PARUL INSTITUTE OF NURSING

FIRST YEAR MSC NURSING

MEDICAL SURGICAL NURSING
CASE STUDY
On
Rheumatic Heart Disease

Submitted to, Submitted by

Mr Swapnil Rahane, Ms Megha Ghosh
Assistant Professor, (PIN) 1st year M.Sc. Nursing
Medical Surgical Nursing Medical Surgical
Parul University Nursing

Submitted on- 05-06-25

1
PATIENT INFORMATION:

 Name : MRS KRISHNA SINDHI

 Age : 48 years
 Sex : Female
 Marital Status : married.
 Hospital Registration No. : PSH 164958
 Ward/Bed No. : ICU
 Address : Gokul Nagar, VADODARA
 Religion : -Hindu
 Education : -12th class
 Date of Admission : 12/9/2024

NURSING ALERT:

Sensitivity / Allergy / Precaution: no specific allergy

Weight : 60kgs

Height : 5’3”

SOCIO ECONOMICSTATUS: -

A) Housing: –
a. Type of house : small house of three rooms made up of bricks.
b. Lighting : Proper lighting facilities are available.
c. Ventilation : Eight windows and door, good ventilation facility are
a. available.
d. Water facility : day by day.
e. Sanitation : Lack of sanitation and hygiene.

B) Food hygiene practices : They wash vegetables & cooking food in hygienic condition.

C) Personal hygiene practice: -They are maintaining personal hygiene, taking bath
Daily, washing hands, cutting nails, brush daily etc.

D)Community resources : -Resources like bus and train are available for transportation,
Educational resources are available up to 12th std. proper health resource is available.

E) Religious practices : Client and her family members are strong believers of Hindu
Religion.
F) Family income and expenditure: -
 Food – 1500/-
 Clothing – 1000/-
 Education – 5000/-
 Health – 4000/-
 Others – 1000/-

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 ALLERGIES AND MEDICATION: -

 Drugs / Foods / Dyes / Others : Client have allergies from dust and pollution .
 Signs and symptoms : sneezing
 Blood reaction : Nil

HISTORY OF ILLNESS: -

Chief complaints with duration

Mrs Krishna was relatively asymptomatic before 15 days. One day she had suddenly started.

exertional dyspnoea, palpation tachycardia and increase in BP. She had admitted to PSH and

diagnosed RHD

History of present Illness

Presently my client Mrs Krishna sandhi is suffering from the Rheumatic Heart Disease and
treatment taken as per doctor’s order.

History of past medical Illness :

Mrs Krishna was 5 years old she had got the streptococcal infection of the throat with fever
and severe joint pain. due to this infection, she developed the rheumatic endocarditis. she got
treatment from private hospital of Ahmedabad. penicillin prophylaxis given at that time.

Other history like chest pain, hypertension, jaundice, diabetes mellitus.

History of past surgical illness:

Mrs Krishna has no significant past history of any surgical illness like appendectomy, hernia,
etc.

FAMILY HISTORY:

1. Mr. Hari 55yrs patient worker healthy -

sandhi .

2. Mrs. 48yrs Wife Housewife Unhealthy Walking

Kirshna
sandhi

3. Mr. Sahil 30yrs Son Business Healthy cycling

sandhi

3
4. Mrs. Susila 26yrs Daughter-in-law Housewife Healthy Walking
sandhi

5. Mr. Bhavesh 15yrs Grand son Student Healthy Walking

FUNCTIONAL HEALTH PATTERN -

 Inter Personal Relationship: -

Patient maintains good IPR with every hospital staff. She is very calm and co-
operative.

 Hygiene: -
Patient is able to do her daily routine activities.

 Activity / Exercises: -
she is able to do active and passive exercise using both the upper and lower
extremities.

 Rest / Sleep:-
she is not able to take proper sleep at night because of hospitalization and
anxiety about disease condition.

 Elimination Pattern: -
The bowel and bladder elimination patterns are normal.
 Cognitive / Perceptual:-
Cognitive functions are normal.

