Rheumatic Heart Disease - Case Study Example

Rheumatic Heart Disease Essay Heather, a 16-year-old Indigenous girl, living with her extended family in a community close to Darwin becomes pregnant during her relationship with Henry. When he finds that Heather is pregnant, Henry ends the relationship and leaves town. Heather was first told she had Rheumatic Heart Disease when she was 10 years old. This is the basis of this essay, trying to link Heather’s health status, health education and health promotion activities as well as the role the nurse play with an adolescent patient with cardiac disease. Rheumatic heart disease was initially one of the severe and serious forms of heart disease in the early stages of childhood and adolescence (Gene 2001, p. 806-814; Frank 1995, p. 215; Maurice 1996, p. 303-307). Rheumatic heart disease generally involves damage to the heart including its membranes. Rheumatic heart disease refers also to a complication of rheumatic fever usually occurring after rheumatic fever attacks. The incidences of rheumatic heart disease are substantially reducing in the modern day by the widespread use of antibiotics, which are effective against the streptococcal bacterium causing the rheumatic fever (Maurice 1996, p. 303-307; Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446). A patient with Rheumatic heart disease is likely to show common symptoms of the disease including fatigue, palpitations, breathlessness, fainting attacks and chest pain. It is appropriate to look into the Rheumatic heart disease in patients to understand better what the patient goes through before looking into Heather’s health education and health promotion activities and the role the nurse in such a condition as hers. This will give an over view of her health status in her current condition. Heather is among the diseases Rheumatic heart disease victims enduring complications of 1% to 4% of pregnancies in overall women without any types of preexisting abnormalities. A working knowledge of the physiology of pregnancy is helpful in managing patients with heart disease (Maurice 1996, p. 303-307; Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446). Patients having preexisting Rheumatic heart disease as the case with Heather should receive counseling from the nurses and other professionals who work with them in their condition well in advance about the risk involved in pregnancy (Gene 2001, p. 806-814; Frank 1995, p. 215; Maurice 1996, p. 303-307). This is ideal, as it would have helped heather to learn well in advance, prepare in advance before she got married or even pregnant, and prevent late worries of individual physical health. Familiarity with the various treatments of commonly encountered Rheumatic heart disease during pregnancy has lately become increasingly relevant for cardiologists and internists as they join hands with anesthesiologists and obstetricians in the care of these complications in patients. Hemodynamic alterations happen during pregnancy, delivery and labor, as well as the postpartum period (Gene 2001, p. 806-814; Frank 1995, p. 215; Maurice 1996, p. 303-307). These changes start taking place in the period between 5 to 8 weeks of pregnancy reaching their peak in the second trimester late stages. In patients suffering preexisting Rheumatic heart disease, heart damages coincide often with this peak. Blood increases 40% to 50% in the normal pregnancy but in the conditions of Rheumatic heart disease, blood increase in volume is far greater than the red blood cell mass increase. This contributes to hemoglobin concentration fall normally known as anemia of pregnancy. Similarly, cardiac output rises to 50% above baseline, peaks by the second trimester and reaches a plateau until delivery (Maurice 1996, p. 303-307; Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446). The cardiac output increase is achieved by three key factors including preload increase due to more blood, reduced after load due to systemic vascular resistance decrease as well as maternal heart rate rise by five beats per min. Stroke volume relatively increases in the first and second trimesters (Gene 2001, p. 806-814; Frank 1995, p. 215; Maurice 1996, p. 303-307) and later declines in the third trimester due to the inferior vena compression of the uterus. Blood pressure characteristically falls about 10 mm Hg far much below baseline by the second trimester due to reduction in resistance of systemic vascular and the new blood vessels addition in the uterus as well as within the placenta. During delivery and labor, hemodynamic fluctuations are usually profound. Each uterine contraction relatively displaces a maximum of 500 ml of blood into the body circulation. Stroke volume relatively increases, with a rise in output of cardiac by an additional 50% actually with each contraction (Maurice 1996, p. 303-307; Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446). Therefore, there