Lyceum of the Philippines University-Batangas College of Nursing

A Partial Requirement in Level 3 Case Analysis of Rheumatic Heart isease

Prepare! to" #rs$ %illano R$N Clinical &nstructor

A ocumentation Prepare! 'y" B(N &&& -)

*st (emester (+ ,--. - ,-*-

I.

Introduction Acute rheumatic fever/ 0hich occurs most often to school-age chil!ren/ may !evelop after an episo!e of group A 'eta-hemolytic streptococcal pharyngitis$ Patients 0ith rheumatic fever may !evelop rheumatic heart !isease as evi!ence! 'y a ne0 heart murmur/ car!iomegaly/ pericar!itis/ an! heart failure$ Rheumatic heart !isease is a con!ition in 0hich permanent !amage to heart valves is cause! 'y rheumatic fever$ &t is an acute / recurrent inflammatory !isease that causes !amage to the heart as a sequela to group A 'eta-hemolytic streptococcal infection/ particularly the veavles/ resulting in valve lea1age 2insufficiency3 an! or o'struction 2narro0ing stenosis3$ 4he heart valve is !amage! 'y a !isease process that are generally 'egins 0ith a strep throat cause! 'y streptococcus$ Bacteria that may eventually cause rheumatic fever$ 4here are associate! compensatory changes in the si5e of the heart6s cham'er an! the thic1ness of cham'er 0all$ The effect of rheumatic fever: Rheumatic fever/ an inflammation !isease can affect many connective tissues/ especially in the heart 7oints/ s1in or 'rain$ Rheumatic fever can occur at any age 'ut usually occurs in chil!ren five 283 to fifth teen 2*83 years ol!$ Rheumatic fever causes heart !amage/ particularly scarring of the heart valves/ forcing the heart to 0or1 har!er to pump 'loo! an! may eventually cause congestive heart failure$ The symptoms of rheumatic fever" 4he follo0ing are the most common symptoms for rheumatic fever9 ho0ever/ each in!ivi!ual may e:perience symptoms !ifferently$

(ymptoms/ 0hich may vary greatly typically 'egin one 2*3 to si: 2;3 0ee1s after a'out of strep throat/ although/ in some cases/ the infection may have 'een to mil! to have 'een recogni5e!$ (ymptoms may inclu!e" <ever/ s0ollen/ ten!er/ re! an! e:tremely painful 7oints-particularly the 1nees/ an1les/ el'o0s or 0rist/ no!ules/ over s0ollen 7oints/ re!/ raise!/ lattice-li1e rash/ usually on the chest/ 'ac1/ an! a'!omen$ Uncontrolle! movements of arms/ legs/ or facial muscles$ 0ea1ness an! shortness of 'reath$ 4he symptoms of rheumatic fever may resem'le other 'one !isor!ers or me!ical pro'lems$ Treatment for rheumatic heart disease: +our physician 0ill !etermine specific treatment for rheumatic heart !isease 'ase! on" *$ +our over all health an! me!ical history$ ,$ e:tent of the !isease 3$ your tolerance for specific me!ication proce!ure or therapies =$ e:pectation for the cause of the !isease 8$ your opinion or preference since rheumatic fever is the cause of rheumatic heart !isease/ the 'est treatment is to prevent rheumatic fever from occurring$ Penveillin an! other anti'iotics can usually treat strep throat 2a streptococcus A 'acterial infection3/ an! stop acute rheumatic fever from !eveloping$ Person 0ho have previously contracte! rheumatic fever are often given continuous 2!aily or monthly3 an! lo0er the ris1 of heart !amage$ Anti'iotics therapy has sharply re!uce! the inci!ence an! mortality rate of rheumatic fever> rheumatic heart !isease$ 4o re!uce inflammation/ aspirin/ steroi!s/ or non-steroi!al me!ication may 'e given$ (urgery may 'e necessary to repair or replace the !amage valve$

II.

Objectives

General Objectives: 4he stu!y aims to !evelop certain competencies-cognitive/ psychomotor an! affective-of the stu!ent nurses an! to esta'lish critical thin1ing a'ilities for patients 0ith Rheumatic Heart isease

Specific objectives: At the en! of the stu!y/ the stu!ent 0ill 'e a'le to" *$ Provi!e information regar!ing the general overvie0 of the !isease/ it6 s !escription/ an! it6s inci!ence rate in the country$ ,$ (tate the patient6s profile/ past me!ical history/ personal an! social an! family history as 0ell as history of present illness 3$ Asses the physical appearance of the patient an! recogni5es the clinical manifestation of the !isease$ =$ &!entify/ interpret an! relate la'oratory e:amination an! !iagnostic test in!icate! in it6s significant fin!ing 0ith proper application of critical thin1ing s1ills 8$ Analy5e the anatomical parts an! functions of the heart$ ;$ ?:plain the nature an! i!entify the cause an! !isease process$ @$ Utili5e the nursing process in the !elivery of the care 'ase! in the client6s nee!s an! concerns$

)$ ?numerate an! analy5e the !rugs that ha! 'een a!ministere! to the patient$ .$ Provi!e information in the prognosis an! !ischarge planning inten!e! to the patient6s con!ition$ *-$ Apply metho!s of prevention an! management of Rheumatic Heart isease

III.