 Self-perception / self-concept pattern :-

Patient has insight and she is having general sense of emotions.

 Coping Stress Tolerance:-

Patient is able to tolerate the stress.

 Values and Beliefs:-

Patient is a believer of Hindu religion.

 Personal Habits :-
He uses to take rest and sleep.

DIETARY HISTORY:

 General appearance : Average

 Appetite : Fair
 Diet : Non veg.
 Meal pattern : Two times in day and breakfast in the morning

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  Need assistant / Feed self : No need of assistant.
 Other method of feeding : Nil

PHYSICAL EXAMINATION:

General appearance:

 Level Of Consciousness : Conscious

 Orientation : To Place / Person / Time
 Activity : Dull
 Body Built : Moderate

Anthropometric measurement:

 Height : 5’3’’cm
 Weight : 49kgs.

Vital signs:

 Temperature : 99oF
 Pulse : 92 beats/ minute
 Respiration : 26 breaths/minute
 Blood pressure : 100/70 mm of Hg.

Head and Face:

 Hair : Equally Distributed

 Color of Hair : brown
 Scalp : Clean, No Dandruff
 Pediculosis : Absent
 Face : Symmetrical
 Facial Puffiness : Present
Eyes:

 Eyebrows : Symmetrical
 Eye Lid / Lashes : No Redness / Swelling / Discharge / Lesions
 Eyeball : No Sunken / Protrusion
 Conjunctiva : Normal / No Swelling / Lesions
 Sclera : White/ No Tenderness/Discharge/Lesions
 Cornea : Regular Ridges
 Iris : Flat Shape
 Eye Discharge : Absent
 Use of Glasses : No
Ears:

 Redness : Absent

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  Discharge : Absent
 Crewmen : Absent
 Lesions : Absent
 Foreign Body : Absent
 Use of Hearing Aids : No
 Tympanic membrane : no perforations, lesions and bulging.
 Hearing acuity : medium.

Nose:

 External nares : no crusts or discharges.

 Patency : patent
 Olfactory Sense : present
 Nasal Septum :Central
 Nasal Polyps :Absent
 Nasal Discharge : Absent

Mouth:

 Number of Teeth : 30
 Dentures : Absent
 Dental Carries : Absent
 Odor of Mouth : Foul Smell
 Gums : Weak /No Swollen / Pale Color
 Palates and Uvula : visible
 Tonsillar area : no inflammation
 Hygiene : hygienic

Lips:

 Lips : No Crack / brown in colour

 Cleft Lips : Not present
 Stomatitis : Absent

Neck:

 Muscles : normal range of motion

 Trachea : presence of thick tenacious sputum
 Thyroid : no thyroid enlargement
 Nodes : no lymph node enlargement
 Vein distension : no distension

Thorax:

 Chest shape : normal

 Respiratory Rate : 24 breaths per minute

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  Type of Respiration : normal
 Thoracic Expansion : symmetrical
 Palpation : ribs are palpable and normal
 Percussion : normal breath sounds

Nervous system:

 Language : clear and understandable

 Mental status : sound mental health
 Orientation : well oriented
 Memory Attention span : long term memory
 Level of Consciousness : 14
 Cranial Nerves : normal function
 Deep Tendon Reflex : present
 Gross and Fine motor
Function of UE and LE : normal
 Sensory function : normal
 Light touch : sensible to light touch
 Pain : sensitive to pain
 Temperature : frequent episode of fever
 Position : normal

Respiratory system

 Respiratory Rate : 26 breaths per minute

Inspect the Chest

 Thoracic Cage- Shape : Normal /No Barrel Chest/Scoliosis/ Kyphosis

 Configuration : Normal
 Skin Colour and Condition : Pallor
 Chest Expansion : Symmetric

Percussion

 Lung Field : congestion present

 Resonance : Hyper Resonance
 Diaphragmatic Excursion : Dull

Auscultation

 Breathing Sound : crackles in lower zone of lungs

 dyspnoea : present
 Respiratory Pattern : arrhythmia
 Cough : productive cough

Cardiovascular system:

