Rheumatic Fever

Rheumatic Fever
Nama Kelompok :
1. Agness Pello
2. Billy Yulianto
3. George Aritonang
Instruct the client how to reduce exposure to streptococcal infections as follows :

1. Take good care of teeth and gums, and obtain prompt dental care for cavities and gingivitis.

2. Avoid people who have an upper respiratory infections or who have had a recent streptococcal infection.

3. notify the physician if any of the manifestations of streptococcal sore throat develop.it is extremely important to begin antibiotic therapy promptly for any infection.
Interventions

Today, streptococcal infections do not have to develop onto rheumatic fever if the clients seeks immediate assessment and begins antibiotics.
Outcomes

The client and family will demonstrate adequate knowledge of rheumatic fever and its cause,course and therapy,as evidenced by the ability to accurately describe
Risk for ineffective management of therapeutic regimen
.Interventions

Bed rest is important in the acute phase,because it reduces myocardial oxygen demand, and usually continues until the following criteria are met :

1. Temperature remains normal without use of salicylates

2. Resting pulse remains under 100 BPM

3. ECG tracings show no signs of myocardial demage

4. Pericardial friction rub is no present
Evaluation

Rheumatic fever is treated over 10 days. Expect activity tolerance to improve once fever and pain are controlled altered nutrition may require more than 2 weeks to show improvement, depending on the severity of anorexia and the fever
NURSING CARE PLAN
Diagnosis
Penurunan curah jantung berhubungan dengan adanya gangguan pada penutupan pada katub mitral (stenosis katup).
Perfusi jaringan perifer tidak efektif berhubungan dengan penurunan metabolisme terutama perifer akibat vasokonstriksi pembuluh darah.
Nyeri akut berhubungan dengan peradangan pada membran sinovial.
Hipertermi berhubungan dengan peradangan pada membran sinovial dan peradangan katup jantung.
Ketidakseimbangan nutrisi : kurang dari kebutuhan tubuh berhubungan dengan peningkatan asam lambung akibat kompensasi sistem saraf simpatis.

Intoleransi aktivitas berhubungan dengan kelemahan otot, tirah baring atau imobilisasi.
Syndrome kurang perawatan diri berhubungan dengan gangguan muskuloskeletal; poliarhritis/ athralgia dan therapi bed rest.
Kerusakan integritas kulit berhubungan dengan peradangan pada kulit dan jaringan subcutan.
Resiko kerusakan pertukaran gas berhubungan dengan penumpukan darah di paru akibat pengisian atrium yang meningkat.
Resiko cidera berhubungan dengan gerakan involunter, irrigular, cepat dan kelemahan otot/ khorea.


Lihat pucat, sianosis, belang, kulit dingin atau lembab. Catat kekuatan nadi perifer.
Kaji tanda edema.
Pantau pernapasan, catat kerja pernapasan.
Pantau data laboratorium, contoh: GDA, BUN, creatinin, dan elektrolit.
Perfusi serebral secara langsung sehubungan dengan curah jantung dan juga dipengaruhi oleh elektrolit atau variasi asam basa, hipoksia, atau emboli sistemik.
Vasokontriksi sistemik diakibatkan oleh penurunan curah jantung mungkin dibuktikan oleh penurunan perfusi kulit dan penurunan nadi.
Indikator trombosis vena dalam.
Pompa jantung gagal dapat mencetuskan distress pernapasan. Namun dispnea tiba-tiba atau berlanjut menunjukkkan komplikasi tromboemboli paru.
 Indikator perfusi atau fungsi organ


Diberikan untuk meningkatkan kontraktilitas miokard dan menurunkan beban kerja jantung.
Perfusi jaringan perifer tidak efektif berhubungan dengan penurunan metabolisme terutama perifer akibat vasokonstriksi pembuluh darah.
Tujuan : Setelah dilakukan tindakan keperawatan , perfusi jaringan perifer efektif
Kriteria hasil : Klien tidak pucat, Tidak ada sianosis, Tidak ada edema
Intervensi
Rasional
Selidiki perubahan tiba-tiba atau gangguan mental kontinyu, contoh: cemas, bingung, letargi, pingsan.


