Scope and Limitations This case study compiles with respondents and conducted last July 24, 2011

at Northern Mindanao Medical Center with the group 1 level 2 nursing students. This Case Study is all about the condition of pregnant women having a rheumatic heart disease during pregnancy.

Objective of the Study a. Establish rapport and gain trust and cooperation of the patient and immediate family members b. Perform and obtain thorough and complete physical assessment using the assessment techniques, obtain complete medical, socio cultural and family history related to patients current health condition. c. Plan the appropriate nursing intervention to address the patients health needs. d. Impart useful health teaching to the patient and immediate family members to prevent further development of patients condition and other related complications and for to be able to adjust well continue with her normal life after being discharge from the hospital.

I.

Introduction

Overview Rheumatic heart disease is a condition in which permanent damage to heart valves is caused from rheumatic fever. The heart valve is damaged by a disease process that begins with a strep throat caused by streptococcus A bacteria, that may eventually cause rheumatic fever. Rheumatism is a non-specific term used to describe medical conditions concerning joints and connective tissue. Some conditions that were once given the general label of rheumatism or called rheumatic diseases were later classified as rheumatoid arthritis, osteoarthritis, lupus, fibromyalgia, and tendonitis. Autoimmune disorders, when remain unnamed but cause pain as well as affecting other organs, were classed as rheumatism. Illnesses like lupus were particularly susceptible to being called rheumatism. Later understanding of the causes of these illnesses shows that the problem is not dysfunction of the joints, but rather immune systems that can attack joints, muscles and organs. The general term rheumatism is seldom heard now in medical communities because health professionals feel that specific naming of illnesses can better point toward standards or treatment and care. Rheumatic fever can affect many connective tissues of the body especially those of the heart, joints, brain or skin. Anyone can get acute rheumatic fever, but it usually occurs in children five to 15 years old. It is a rare but potentially life-threatening disease, a complication of untreated strep throat. Because of antibiotics, rheumatic fever is now rare in developed countries. However, in recent years, it has begun to make a comeback in the United States, particularly among children living in poor inner-city neighborhoods. The greatest danger from rheumatic fever is the damage it can do to the heart. In more than half of all cases, rheumatic fever scars the valves of the heart, forcing it to work harder to pump blood. Over a period of months or even years, particularly if the disease strikes again, damage to the heart can lead to the serious condition of rheumatic heart disease. In rheumatic heart disease, the damaged heart valve either does not completely close or completely open. Sometimes damage to heart valves is not immediately noticeable, but eventually damaged heart valves can cause serious, even disabling, problems. These problems depend on the severity of the damage and on which heart valve is affected. The most advanced condition is congestive heart failure. Mitral valve disease is the most common cardiac problem seen in rheumatic heart disease. In rheumatic heart disease, the mitral valve becomes laden with heavy deposits of calcium, which disrupt the normal function of the valve. Because of these heavy calcium deposits, the valve often fails to open completely (a condition called

mitral stenosis). The same calcium deposits can also prevent the valve from closing completely, leading to mitral regurgitation (a "leaky" valve). So, people with rheumatic mitral valves often have both mitral stenosis and mitral regurgitation. Aortic valve disease is also common in rheumatic heart disease. Aortic valve damage is also caused by calcium deposits that disrupt normal valve function. And as with rheumatic mitral valves, rheumatic aortic valves can develop either stenosis or regurgitation, or both. The mechanical valve problems (both stenosis and regurgitation) caused by rheumatic heart disease can tremendously increase the workload on the heart muscle, and as a result heart failure frequently develops, often after a period of many years. Atrial fibrillation is very commonly seen in rheumatic heart disease, especially if the mitral valve is involved. Blood clots (which can lead to stroke, and which are always a risk in patients with atrial fibrillation) are a particular risk in people who have both atrial fibrillation and rheumatic mitral disease. So, virtually all patients with rheumatic mitral disease and atrial fibrillation ought to be on chronic blood-thinning (anticoagulation) therapy with Coumadin. In order to understand how rheumatic heart disease manifests, it is pertinent to know what happens when the individual experiences an episode of rheumatic fever. The fever itself is an inflammatory disease that manifests itself as strep in the throat. The infection in the throat can work through the connective tissue in the body, eventually making its way to the joints, the skin, and even the heart and the brain. Repeated episodes of rheumatic fever can cause damage to any of the organs that are reached through the connective tissue. In the case of the heart, the infection can cause the heart valves to thicken, a condition which makes the enlarged valves work less efficiently.