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  Pulse : 91 beats/min
 Heart Sound : S1, S2 Heard
 Abnormal Heart Sound : S3 or S4 Present / Absent
 Murmurs : Present / Absent
 Carotid Pulse Rate :74/min
 Blood Pressure :140/70 mmHg

Central and peripheral lymphatic system

 Inspect and Palpate the Leg : edema

 Carotid arteries : palpable
 Peripheral pulses : palpable
 Radial : palpable
 Femoral : palpable
 Popliteal : palpable
 Posterior Tibial Pulse : palpable
 Dorsal is Pedi’s Pulse : palpable
 Edema : present
 Varicose Veins : Present
 Venous Ulcer : Absent

 Capillary Refill : 3seconds

Digestive system

 Abdominal Girth : 60
 Diarrhoea / Constipation : nil

Inspection

 Size : Scaphoid Protuberant Flat Rounded

 Symmetry : no Bulges Masses or Hernia
 Scar : absent
 Lesions : absent
 Redness : absent

Palpation

 Tenderness : Absent
 Fluid Collection : Absent
 Mass / Soft : soft

Percussion

 Ascites / Peritonitis : nil

 Gas / Fluid Collection : Not present

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Auscultation

 Bowel Sound : Borborygmus Absent

Musculoskeletal system:

 Gait : no significant spinal abnormalities and gait

Disturbances
 Upper Extremities : normal ROM
 Lower extremities : ROM normal
 Muscle strength : no muscle weakness
 Range of Motion : normal
 Spine : absence of lordosis, kyphosis or scoliosis
 Joint Swelling / Pain : pain in joint
 Weakness / Paralysis :absent

Genito urinary system:

 Frequency of Urination : 5 to 6 times a day

 Colour of the urine : pale yellowish coloured
 Normal / Anuria / Haematuria / Dysuria/ Incontinence / Any Other: - not present
 Catheter Present : No
 Urethral Discharge : No

Integumentary system:

 Skin Colour : Normal Brown

 Dermatitis : No
 Allergies : No
 Cause : Nil
 Reaction : Nil
 Lesions / Abrasions : No
 Tenderness / Redness : No
 Surgical scar : No
 Secretion : sweating present

Mental status :

 Memory : Good
 Knowledge : Good
 Thinking : Good
 Judgement : Good
 Insight : Yes

Neurological assessment:

Level of consciousness

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 GCS (Glasgow coma scale)

Content Normal score Patient score

Eye opening response

Spontaneous 4

To Voice 3 3

To pain 2

No response 1

Best motor response

Obeys verbal command 6 6

Localize pain 5

Flexion 4

Flexion abnormal 3

Extension abnormal 2

No response 1

Best verbal response

Oriented to place & person 5 5

Conversation with confused 4

Inappropriate words 3

Incomprehensive Sounds 2

No response 1

TOTAL 15 14

Motor function:

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 Reflexes

Sr. No. NAME OF THE REFLEX REMARK

1. Biceps Normal
2. Triceps Normal
3. Patellar Normal
4. Achilles Normal
5. Plantar Normal
6. Gluteal Normal

Sr. Name of Cranial

Functions Remarks
No. Nerve
1 Olfactory Identify familiar odour Normal

2 Optic Check the visual acuity and field Normal

Check the pupillary reflex
3 Oculomotor Extra ocular muscle movement Normal

4 Trochlear Extra ocular muscle movement Normal

5 Trigeminal Clench teeth Normal

6 Abduces Extra ocular muscle movement to Normal

right and left side
7 Facial Smile/Puff cheeks/ Identify tasks Normal

8 Acoustic Hearing acuity(Weber and rinne test) Normal

9 Glossopharyngeal Gag reflex Normal

10 Vegas Swallowing Normal

11 Spinal Accessory Turn head Normal

Shrug shoulders again resistance
12 Hypoglossal Protrude tongue Normal
Wiggle tongue from side to side
Cranial nerve function: -

FINAL IMPRESSION: -All the cranial nerves function is normal.