Kolaborasi untuk pemberian digitalis
Memonitor adanya perubahan sirkulasi jantung sedini mungkin dan terjadinya takikardia-disritmia sebagai kompensasi meningkatkan curah jantung.
Pucat menunjukkan adanya penurunan perfusi perifer terhadap tidak adekuatnya curah jantung. Sianosis terjadi sebagai akibat adanya obstruksi aliran darah pada ventrikel.
Istirahat memadai diperlukan untuk memperbaiki efisiensi kontraksi jantung dan menurunkan komsumsi O2 dan kerja berlebihan.
Stres emosi menghasilkan vasokontriksi yang meningkatkan TD dan meningkatkan kerja jantung.
Meningkatkan sediaan oksigen untuk fungsi miokard dan mencegah hipoksia.


Intervensi
Rasional
Kaji frekuensi nadi, RR, TD secara teratur setiap 4 jam.
Kaji perubahan warna kulit terhadap sianosis dan pucat.
Batasi aktifitas secara adekuat.
Berikan kondisi psikologis lingkungan yang tenang.
Kolaborasi untuk pemberian oksigen.
Kolaborasi untuk pemberian digitalis
Memonitor adanya perubahan sirkulasi jantung sedini mungkin dan terjadinya takikardia-disritmia sebagai kompensasi meningkatkan curah jantung.
Pucat menunjukkan adanya penurunan perfusi perifer terhadap tidak adekuatnya curah jantung. Sianosis terjadi sebagai akibat adanya obstruksi aliran darah pada ventrikel.
Istirahat memadai diperlukan untuk memperbaiki efisiensi kontraksi jantung dan menurunkan komsumsi O2 dan kerja berlebihan.
Stres emosi menghasilkan vasokontriksi yang meningkatkan TD dan meningkatkan kerja jantung.
Meningkatkan sediaan oksigen untuk fungsi miokard dan mencegah hipoksia.

Penurunan curah jantung berhubungan dengan adanya gangguan pada penutupan pada katub mitral (stenosis katup).
Tujuan: Setelah diberikan asuhan keperawatan,penurunan curah jantung dapat diminimalkan.
Kriteria hasil: Menunjukkan tanda-tanda vital dalam batas yang dapat diterima (disritmia terkontrol atau hilang) dan bebas gejala gagal jantung (misal : parameter hemodinamik dalam batas normal, haluaran urine adekuat). Melaporkan penurunan episode dispnea,angina. Ikut serta dalam akyivitas yang mengurangi beban kerja jantung.


Assessment

Asses vital signs to reveal the presence of fever,tachycardia,and stability of blood pleasure.
Vital sign are also used as a measure of activity tolerance.
Auscultate heart sounds for presence of a friction rub,and palpate peripheal pulses .
Nursing Management of the medical client
Minor manifestations

1. Clinical findings
A. Arthralgia
B. Fever
2. laboratory findings
A. Elevated acute phase reactans
(1) Erythrocyte sedimentation rate
(2) C-reactive protein
B. Prolonged P-R interval


The left atrium (left atrium)

Form thicker cavity of the right atrium cavity as a reservoir of blood from the pulmonary veins, which is already oxygenated blood from the lungs.

The left ventricle (left ventricle)

The left ventricle is shaped like an egg, essentially formed by a ring of the mitral valve, left ventikel basically approximately 3-4 times thicker than the right ventricle and a 75% weight kesuluhan organs.

heart valve

Heart valves are divided into four sections:

The tricuspid valve.
valve Bicuspidalis
Aortic valve.
Pulmonary valve (Syaiffudin, 2006).

The heart consists of 4 rooms

The right atrium (right atrium)

Muscular cavity directly adjacent to the mouth of the vein and the superior capa and limits of the foramen ovale.

The right ventricle (right ventricle)

Ronggo berbentukan triangle anatomically divided into the upper estuary of the pulmonary truncus and the bottom of the tricuspid valve that is capable of producing low pressure a sizeable contraction age pylmonalis arterial blood flow into the lungs.

The heart consists of three layers:

Endocardial. Is located next to the lining of the heart in one composed of endothelial tissue or mucus membranes lining the heart cavity surface.

