Nursing care to children Rheumatism with heart disease )

1. Defenisi
Heart disease is the symptoms of rheumatism the rest of fever rheumatism (DR) which is also an acute disease acute inflammation that can accompany the faringitis caused by Streptococcus beta-hemolyticus group A. This disease tends to recur and is seen as a cause of acquired heart disease in children and young adults around the world.
2. Etiology
Streptococcus infection of beta-hemolyticus group A in throat always precede the occurrence of fever, rheumatism, both in the first attack and attack back.
Has been known that in cases of fever, rheumatism, there are several predisposisi include:
a. There is a history fever rheumatism in the family
b. Age
DR often occurs between ages 5 - 15 years and rarely at the age of less than 2 years.
c. Social condition
Often occur in families with less social and economic conditions, poor housing with the solid and the air is humid, and nutrition and health that are less good.
d. Season
In countries with 4 seasons, there is a high incidence in late winter and the beginning of the semi (March-May) while the lowest incidence in August - September.
e. Distribusi area
f. Fever rheumatism previous attacks.
DR re-attack after the reinfeksi with beta-Streptococcus group A hemolyticus is often the children who previously never got DR.
3. Patofisiologi
According to the hypothesis Kaplan et al (1960) and Zabriskie (1966), DR occurs because there is a process autoimun or antigenic similarity between the body tissue and somatic antigen streptococcus. When the body infected by Streptococcus beta-hemolyticus group A against the foreign antigen is immediately form imunologik the antibody reaction. Due to the nature of this antigen with the antibody will also attack the body of the network components in this case the sarcolemma due to myocardial there with the antibody against the network in the heart of serum and tissue penderiat DR myocard damaged. One of the toxin that may have a role in the event DR is stretolysin titer 0, a product extraseluler Streptococcus beta-hemolyticus A group that is known to be toxik network myocard.
Several of the various somatic streptococcal antigen settle for a short period of time and the other for a long time. Serum imunologlobulin will be increased in patients after streptococcal sore get especially IG G and A.
4. Clinical manifestations
Associated with the diagnosis, clinical manifestations in the DR on differentiated acute manifestation of major and minor.
a. Major manifestations
• Karditis. Karditis rheumatic inflammation is an active process on the endokardium, miokardium, and pericardium. Early symptoms are feeling tired, pale, and anoreksia. Clinical sign karditis include takikardi, disritmia, noisy patologis, the kardiomegali in radiology that the longer the swell, the heart failed, and alert perikarditis.
• Artritis. Arthritis occurs in approximately 70% of patients with rheumatic fever, in the form of movement is not intentional and does not aim or inkoordinasi muskuler, usually on the face and muscle ektremitas.
• Eritema marginatum. Eritema marginatum found in approximately 5% patients. No itching, macular, eritema edge with a worm that appears to encircle the skin normal.often on the torso and leg proksimal, and does not involve the face.
• Nodulus subkutan. Found in 5-10% of patients. Nodul measuring between 0.5 - 2 cm, no pain, and can be moved freely. Mostly located at the surface ekstendor joints, especially elbow, finger joint, knee, foot and pivot.
b. Minor manifestations
Minor manifestation in acute rheumatic fever include fever can be remiten, antralgia, painful abdomen, anoreksia, Nausea, and vomiting.
5. Inspection Diagnostic
a. Examination of blood
a. LED high
b. Lekositosis
c. Low hemoglobin values may be
b. Bacteriology examination
• clear the throat culture to prove the existence of streptococcus.
• Vetting serologi. Titer measured ASTO, astistreptokinase, anti-hyaluronidase.
c. Radiology examination
Elektrokardoigrafi and ekokardiografi to assess the deviation of the heart.
6. Diagnosis
Acute rheumatic fever diagnosis portrait Jones based on criteria that have been revised. Because patologis depend on the clinical manifestations and diagnosis should be referred to the clinic manifestation, such as fever rheumatism with poliatritis only. The existence of two major criteria or one major and two minor criteria, indicates the possibility of fever, acute rheumatism, if supported by evidence of group A infection sterptokokus before.
7. Complications
a. Dekompensasi Cordis
Current dekompensasi cordis in babies and children there is described the clinical syndrome caused myocardium not able to meet the metabolic needs, including growth. This situation arose because of excessive heart muscle, usually because the structure of the heart rudiment, rudiment, such as heart muscle itself inflamasi process or a combination of both these factors.
In general pains in the heart of the classic children treated with digitalis and drugs diuretika. Treatment goal is to eliminate symptoms (simptomatik) and the most important primary treat disease.
b. Pericarditis
Inflammation in pericard visceralis and parietalis which vary from a mild inflammation reaction buried until the liquid in the cavum pericard.
8. Medicine
Because fever rheumatism closely associated with inflammation-hemolyticus beta Streptococcus group A, the eradication and prevention of inflammation is directed at. This can be:
a. Eradikasi bacteria Streptococcus beta-hemolyticus group A
Adekuat treatment must begin as soon as possible in the DR and proceed with precaution. Erythromycin was given to those who are allergic to penicillin.
b. Anti-rheumatism drug
Cortocisteroid and salisilat well known as a useful drug to reduce / eliminate symptoms of acute inflammation in the DR.
c. Diet
Food enough calories, protein and vitamins.
d. Rest
Rest is recommended until the signs disappear and inflamasi decline in the heart of the cases kardiomegali. Usually 7-14 days in the case of DR minus carditis. In the case of plus carditis, long rest average sunday 3 - 3 months depending on the weight difference ringannya the journey and the progress of disease.
e. Other medicines
Given in accordance with their needs. In the case of the dekompensasi kordis given digitalis, diuretika and sedative. When given largactil have chorea, and others.