ANATOMY AND PHYSIOLOGY OF HEART: -

INTRODUCTION: -

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Every tissue in the body requires an adequate supply of oxygen, nutrients and hormones.

The waste products should be removed from the tissue from time to time. These
functions are carried out by the blood.

The blood is pumped out by the heart into the Aorta from which is it distributed to all
parts of the body.

THE HEART: -

It is a hollow muscular organ, which is situated in the middle mediastinum in the thorax.
It lies between the two lungs and just above the diaphragm.

The heart is slightly larger than a clinched fist.

The heart measures about 12 x 9 cm. and weighs about 300 gm. In males and 250 gm. In
females.

The heart is a cone shaped organ.

RELATIONS OF THE HEART: -

Anterior – Sternum, costal cartilage and ribs.

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Posterior – Oesophagus, thoracic duct, Azygos vein.

Superior – superior vena cava,

Inferior – diaphragm.

Lateral-lungs

EXTERNAL FEATURE OF THE HEART: -

Coverings of the heart – The wall of the heart consists of 3 layers.

1. Endocardium. 2. Myocardium 3. Pericardium

1. Pericardium – It is a double wall sac around the heart composed of –

A superficial fibrous pericardium.

A deep two layer serous pericardium.

The parietal layer lines the internal surface of the fibrous pericardium.

The visceral layer surface of the heart.

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They are separated by the fluid filled pericardial cavity.

2. Myocardium – It is a middle muscular layer. It is the thickest layer and forms the main
mass of the heart. It is responsible for the contraction of the heart.

3. Endocardium – It is the innermost layer of tissue that lines the chambers of the heart. They
are made up of epithelium tissue.

BASE, APEX AND SURFACE OF THE HEART: -

The heart has a base, an apex and 3 surfaces – stern costal, the diaphragmatic, pulmonary
surfaces. It has 4 borders – right, left, sup. And INF.

The base of the heart is located posteriorly and is formed mainly by the left atrium.

The apex of the heart is formed by the left ventricle. It is located posterior to the 5th left
intercostal space in adults.

The stern costal surface of the heart is mainly formed by the right ventricle.

The Diaphragmatic surface is formed by the both ventricles.

The pulmonary or the left surface of the heart is formed mainly by the left ventricle.

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CHAMBERS OF THE HEART: -

The heart has 4 chambers, 2 atria and 2 ventricles.

The right atrium- It forms the right border of the heart, between the SVC and IVC. It
receives venous blood from the superior and inferior vena cava and coronary surface.

The intertribal septum separates the right atrium from the left atrium.

The Sino- atrial node (S.A NODE) lies in the wall of the right atrium. It is the natural
pacemaker of the heart.

Tricuspid valve is located between the R.A and L.A.

RIGHT VENTRICLE: -

It is the largest part of the stern costal surface.

There are numerous irregular muscle bundles, papillary muscles, within the ventricles. A
number of fibrous threads called chorda tendineae.

The right atrioventricular valve or tricuspid valve guards the right atrioventricular orifice.

The pulmonary valve consist of 3 semilunar cusps, guards the pulmonary orifice.

THE LEFT ATRIUM: -

It forms the base or posterior aspect of the heart.

Four pulmonary veins enter the posterior wall of the left atrium.

The bicuspid (left atrioventricular valve) is located between the left atrium and the left
ventricle.

LEFT VENTRICAL: -

It forms the apex of the heart

The wall of left ventricle is twice as thick as that of the right ventricle, because the left
ventricle performs more work than the.

The left atrioventricular valve or Mitral valve or bicuspid valve guards the left
atrioventricular orifice.

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The left ventricle is separated from the right ventricle by a thick, interventricular septum.

BLOOD SUPPLY OF HEART:

Arterial supply – The heart gets its nutrient and oxygen from two arteries – The right and left
coronary arteries.

These are the first branches of aorta.

The right and left coronary arteries are called “coronary “because they encircle the base of
the ventricle somewhat like a crown.

The Right coronary artery (RCA) – It arises from the right aortic sinus. Branches of right
coronary artery are –

Posterior Interventricular branch.

