Rheumatic

Heart
Disease
01
GROUP 9
Rheumatic Heart Disease

ADRIAN JAMAICA JOEFRELYN ROAN

LEVEL III SN LEVEL III SN LEVEL III SN LEVEL III SN
2
What is RHD?
Definition, Cause & Risk Factors

3
Rheumatic heart disease is a
chronic condition resulting
from rheumatic fever which
involves all layers of the heart
(endocardium, myocardium,
pericardium) and is
characterized by scarring and
deformity of heart valves.

4
The most common valve affected is
mitral and aortic valves. This is a
condition in which permanent damage
to heart valves is caused by rheumatic
fever. The heart valve is damaged by a
disease process that generally begins
with a strep throat caused by bacteria
called Streptococcus, and may
eventually cause rheumatic fever.

5
Cause of RHD

Rheumatic Fever
• an inflammatory disease that can affect many
connective tissues, especially in the heart, joints,
skin, or brain.

6
Etiology

1 2

Group A Rheumatic
beta-hemolytic streptococcus Fever

7
Risk Factors
Climate and season: It occur more in the rainy season and cold
climate

Upper Respiratory Tract Infection: RF is an outcome of upper

respiratory tract infection with a group a beta-hemolytic
streptococcus

Previous History of Rheumatic Fever: Client with prior history of

RF are at risk to develop RHD

Genetic Predisposition: RHD shows a family tendency

8
Pathophysiology
Rheumatic Heart Disease

9
Pathophysiology
Modifiable Factors Non-Modifiable Factors
-Poverty -Age: 5-15 years old
-Overcrowding -Sex: Women
-Environmental Factors -History of Rheumatic F.
  -Genetics
   
 
 
 

Repeated strep infections

10
 Inflamed/scarred heart
valves

Narrowing/leaking
of heart valve

Signs and Symptoms

-Shortness of breath
-Chest pain or discomfort Rheumatic Heart
-Swelling of stomach, hands or joints Disease
-Fatigue
-Rapid/irregular heart beat
11
Signs & Symptoms
Rheumatic Heart Disease

12
Symptoms of rheumatic fever, which
can lead to rheumatic heart disease,
include:
• Swelling, redness and pain in the joints      
• An inflammation of the heart muscle and tissue, causing a rapid heart rate,
fatigue, shortness of breath and exercise intolerance    
• Fever    
• Involuntary movements of the extremities    
• A rash that is often blotchy and not itchy

13
Symptoms of rheumatic
heart disease depend on
the extent and location
of heart damage.
14
Symptoms of heart valve problems,
which can result from rheumatic heart
disease, include:
• Chest pain    
• Excessive fatigue    
• Heart palpitations    
• Shortness of breath    
• Swollen ankles, wrists or stomach    
• Thumping/pounding sensation in the chest

15
Laboratory and
Diagnostic
Procedure
Rheumatic Heart Disease

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The following laboratory suggested to
the patient with Respiratory Failure
are as follows:
• ESR - Erythrocyte Sedimentation Rate is a test that can help to
determine if you have a condition that causes inflammation.
• C - Reactive Protein - it measures the level of c-reactive protein in your
blood. It also used to monitor or find conditions that cause inflammation.
• Leukocytosis - is a common laboratory findings that is often due to
relatively benign conditions such as infections or inflammatory process.

17
The following diagnostic test used to
the patient with Rheumatic Heart
Disease are as follows:
• Chest X-ray - to detect cardiomegaly, pulmonary congestion
• ECG - to examine 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 RHD.

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Pharmacologic and
Surgical
Management
Rheumatic Heart Disease

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Pharmacologic Management:
Antibiotics
1. Benzathine Penicillin G: For sore throat treatment, given in a single
dose. People with a history of rheumatic fever are at high risk of recurrent
attacks of rheumatic fever and developing rheumatic heart disease
following a streptococcal throat infection. Giving penicillin to these
people can prevent recurrent attacks of rheumatic fever and subsequent
rheumatic heart disease.