CONCEPT Nursing
1. Of
Make a routine of physical
Get the history of health, particularly on the evidence of infection streptokokus antesenden.
Observation of manifestation fever rheumatism.
2. Nursing Diagnosis
a. High rainfall decrease in the risk associated with heart disfungsi myocardium
b. Increased body temperature (hipertermia) associated with the infection disease.
c. Nutrition needs of less-related nausea, vomiting, anoreksia.
d. Pain associated with the process inflamasi.

3. Nursing Plan
a. High rainfall decrease in the risk associated with heart disfungsi myocardium
Objectives: Patients can show improvement rainfall heart.
Rational intervention
Digoksin according to its instructions, with the precautions that have been determined to prevent toksisitas.
Knowledge signs toksisitas digoksin (nausea, vomiting, anoreksia, bradikardia, disritmia)
Often taken EKG rhythm strip
Jamin entries that potassium strong

Observation of signs hipokalemia
Give drugs to reduce afterload appropriate instructions rainfall can increase heart


To prevent the occurrence of toksisitas

Assess the status of the heart
Decrease in serum potassium level increases toksisitas digoksin


b. Increased body temperature (hipertermia) associated with the infection disease.
Destination: normal body temperature (36 - 37 'C)
Rational intervention
Knowledge while the incidence of fever
Observation vital signs: temperature, pulse, TD, breathing every 3 hours
Give an explanation of the causes of fever or increased body temperature

Please provide an explanation on the client and family about the things that made
Explain the importance tirah lie for the client and the consequences if it does not do
Encourage clients to drink lots of approximately 2.5 - 3 liters / day and explain the benefits

Give a warm compress and recommend wear thin


Give antipiretik accordance with the instruction pattern can be identified / high fever
Signs is a vital reference for the general client condition
Explanation of the conditions that experienced clients can help reduce the client and family care
To overcome the fever and encourage clients and families to be more cooperative
The involvement of family is very meaningful in the process of healing the client in the hospital

Increased body temperatures cause increased evaporation body fluids so that the need to offset with a lot of liquids Feed
Will compress can help lower body temperature, light clothing will be able to help improve the body's heat evaporation

Antipiretika who have reseptor in the hypothalamus can regulation body temperature so that the temperature near the body temperature normal effort
c. Nutrition needs of less-related nausea, vomiting, anoreksia.
Destination:
Client's nutrition needs met, the client is able to consume food that has been provided.
Rational intervent
knowledge factors that cause

Explain the importance of adequate nutrition


Encourage clients to eat in small portions and often, if vomiting does not continue
Make a good mouth care after vomiting
Measure BB every day

Record the amount of the portion of the client spent
Factor determining the cause, will determine the intervention / follow-up
Enhance client and family so that the client motivated to consume food
Avoid nausea and vomiting and excessive stomach distensi

That does not smell good at the mouth increase the likelihood of vomiting
BB is an indicator not met the needs of nutrition
Knowing the number of Feed / client fulfillment nutrition





d. Pain associated with the process inflamasi.
Destination: pain is reduced or lost
Rational intervention
Knowledge level of pain experienced by clients with a range of pain (1-10), specify the type of pain and patient response to the pain experienced
Knowledge-factor of factors that influence the reaction of the patient's pain

Provide a comfortable position, try to calm the situation room
Give the happy atmosphere for patients, patient divert attention from pain (Involve families)
Give the client the opportunity to communicate with friends / people nearby

Give medicines analgetik appropriate instructions To know how many levels of pain experienced


Patient react to the pain can be affected by various factors like that also individual responses to pain vary different dab
Reduce excitatory painful stimulus due to external
By doing other activities, clients can forget a little attention to the pain experienced
Stay in touch with the nearest / friend to make the patient happy / happy and dapaty divert attention to the painful
Reducing pain with effect farmakologik..