Marginal branch.

2. The left coronary artery (LCA) – It arises from the left aortic sinus. Branches of left
coronary artery are-

Anterior interventricular branch.

Circumflex branch.

VENOUS DRAINAGE OF THE HEART: -

The walls of the heart are drained by veins that empty into the coronary sinus.

Tributaries of the Coronary sinus –

The Great Cardiac vein.

Middle cardiac vein.

Small cardiac vein

Some venous blood of the heart drained by anterior cardiac vein or Thebe Sian veins. It opens
directly into the right atrium.

NERVE SUPPLY OF THE HEART:-

The heart is supplied by Autonomic nerve fibers.

16
Parasympathetic fibers are derived from both Vegas nerves. Sympathetic fibers are derived
from sympathetic trunk.

Both these Fibers from a Network called the Cardiac plexus.

INVESTIGATIONS: -

SR NO. NAME OF NORMAL PATIENT REMARK

INVESTIGATION VALUE VALUE

haemoglobin 12-16 gm.% 11.9 gm% normal

WBC count 4000-11000/ 6,800 /cumm Normal

cumm

40-75 %
Neutrophils 65 %

20-45 %
Lymphocytes 47 %

0-5 %
Eosinophil 03 % Normal

0-5%
Monocytes 04%

0-2%
Basophils 00 %

Normal
70-120 mg%
Random blood sugar 140 mg%

---
---
Blood group B positive

---
---
HIV Negative

17
Serum sodium 135-145 mEq/L 141mEq/L normal

Serum potassium 4.1mEq/L normal

3.5 -5.5 mEq/L

Serum creatinine 0.53 mg/dl normal

O.8-1.4 mg /dl

Serum chloride 101mEq/L Normal

96-106mEq/L

Erythrocyte Sedimentation 0.4mm\hr Normal

Rate(ESR)
F: 312mm
Urea
24.0mg/dl Normal
Protein
13-40mg / dl
Albumin
6.6-8.3 G/L Normal
Globulin
6.36 G/L 3.5-5.0G/L Normal
PT /INR
12.9 G/L

13.8/1.072 sec

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Special Test

1.X-ray chest -: BVM prominent LVH.

2.ECG -: Q wave in 1, aVL,V1 to V6 , normal rhythm, 90 / min.

3.echocardiogram -: Mitral valve: Thick

-: aortic valve: Thick and Calcified

-: LVEF – 60%

-; RA and RV – Normal

-; LVOT diameter – 21 mm

4.Angiography -: LMCA++ DVD + old anterior wall MI + Mild LV

dysfunction

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 PHARMACOLOGICAL MANAGEMENT

S.no Trade name and generic dose Route frequency Mode of action Side effects Nurses
name of the drug responsibility

1. Inj. Dopamine 5-10 IV BD Stimulate cardiac activity and Nausea, Vomiting, -Check the vitals
mg/min Vaso constriction effect. tachycardia, anginal
pain, -assess for accurate
dose.

2. Tab. Dobutamine 2.5 IV OD Stimulate Beta – 1 receptors of teach

Check the vitals
mg/kg/m the heart to increase
in myocardial contractility and -provide complete
stroke volume, resulting in bed rest.
increased cardiac output. -monitor urine
output.

3. Tab. Lasix 20 mg P/O BD to reduce extra fluid in the ringing in your ears, -provide
body (oedema) caused by hearing loss; comfortable
conditions such as heart confusion, position.
drowsiness,
failure, liver disease,
problems with -provide adequate
and disease used to treat high memory or speech; fluid.
blood pressure
-check B.P.
frequently.

20
4. Inj fortum 1 gm IV BD
Serious infection of the Skin rash, pain at
respiratory tract, ENT, skin, GI, infection site, fever, -check the vitals
ETC headache, -give slowly
thrombocytopenia,
-see the infection
phlebitis. site for phlebitis

5 Tab. Amikacin 500 mg 1V BD Bacteraemia, septicaemia Hypertension, -check vital sign

burns and post operative nausea, vomiting,
infection nephrotoxicity - monitor urine
output.