20
Pharmacologic Management:
Antibiotics
2. Azithromycin inhibits protein synthesis in bacteria by binding to 50s
ribosomal subunits and preventing translocation of peptides. Its advantages
are as follows:
• Suppressing inflammatory process in the heart.
• It is effective orally, no degradation by the gastric acids.
• It is well-absorbed, especially on an empty stomach.
• Due to its high concentration in phagocytes, the drug reaches the
infection site.
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Pharmacologic Management:
Antibiotics
3. Cephalexin is also used and is given orally for 10 days.

22
Pharmacologic Management:
Additional Information

The length of treatment is at least 10 years, and may be longer depending on

the severity of damage to the heart valves.
• Rheumatic fever with carditis and residual heart disease (persistent
valvular disease) - 10 years or until age 40 years (whichever is longer);
lifetime prophylaxis may be needed

23
Pharmacologic Management:
Additional Information

• Rheumatic fever with carditis but no residual heart disease (no valvular
disease) - 10 years or until age 21 years (whichever is longer)
• Rheumatic fever without carditis - 5 years or until age 21 years (whichever
is longer)

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Pharmacologic Management:
Anti-inflammatory
(Steroids/NSAIDS)
The manifestations of acute rheumatic fever (including carditis) typically
respond rapidly to therapy with anti-inflammatory agents. Aspirin, in anti-
inflammatory doses, is the drug of choice. Prednisone is added when evidence
of worsening carditis and heart failure is noted.

25
Pharmacologic Management:
Anticoagulant
To prevent stroke or thin the blood for valve replacement. When
mechanical heart valve replacements are used during surgery, clots can form
around the valve – blood thinning medication is used to prevent this.
Anticoagulants, more commonly referred to as “blood thinners,” work
by inhibiting the clotting factors.

26
Pharmacologic Management:
Antiplatelet
Antiplatelets work by making your blood less sticky. This prevents
arteries and stents from being plugged by clots. Antiplatelets work by
inhibiting the enzymes that cause the platelets to clump together. Aspirin was
administered as the sole antiplatelet agent in 147 patients following valve
replacement, who were at low risk for thromboembolism. In conclusion,
aspirin as the sole antiplatelet agent appears to be safe and effective following
prosthetic valve replacement in selected patients. It is used to prevent
thromboembolic complications.
27
Surgical Management:
Valvotomy
Surgical valvotomy is a procedure done to open up a valve. It is done by
cutting in to the valve leaflets which have become sealed. It is often done to
treat pulmonary stenosis and aortic stenosis. It is a minimally invasive
procedure wherein a doctor uses a thin flexible tube (catheter) inserted
through an artery in the groin or arm and threaded into the heart. When the
tube reaches the narrow mitral valve, a balloon device located on the tip of the
catheter is quickly inflated.

28
Surgical Management:
Valvuloplasty
A valvuloplasty, also known as balloon valvuloplasty is a procedure to
repair a heart valve that has a narrowed opening. In a narrowed heart valve,
the valve flaps (leaflets) may become thick or stiff and fuse together
(stenosis). This reduces blood flow through the valve. Balloon is inserted
through a vein to open up stuck valves.

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Surgical Management:
Mitral Valve Replacement
An open mitral valve replacement is a surgery to replace a poorly
working mitral valve with an artificial valve. The mitral valve is 1 of the
heart's 4 valves. It helps blood flow through the heart and out to the body. The
mitral valve lies between the left atrium and the left ventricle. It is performed
with open-heart surgery, which involves a cut (incision) in the chest. In some
cases, mitral valve repair surgery may be performed with minimally invasive
heart surgery, in which surgeons perform the procedure through small incision
in the chest.
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Drug Study
Rheumatic Heart Disease

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Antibiotic
Drug Study #1

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Name of Dosage Mechanism of Indication Contraindication Adverse Nursing Responsibility
Drug Action Reaction

Generic: Dosage: Interferes with Severe infections Benzathine Nausea, vomiting Before