Myocardium. Is the core layer of the heart consists of muscle - the heart muscle, which forms bundalan - muscle bundalan

Bundalan atrial muscle, which is located on the left or right of the apex and base which forms a porch or auricle cordis.
Bundalan ventricular muscle, which forms the heart chambers starting to ring in the musty atrio ventricular heart.
Bundalan atrial ventricular muscle, which is the dividing wall between the porch and the chambers of the heart

Pericardium. Outer layer of the heart which is the wrapping membrane, consisting of two layers, namely the parietal and visceral layers meet at the base of the heart form the cardiac sac.
Anatomy and Physiology

Cardiofaskuler system is divided into 3 parts that affect each other, namely:

Heart: Serves as the blood pumping
Blood vessels: Served mengalirankan or drain
Blood: The Duty to store and orga
Layer rounded heart called the pericardium consists of two layers. Inner layer: the visceral pericardium and the outer layer called parietal pericardium. nize















A. Definition

Rheumatic fever is a diffuse inflammatory disease .it is a delayed response to an infection by group A Beta –hemolytic streptococci.














Etiology

Pericarditis: viral infections, bacterial, uremia, trauma, post-myocardial infarction syndrome, idiopathic, post-pericardiotomi syndrome, neoplasm, or collagen disease.
Myocarditis: acute rheumatic fever (acute rheumatic fever), viral infections, bacterial, rickettsial, fungal and parasitic.
Endocarditis: β hemolytic streptococcus group A, Staphylococcus aureus, Streptococcus viridans, Streptococcus fecalis, candida, aspergillus, and basil E. Choli.

Signs and Symptoms

Symptom onset (mode of onset)

If only the manifestation of carditis: hidden onset with malaise and fatigue to progressive CHF, abdominal pain due to acute hepatic distension, dipsnea; peripheral edema and pulmonary rales (late manifestation).
If also accompanied by pericarditis: perikordial acute pain, cardiac temponade possible with pulsus paradox and syncope (due to decreased venous return to the right heart), and arthralgia.
pathofisiology
Rheumatic fever initieates a diffuse , proliferative , and exudative inflamatory process. In rheumatic fever , the heart , joints subcutanaeous tissue, central nervous system ( CNS) and skin are affected.
These antigen bind to receptor on the heart, other tissues and joint , which begins the auto imun response. The inflammatory process often produces permanent and severe heart damage.
Major Manifestations

1. Carditis
2. Polyarthritis
3. Chorea
4. Erythrma marginatum
5. Subcutancous nodules
Medical management
The chief aims of management are to eradicate the infecting organism and to treat complication. The advent of antimicrobial therapy has changed this infection from one that was almost always fatal to one that is rarely fatal
The choice of antibiotics depends on the organism involved. Penicillin and streptomycin are commonly used. Therapy is usually administered by the IV route and continued 4-6 weeks

 Chest X-ray : assess cardiomegaly ( Cardio - Thorax Ratio CTR and pulmonary infiltrates . The titer of anti - streptolysin O
( ASO ) : assessing the causative organism and the exclusion of diagnosis of systemic lupus erythematosus ( SLE ) , rheumatic fever , a disease Sickle - Cell .
Positive C-reactive protein . Complete blood cell count and differential : assessing the chronic or acute infection , anemia due to destruction of erythrocytes , splenomegaly .
 Echocardiogram : assessing myocardial hypertrophy , valvular dysfunction , cardiac chamber dilatation , pericardial effusion , and valvular vegetation .
Blood Urea Nitrogen ( BUN ) : assessing the decline in renal function due to decreased cardiac output . Rheumatoid factor : positive .

Diagnostic test
Cardiac iso - enzyme ( especially CPK and CK - MB ) is increased . ECG : ischemia ( T wave inversion )
strain or strains ( ST-segment elevation , Q waves may appear ) , myocardial damage , heart block , dysrhythmias . Pericarditis ECG : ST segment elevation and T wave inversion in flat or , Q waves did not appear , and the amplitude R is low.
 Monitor ECG : evaluate the frequency and type of dysrhythmias . Blood cultures to assess the etiology of infection and antibiotic sensitivity . The state of exhaustion within 1-6 weeks .

Treatments
While the symptoms of rheumatic fever may disappear on their own, the inflammation can cause rheumatic heart disease, where there is scarring of the heart valves.
People with rheumatic heart disease need monthly penicillin injections for 10 or more years to prevent getting rheumatic fever again which would cause more damage.
They need regular specialist care and may need heart valve replacement surgery at some stage.
Even with all our treatments and surgery, it can cause premature death – so it is very important to do all we can to prevent this disease affecting more children.
Whenever you have any dental or medical treatment, make sure the team know you have had rheumatic fever as you need prophylactic antibiotics


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