALS MET. slowed circulation. Elevate feet when sitting. and provide padding. reduce edema NURSING INTERVENTIONS AND RATIONALE: Independent:  Restricted-sodium diet as appropriate to favor the renal excretion of excess fluid.  Instruct in need for antiembolic stockings or bandages as ordered to help promote venous return and to minimize fluid accumulation in the extremities. Long Term:  After 3 days of nursing intervention.  Change position frequently.

A gastric acid-pump inhibitor: Suppresses gastric acid secretion by specific inhibition of the hydrogen-potassium ATPase enzyme system at the secretory surface of the gastric parietal cells. given 80mg to the patient orally to works by interfering with the production of compounds in the body that cause pain. dry skin. fever. blocks the final step of aid production. and blood clots. patient was able to reduce recurrence of fluid excess as manifested by decreased abdominal girth and edema GOALS MET. ASA is also used for rheumatic fever in combination with other medications. antipyretics (fever reducers). fever. coughing up blood or vomit that looks like coffee grounds. or pain lasting longer than 10 days. an Antisecretory drug given 20 mg per orem once a day. cancer in preclinical studies. or stomach pain. severe nausea. vomiting. alopecia. back pain and fever. Stir and have patient drink immediately. swelling. Some are serious Side effects like black. prurits. or crush them. tongue. urticaria. There are signs of an allergic reaction while taking aspirin (the active ingredient contained in Acetylsalicylic Acid) hives. or throat. DRUG STUDY Omeprazole is a generic name of Prilosec. anti-inflammatories (inflammation reducers). fever lasting longer than 3 days. bloody. The nurse should administer before meals. A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 28 . Acetylsalicylic called analgesics (pain acid (ASA) belongs to the group of medications relievers). lips. fill cup with water and have patient drink this water. swelling of your face. or hearing problems. difficulty breathing. Caution patient to swallow capsules whole—not to open. inflammation. It is used to relieve pain. Do not use any other diluents. Forshort-term treatment of active duodenal ulcer and first-line therapy in treatment of the heart burn of symptoms of GERD. empty packet into a small cup containing 2 tbsp of water.Evaluation: Short Term  After 8 hrs of continuous nursing intervention. Adverse effects are rash. If using oral suspension. chew. inflammation. Contraindicated to patients with hypersensitivity to omeprazole or its components and use cautiously with pregnancy. lactation. or tarry stools. and platelet aggregation inhibitors (anticlotting agents). and inflammation in various conditions such as lower back and neck pain.

heartburn. It used to relieve symptoms of allergy. mild diabetes. for milder forms of the disorder in other age groups. blurred vision. assess pain and/or pyrexia one hour before or after medication. runny nose. Contraindicated to people who are allergic to ibuprofen or naproxen or who have salicylate intolerance or a more generalized drug intolerance to NSAIDs. constipation. Indications includes Relief of symptoms associated with perennial and seasonal allergic rhinitis. amelioration of allergic reactions to blood or plasma. This medication works by blocking a certain natural substance (histamine) that your body makes during an allergic reaction. aspirin increases risk of Reye's disease (serious (often fatal) liver & neurological disease). Side effects are Drowsiness. hay fever. drowsiness. vomiting and dizziness caused by motion sickness. Its drying effects on such symptoms as watery eyes and runny nose are caused by blocking another natural substance made by your body (acetylcholine). uncomplicated urticaria and angioedema. and the common cold. Parkinsonism (including drug-induced parkinsonism and extrapyramidal reactions). Diphenhydramine can also be used to help you relax and fall asleep. drink water. itchy eyes/nose/throat. Adverse Effects of Aspirin may causes stomach irritation & bleeding (even more so when consumed with alcohol). manufacturers recommend people with peptic ulcers. suck (sugarless) hard candy or ice chips.especially warfarin which is a special hazard. the risk of stomach bleeding is still increased when aspirin is taken with alcohol or warfarin. Diphenhydramine HCl Oral is the generic term of Benadryl. allergic conjunctivitis. or use a saliva substitute. flu or chicken pox. In long-term therapy monitor renal and liver function and ototoxicity. Owing to its effect on the stomach lining. cough. adjunctive therapy in anaphylactic reactions. And less serious side effects of aspirin may include upset stomach. and in combination with centrally acting anticholinergic antiparkinsonian drugs Syrup formulation: Suppression of cough due to colds or allergy. in the elderly intolerant of more potent agents. Adverse effects A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 29 . Nursing considerations are for patients who have had oral or dental surgery or tonsillectomy in the last seven days avoid chewable or dispersible aspirin tablets. mild. in those <16 yr with virus. and sneezing. or gastritis seeks medical advice before using aspirin. chew (sugarless) gum. stomach upset. itching. watery eyes. Active and prophylactic treatment of motion sicknessNighttime sleep aid. dizziness. 50mg given to the patient orally. and caution should be exercised in those with asthma or NSAIDprecipitated bronchospasm. or dry mouth/nose/throat may occur. These symptoms include rash. or headache.ringing in your ears. To relieve dry mouth. be aware that aspirin is a common constituent of a variety of over-the-counter medications. Even if none of these conditions is present. or aspirin in crushed tablets or gargles. vasomotor rhinitis. dermatographism. It is also used to prevent and treat nausea. assess other medication for possible interactions .