Penicillin G 1.2 million bacterial cell caused by penicillin is , diarrhea - Observe 12 rights of
Benzathine units (>27) wall synthesis sensitive contraindicated in Itching, drug administration
  and 0.6 during active organisms(strept patients who have sweating, allergic - Reduce dosage with
Brand: million multiplication, ococci) had a previous reaction hepatic or renal failure.
Penadur units causing cell wall   anaphylactic - Assess for
  (<27kg) death and URTI caused by reaction or serious Flushing hypersensitivity to drug.
Drug   resultant sensitive skin reaction to any - Assess for any
class: Route: IM bactericidal streptococci. penicillin, for Feeling anxious, contraindications to the
Antibiotic activity against   example, Steven- nervous, weak, or drug.
susceptible Treatment of Johnson or toxic tired - Educate about side
bacteria syphilis, bejel, epidermal necrosis. headache,  effects of drug.
congenital and precaution for dizziness,
syphilis, pinta, renal disorder drowsiness During
yaws, - Drug is not for IV use.
prophylaxis of Do not inject or mix with
rheumatic fever other IV solutions.
and chorea.

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Name of Dosage Mechanism of Indication Contraindication Adverse Nursing Responsibility
Drug Action Reaction

Muscle or joint - Give IM injection in

pain or pain, upper outer quadrant of
swelling, the buttock. deltoid
bruising, or a - Avoid contact with the
hard lump where needle.
an injection was - Withdraw needle as
given. quickly as
possible to avoid
discomfort.
- Stay with patient
throughout whole
duration of administration.

After
-Monitor client for at least
30 minutes.

34
Name of Dosage Mechanism of Indication Contraindication Adverse Nursing Responsibility
Drug Action Reaction

- Arrange for regular

follow-up, including blood
tests, to evaluate effects.
- Instruct to report
difficulty
breathing, rashes, severe
pain at
injection site, mouth sores,
unusual
bleeding or bruising.
- Instruct to take
medication as prescribed

35
Anti-Inflammatory
(Steroids)
Drug Study #2

36
Name of Dosage Mechanism of Indication Contraindication Adverse Nursing Responsibility
Drug Action Reaction

Generic: Dosage Inhibits Indicated for Contraindicated for Frequent: Before:

Prednison PO: accumulation of patient with cute superficial Insomnia, -Monitor B/P, serum
e Adults, inflammatory arthritis, herpes simplex heartburn, electrolytes, glucose,
  elderly: 5– cells at rheumatic keratitis, systemic nervousness, results of bone mineral
Brand: 60 mg/day inflammation carditis; allergic, fungal infections, abdominal density test.
Prednison in sites, collagen, varicella, distention, -Be alert to infection (sore
e intensol Divided phagocytosis, intestinal tract, administration of diaphoresis, throat, fever, vague
  doses. lysosomal multiple live Acne, mood symptoms).
Drug   enzyme sclerosis or attenuated virus swings, increased  
class: Children: release/synthesis exacerbations; vaccines. appetite, During:
Adrenal 0.05–2 , release of liver, ocular, Facial flushing, -Take this medicine
Corticoste mg/kg/ mediators of renal, skin delayed wound with food or milk to avoid
roid and Day in 1–4 inflammation. diseases; healing, stomach irritation.
Glucocort divided bronchial Increased -Swallow the delayed-
icoid doses. Prevents/ asthma, susceptibility to release tablet whole. Do
  suppresses cell- cerebral edema, infection, not crush, break, or chew
mediated malignancies. diarrhea, it.
immune constipation.
reactions.

37
Name of Dosage Mechanism of Indication Contraindication Adverse Nursing Responsibility
Drug Action Reaction

Decreases/ -Measure the oral liquid

prevents tissue with a marked measuring
response to spoon, oral syringe, or
inflammatory medicine cup.
process.
After:
-Report fever, sore throat,
muscle
aches, sudden weight gain,
swelling, loss
of appetite, or fatigue.

