Jul. 6, 2019

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  2. RHEUMATIC FEVER  A non-contagious acute fever marked by inflammation and pain in the joints. It chiefly affects young people and is caused by a streptococcal infection.
  3.  The term "rheumatic heart disease" refers to the chronic heart valve damage that can occur after a person has had an episode of acute rheumatic fever. This valve damage can eventually lead to heart failure.
  4. RHD in India  Prevalence: 5/1000 population of 5-15 age group  1 million RHD cases in India
  5.  Rheumatic heart disease describes a group of short-term (acute) and long-term (chronic) heart disorders that can occur as a result of rheumatic fever.  One common result of rheumatic fever is heart valve damage. Every part of the heart, including the outer sac (the pericardium), the inner lining (the endocardium) and the valves may be damaged by inflammation caused by acute rheumatic fever.
  6. ETIOLOGY  Rheumatic heart disease is a chronic heart condition caused by rheumatic fever that can be prevented and controlled. Rheumatic fever is caused by a preceding group A streptococcal (strep) infection.  Treating streptococcal throat with antibiotics can prevent rheumatic fever.
  7. RISK FACTORS Factors that may increase the risk of rheumatic fever include:  Family history (genes)  Type of strep bacteria Certain strains of strep bacteria are more likely to contribute to rheumatic fever than are other strains.  Environmental factors A greater risk of rheumatic fever is associated with overcrowding, poor sanitation, and other conditions that may easily result in the rapid transmission or multiple exposures to strep bacteria. 7/6/2019Free template from 9
  9.  RHD often involves damage to the heart valves. Typically, the damaged heart valve cannot open or shut properly. This interferes with the proper flow of blood through the heart. Without treatment, the damaged valve may continue to deteriorate.
  10.  Rheumatic fever results in rheumatic heart disease and involves;  Valve stenosis. This condition is a narrowing of the valve, which results in decreased blood flow.  Valve regurgitation. This condition is a leak in the valve, which allows blood to flow in the wrong direction.  Damage to heart muscle. The inflammation associated with rheumatic fever can weaken the heart muscle, resulting in poor pumping function. 7/6/2019 12
  11.  Damage to the mitral valve, other heart valves or other heart tissues can cause problems with the heart later in life. Resulting conditions may include: ---Atrial fibrillation, an irregular beating of the upper chambers of the heart (atria) ---Heart failure, an inability of the heart to pump enough blood to the body
  12. SYMPTOMS OF RHD  Chest pain  Heart palpitations  Breathlessness on exertion .  Breathing problems when lying down. 7/6/2019 14
  13.  paroxysmal nocturnal dyspnoea  Swelling (oedema)  Fainting (syncope)  Stroke  Fever associated with infection of damaged heart valves.
  14. DIAGNOSIS Diagnosis may include:  History collection  Physical examination – while a heart murmur may suggest RHD, many patients with RHD do not have a murmur  Medical history – including evidence of past ARF or strep infection 7/6/2019 16
  15.  Chest x-ray – to check for enlargement of the heart or fluid on the lungs  Electrocardiogram (ECG) – to check if the chambers of the heart have enlarged or if there is an abnormal heart rhythm (arrhythmia)  Echocardiogram – to check the heart valves for any damage or infection and assessing if there is heart failure. This is the most useful test for finding out if RHD is present.
  16. TREATMENT Treatment depends on the severity of rheumatic heart disease, but may include:  Hospital admission to treat heart failure  Antibiotics for infection (especially of the heart valves)  Blood-thinning medicine to prevent stroke or thin blood for replacement valves 7/6/2019Free template from 18
  17.  Balloons inserted through a vein to open up stuck valves (VALVULOPLASTY)  Heart valve surgery to repair or replace damaged heart valves.
  18. NURSING MANAGEMENT  Assess the general condition of the patient.  Assess the onset, duration and other characters of pain.  Assess the respiratory pattern of the patient.  Monitor vital signs frequently.  Assess for any peripheral cyanosis.  Check the peripheral pulses of the patient.
  19.  Monitor arterial blood frequently.  Administer oxygen as per order.  Incubate the patient if necessary.  Provide psychological support for the patient and family.  Provide medicines on proper time.
  20. NURSING DIAGNOSIS  Decreased cardiac output related to impaired cardiac valve functions as evidenced by peripheral cyanosis.  Impaired breathing pattern related inadequate cardiac function as evidenced by breathing difficulty.
  21.  Imbalanced nutrition less than body requirement related to breathlessness as evidenced by weight loss  Disturbed sleep pattern related to shortness of breath as evidenced by presence of dark circles around the eyes.
  22.  Activity intolerance related to decreased cardiac activity and laboured respirations as evidenced by difficulty in performing activities of daily living.  Fear and anxiety related to intensive care environment as evidenced by fearful facial expression
  23. Thank uuuuuuu………………. 7/6/2019Free template from 25