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LIST OF NURSING DIAGNOSES AND NURSING CARE PLANS:-

 Altered breathing pattern related to pulmonary congestion as evidence by

high pulse rate and low saturation.
 Decease cardiac output R/T contractibility secondary to Rheumatics
Heart Disease
 Hypertension related to streptococcal infection as evidence by rigor and
high fever.
 Anxiety and fear related to disease and prolong hospitalisation as
evidence by patient verbalization.
 Risk for excess fluid volume related to increase sodium / water retention.

22
ng Nursing Expected Out Interventions Rationale Eva
ment Diagnosis Come

data: Altered breathing To relief dyspnoea -Fowler position is given to -patient’s discomfortable
s that pattern related to the patient. position can increase Expected
ng pulmonary breathing difficulty. has met a
ble in congestion. as -maintain urine output chart. patient w
evidence by high - fluid was restricted. comforta
pulse rate and low -inj Lasix was given as -fluid and urine output breathing
data : saturation. physician advice. should be maintain as fluid rate was
a. accumulation in the body normal .
macing can increase the risk of heart
ss, failure.
level
sness - diuretic drugs may
P theoretically improve
respiratory in chronic
obstructive pulmonary
- disease.

-Administer supplemental
oxygen by means of nasal
cannula or face mask, as
indicated.

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ASSESSMENT NURSING EXPECTED INTERVENTION RATIONA
DIAGNOSIS OUTCOME

Subjective: Decrease cardiac Patient will able to Keep patient on bed Decrease
output R/T alt alleviate feelings of rest / chair rest workload
_ patient complaint contractibility chest pain and position of comfort. comfort.
for uncomfortable secondary to acute shortness of breath
and uneasy. Rheumatic Heart and verbalise feeling Monitor vital sign _ to no
Disease. of comfort. and cardiac rhythm current
frequently as well as response t
0bjective: hemodynamic and interve
measurement as
_ decrease in prescribe. _ to incre
saturation. available
_ administer oxygen function
_ alt vital sign via face mask or perfusion.
ventilator as indicate.
BP = 90/60 _ antibioti
_ administer to tre
PR = 90
medication as order. underlying
RR = 21 streptococc
ction an
further
Analgesic
treat the
by RHD.

ASSESSMENT NURSING EXPECTED INTERVENTION RATIONA

24
 DIAGONOSIS OUTCOME

Subjective: Hypertension related Patient will maintain Adjust the monitor Cool en
to streptococcal body temperature environment factor will hav
Patient complaint for infection as evidence below 99 c. like room discomfort
chill and cold. by rigor and high temperature and bed patient w
Objective: fever. linen. episode of r

Temp = 99.2 F Keep ready oxygen Patient w

therapy for extreme discomfort
cases. breathing.

Eliminate excess Excessive

clothing and covers. Make th
warmer.
Stop iv fluid for a
while. Antipyretic
given to de
Give antipyretic fever
medication as
prescribe.

ASSESSMENT NURSING EXPECTED INTERVENTION RATIONA

DIAGONOSIS OUTCOME

25
Subjective: Anxiety and fear Patient will be able to Listen to the patient Due to
related to disease overcome from fear feelings and hospitalisat
Patients express the condition and and anxiety and cope emotions. disease like
feeling of fear and prolong up with the process. cause fe
anxiety. hospitalisation as Give emotional nervousnes
evidence by patient support to the patient patent an
Objective: and her family.
verbalization member.
Fear in facial Acknowledge the
expression. There mig
patient about disease of losing
Verbalise fear of condition and member
losing family. ongoing treatment. threatening

Anxiety for prolong Provide comfortable acknowledg

hospitalization. environment to patient an
patient her family. help them
with
Build good process.
interpersonal
relationship.

