I.

INTRODUCTION

RHEUMATIC HEART DISEASE Commonly called arthritis (inflammation of the joint) and thought as one condition, the rheumatic heart diseases are more than 100 different types of disorders that primarily affect skeletal muscle, bones, cartilage, ligaments, tendons, and joints in males and females of all ages. (Brunner and Suddarth.Textbook of Medical-Surgical Nursing.Vol. 2.12th Edition.p.1632) 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. This damage to the heart valves may lead to a valve disorder. It usually starts out as a strep throat (streptococcal) infection. Anyone can get acute rheumatic fever, but it usually occurs in children between the ages of 5 and 15 years. About 60% of people with rheumatic fever develop some degree of subsequent heart disease. (Brunner and Suddarth.Textbook of MedicalSurgical Nursing.Vol. 2.12th Edition.p.1632) 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. However, the most common form of rheumatic heart disease affects the heart valves, particularly the mitral valve. It may take several years after an episode of rheumatic fever for valve damage to develop or symptoms to appear. (Brunner and Suddarth.Textbook of Medical-Surgical Nursing.Vol. 2.12th Edition.p.1632) Symptoms of heart valve problems, which are often the result of rheumatic heart disease, can include: chest pain, excessive fatigue, heart palpitations (when the heart flutters or misses beats), a thumping sensation in the chest, shortness of breath, and swollen ankles, wrists or stomach. (Brunner and Suddarth.Textbook of Medical-Surgical Nursing.Vol. 2.12th Edition.p.1633) Cardiac diseases complicate 1% to 4% of pregnancies in women without preexisting cardiac abnormalities. A working knowledge of the normal physiology of pregnancy is often helpful in the management of patients with heart disease. Pregnancy is associated with several cardiocirculatory changes that can significantly impact underlying cardiac disease. These changes begin early in pregnancy (within the first five to eight weeks), reach their peak during the late second trimester, and then remain relatively constant until delivery. (World Heart Federation, 2013) Risk factors for developing Rheumatic Heart Disease include poverty, overcrowding, family history, repeated upper respiratory tract infection, and reduced access to medical care. (American Heart Association, 2012) The mortality rate from this disease remains 1-10%. (WHO)

A comprehensive resource provided by the World HealthOrganization

addresses the diagnosis and treatment of this latter population. Estimations worldwide are that 5-30 million children and young adults have chronic Rheumatic heart disease, and 90,000 patients die from this disease each year.

In the Philippines, about 2, 389 Filipinos under all age groups die because of Chronic Rheumatic Heart Disease each year and 873 of that are young Filipinos under 10-24 years old. (Philippine Health Statistics 2009, DOH) Rheumatic heart disease was the most common underlying condition (27% of cases) found in pregnant patients. It is accounted for 88% of cardiac diseases in pregnant women. (American Heart Association, 2012) The group decided to choose this case because we find it to be challenging and interesting since this case deals with one of the most important part of the body. Moreover, we can gain adequate knowledge and information about the said topic and its management.

II.

OBJECTIVES

GENERAL OBJECTIVES: This case presentation aims to identify and determine the general health problems and needs of the patient with a diagnosis of Rheumatic Heart Disease. This presentation intends to value the importance of the management that we rendered to the patient and help patient promote health and medical condition through the application of nursing skills. SPECIFIC OBJECTIVES: To be able to define Rheumatic Heart Disease, its sign and symptoms, incidence rate in the Philippines, and the reason for choosing this study. To be able to discuss the background of our client (lifestyle, history of past and present illness and family history) and to show how may this affect the occurrence of the disease. To be able to assess our client in performing a thorough physical assessment To be able to relate the disease condition in the laboratory examinations To trace the pathophysiology and understand the etiology of the disease To be able to obtain the anatomy and physiology of the affected part To be able to understand the mechanism of action of the drugs given and how it affects the client To formulate and apply nursing care plan in utilizing the nursing process To learn new skills that will help enhance our current clinical skills required in the management of the patient with Rheumatic Heart Disease To develop our empathy in rendering nursing care to our patient so that we may be able to serve future clients with higher level of holistic understanding

XI. PROGNOSIS In general, the prognosis of the patient was fair because Rheumatic Heart Disease is irreversible and management is focused on prevention of further complications since the patient is pregnant. Compliance with the treatment regimen can be observed with the patient.

XII. DISCHARGE PLANNING M- Instructed to take medications on time E- Instructed the patient to maintain a clean, safe environment and eliminate the presence of breeding sites of harmful insects T- Instructed to strict follow treatment regimen H- Encouraged proper body hygiene and proper perineal care O- Instructed to have a follow-up check up D- Encouraged to eat nutritious, low in fat and low in sodium foods S- Encouraged the patient and family to ask for the Lords guidance. Always pray at night before sleeping and attend mass every Sunday for continuous blessing of God in her life