Rheumatic heart disease: Nursing process (ADPIE)

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Transcript
Saanvi Kumar is a 17-year-old female client who recently immigrated from India. Saanvi has a history of recurrent rheumatic fever with the last episode resolving 10 years ago. Lately, Saanvi noticed she feels more tired than usual and started feeling short of breath during gym class, so her pediatrician referred her to a cardiologist for further evaluation. The cardiologist ordered an echocardiogram, a chest X-ray, and an electrocardiogram, or ECG, and Saanvi is diagnosed with rheumatic heart disease.
Rheumatic heart disease is a complication of rheumatic fever, which is a delayed multisystemic inflammatory condition that typically occurs two to four weeks after a strep throat infection. Strep throat is caused by bacteria called Streptococcus pyogenes, which is often referred to as group A beta hemolytic streptococcus or GAS for short. Not everyone who has strep throat will develop rheumatic fever, but it’s important to note that children between the age 5 and 15 are at a higher risk.
Rheumatic fever arises because Streptococcus pyogenes has a bacterial protein that mimics the structure of some proteins in the human body. So, when the immune system produces antibodies against the bacterial protein, these antibodies also end up targeting our own tissue. The heart is one of the major organs affected but others include the joints, skin, and brain. Once bound to human proteins, these antibodies activate nearby immune cells, which induce an inflammatory response that leads to tissue destruction and fever.
Now let’s focus on the inflammation of the heart, which is also known as carditis. Clients with rheumatic fever typically develop pancarditis, which is the inflammation of all three layers of the heart: endocardium, myocardium, and pericardium. But, if a client repeatedly experiences attacks of rheumatic fever, chronic inflammation of the heart can lead to leaflet damage and valvular lesions. This condition is called rheumatic heart disease and it's most commonly associated with valvular heart disease called mitral regurgitation. In mitral regurgitation, valve leaflets do not form a tight seal and this results in an abnormal blood flow from the left ventricle back into the left atrium during systole. This can result in left-sided heart failure where the left side of the heart can’t pump blood effectively, causing blood to back up into the lungs and pulmonary edema.