Patient's Profile Name: R$ AA ddress: Ayala/ Po'lacion !ate of "irth: April 3/ *.)@ Se$:#ale %ivil Status: (ingle &eli#ion: Roman Catholic Nationality: <ilipino !ate of dmission: August *3/ ,-*39 ."38 am ttendin# Physician: ra$ ?n!aya #e" ,;

%hief %omplaint: Cough for * month dmittin# !ia#nosis: High 'loo! pressure/ Rheumatic Heart isease/ 4>C (ei5ure isor!er

'inal !ia#nosis: (evere Hypertension 0ith un1no0n etiology/ Rheumatic Heart isease/ 4>C (ei5ure isor!er

I(.

%linical ppraisal

a. Past health history C$A is an ** year ol! chil! 0ho ha! complete! the immuni5ation vaccines$ Her common illness is fever/ cough an! col! an! is relive! 'y ta1ing Paracetamol 2Neo5ep3$ 4here is no presence of allergy from foo!s an! other !rugs or me!ications$ (he ha! history of !og an! 'ee 'ite$ Bhen she 0as a 1i! she encountere! tricycle acci!ent$ <irst attac1s -Cune that6s 0hy she is not a'le to go to school for her ;th gra!e in elementary level$ Her father !i!n6t 1no0 0hat to !o e:cept 'y screaming of 0hat he 0as sa0 !uring her sei5ure$ He !oesn6t even 1no0 0hat 0ill 'e the right treatment for

the$ ,n! attac1 happene! last August ,--.$ (he 0as 'rought 'y her father to the hospital for proper consultation an! treatment$ Captopril/ ia5epam 0ere the prescri'e! me!ications for her thir!

attac1$ Her thir! attac1 happene! 0hen she 0as confine! in the hospital$ Bhen she is un!er sei5ure attac1s/ she 'ecomes irrita'le b. 'amily history C$A is the youngest chil! among her si'lings$ Dn her father si!e/ she has a history of ia'etes #ellitus/ an! her father a!!e! that they !o not have any health history of hypertension/ heart !isease an! here!itary !isease$ (he !oesn6t 0ant to tal1 everything a'out her mother for some confi!ential purposes$ c. Personal history As li1e 0hat the typical chil!ren !o/ this cheerful girl is fon! of playing games$ But she a!!e! that she stoppe! playing outsi!e 'ecause she is ol! enough to !o so$ As a gra!uating stu!ent/ she has 'een an honor stu!ent of their 'atch$ At present/ her sleep an! rest pattern is irregular 'ecause of some health !istur'ances$ 4hough she eat 7un1 foo!s often times/ she love to eat green leafy vegeta'les especially 1ang1ong$ d. Social history Last Cune/ she starte! e:periencing (ei5ure that lea!s her to stop from school$ (he is living 0ith her father an! financially supporte! 'y her 'rother6s a'roa!$ 4heir neigh'orhoo! is their relatives 0hom they have goo! communication an! relationship$ 4hey consult health center for me!ical assistance$ e. Psycholo#ical history C$A$ haven6t e:perience! any emotional !istresse!$ Her father help her to cope up 0ith those pro'lems that may affect her$ 4here6s a presence of eye contact/ cooperation an! responsiveness in our communication 0ith her$

