Rheumatic Heart Disease IV: Nursing 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.