Drug rash with eosinophilia and systemic symptoms (DRESS). Stevens-Johnson syndrome. vomiting. GI disturbances. Vomiting Side effects are Drowsiness. Weigh patient under standard conditions before therapy begins and daily throughout therapy. diarrhea. Impotence. If any of these effects persist or worsen. Contraindications and should not be taken under any circumstance by pregnant women due to the high risk of feminization of male fetuses. dizziness. occur. mitotane. Rash. birth control pills containing drospirenone). and signs of digoxin toxicity. tomatoes. Lab tests: Monitor serum electrolytes (sodium and potassium) especially during early therapy. congestive heart failure) by removing excess fluid and improving symptoms such as breathing problems. Nursing responsibilities are to monitor patient response. sedation. potatoes. Used to treat high blood pressure. urinary retention. heart attacks. Diarrhea. Abdominal cramping. For patients with ascites. Headache. Adverse Effects are Lethargy. and low-salt milk.. or lightheadedness. headache may lightheadedness. lithium. both may indicate tolerance to drug. Consult your doctor or pharmacist for more details. Report lack of diuretic response or development of edema. physician A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 30 . Gynecomastia. Nursing responsibilities are to check blood pressure before initiation of therapy and at regular intervals throughout therapy. Gastritis. drugs that may increase the level of potassium in the blood (such as amiloride. Mental confusion. neonates and lactation. Lowering high blood pressurehelps prevent strokes. Assess for signs of fluid and electrolyte imbalance. Interactions to some products that may interact with this drug include: certain hormones (ACTH). and arrange for adjustment of dosage to lowest possible effective dose and assess for allergy to any antihistamines. This medication is also used to treat low potassium levels and conditions in which the body is making too much of a natural chemical (aldosterone). Spironolactone is the generic name of Aldactone given 100 mg per day per orem. Menstrual disorders. toxic epidermal necrolysis. get up slowly when rising from a seated or lying position. triamterene. blood dyscrasias. monitor digoxin level when used concurrently.g. Nausea. including recommendations. notify your doctor or pharmacist promptly. nausea. Weight is a useful index of need for dosage adjustment. paradoxical stimulation in children.are CNS depression. Monitor daily I&O and check for edema. eplerenone. blurring of vision. dryness of mouth. Precautions are may increase your potassium levels. headache. cyclosporine. To stomach minimize upset. Limit foods high in potassium such as bananas. Contraindicated to Hypersensitivity. and kidney problems. Before using potassium supplements or salt substitutes that contain potassium.digoxin. thickened respiratory secretion. Urticaria. It is also used to treat swelling (edema) caused by certain conditions (e. tacrolimus. consult your doctor or pharmacist.

