Assessment
A comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and erythema marginatum.
Review laboratory results, including erythrocyte sedimentation rate, C-reactive protein, and antistreptolysin O titer, to assess for inflammation and recent streptococcal infection. Evaluate echocardiography results to assess valvular damage and cardiac function.
Based on the assessment, the nursing diagnoses are formed:
The next step is to set goals to improve cardiac output, increase activity tolerance, improve patient understanding of treatments, and implement the following interventions:
Patient Positioning: Position the patient in a semi-Fowler's position (head of the bed elevated 30-45 degrees) to improve breathing and reduce the workload on the heart.
Supplemental Oxygen: Administer supplemental oxygen via nasal cannula or mask as prescribed to maintain adequate oxygen saturation levels.
Medication Administration: Administer prescribed medications such as antibiotics, anti-inflammatory drugs, diuretics, beta-blockers, ACE inhibitors, and analgesics to manage chest pain or discomfort. Maintain a patent IV access for medication administration and fluid management. Carefully monitor and manage IV fluid administration to avoid fluid overload, especially in patients with heart failure.
Vital Signs Monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of hemodynamic instability or infection.
Intake and Output Monitoring: Accurately record IV fluids and oral intake to ensure proper hydration and avoid fluid overload. Monitor urine output closely to assess kidney function and fluid balance. Report any significant changes or reductions in output.
Patient Education: Educate the patient and family about rheumatic heart disease, including its causes, symptoms, and potential complications. Emphasize the importance of taking prescribed medications, understanding their purpose, and being aware of potential side effects. Instruct the patient and family on recognizing signs and symptoms of worsening heart failure or infection (e.g., increased shortness of breath, swelling, fever) and when to seek medical help. Educate on the importance of regular follow-up appointments with healthcare providers for ongoing monitoring and management.
A comprehensive nursing assessment for a patient with rheumatic heart disease, or RHD, starts with gathering a detailed medical history, including any recent streptococcal infection, rheumatic fever, or RHD.
The nurse then assesses for clinical signs like fever, chest pain, heart murmurs, and peripheral edema and reviews diagnostic results such as a prolonged PR interval on ECG and elevated antistreptolysin-O titer.
Based on the assessment, the nurse forms the nursing diagnoses:
Decreased cardiac output related to valvular damage, as evidenced by heart murmurs.
Activity intolerance related to reduced cardiac function, as evidenced by patient reports of fatigue with minimal exertion.
Next, the nurse sets goals to improve cardiac output and limit activities, with interventions including:
Positioning the patient in semi-Fowler's to reduce heart workload and limiting activities that cause fatigue.
Administering supplemental oxygen, medications, and IV fluids as prescribed.
Monitoring vital signs and fluid intake and output.
Educating the patient on medication adherence and recognizing heart failure symptoms.
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