f. )istory of Present Illness Patient is hypertensive an! non !ia'etic 0ho 0as a!mitte! an! !ischarge! several this month$ (he 0as !ischarge! 'ut again a!mitte! !ue to financial constraints$ 40o 0ee1s later/ she 0as a!mitte! in the hospital after e:perience! sei5ure last August **/ ,--.$ Bhile a!mitte!/ she complaint !ifficulty of 'reathing an! mil! pain in her eyes$ (he is sche!ule! for C4 scan as soon as possi'le$ (he 0as also referre! to Batangas Regional Hospital for close monitoring of her status$ (he 0as a!vise! nephro t0ice the a!mission for further evaluation an! management$ (. natomy and Physiolo#y 4he heart 0eighs 'et0een @ an! *8 ounces 2,-- to =,8 grams3 an! is a little larger than the si5e of your fist$ By the en! of a long life/ a person6s heart may have 'eat 2e:pan!e! an! contracte!3 more than 3$8 'illion times$ &n fact/ each !ay/ the average heart 'eats *--/--- times/ pumping a'out ,/--- gallons 2@/8@* liters3 of 'loo!$ +our heart is locate! 'et0een your lungs in the mi!!le of your chest/ 'ehin! an! slightly to the left of your 'reast'one 2sternum3$ A !ou'lelayere! mem'rane calle! the pericar!ium surroun!s your heart li1e a sac$ 4he outer layer of the pericar!ium surroun!s the roots of your heart6s ma7or 'loo! vessels an! is attache! 'y ligaments to your spinal column/ !iaphragm/ an! other parts of your 'o!y$ 4he inner layer of the pericar!ium is attache! to the heart muscle$ A coating of flui! separates the t0o layers of mem'rane/ letting the heart move as it 'eats/ yet still 'e attache! to your 'o!y$ +our heart has = cham'ers$ 4he upper cham'ers are calle! the left an! right atria/ an! the lo0er cham'ers are calle! the left an! right ventricles$ A 0all of muscle calle! the septum separates the left an! right atria an! the left an! right ventricles$ 4he left ventricle is the largest an! strongest cham'er in your heart$ 4he left ventricle6s cham'er 0alls are

only a'out a half-inch thic1/ 'ut they have enough force to push 'loo! through the aortic valve an! into your 'o!y$

The )eart (alves <our types of valves regulate 'loo! flo0 through your heart" 4he tricuspi! valve regulates 'loo! flo0 'et0een the right atrium an! right ventricle$

4he pulmonary valve controls 'loo! flo0 from the right ventricle into the pulmonary arteries/ 0hich carry 'loo! to your lungs to pic1 up o:ygen$

4he mitral valve lets o:ygen-rich 'loo! from your lungs pass from the left atrium into the left ventricle$

4he aortic valve opens the 0ay for o:ygen-rich 'loo! to pass from the left ventricle into the aorta/ your 'o!y6s largest artery/ 0here it is !elivere! to the rest of your 'o!y$ (I. Physical ssessment

General ppearance: C$A$/ a ** year ol! 0oman 0ho is conscious/ not coherent/ felt !iscomfort !ue to !ifficulty of 'reathing an! eye pain$ (ital Si#ns: P&: *,; 'pm T: 3;$.oC &&: 3- 'pm "P: *;->.-mmHg

"ody Parts

*ethod

'indin#s

nalysis

(1in

&nspection Palpation

Light 'ro0n -no s1in moisture -e!ema

Normal Normal ?:cessive accumulation interstitial flui! #ay accumulate of

pre!ominantly in the lo0er e:tremities

Hair

&nspection

?venness of the hair gro0th 0hich is evenly !istri'ute!$ -thin hair -'lac1 an! shiny hair$ - equal amount of 'o!y hair -presence of lice

Normal

Normal Normal Normal

A'normal"

Nails

&nspection

-conve: curvature/ angle of nail plate a'out *;-o -highly vascular an! pin1 -intact epi!ermis

Normal

Normal Normal Normal

Palpation

-prompt return of pin1 or usual color 2less than =

secon!s3 &nspection (1ull an! face -(ymmetrical/ roun!e!/ Normal

s1ull contour -uniform consistency/ a'sence of no!ules or masses -e!ematous chee1s A'normal"e:cessive accumulation of interstitial flui! ?yes &nspection ?ye'ro0 -Hair e:actly !istri'ute!/ s1in intact inspection - symmetrically aligne!/ equal movements Normal Normal Normal

inspection ?yeli!s

-s1in intact/ no !ischarge/ Normal no !iscolori5ation -li!s close symmetrically -a'le to have voluntary 'lin1 Normal Normal

Bul'ar con7unctiva

-transparent/ capillaries/ sometimes evi!ent/ sclera/ appears 0hite Normal

-shiny/ smooth an! pin1 inspection Palpe'ral con7unctiva Normal

inspection Lacrimal glan! inspection Cornea palpation -transparent/ shiny/ smooth -clients 'lin1 0hen the cornea is touche! -pupil constrict 0hen loo1ing near o'7ect -'lac1 in color &nspection ?ars -same color of 0ith facial s1in/ symmetric an! aligne! of the cantus of the eye &nspectio Heart an! central vessels &nspection A'!omen No pulsation Normal Normal -no ten!erness Normal

Normal

inspection Pupil

Normal Normal Normal

-uniform s1in color

Normal

-presence of 'o0el soun! Normal" @ 'o0el soun! in every 8-*#usculos1eletal &nspection #uscles -no !eformities -muscles are normally firm Normal -muscles have 0ea1ness Normal

Normal

(II.