blood in your urine. nausea. Buerger's disease. or pounding heartbeats. slow. headache. burning. during pregnancy and breastfeeding. feeling anxious. weak or shallow breathing. Observe for and report immediately the onset of mental changes. swelling in your feet or ankles. Monitor urine flow. Raynaud's disease. prescribed for heart failure. pain. cardiac output and blood pressure regularly while taking this medication. ascending tachycardia. other indices of adequate dosage and perfusion of vital organs include loss of pallor. and urinary output at intervals prescribed by physician. or stupor in patients with liver disease. Nursing responsibilities are Monitor blood pressure. vomiting. painful or difficult urination. Serious Side Effects such as. it may persist in some after drug is stopped. Adverse reactions are generally reversible with discontinuation of drug. cold feeling. Dopamine Hydrochlorid is the generic name of Intropin which is an adrenergic and dopaminergic cardiac stimulant. pain. given200 mg per 250 mL IVTT which helps to increases the pumping strength of the heart. complaints of tenderness. and chronic cardiac decompensation as in congestive failure. endotoxic septicemia. urinating less than usual or not at all. renal failure. Contraindications in patients with pheochromocytoma. increase in diastolic pressure. fast. restoration of blood volume with a suitable plasma expander or whole blood should be instituted or completed prior to administration of DOPAMINE. numbness. weakness.may want measurements of abdominal girth. Precise measurements are essential for accurate titration of dosage. Gynecomastia appears to be related to dosage level and duration of therapy. coldness. signs of peripheral ischemia (pallor. chest pain. pulse. Monitor therapeutic effectiveness. or chills. numbness. increase in toe A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 31 . goosebumps. feeling like you might pass out. any allergy. or blue-colored appearance in your hands or feet or darkening or skin changes in your hands or feet while Less serious side effects of dopamine may include. who are taking other medications. Where appropriate. or burning sensation). uncorrected tachyarrhythmias or ventricular fibrillation and hypersensitivity. Indicated for the correction of hemodynamic imbalances present in the shock syndrome due to myocardial infarctions. Precautions are should be exercised in patients with history of thickening and hardening of arteries. open heart surgery. lethargy. disproportionate rise in diastolic pressure (marked decrease in pulse pressure). In addition to improvement in vital signs and urine flow. diabetic endarteritis. even while lying down. cyanosis. mottling. peripheral pulses. Report the following indicators promptly to physician for use in decreasing or temporarily suspending dose: Reduced urine flow rate in absence of hypotension. or swelling around the IV needle. trauma. dysrhythmias. confusion. Blood volume should be corrected before infusion of this medication.

digoxin side effects can be avoided by keeping blood levels within the therapeutic level. can cause serious slowing of the heart rate. alprazolam amiodarone (Cordarone). and mental changes. abdominal pain. Isoptin. Anorexia. Digoxin may be taken with or without food. Digoxin is the generic name of Lanoxin. skin rash. atrial flutter. Serious side effects associated with digoxin include heart block. verapamil). and others. or thiamine levels). Many digoxin side effects are dose dependent and happen when blood levels are over the narrow therapeutic range. dizziness. Niravam). Verelan. dizziness. magnesium. Heart problems and with history of electrolyte or vitamin problems (such as low or high blood potassium. Diarrhea. headache. therefore. spironolactone (Aldactone). The usual starting dose is 0. Digoxin (Lanoxin) is used in the treatment of congestive heart failure and abnormally rapid atrial rhythms (atrial fibrillation. and slow heart rate. beta blockers.temperature. Digoxin has also been associated with visual disturbance (blurred or yellow vision). Common side effects include vomiting. Adverse Effects Dizziness.06250. calcium. skin rash. nausea. Maculopapular rash. high calcium and low magnesium blood levels can increase digoxin toxicity and produce serious disturbances in heart rhythm. Arrhythmia in children (consider a toxicity). 0. which also reduces heart rate. It belongs to a class of medications called cardiac glycosides. the dose of digoxin should be reduced in patients with kidney dysfunction. and itraconazole (Sporanox) can increase digoxin levels and the risk of toxicity. Verelan PM. steady. quinidine (Qunaglute. rapid heartbeat. vomiting. Vomiting. headache. diuretics. such as kidney failure (renal failure).Quinide). Nausea. Xanax XR. and reversal of confusion or comatose state. indomethacin (Indocin. This reduces strain on the heart and helps it maintain a normal. Cardiac dysrhythmia.25 given to the patient orally.Indocin-SR). Contraindicated to Kidney disease. Headache. atrial tachycardia). Mental disturbances. and mental changes. Drug interactions include calcium channel blockers. Common Side effects includes nausea. Covera-HS). Nursing Responsibilities are to A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 32 . Inderal LA) or calcium channel blockers (for example. Digoxin blood levels are used for adjusting doses in order to avoid toxicity.25 mg daily depending on age and kidney function. Drug Interactions to drugs such as verapamil (Calan. The dose may be increased every two weeks to achieve the desired response. Isoptin SR. adequacy of nail bed capillary filling. It works by affecting certain minerals (sodium and potassium) inside heart cells. and strong heartbeat. The co-administration of digoxin and beta-blockers [for example propranolol (Inderal. Digoxin is primarily eliminated by the kidneys. (Xanax. Patients with low blood potassium levels can develop digoxin toxicity even when digoxin levels are not considered elevated. Similarly. and breast enlargement. Therefore.