38
Anti-Inflammatory
(NSAIDS)
Drug Study #3

39
Name of Dosage Mechanism of Indication Contraindication Adverse Nursing Responsibility
Drug Action Reaction

Generic: Dosage: Inhibits Treatment of History of Nausea, Before:

Ibuprofen Adults, prostaglandin fever, juvenile hypersensitivity to vomiting, -Assess onset, type,
  Elderly, synthesis. rheumatoid aspirin, and dyspepsia, location, duration of
Brand: Children For the arthritis (JRA), NSAIDs. dizziness, rash. pain, and inflammation.
Advil 12 Yrs therapeutic osteoarthritis, Treatment of peri- -Assess temperature.
  And Older: effect: it minor to operative pain in -Assess allergy to NSAIDs
Drug 200–400 produces moderate pain, coronary artery During:
Class: Mg Q4–6h analgesic. primary bypass -Administer drug with
NSAIDS, Pr N For the anti- dysmenorrhea. graft (CABG) food or after meals if GI
And   inflammatory surgery. upset occurs.
Antirheu Route: effects: it After:
matic Oral decreases fever. -Monitor for evidence of
nausea, dyspepsia.
-Monitor CBC
-Monitor for fever.

40
Anticoagulant
Drug Study #4

41
Name of Dosage Mechanism of Indication Contraindication Adverse Nursing Responsibility
Drug Action Reaction

Generic: Individuali Warfarin Prophylaxis & Hypersensitivity. Significant: Ac Before:

Warfarin zed dosage competitively treatment of Hemorrhagic ute kidney -Assess for signs of
  & duration inhibits the venous tendency or blood injury. Rarely, bleeding and hemorrhage
Brand: of vitamin K thrombosis, dyscrasias. Recent or skin necrosis or (bleeding gums;
Coumadin treatment. epoxide atrial fibrillation contemplated surgery gangrene, nosebleed; unusual
  Initially 2- reductase w/ embolization, of CNS, eye or hypersensitivit bruising; tarry, black
Drug 5 mg daily. complex 1 pulmonary traumatic surgery y reactions. stools; hematuria; fall in
Class:   (VKORC1), embolism, resulting in large G.I. hematocrit or BP; guaiac-
Anticoagu Maintenan which is an adjunct in open surfaces. disorders: Nau positive stools, urine, or
lant ce: 2-10 essential enzyme prophylaxis of Bleeding tendencies sea, vomiting, nasogastric aspirate).
mg daily. for activating the systemic associated w/ active diarrhoea, -Assess for evidence of
vitamin K embolism after ulceration or overt abdominal additional or increased
available in the MI & in bleeding of GI, pain, thrombosis. Symptoms
body. Through treatment of genitourinary or resp flatulence, depend on area of
this mechanism, coronary tracts; pancreatitis, involvement.
warfarin can occlusion. melaena, taste
perversion.

42
Name of Dosage Mechanism of Indication Contraindication Adverse Nursing Responsibility
Drug Action Reaction

deplete cerebrovascular General During:

functional hemorrhage; disorders and -Administer medication at
vitamin K cerebral administration same time each day.
reserves and aneurysms, site Medication requires 3–5
therefore reduce dissecting aorta; conditions: Feve days to reach effective
the synthesis of pericarditis & r, chills. levels; usually begun
active clotting pericardial Hepatobiliary while patient is still on
factors. The effusions; bacterial disorders: Hepat heparin.
hepatic synthesis endocarditis. ic dysfunction, -Do not interchange
of coagulation Threatened jaundice. brands; potencies may not
factors II, VII, abortion, eclampsia Investigations:  be equivalent.
IX, and X, as & preeclampsia. Decreased Hb After:
well as Unsupervised and haematocrit. -Advise patient to report
coagulation patients w/ senility, Renal and any symptoms of unusual
regulatory alcoholism, urinary bleeding or bruising
factors protein C psychosis or lack disorders: Haem (bleeding gums;
and protein S, aturia. nosebleed; black, tarry
stools;

43
Name of Dosage Mechanism of Indication Contraindication Adverse Nursing Responsibility
Drug Action Reaction

require the of patient Skin and hematuria; excessive

subcutaneous tissue
presence of cooperation. menstrual flow) and pain,
disorders: Alopeci
vitamin K. Spinal puncture. color, or temperature
a, rash,
Vitamin K is an Major regional, change to any area of your
dermatitis,
essential lumbar block body to health care
purpura.
cofactor for the anesth, malignant professional immediately. 
Vascular
synthesis of all HTN. Pregnancy. -Instruct patient not to
disorders: Vascu
of these vitamin drink alcohol or take other
litis.
K-dependent Rx, OTC, or herbal
Potentially
clotting factors. products, especially those
Fatal: Haemorrh
containing aspirin or
age,
NSAIDs, or to start or stop
calciphylaxis,
any new medications
Rarely, purple
during warfarin therapy
toes resulting
without advice of health
from
care professional.
atheroemboli/cho
lesterol
embolism.

