Asian Pac. J. Nursing and Health Sci., 2018; 1(1):7-9 e-ISSN: 2581-7442 ____________________________________________________________________________________________________________________________________________ A case presentation on rheumatic heart disease with mitral regurgitation Jayasudha.A 1* , Sreerenjini B 2 , Kaveri P 3 , Anitha P 4 1 Principal, PSG College of Nursing, Coimbatore, Tamil Nadu, India 2 HOD, OBG Nursing Department, PSG College of Nursing, Coimbatore, Tamil Nadu, India 3 Asst. Professor, OBG Nursing Department, PSG College of Nursing, Coimbatore, Tamil Nadu, India 4 M.Sc (N), PSG College of Nursing, Coimbatore, Tamil Nadu, India Received: 22-08-2018 / Revised: 15-10-2018 / Accepted: 26-10-2018 Abstract In pregnancy there is increased pressure on the heart valves. Counseling of women with rheumatic heart disease gives appropriate surveillance of maternal and fetal well being, as well as planning and documentation of the management of elective and emergency delivery. However, many women with rheumatic heart disease have healthy pregnancies, healthy babies with the right medical care. Keywords : Prevention, anaemia, Adolescent girls. Introduction Rheumatic heart disease (RHD) is a disease of poverty. Diagnosis Rheumatic heart disease describes a group of short- History of Rheumatic fever, especially if it is treated term (acute) and long-term (chronic) heart disorders with long term secondary prophylaxis, doesn’t always that occurs as a result of acute rheumatic fever. It is lead to RHD. usually seen in children who are 5 to15 years old. RHD Physical examination used to assess the signs of is a disease of the young and its impact is seen in rheumatic fever, including joint pain and inflammation. women of reproductive age. It is an active or inactive Stethoscope is used to listen the heart abnormal disease of the heart and the most affected is generally rhythms. the mitral valve which is characterized by reduced Blood test like complete blood count, culture and ESR functional capacity of the heart caused by to be done to find out any infection and can detect inflammatory changes in the myometrium or scarring antibodies. of the valves. Risk factors of rheumatic heart disease Chest X-ray to check the size of the heart include poverty, poor housing, overcrowding and under Electrocardiogram is used to find out the changes nutrition. The signs and symptoms are joint pain, seen on heart. fatigue, joint stiffness, tachycardia, dyspnea, weakness, Echocardiography is a non-invasive ultrasound that a “butterfly’’ rash across the cheeks, sun sensitivity and uses sound waves to create a moving image of the heart hair loss. For some of these women an initial diagnosis and to measure its size and shape. The echo test may be is made antenatal or postpartum, as they fail to tolerate done one or more times during pregnancy, to monitor the impact of the physiological changes of pregnancy how well the heart is performing. on their damaged heart valves resulting in clinical decompensation. However early diagnosis, appropriate Management management prior to pregnancy, and good functional Preventive aspects status at the time of entering pregnancy allowed for a Primordial prevention is reducing the risk factors good maternal and neonatal outcomes. for rheumatic fever by covering the mouth while ____________________________ sneezing or coughing, proper hand washing and *Correspondence maintaining distance from sick people. Dr. Jayasudha.A, General management: PSG College of Nursing, Coimbatore, Tamil Nadu, More frequent antenatal visits India More rest E-Mail: jayasudham2003@yahoo.com ____________________________________________________________________________________________________________________________________________ Jayasudha et al ASIAN PACIFIC JOURNAL OF NURSING AND HEALTH SCIENCES, 2018; 1(1):7-9 7 www.apjnh.com
Asian Pac. J. Nursing and Health Sci., 2018; 1(1):7-9 e-ISSN: 2581-7442 ____________________________________________________________________________________________________________________________________________ Diet is directed to restrict weight gain and prevent months. She was admitted in antenatal ward with the anemia as it increases cardiac strain complaints of breathlessness, palpitation, fatigue, Infection should be avoided and properly treated weakness, bilateral pitting pedal edema for 2 months Hospitalization is needed if tachycardia duration. On assessment her BP was 110/80 mmHg, (exceeding 100 beats/ minute) occurs. pulse 96 beats/mt and she was conscious and oriented. She has undergone investigations like complete blood count and thyroid hormone test. Her Hb is 12.1gm/dl, Medical management Digoxin is indicated in atrial fibrillation to slow WBC 9,400cells, platelet 2.19 lakhs and TSH level was the ventricular response and in acute heart failure 4.760 micro IU/ml. Then she had echo. In that the to increase myocardial contractility findings are severe MR with dilated left atrium and Diuretics are used in acute and chronic heart pulmonary hypertension (42mmhg). EF level was 63%. failure She is on medical treatment like Tab. Lasix-40mg, Tab. Beta-adrenergic blockers as propranolol may be Pentids-400000 units, Tab.Eltroxin-50mcg, Tab. indicated for arrhythmia Livogen and Tab. Calcium. She is on salt restriction Anticoagulants including warfarin or low diet with 1 litre fluid restriction. Mother kept under molecular weight heparin should be taken to observation. promote circulation and to prevent clotting. Then she has undergone the elective LSCS. She Secondary prophylaxis (antibiotics) should be delivered an alive male baby with the birth weight of administered to prevent infection. 2.01kg. APGAR score is 7/10 at 1 min, 8/10 at 5 min. Oxygen suplemenation is needed to improve Mother & baby were healthy and kept under close observation till the 4 th post-operative day. Then the circulation and to maintain balance between oxygen need and demand. mother and her baby discharged from the hospital on 7 th post operative day with diuretics and antibiotics. Surgical management Therapeutic abortion should be considered in early pregnancy Nursing Care Cardiac surgery may be an alternative to Rheumatic heart disease can be very unpredictable therapeutic abortion. and manifests in many atypical ways and it leads to severe complications can arise. Effects of Pregnancy on Rheumatic Heart Disease Attention should be drawn to the pulse, respiration Maternal and blood pressure during birth. Continuous Pregnancy can lead to the worsening of symptoms monitoring of pulse and repeated Blood pressure including measurements to be taken. Shortness of breath with simple activity Fast initiation of proper treatment may be crucial Waking at night out of breath for the outcome. Pulmonary oedema Nursing Diagnosis Atrial fibrillation or clotting 1) Decreased cardiac output related to inadequate Fetal: blood pumped by the heart to meet metabolic Abortion demands of the body as evidenced by tachycardia Intrauterine growth retardation Goal: Maintaining normal cardiac output. Still birth Premature labour Interventions Asphyxia Assess heart rate, heart sounds for gallops and Respiratory distress syndrome blood pressure Note skin color, temperature and moisture Case Description Check for peripheral pulses including capillary 26 years old primigravida women with 38weeks+5days refill gestation with known history of Rheumatic heart Assess for reports of fatigue and reduced activity disease with severe mitral regurgitation in the age of 14 tolerance years. She had rheumatic fever with sore throat in Inspect fluid balance and weight gain (weigh the childhood age later she developed rheumatic heart mother prior to breakfast) disease. She received medications like Tablet. Monitor ECG for rate, rhythm and ectopy Pencillin G potassium from the onset of disease and Provide adequate rest with semi fowler’s position she was on injection penicillin in 2012 for upto 18 ____________________________________________________________________________________________________________________________________________ Jayasudha et al ASIAN PACIFIC JOURNAL OF NURSING AND HEALTH SCIENCES, 2018; 1(1):7-9 8 www.apjnh.com
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