is a possibility of the cardiac output during delivery and labor to be 75% relatively above baseline and this is a danger to the woman. Blood loss during the period of delivery also contributes to acute hemodynamic stress. Having understood the disease well enough and the complications possible in an individual, it is proper to look into Heathers health education and health promotion activities and the role the nurse in such a condition as hers (Margaret et al 2001, p. 439-446). Heather her condition requires counseling more than ever. Her husband has left her the time she needed him most at her state of health (Maurice 1996, p. 303-307; Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446). She requires skills on how to deal with her condition before she gives birth and a postnatal care after delivery. Health education for Rheumatic heart disease is a composite of many issues, topics and elements combined to give them a survival kit during the event of pregnancy. A woman with a history of heart disease for instance, rheumatic fever in the case of Heather should talk to her healthcare provider sometime before she makes the decision of becoming pregnant. A woman who has a serious congenital heart disease develops a higher risk of giving birth to a baby with a type of heart defect (Maurice 1996, p. 303-307; Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446). This is what patients with Rheumatic heart disease as Heather should do, that is, visiting the healthcare provider often. However, for those who become pregnant already like the case of Heather without consulting the professional medic first, diagnostic tests (Gene 2001, p. 806-814; Frank 1995, p. 215; Maurice 1996, p. 303-307) are crucial for instance fetal ultrasound test to determine the health status of the mother before she gives birth. At times, the condition might be severe to the point that it leads to termination of pregnancy to safeguard the mother’s life (Maurice 1996, p. 303-307; Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446). Heather needs to note that she does not know how serious her condition is because she has had a history of Rheumatic heart disease since childhood, therefore, she must be close to the professional to determine her state at this stage of her pregnancy. A single mother as Heather will suffer stress in the event of Rheumatic heart disease during pregnancy not only for her husband leaving but also for complications emanating from the disease (Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446). Heather needs counseling; this is best obtained from a qualified practitioner. She needs to undergo a therapy session, which will help her undergo internal emotional healing and gain strength to live with the condition. Stress in Rheumatic heart disease worsens the situation and more damages to the heart causing eventual death (Maurice 1996, p. 303-307; Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446). With early counseling at her state, she will salvage the situation and prevent any complication, which could result from an event of stress. A Rheumatic heart disease and pregnant patient as the case with heather needs medications and other prescriptions to survive. A pregnant woman needs a strong heart to supply blood not only for her body but also for the placenta of the baby that requires regular nourishing. This, therefore, is a danger to the mother who has a Rheumatic heart disease condition because the heart dies off in severe conditions (Gene 2001, p. 806-814; Frank 1995, p. 215; Maurice 1996, p. 303-307). Monitoring the patient’s condition with medications and other prescriptions would help counter the pregnant mother’s condition and help maintain her heart processes and secure her pregnancy as well as her life. Heather will need education on the dos and don’ts when it comes to coping with Rheumatic heart disease especially in her pregnancy state (Maurice 1996, p. 303-307; Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446). She knows quite well that she is in a risky health state that could end her life in a wink of an eye if she does not take care. In her state, there are things she should unreservedly avoid preventing the worsening of her Rheumatic heart disease condition and complicating her survival in the pregnancy period. Smoking and drug abuse are some of the don’ts that a pregnant mother suffering from Rheumatic heart disease should practice. Heather’s condition is a dire condition that involves the damages to the heart. In this case, nothing complicating the functioning of the heart should be of use by the patient suffering from her condition (Maurice 1996, p. 303-307; Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446). Smoking and drug abuse produces content that clogs the heart even more. This worsens the patient’s condition and can literally block the arteries that supply blood to the heart. As per Heather’s condition, it is