44
Antiplatelet
Drug Study #5

45
Name of Dosage Mechanism of Indication Contraindication Adverse Nursing Responsibility
Drug Action Reaction

Generic: Dosage: Dipyridamole A platelet Hypersensitivity to Dizziness, Before:

Persantine The dosage appears to act in inhibitor used to dipyridamole and stomach upset, -Prior to the
  is based on vivo by prevent blood any of the other diarrhea, administration of
Brand: the severity synergistically clots after heart components. vomiting, medications, the nurse
Dipyrida of you modifying valve headache, and must check and validate
mole condition several replacement flushing may the medication order.
  and biochemical surgery. occur as your -Conduct thorough
Drug response to pathways, This medication body adjusts to physical assessment before
Class: treatment. including: a) is used in the medication beginning drug therapy to
Antiplatel   inhibition of combination establish baseline status,
et platelet cAMP- with "blood determine effectivity of
phosphodiesteras thinners" such as therapy, and evaluate
e; warfarin to keep potential adverse effects.
b) potentiation clots from
of adenosine forming after
inhibition of heart valve
platelet function replacements.
by blocking

46
Name of Dosage Mechanism of Indication Contraindication Adverse Nursing Responsibility
Drug Action Reaction

The usual reuptake by Dipyridamole is -Follow the 10 rights of

dose for vascular and an antiplatelet medication administration
slow- blood cells, and drug. It helps to (Medication, dose, time or
release subsequent keep blood frequency patient, route,
capsules is degradation of flowing by client education,
200mg,
adenosine. stopping documentation, right to
taken twice
a day. The platelets from refuse assessment and
usual dose clumping evaluation.
for tablets together and by During:
and liquid keeping heart -Ensure that the client will
is 300mg to blood vessels take the medication given.
600mg, open. After:
taken 3 or 4 -Monitor patient for any
times a day unusual effect from drug.
Frequency:
q 2-4/day

47
Name of Dosage Mechanism of Indication Contraindication Adverse Nursing Responsibility
Drug Action Reaction

-Obtain baseline status for

complete blood count and
clotting studies to
determine any potential
adverse effects.

48
Nursing Care Plan
Rheumatic Heart Disease

49
Activity Intolerance
NCP #1

50
Assessment Diagnosis Outcome Planning Intervention Evaluation

Subjective: Activity After nursing Short Term: Independent: Short Term:

“Nanghihina intolerance intervention, After 3 hours of Establish rapport to the client After 3 hours of
at related to the client will nursing Rationale: To gain trust and full nursing
nahihirapan decrease be able to: interventions the cooperation of the client. interventions the
akong cardiac output   patient will be   patient was able to
huminga as evidence by -Verbal able to Monitor vital signs and cardiac rhythm demonstrate a
kapag nag- dyspnea and response to demonstrate a during and after activities. decrease in
eexcercise fatigue reduced decrease in Rationale: Identifies the cardiopulmonary physiologic signs
ako” as fatigue. physiologic signs status of the client needed to help of intolerance.
verbalized by   of intolerance. determine the ability to tolerate an Long Term:
the patient. -Participate in Long Term: activity. After 2 days of
  desired After 2 days of nursing
Objective: activities. nursing intervention,
Dyspnea intervention, patient was able to
Fatigue patient will be identify techniques
  able to identify to enhance activity
techniques to intolerance and
enhance activity participate
intolerance willingly in desired
activities.

51
Assessment Diagnosis Outcome Planning Intervention Evaluation

Vital signs and participate Assess the client’s activities of daily living,
taken as willingly in as well as actual and
follows: desired activities. perceived limitations to physical activity.
T: 36.5oC Ask for any form of exercise that he used to
PR: 55 bpm do.
Rationale: To create a baseline of activity
RR: 11 cpm
levels and mental status related to fatigue
BP: 129/90 and activity intolerance
mmHg
Encourage physical activity, develop
proper client exercise
programs, and ensure they are followed
regularly to help prevent muscle atrophy
and strengthen the client’s cardiovascular
system
Rationale: Physical activity can also have
a positive effect on the client’s
psychological status

52
Assessment Diagnosis Outcome Planning Intervention Evaluation

Allow and encourage proper rest periods

in between individual exercises to ensure
optimal performance during sessions.
Rationale: To create a baseline of activity
levels and mental status related to fatigue
and activity intolerance.
 