Contraindicated to Hypersensitivity to cephalosporins. This medication is known as a cephalosporin antibiotic. severe skin reactions. leading to overgrowth of a bacterium called Clostridium difficile. bacteria are not able to survive. Cephalosporins stop or slow the growth of bacterial cells by preventing bacteria from forming the cell wall that surrounds each cell. GI disturbances. and many others. rash.instruct patient to take digoxin at same time each day to ensure steady-state dosing and to contact health care provider for instructions if dose is missed. nephrotoxicity. nausea. vomiting. Adverse effects that are in Large doses can cause cerebral irritation and convulsions. coli. hives. and seizures also may occur. Haemophilus influenzae. Streptococcus pneumoniae. Patients should maintain adequate dietary intake of potassium as directed by health care provider. and mouth ulcers. for example. vaginitis. Cefuroxime is the generic name of Ceftin which is a semisynthetic cephalosporin antibiotic. flu)..g. Emphasize importance of regular follow-up exams to determine effectiveness and to monitor for toxicity. Caution patient to avoid taking OTC medications without consulting health care provider. H2-blockers. Allergic reactions. administration. Overgrowth of this bacterium leads to the release of toxins that contribute to the development of Clostridium difficileassociated diarrhea. It will not work for viral infections (e.This antibiotic treats only bacterial infections. Stevens-Johnson syndrome. and side effects are usually transient which includes diarrhea. Side effects is generally well tolerated. slow absorption of digoxin. such as Staphylococcus aureus. patients allergic to penicillin may develop an allergic reaction (sometimes even anaphylaxis) to cefuroxime. diarrhea. N. Cefuroxime like other antibiotics can alter the colon's normal bacteria. Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness. action. Since cefuroxime is chemically related to penicillin. which may range in severity from mild diarrhea to fatal pseudomembranous colitis. vomiting. Teach patient and family name. nausea. Drugs that reduce acidity in the stomach (for example. adverse reactions. erythema multiforme. chemically similar to penicillin given 250-500 mg twice daily per orem. common cold. Drug interactions to Probenecid increases the concentration of cefuroxime in the blood. And it is use to treat a wide variety of bacterial infections. abdominal pain. gonorrhea. and toxic effects of particular digoxin preparation. proton pump inhibitors) may reduce absorption of cefuroxime. Without a cell wall. epidermal necrolysis and Potentially Fatal: Anaphylaxis. Teach patient and family to take pulse and to seek health care provider's advice for rates less than 60 bpm or more than 100 bpm (adults). pseudomembranous colitis. Nursing Page 33 A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 . It works by stopping the growth of bacteria. The cell wall protects bacteria from the external environment and keeps the contents of the cell together. Antacids and antidiarrheals. Cefuroxime is effective against a wide variety of bacteria. headache. antacids. anemia. E.