apparent that she should live a simple life with minimal intake of anything beyond a balanced diet. The smoke and drugs also risks high-blood pressure, which exacerbates Rheumatic heart disease and makes it even worse as well as increasing its damaging intensity. Heather could do herself justice if she lives a normal live and away from anything that might compromise her capacity of healing (Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446). Most women in her condition take drugs to relieve the pain and stress, which is a danger to their eventual health. A recent study report suggests that women smokers during the period before pregnancy up to the first trimester period have a higher likelihood of having a baby with birth defects, specifically congenital heart defects (Gene 2001, p. 806-814; Frank 1995, p. 215; Maurice 1996, p. 303-307). The risk of heart defects especially for Rheumatic heart disease appears to increase relatively with the cigarettes the woman continues to smoke. Alcohol is also an enemy of a victim with Rheumatic heart disease. Heather has no history of taking alcohol. However, having lost her husband could lead to a practice as such just as many women do in such situations. Alcohol is an enemy of Rheumatic heart disease. The contents in alcohol perpetuate the damaging effect of the disease in the heart (Maurice 1996, p. 303-307; Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446). A recent study indicated that women who take alcohol and suffer from Rheumatic heart disease have the highest risk of dying within a short period of their fighting with the disease. This is, therefore, apart of bad practices, which heather could engage in and risk her life (Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446). Having been pregnant, heather’s blood pressure is already high though not to the extremes because of the bodily processes she undergoes. Taking alcohol risks the blood pressures to the extremes and adds complications to her pregnancy that could spell more havoc. Visiting the clinic and other medical institutions are tremendously valuable for heather or any other patients with Rheumatic heart disease conditions (Gene 2001, p. 806-814; Frank 1995, p. 215; Maurice 1996, p. 303-307). Nurses are highly crucial in these institutions when dealing with cardiac disease patients. The nurses take care of the patients in the event of collapse that happens often for such patients. They also take care of some chores for instance bringing (food, water, medications, making the bed among others) to patients who cannot even do anything for themselves at such a state and comfort the patients when in pain in such difficult circumstances, when fighting for their lives. They are ideal for a patient like heather whose husband has already run away and left her alone with no one to care for them. For Rheumatic heart disease patients, they should always try and avoid staying alone because succumbing to attacks is unpredictable, therefore, needing someone to take care of them when such situations arises (Gene 2001, p. 806-814; Frank 1995, p. 215; Maurice 1996, p. 303-307). This is what nurses are for, which is why Heather should consider moving to hospital at her state before she gives birth. Conclusion Heather’s condition clearly discusses the link between Rheumatic Heart Disease (RHD), and pregnancy. It shows that the condition compromises normal pregnancy prompting a worry as a cause death if not well monitored. It shows appreciable link between Heathers health status, health education and health promotion activities, which she should practice in her condition including seeing the professional doctor, avoiding anything that compromises the heart functioning (alcohol, drugs etc) and portrays the role the nurse with a patient with cardiac disease as providing general care. Rheumatic Heart Disease is manageable (Maurice 1996, p. 303-307; Drury 1994, p. 70-73; Margaret et al 2001, p. 439-446) but requires individual effort and in situations of pregnancy, it demands an intensive monitoring of the patient and self-determination to survive. References Drury, M 1994, Rheumatic Heart Disease Complicating Pregnancy Rheumatic Heart Disease Complicating Pregnancy, The British Medical Journal, Vol. 1, No. 4853 (Jan. 9, 1994), pp. 70-73 Frank, D 1995, Rheumatic Heart Disease Complicating Pregnancy Rheumatic Heart Disease Complicating Pregnancy, The British Medical Journal, Vol. 1, No. 4855 (Jan. 23, 1995), p. 215 Gene, H 2001, Rheumatic Fever in the 21st Century Rheumatic Fever in the 21st Century, Clinical Infectious Diseases, Vol. 33, No. 6 (Sep. 15, 2001), pp. 806-814 Margaret, L. et al 2001, Maternal Pre-pregnancy Weight and Congenital Heart Defects in the Offspring, Epidemiology, Vol. 12, No. 4 (Jul., 2001), pp. 439-446 Maurice, S 1996, Heart Disease Today Heart Disease Today, American Journal of Nursing, Vol. 66, No. 2 (Feb., 1996), pp. 303-307 Read More