Eliminate nonessential activities or
procedures
Rationale: To conserve energy output,
conserve strength for important activities,
and ensure adequate rest.

Maintain the gradual progression of

activities
Rationale: To improve performance over
time and to gradually increase the client’s
tolerance to physical activity.

53
Assessment Diagnosis Outcome Planning Intervention Evaluation

Teach deep breathing exercises and

relaxation techniques.
Rationale: To allow the client to relax
while at rest and to facilitate effective
stress management.
 
If client feel symptoms of activity
intolerance such as dizziness or their
condition has worsened, encourage them
to stop their activity until they
recover
Rationale: To avoid more complication

Collaborative:
Refer to physiotherapy or occupational
therapy team as required.
Rationale: to provide a more specialized
care for the client.

54
Risk for Infection
NCP #2

55
Assessment Diagnosis Outcome Planning Intervention Evaluation

Subjective: Risk for After all the Short Term: Independent: Short Term:
“Nanghihina infection nursing After 8 hours of Develop a therapeutic relationship After 8 hours of
po ako“ as related to interventions nursing between and among the patient and performing nursing
verbalized by compromised the client will intervention the significant others. intervention the
the patient host defense be: client will Rationale: This allows the patient to gain client’s vital signs
  as evidenced   manifest normal trust from the nurse and will boost are stable and
Objective: by sore and Free from any vital signs and confidence in the completion of the showed absence of
Sore and scratchy throat nosocomial absence of signs treatment. signs and
scratchy and neutrophil infections and symptoms of   symptoms of
throat count of < 600 while in the infection. Maintain strict asepsis for dressing changes, infection.
VS taken as hospital. Long Term: wound care, intravenous therapy, and Long Term:
follows:   After 1 day of catheter handling. After 1 day of
T: 38.2C Able to nursing Rationale: Aseptic technique decreases the performing nursing
PR: 60 verbalize the 5 intervention the chances of transmitting or spreading intervention the
pathogens to or between patients.
RR:16 moments of client will client
Interrupting the chain of infection is an
BP: 120/80 hand hygiene demonstrate the effective way to prevent the spread of demonstrated
Neutrophil proper hand infection. proper hand
count: <600 washing washing technique
technique and Ensure that any articles used are properly and understand 5
understanding the disinfected or sterilized before use. moments of hand
5 moments of Rationale: This reduces or eliminates hygiene.
hand hygiene. germs.

56
Assessment Diagnosis Outcome Planning Intervention Evaluation

Able to Wash hands or perform hand hygiene

verbalize the before having contact with the patient.
importance of Also, impart these duties to the patient
encouraging and their significant others and know the
family and instances when to perform hand hygiene
friends to stay or “5 moments for hand hygiene”.
at home until Rationale: Friction and running water
his effectively remove microorganisms from
neutropenia hands. Washing between procedures
resolves reduces the risk of transmitting pathogens
from one area of the body to another.
Wash hands with antiseptic soap and
water for at least 15 seconds, followed by
an alcohol-based hand rub. If hands were
not in contact with anyone or anything in
the room, use an alcohol-based hand rub
and rub until dry. Plain soap is good at
reducing bacterial counts, but
antimicrobial soap is better, and alcohol-
based hand rubs are the best.

57
Assessment Diagnosis Outcome Planning Intervention Evaluation

Educate clients and SO (significant other)

about appropriate cleaning, disinfecting,
and sterilizing items.
Rationale: knowledge of ways to reduce
or eliminate germs reduces the likelihood
of transmission.
 
Encourage intake of protein-rich and
calorie-rich foods and encourage a
balanced diet.
Rationale: Proper nutrition and a
balanced diet support the immune
systems’ responsiveness and enhance the
health of all the body’s tissues. Adequate
nutrition enables the body to maintain
and rebuild tissues and helps keep the
immune system functioning well.

