- About heart function.
- Nutritional status of patients.
- Tolerance to the activities and attitudes of patients toward limiting the activities undertaken.
- Disturbances in sleep patterns.
- Level of discomfort felt by rheumatic fever patients.
- Ability of the patient in terms of troubleshooting.
- Knowledge of patients and families will be suffered by rheumatic heart disease.
- History of rheumatic heart disease.
- Monitor cardiac complications in the event.
- Auscultation of heart sounds, usually typical in patients with rheumatic heart was weakened heart sounds with the rhythm of galloping diastole.
- Assessment of the patient's vital signs.
- Assessment of pain.
- Assessment of the presence of markers of inflammation in the joints.
- Assessment of the presence of lesions on the skin.
Nursing Care Plan for Rheumatic Heart Disease
1. Decreased cardiac output related to valvular stenosis
Goals to be achieved is to increase cardiac output.
Expected outcomes are:
- Patients showed reduced levels of dyspnoe experienced.
- Patients participating in participating in the activity and demonstrate increased tolerance.
- Monitor vital signs such as: blood pressure, apical pulse and peripheral pulse.
- Monitor cardiac rhythm and frequency.
- Semifowler bed rest in a position that is 45 degrees.
- Encourage the patient to stress management techniques (quiet environment, meditation).
- Bantu patient activity as indicated when the patient is able.
- Medical collaboration in terms of oxygen delivery and therapy.
2. Activity intolerance related to decreased cardiac output, oxygen supply and demand imbalance.
Goals to be achieved is an optimal patient can tolerate the activity does.
Expected outcomes are:
- Verbal response to reduced fatigue
- Conducting activities within the limits of his ability (pulse activity should not be more than 90X/mnt, no chest pain).
- Energy saving during the acute patients.
- Maintain bed rest until the results of laboratory and clinical status of patients improved.
- In line with the good general condition, monitor the gradual increase in the level of activity undertaken.
- Teach to participate in activities of daily necessities.
- Create a schedule of activities and also the breaks.
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