Rheumatic heart disease (nursing ppt )

from nursing point of view

1. Name : Obieda Mansour Title :  Rheumatic Heart Diseas e Outline: Definition Prevalence  etiology Predisposing factors  Pathophysiology Clinical manifestation Laboratory +diagnostic tests Complications Nursing management 

2. What is Rheumatic fever Rheumatic fever is an inflammatory disease of the heart potentially involving all the layers of the heart ( endocardium ,myocardium and pericardium, particularly the valves), resulting heart damage in valve leakage (insufficiency) and/or obstruction (narrowing or stenosis)the resulting damage from rheumatic fever is called Rheumatic Heart Disease (RHD)

3. Prevalence Acute rheumatic fever is complication of respiratory infection  caused by group A B-hemolytic streptococci  ARF are most common from age 6 to 15 years . ARF may attack again up to age 22

4. etiology  ARF occur 3 weeks after group A β-streptococcal infection of the upper respiratory system  The Streptococcus is spread by direct contact with oral or respiratory secretions

5. Predisposing factors Immune system (immune system may be genetically weak )(  risk for infection and development ) Socioeconomic factors (overcrowding)(lower socioeconomic status) Family factors ( genetics )  Nutrition (poor nutrition-bad health )(malnutrition) poor hygiene

6. Pathophysiology Rheumatic fever is a sequela to group A streptococcal infection that occurs in about 3% of untreated infections. It is a preventable disease through the detection and adequate treatment of streptococcal pharyngitis. Connective tissue of the heart, blood vessels, joints, and subcutaneous tissues are affected. Lesions in connective tissue are known as Aschoff bodies, which are localized areas of tissue necrosis surrounded by immune cells.

7. Patho cont. Heart valves are affected, resulting in valve leakage and narrowing. Compensatory changes in the chamber sizes and thickness of chamber walls occur. Heart involvement ( carditis ) also includes pericarditis, myocarditis, and endocarditis

8. Clinical manifestation Symptoms of streptococcal pharyngitis may precede rheumatic symptoms : fever (38.9 to 40 C) chills Sore throat (sudden ) Abdominal pain (children) Enlarged and tender lymph nodes  polyarthritis Chorea  Erythema marginatum  Subcutaneous nodules Carditis  

9. Chorea irregular muscular movement affecting head, face or limbs Characterized by : weakness    choreic movement 

10. polyarthritis Polyarthritis  is defined as pain, with or without inflammation, that affects joints  Causing :  limited ROM Swelling joints redness

11. Erythema marginatum Lesions occur mainly on the inner aspect of the arm ,thigh but never on the face  Not painful

12. Subcutaneous nodules Small, painless swelling in different part of the body e.g. ( spine,elbow,knees )

13. Carditis It is important manifestation It include : Myocarditis, Pericarditis and Endocarditis  Heart murmur  Aortic regurigation Cardiac enlargement Chest pain 

14. Laboratory and Diagnostic Tests •WBC count and ESR is elevated • C- reactive protein is positive. • Cardiac enzymes levels may increase in severe carditis . • Throat cultures continue to presence of GABS; however they usually occur in small numbers. Isolating them is difficult. • ECG reveals no diagnostic changes, but 20% of patient show a prolonged PR interval.  Echocardiography helps evaluate valvular damage, chamber size, ventricular function and the presence of a pericardial effusion. • Cardiac catheter evaluates valvular damage and left ventricular function in severe cardiac dysfunction.

15. Complication Heart failure Atrial fibrillation  Infective endocarditis  Atrial and ventricular arrhythmias  cerebral vascular complications  valve stenosis or regurgitation myocardial damage

16. Treatment Antibiotics Anti-inflammatory treatment. Anticonvulsant medications.  For severe involuntary movements caused by Sydenham chorea,  Valve replacement

17. Nursing management  Teaching patients about the disease ,its treatment and the prevention steps needed to avoid potential complication Monitor patient’s temperature; a fever may be present for weeks Assess heart sounds for new or worsening murmur Instruct patient and family about activity restrictions, medications, and signs and symptoms of infection. Assess for signs and symptoms of organ damage such as stroke , meningitis, heart failure, myocardial infarction

18. Medical Management   Isolating causative organism through serial blood cultures. Blood cultures are taken to monitor the course of therapy.   Monitoring patient’s temperature for effectiveness of the treatment. After recovery from the infectious process, seriously damaged valves may require debridement or replacement. 

19. Nursing Management (Assessment ) Subjective Data  Objective Data  History of health   erythema marginatum Family history of health chorea Nutrition polyarthritis Activity exercise  Subcutaneous nodules

20. Collaborative Care Penicillin  (elimination of group A B-Hemolytic streptococci ) Corticosteroids (anti-inflammatory to control fever and joint manifestations)

21. Nursing diagnosis Acute Pain related to migratory inflammation of the joints. Activity Intolerance related to joint pain. Altered thermoregulation (Hyperthermia) related to microorganisms invasion  Decreased cardiac output related to valve dysfunction of heart failure 

22. Nursing Diagnosis Expected Outcome Interventions  Hyperthermia related to fever (temp +39) Patient will  maintain body temperature below 39° C Adjust and monitor environmental factors like room temperature and bed linens as indicated Ready oxygen therapy for extreme cases Eliminate excess clothing and covers Encourage  fluid intake Give antipyretic medications as prescribed

23. Nursing Diagnosis Expected outcome Interventions Activity intolerance related to joint pain  Patient will exhibit tolerance during physical activity Rest periods monitor patient response to activity  Monitor heart rate +respiratory rate +  Bp   (Before-during-after) Activity  Gradually increase activity with active range-of-motion exercises in bed Evaluate the need for additional help at home 

24. Nursing Diagnosis Expected outcome Interventions Acute Pain related to joint pain  Patient will be relieved  from pain  Assess Pain characteristics ( Quality,Severity,Onset,Location,duration ..) Change for comfortable position Report for pain immediately  analgesics Provide rest periods to promote relief, sleep, and relaxation Give medication as prescribed

25. Nursing Diagnosis Expected Outcome Interventions Decreased cardiac output related to valve dysfunction   Patient will demonstrates adequate cardiac output Record intake and output Auscultate heart sounds; note rate, rhythm, presence of S3, S4, and lung sounds. Place on cardiac monitor; monitor for dysrhythmias, especially atrial fibrillation. Monitor laboratory tests such as complete blood count,  sodium  level, and serum creatinine. Administer oxygen therapy as prescribed

26. Reference Dermatology Book  By Jean L. Bolognia, Joseph L. Jorizzo , Ronald P.( 2008 )(224) Brunner book (780)(cardiovascular unit) Suddarth’s textbook of medical-surgical nursing (12th ed.). Philadelphia: Lippincott Williams & Wilkins.