58
Assessment Diagnosis Outcome Planning Intervention Evaluation

Perform measures to break the chain of

infection and prevent infection.
Rationale: The following methods help
break the chain of infection and prevent
conditions that may be suitable for
microbial growth:
Change dressing and bandages that are
soiled or wet.
Assist clients in carrying out appropriate
skin and oral hygiene.
Dispose of soiled linens properly.
Ensure all fluid containers are covered or
capped.
Avoid talking, coughing, or sneezing over
open wounds or sterile fields.
Wear gloves when handling patient
secretions.
Instruct clients to perform hand hygiene
when handling food or eating

59
Assessment Diagnosis Outcome Planning Intervention Evaluation

Encourage increased fluid intake unless

contraindicated (e.g., heart failure, kidney
failure).
Rationale: Fluids help promote diluted
urine, frequent emptying of the bladder,
and reducing the stasis of urine. This
ultimately reduces the risk of bladder
infection or urinary tract infection.
Increased fluid intake also helps replace
fluid lost during fever and helps thin
secretions.
 
Encourage sleep and rest.
Rationale: Adequate sleep is an essential
modulator of immune responses. A lack of
sleep can weaken immunity and increased
susceptibility to infection.

60
Assessment Diagnosis Outcome Planning Intervention Evaluation

Teach the importance of avoiding contact

with individuals who have infections or
colds.
Rationale: Other people can spread
infections or colds to a susceptible
patient through direct contact,
contaminated objects, or air currents.
 
Dependent:
Administer antibiotic as prescribed such
as benzathine penicillin G.
Rationale: Antibiotic therapy reduced the
incidence and mortality rate of rheumatic
heart disease it also used to prevent
further infection.

61
References
Rheumatic Heart Disease

62
References

• Coumadin Full Prescribing Information, Dosage & Side Effects | MIMS

Philippines. (n.d.). MIMS Philippines. Retrieved October 29, 2021, from
https://www.mims.com/philippines/drug/info/coumadin?type=full
• Gartlan, W. A. (2021, October 21). NCBI - Benzathine Penicillin. National
Center for Biotechnology Information. Retrieved October 27, 2021, from
https://www.ncbi.nlm.nih.gov/books/NBK507723/
• Hodgson, B. B., & Kizior, R. J. (2016). Saunders nursing drug handbook.
Philadelphia: Saunders.

63
References

• John, S. (1994, October). NCBI - Use of Aspirin. National Center for

Biotechnology Information. Retrieved October 23, 2021, from
https://pubmed.ncbi.nlm.nih.gov/7797223/
• Martin, P. B. (2019, April 9). 4 Acute Rheumatic Fever Nursing Care Plans.
Nurseslabs. Retrieved October 29, 2021, from https://nurseslabs.com/acute-
rheumatic-fever-nursing-care-plans/#activity_intolerance

64
References

• Palisoc, D. (n.d.). Penicillin G Benzathine-Drug Study. Scribd. Retrieved

October 26, 2021, from
https://www.scribd.com/document/38516435/Penicillin-G-Benzathine-Drug-
Study
• Rheumatic Heart Disease. (n.d.). Johns Hopkins Medicine. Retrieved
October 26, 2021, from https://www.hopkinsmedicine.org/health/conditions-
and-diseases/rheumatic-heart-disease
• Rheumatic heart disease. (n.d.). Baptist Health. Retrieved October 26, 2021,
from
https://www.baptisthealth.com/services/heart-care/conditions/rheumatic-
65
heart-disease
References

• Rheumatic Heart Disease - Health Encyclopedia - University of Rochester

Medical Center. (n.d.). University of Rochester Medical Center. Retrieved
October 29, 2021, from
https://www.urmc.rochester.edu/encyclopedia/content.aspx?
ContentTypeID=85&ContentID=P00239
• Rheumatic Heart Disease. (2020, November 6). World Health Organization.
Retrieved October 29, 2021, from https://www.who.int/news-room/fact-
sheets/detail/rheumatic-heart-disease

66
References

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Thank you!

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