26
27
ng Nursing Expected Out Interventions Rationale Eva
ment Diagnosis Come

data: Risk for Excess -Maintain fluid -Auscultate breath sounds for - May indicate pulmonary Not appl
Fluid Volume balance as presence of crackles. edema secondary to cardiac the patie
ble as related to evidenced by BP decompensation. it is not a
s at increased within patient’s nursing d
t an sodium/water normal limits. -Note JVD, development of - Suggests developing
ng retention -Be free of dependent edema. congestive heart failure or
peripheral/venous fluid volume excess.
data : distension and Measure I&O, noting
dependent edema, decrease in output,
ble. A with lungs clear and concentrated appearance.
sis is weight stable.
ed by -Calculate fluid balance. - Decreased cardiac output
results in impaired kidney
as the perfusion, sodium and water
s not retention, and reduced urine
d output.
-Weigh daily.
ns are - Sudden changes in
weight reflect alterations in
fluid balance.
-Maintain total fluid intake at
2000 mL/24 hr within - Meets normal adult body
cardiovascular tolerance. fluid requirements, but may
require alteration or
restriction in presence of
cardiac decompensation.
-Provide low-sodium
diet/beverages. - Sodium enhances fluid
retention and should
therefore be restricted during
active MI phase and/or if
heart failure is present.
-Administer diuretics:
furosemide (Lasix), - May be necessary to correct
spironolactone with fluid overload. Drug choice
hydrochlorothiazide is usually dependent on acute
(Aldactazide), hydralazine or chronic nature of
(Apresoline). symptoms.

-Monitor potassium as
indicated. - Hypokalemia can limit
effectiveness of therapy and
can occur with use of
potassium-depleting
diuretics.

28
 HEALTH EDUCATION ON
RHEUMATIC HEART DISEASE

MEDICINE:

Mrs Krishna has taught to take regular medicine without any fail. To complete
the full doses and has taught about the side effect of the medicine and make sure
that if get any kind of complication immediately inform to the doctor.

KNOWLEDGE ABOUT DISEASE:

RHD is a condition where the heart valve have been permanently damaged by
rheumatic fever. There is no cure for rheumatic heart disease and the damage to
the heart valve are permanent. Patients with severe rheumatic heart disease will
often require surgery to replace the damages valve or valve.

EXERCISE

Encourage the patient to do some exercise like walking, water

exercise, and bicycling.

DIET

Educate the patient to take proper diet. A Healthy diet for people with rheumatic
heart disease can include:

29
 Fruits and Vegetables: These are rich in fibres, antioxidants, vitamins,
and minerals, which can help reduce bad cholesterol, lower inflammation,
and protects the heart.
 Whole grains: These can lower levels of C-reaction protein, a marker of
inflammation, and reduce the risk of heart disease.
 Fatty fish: These are rich in omega-3 fatty acids, which can help control
inflammation.
 Pea and beans: These are a good source of protein, which is importan6t
for muscle health.
 Nuts: These are full of monounsaturated fat, which can protect the heart.
 Olive oil: This can be used instead of other oils and fats.

BIBLIOGRAPHY
 Brunner and Suddarth’s Textbook of Medical Surgical Nursing. 10th
edition, Lippincott William and Wilkins publication.
 Brunner and Suddarth’s Textbook of Medical Surgical Nursing.13th
edition, Janice L. Hinkle Kerry H. Cheever.
 Lewis Heitkemper, Dirksen (2005), Textbook of Medical- Surgical
Nursing, 6th edition, Mosby Publications.
 Ross & Wilson (2006), Textbook of Anatomy & Physiology, 10th edition,
Elsevier publications, Philadelphia, USA.

30
 Parul Institute of Nursing
Medical Surgical Nursing
Evaluation Criteria – Care Study
Name of Students: - Megha Ghosh Date: - 24-03-25

Clinical Area: -Medical-Surgical Diagnosis: - RHD

ALLOTTED OBTAINED
SR.NO CONTENT MARKS MARKS
1 History Collection 06
Physical Examination 08
2

3 Drug investigation 04
Adequacy of the Content 08
4 Anatomy and Physiology of Heart 08

List of nursing care plan 08

5 NCP and intervention.

Health education of the client 04

6

8 Bibliography 02
Total
50

Comments: -

Signature of the evaluator: Signature of the student:

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