Rheumatic Heart Disease IV: Nursing Management

A comprehensive nursing assessment begins with gathering detailed medical history, including recent streptococcal infections, rheumatic fever, or prior RHD diagnosis. The nurse then evaluates clinical signs such as fever, chest pain, heart murmurs, and peripheral edema, while reviewing diagnostic results like prolonged PR intervals on ECG and elevated antistreptolysin-O titers to guide treatment planning.

The main nursing diagnoses include decreased cardiac output related to valvular damage, evidenced by heart murmurs; activity intolerance related to reduced cardiac function, evidenced by fatigue with minimal exertion; and deficient knowledge related to disease management and treatment adherence, evidenced by patient questions or misconceptions about the condition.

Positioning the patient in semi-Fowler's position, with the head of the bed elevated 30-45 degrees, improves breathing and reduces the workload on the heart. This positioning enhances oxygenation and comfort while decreasing cardiac strain, supporting the nursing goal of improving cardiac output and activity tolerance.

Prescribed medications include antibiotics to prevent infection, anti-inflammatory drugs to reduce inflammation, diuretics to manage fluid overload, beta-blockers and ACE inhibitors to improve cardiac function, and analgesics for chest pain relief. The nurse maintains patent IV access for medication administration and carefully monitors fluid intake to prevent heart failure complications.

Accurate recording of IV fluids and oral intake prevents fluid overload, which can worsen heart failure in RHD patients. Close monitoring of urine output assesses kidney function and fluid balance. Significant changes in output indicate hemodynamic instability requiring immediate intervention and healthcare provider notification.

Patient education covers disease causes, symptoms, and potential complications. Nurses emphasize medication adherence and side effects, teach recognition of worsening heart failure signs like increased shortness of breath and swelling, and stress the importance of regular follow-up appointments for ongoing monitoring and disease management.

Nurses regularly monitor vital signs including blood pressure, heart rate, respiratory rate, and temperature to detect early signs of hemodynamic instability or infection. Combined with assessment of clinical symptoms and diagnostic findings, vital sign trends help identify deterioration requiring prompt intervention and physician notification.