Rheumatic fever is a multisystem collagen vascular disease that occurs after a group A streptococcal infection in individuals who have predisposing factors. This disease is still the most important cause of acquired heart disease in children and young adults in many countries, especially developing countries. The involvement of cardiovascular disease is characterized by inflammation of the endocardium and myocardium through an autoimmune process that causes tissue damage. The first attack of acute rheumatic fever occurs most often between the ages of 5-15 years. Rheumatic fever is rare in children under the age of 5 years.
Although knowledge and research has been growing rapidly, but the mechanism of occurrence of rheumatic fever is certainly unknown. In general, experts agree that rheumatic fever is included in autoimmune diseases.
The clinical course of rheumatic fever / rheumatic heart disease can be divided into :
Stage I
This stage in the form of upper respiratory tract infection by the bacteria Group A β-hemolytic streptococcus. Complaints typically include fever, cough, pain when swallowing, often accompanied by vomiting and even in young children diarrhea can occur. On physical examination often found in tonsillar exudate accompanying signs of inflammation. Submandibular lymph nodes are often enlarged. This infection usually lasts 2-4 days and can heal itself without treatment.
The researchers noted 50-90% history of upper respiratory tract infections in patients with rheumatic fever / rheumatic heart disease, which usually occurs 10-14 days before the first manifestations of rheumatic fever / rheumatic heart disease.
Stage II
This stage is also called the latent period, is the period between streptococcal infection, with the onset of the symptoms of rheumatic fever, this period usually lasts 1-3 weeks, unless chorea that may arise 6 weeks or even months later.
Stage III
Rheumatic fever is an acute phase, when the emergence of various clinical manifestations of rheumatic fever / rheumatic heart disease. The clinical manifestations can be classified in the general inflammatory symptoms (symptom minor) and specific manifestations (major symptoms) rheumatic fever / rheumatic heart disease.
3 Nursing Diagnosis and Interventions for Rheumatic Fever
1. Decreased cardiac output related to the disturbances on the closure of the mitral valve.
Goal: Decrease in cardiac output can be minimized.
Expected outcomes:
Intervention:
2. Ineffective Tissue perfusion related to a decrease in peripheral blood circulation.
Goal: adequate tissue perfusion.
Expected outcomes:
Intervention
3. Activity intolerance related to the swelling and pain in the joints, muscle weakness, decreased cardiac output (imbalance between myocardial oxygen supply and needs).
Goal: The client can work within the limits of tolerance for that perfectly measured.
Expected outcomes:
Intervention
Although knowledge and research has been growing rapidly, but the mechanism of occurrence of rheumatic fever is certainly unknown. In general, experts agree that rheumatic fever is included in autoimmune diseases.
The clinical course of rheumatic fever / rheumatic heart disease can be divided into :
Stage I
This stage in the form of upper respiratory tract infection by the bacteria Group A β-hemolytic streptococcus. Complaints typically include fever, cough, pain when swallowing, often accompanied by vomiting and even in young children diarrhea can occur. On physical examination often found in tonsillar exudate accompanying signs of inflammation. Submandibular lymph nodes are often enlarged. This infection usually lasts 2-4 days and can heal itself without treatment.
The researchers noted 50-90% history of upper respiratory tract infections in patients with rheumatic fever / rheumatic heart disease, which usually occurs 10-14 days before the first manifestations of rheumatic fever / rheumatic heart disease.
Stage II
This stage is also called the latent period, is the period between streptococcal infection, with the onset of the symptoms of rheumatic fever, this period usually lasts 1-3 weeks, unless chorea that may arise 6 weeks or even months later.
Stage III
Rheumatic fever is an acute phase, when the emergence of various clinical manifestations of rheumatic fever / rheumatic heart disease. The clinical manifestations can be classified in the general inflammatory symptoms (symptom minor) and specific manifestations (major symptoms) rheumatic fever / rheumatic heart disease.
3 Nursing Diagnosis and Interventions for Rheumatic Fever
1. Decreased cardiac output related to the disturbances on the closure of the mitral valve.
Goal: Decrease in cardiac output can be minimized.
Expected outcomes:
- Vital signs within normal limits,
- Normal ECG,
- Free from symptoms of heart failure,
- Adequate urine output of 0.5-2 ml / kg body weight,
- Clients participate in activities that reduce the heart's workload.
Intervention:
- Assess pulse, respiration, blood pressure regularly every 4 hours.
- Note the heart sounds.
- Assess changes in skin color towards cyanosis and pallor.
- Monitor intake and output every 24 hours.
- Limit activities adequately.
- Give psychological condition quiet environment.
2. Ineffective Tissue perfusion related to a decrease in peripheral blood circulation.
Goal: adequate tissue perfusion.
Expected outcomes:
- Vital sign within acceptable limits,
- Intake and output balance,
- Acral felt warm, cyanosis (-), peripheral pulse strong,
- Patients conscious / oriented,
- No edema,
- Free of pain / discomfort.
Intervention
- Monitor changes suddenly or continuous mental disorders (anxiety, confusion, lethargy, fainting).
- Observation of pale, cyanosis, striped, skin cold / humid, record the strength of peripheral pulses.
- Assess Homan's sign (pain in the calf with dorsiflexion), erythema, edema.
- Encourage leg exercises active / passive.
- Monitor breathing.
- Assess GI function, record anorexia, decreased bowel sounds, nausea / vomiting, abdominal distension, constipation.
- Monitor input and changes in urine output.
3. Activity intolerance related to the swelling and pain in the joints, muscle weakness, decreased cardiac output (imbalance between myocardial oxygen supply and needs).
Goal: The client can work within the limits of tolerance for that perfectly measured.
Expected outcomes:
- Showed an increase in activity, the heart rate / rhythm and pressure within normal limits, warm skin, pink and dry.
Intervention
- Assess the patient's tolerance for activity using the following parameters: pulse 20 beats / min above the resting pulse frequency, noted an increase in blood pressure, dyspnoea, chest pain, severe fatigue, weakness, sweating, dizziness or fainting.
- Increase breaks, limit activity on the basis of pain / hemodynamic response, provide leisure activities that are not heavy.
- Limit visitors or visits by patients.
- Assess readiness to increase activities eg decrease weakness / fatigue, stable blood pressure / pulse rate, increased attention on the activities and self-care.
- Suggest to promote activities / tolerance of self care.
- Provide assistance as needed (eating, bathing, dressing, elimination).
- Advise patients to avoid an increase in abdominal pressure, straining during defecation.
- Describe the pattern of gradual increase of the activity, for example: sitting on the bed when no dizziness and no pain, getting up from the bed, learning to stand and so on.