such over the counter drugs that she is taking.responsibilities are to assess the History Hepatic and renal impairment. DISCHARGE GOALS  Physical/psychological needs being met  Complications prevented/resolved  Patient‘s understanding about his condition will widen.  Instructed the patient to stay in a calm and clean environment as much as possible to free patient from stress. sensitivity tests DISCHARGE PLAN NURSING PRIORITIES  Enhance comfort and general well being  Minimize complications  Promote a positive emotional response  Provide information regarding the disease condition.  Explained the proper drug dosage and time of intake and as much as possible comply with the drug regimen. lactation. M-EDICATION  Instructed patient about the treatment regimen ordered by the doctors must be followed strictly and should not be stopped to prevent the aggravation of the condition.  Encouraged the client to report or inform the physician. will probably have other effects of the medication given moreover emphasize the right of timing or taking the right interval of these drugs to maximize its effects and avoid further complications  Provided information for better understanding regarding the therapeutic regimen. culture of affected area. A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 34 . Skin status. The full course should be followed.  Informed and explained to the client in simple terms that the other drugs. E-XERCISE  Encourage the patient to have an active and passive ROM because it will promote blood circulation and to improve muscle strength in order to promote total range of motion.  Informed the client about the possible side effects of the medication. if any of these side effects occur. pregnancy. renal function tests. LFTs.

egg etc. patient‘s diet and signs and symptoms of the disease.  Encouraged patient for the compliance of medication regimen to promote optimal health. Most germs are spread by hand-to-mouth contact.  Encouraged patient to visit regularly to the nearest Health Center in to the nearest health care facility. D-IET  Eats foods low in cholesterol.  Eat a variety of foods from the five different foods groups to supply your body with the nutrients it needs. O-UTPATIENT  Reminded patient and the family members to return to Northern Mindanao Medical Center Out Patient Department for follow up check up 1 week prior to discharge. keep them away from your face. fish.  Discouraged patient to participate in strenuous activities that might precipitate stress. to promote fast healing. These periods are usually in the morning or after a nap. and route.  Explain to the significant others the precaution. T-REATMENT/ T-HERAPY  Instructed patient to consult the physician first if what activities must she avoid or put into limits.  Report immediately to the physician if any unusualities occur. Stress the importance of taking medications in a correct dosage.  Wash your hands often. fiber and fruits. Planned your daily activities around the times when you feel more energetic. saturated and salt.  Lifestyle changes often help you continue your daily activities H-EALTH TEACHINGS/ H-YGIENE  Importance of personal hygiene to prevent infection.  Intake of nutritious foods like.  Strict compliance of medication regimen to promote wellness. S-PIRITUAL  Always ask God for guidance in everything especially with her condition.  Make sure that the diet is well-balanced and contains plenty of fiber like vegetables. vegetables and fruits and intake of foods that is rich in protein such as meat.  Praying also for all the people who are helping her with her ups and downs. A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 35 . timing.

our activities as a person at home and beyond have diminished. It is cause by many factors. community. depicts the student nurses need to develop multi-tasking skills A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 36 . and created conflict in some placement areas. While developing our role as a nurse. schools. we were able to work the best we can be because this may help for the patient‘s coping strategy regarding his/her condition by encouraging them either medical or nursing management or also we help them enable for better understanding towards therapeutic regimen. people should have an extra care when it comes to health. ―your learning can oscillate between two extremes. On the other hand. this study also helps us enhance our capability for future nurses and helps us obtain more knowledge. We resent distracting influences. comfort and care.CONCLUSION AND RECOMMENDATIONS Rheumatic heart disease is a condition involving permanent damage to a person's heart. interventions and prevention of illness. all or nothing‖. These could be sourced from. industrial establishments. however. RELATED LEARNING EXPERIENCE Related Learning Experiences (RLEs) are teaching-learning opportunities designed to develop the competencies of students utilizing processes in various health situations. out-patient clinics and general and specialty hospitals. and frequently domestic pressures restrain our desired pace to accumulate factual knowledge. This enthusiasm. Rendering care to everyone who needs it is a real sense of responsibility. Giving care to a patient whether a medical case or surgical case makes no difference. has caused an inhibitory effect on our self-directed researching. It is therefore significant for the nurse caring for the patient to whole-heartedly understand what he/she is doing like in carrying out some basic skills in relation to identified goals. as we attempt to adjust to the demands of both domains. In making this case study. but not limited to: lying-in clinics. We can say that nursing is significant therapeutic and dynamic process. Knowing the precipitating factors leading to the development of this health problem. and an appreciation that each and every daily interaction augments our experienced. Our learning throughout the first year has been helped by an unerring optimism in the value of nursing. As described by Palmer & Spouse.

