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Nurses often engaged themselves in problems associated with managing rheumatic heart disease patients. The nurses sometimes lack the knowledge and comprehension of acute rheumatic fever/ rheumatic heart disease‐ for patients and community, lack of understanding and a lack of observational research of how to best approach essential and primordial prevention action for acute rheumatic fever/ rheumatic heart disease.
The current constraints for nurses are that they cannot recommend – may only initiate medicines indicated by a Scheduled Substance Treatment. They lack the confidence/experience in distinguishing and managing the diverse symptoms of acute rheumatic fever/ rheumatic heart disease. A common issue often faced is the communication issues – for different languages there are lack of interpreters; hearing loss; utilization of complex English, delay in inception of treatment.
Nursing care of a child with rheumatic fever includes the nursing assessment. Nursing assessment for a child with rheumatic is to obtain a complete up-to-date history from the child and therefore the parent; ask about a recent sore throat or upper respiratory infection; decide once the symptoms begun, the extent of illness, and what if any treatment was obtained.
Assess frequently for • Rapid heartbeat • Fatigue • Sign of heart failure (like body swelling) and give appropriate nursing care. The temperatures of the child should at least take twice every day on a graph to distinguish any patterns of elevation. Vital sign should be assessed at least twice daily to distinguish widening pulse pressure and hemodynamic changes. Checking for heart murmurs through cardiovascular auscultation (a new murmur or changing murmur may show intensifying of conditions) and report to the doctor in charge if there is any changes of signs.
Avoid contamination through observing essential general standards of asepsis for example – hand washing, wearing of gloves, and controlling anticoagulants as prescribed. Watch the patient for any sign of response such as rash, diarrhea, and other antagonistic reaction to the antimicrobial treatment and report to the doctor.
Nursing interventions for children suffering from rheumatic fever include; providing comfort and ease from pain. A nurse should position the child to reduce joint pain, warm bath and mild range-of-motion exercise facilitated to mitigate a number of the joint discomforts; use pain indicators scales with children so that they are able to express the level of their pain. For those who do not feel very ill, bed rest can cause distress or resentment; be creating in findings diversional activities that allow bed rest but prevent restlessness and boredom, such as good book; quiet games can provide some entertainment, and plan all activities with the child’s developmental stage in mind. Rest period should be provided between activities to help pace the child energies and provide for maximum comfort; if the child has chorea, inform visitors that the child cannot control the movement, which are as upsetting to the child as they are to others. Protect the child from injury by keeping the side rails up and padding them; do not leave a child with chorea unattended in a wheelchair, and use all appropriate safety measures.
The teaching plan incorporates: the reason of having rheumatic fever and rheumatic heart disease and their course, major reasons of long term antibiotic administration, the requirement for prophylactic antibiotic when undergoing surgical interventions. Nurses should also teach the significance of ongoing assessment in evaluating treatment and recognizing the early signs and symptoms of complications, the significance of good daily oral cleanliness.
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