!ia#nostic and +aboratory &esults

,I. Pro#nosis a. *edical Treatment: b. Nursin# *ana#ement:

,II. !ischar#e Plannin# * - 4he client6s father 0as instructe! to give the client6s me!ication religiously as or!ere!$ . iscusse! an! !emonstrate! to the client !ifferent non-strenuous

activities such as 0al1ing/ stretching/ etc$ T - ?:plaine! to the relative some 0ays to !o 0hen there is episo!e of sei5ure" a$ Avoi! inserting anything 'y mouth to avoi! 'iting or 'rea1age of teeth '$ Position the client on supine or si!e-lying position facing left on flat surface to avoi! falling> acci!ent$ c$ Pa!!e! the si!e rails to prevent any !amage to the client$ !$ Provi!e 0ell ventilate! environment$ e$ Remove fragile things near the patient to avoi! acci!ent !ue to involuntary movement$ f$ Provi!e o:ygen inhalation if nee!e!$

) maintaine!/

Remin!e! the relatives a'out the hygiene of the patient$ &f

0ell groome! patient 0ill 'e a'le to carry out tas1s 0hich ai! to her healing$ O - After * 0ee1 of !ischarge/ the client an! her relatives shoul! consult to the DP for monitoring of current health status$

! - A!vise! the relative to give a Elo0 fat/ lo0 salt !iet6 to her chil! as or!ere! 'y the physician$ S - 4aught the patient an! relatives the importance of having Fo! as the center of everything$ 4his may 'ring a'out changes in their lives 0here the family nee!s in or!er to live as one$

,III. c/no0led#ement:

Df all those efforts an! achievements 0e have !one/ 0e are !eeply than1ful to Fo! 0ho ha! provi!e! us 1no0le!ge/ patience/ goo! health an! strength throughout this 0hole e:perience

&t coul! not 'e !one 0ithout the help of our clinical instructors 0ho teaches us the essential an! !ifferent terminologies that 0e are acquire! an! ma!e us reali5e the value of philosophy an! commitment that serves us the ingre!ient to 'e a great nurse some!ay$ Dur 1no0le!ge an! s1ills 0ere shape! an! mol!e! that gives us the capa'ilities to 'e a responsi'ile stu!ents$ Dur clinical instructors gave us more information in sharing !ifferent 1no0le!ge through practical s1ills that helps us retain 1no0le!ge more effectively in our min!s so that 0e can stay that these instructors 0ere the 'est$ Be are so over0helme! 0ith all their support an! to the time they spent 0ith us$ Be 0holehearte!ly than1 you$ 4han1 +ou !ear clinical instructors 4o our frien!s an! !uty mates that 0e smile 'ehin! those to:ic times 0e 0ere in the area an! for those sleepless nights that helps us 'in! together in completing the requirement 4o our parents 0ho al0ays have 'een supportive throughout our 7ourney for giving us right love that encourages us to reali5e! their 0orth Dur love ones/ 0ho serve! as our inspiration to 0hom 0e get enough strength/ po0er an! cheer us not to sleep yet if 0or1s 0ere not yet !one$

Be coul! also than1 our institution/ Lyceum of the Philippines University for giving us quality e!ucation in ta1ing the lea!$

,I(. &eferences: "oo/s: Te$tboo/ of *edical-Sur#ical Nursin#/ Smeltzer, et. Al., **th e!ition/ pp *3*)-*333 *edical-Sur#ical Nursin#/ Ray Hargrove-Huttel, =th e!ition/ pp =3)-=3. *anual of Nursin# Practice/ Lippincott/ )th e!ition/ pp ;.)-@-, Nurse's Poc/et Guide/ Doenges, et. Al., *-th e!ition/ pp ,=*-,=8/ ;.--;.* Nursin# 1223 !ru# )andboo/4 Lippincott Williams & Wilkins, ,;th e!ition pp$)@)-)@./ ;8.- ;;-/ ;@@ Sprin#house Nurse's !ru# Guide 12254 Samantha ena!le/ pp$@=3-@=8/ ,8@,8)/ 8;.-8@* PP!'s Nursin# !ru# Guide 1225 edition4 "alan #ress, pp$=;3 'undamentals of Nursin#/ $ohzier & %R&, )th e!ition/ pp$ 8))-;3)

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