we know that we can make it as long as we have that determination to finish it. but when we see our patient free from the pain. A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 37 . guidance. as well. for their cooperation during the making of this case study. We thank you for the knowledge you have shared on us. peer-driven University life and home. and teachings of our Clinical Instructor. Sir Hammed Leo Fabre. The conflicts arising from these settings create a disharmony. mentally and physically as they are caught between the cultures of clinical areas. And our learning will always be anchored with the support. The competence of a future nurse is evaluated by evidence-based documents. which we believe for some. Our experience during this rotation adds up not just to our knowledge. The students must be prepared and trained well before their exposure in the clinical areas so as not to commit error. And to the Group 6 RLE 50. there should still be improvement in the learning scheme of the education provider because there is no room for mistakes in the medical profession because it deals with a very fragile thing-life. but to our personality.and a single mistake may cause an enormous damage which is death. Although many have agreed that the student nurses are very effective in delivering their duties and responsibilities in the clinical areas. mentors assignment and examination results and is based on a continuum of regular assessments. has enlightened us despite the very toxic day. as well as the performance level of the student in academic matters. and hearing their appreciation to every care we gave. Our duty days was not that easy as others think of.emotionally. instructors. may undermine nursing as a career choice. The learning experience of a student nurse remarkably influences own practice in clinical areas.

DEFINITION OF WORDS  Streptococcus (Streptococcus pyogenes. the liver is damaged as a result of interruptions to the blood flow. They are often heard only with a stethoscope ("on auscultation").' meaning 'twisted chain. In patients with this condition. Hepatomegaly .  Ventricular dilation – nothing but increase in the diameter of the chamber of the heart.' due to the fact that the bacterium resembles a string of small pearls when viewed under the microscope. or air hunger. causing the person to have to sleep propped up in bed or sitting in a chair.a vein that collects blood from one part of the body and distributes it in another through capillaries.. rattling. or GAS) .is a form of β-hemolytic Streptococcus bacteria. crepitations. or crackling noises that may be made by one or both lungs of a human with a respiratory disease during inhalation.[1] The name derives from the Greek word 'streptos. or rales . Orthopnea .  Portal vein. and fibrous deposits begin to develop. Ascites . It is a gram positive bacterium responsible for a wide range of both invasive and non-invasive infections. shortness of breath (SOB).      Dyspnea . Cardiac cirrhosis . A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 38 .is a gastroenterological term for an accumulation of fluid in the peritoneal cavity. is the subjective symptom of breathlessness.is the failure of an organism in recognizing its own constituent parts as self.  Autoimmunity .are the clicking. which allows an immune response against its own cells and tissues. especially : a vein carrying blood from the digestive organs and spleen to the liver  Crackles.is shortness of breath which occurs when lying flat. Bilateral crackles refers to the presence of crackles in both lungs.is a liver condition caused by chronic heart failure.is the condition of having an enlarged liver.

NOC. Black & Jane Hokanson Hawks Medical-Surgical Nursing: Clinical Management for Positive Outcomes (Single Volume). 7th Edition Brunner and Suddarth's Textbook of Medical Surgical Nursing: In One Volume (Brunner & Suddarth's Textbook of Medical-Surgical Nursing) NANDA.REFERENCES Joyce M. and Interventions A Case Study on Rheumatic Heart Disease – RLE 50 Group 5 Page 39 . and NIC Linkages: Nursing Diagnoses. Outcomes.