Maternal Health & Pediatrics: Rheumatic Heart Disease

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Introduction

Rheumatic heart disease (RHD) is mainly caused by a reaction of bacterial infections in the heart. The illness mainly causes permanent damages to the valves of the heart. Rheumatic heart disease is one of the leading causes of premature deaths.  However, many causes of rheumatic heart disease and resultant death are quit preventable for instance industrialized countries in the 20th century considerable reduced the risk of contraption and death from RHD through reduced transmission an improved healthcare. In most developing countries this diseases is still very common especially in children. In Australia the risk of RHD is highly reduced in the affluent subsection of the population however the condition is very prevalent among the Aboriginal and Torres Strait Islander communities. Of those affected the number of children is very high. According to the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand (2006, p. 1), the chances of the Aboriginals and the Torres Islanders to contract the diseases are high compared to that of the non aboriginals. Also the aboriginals are 20 times more likely to die from the condition that the non-aboriginals.  In this paper, I shall look at the link between rheumatic heart diseases and pregnancy, the Link between Heathers health status, health education and health promotion activities and the role of nurses in handling teenager diagnosed with rheumatic heart disease.

The link between rheumatic heart disease and pregnancy

Any kind of heart disease in pregnant women tends to complicate at least 1% of the pregnancies.  Many deaths during pregnancies have been attributes to heart diseases. No where is this more true than in the developing countries where rheumatic heart disease has been credited to be  the leading of maternal heart disease, contrary to these the in the developed world  maternal congenital heart disease is more common due to the improved survival of children with congenital  diseases occasioned by improved medical services (Pillitteri, 2007).

Unlike Heather, many women with heart diseases in many cases stay in the oblivion not knowing their condition until during pregnancy. Some women only get to be diagnosed of this condition when it is too late and these form the large percentage of those who die.  Pregnancy has a great haemo-dynamic burden on pregnant women.  The burden in most cases unmasks many heart diseases that were asymptomatic.  Many women suffering from rheumatic heart disease have been diagnosed to have the condition during pregnancy due to increased heart rate that exposes symptoms that had never been seen before. Cardio vascular diseases are very life threatening to pregnant women. Most of the symptoms associated with cardiovascular diseases if not diagnosed earlier appear a few weeks to the delivery date or within days or even weeks post-partum. It is also not uncommon for such symptoms to appear several weeks after delivery. Women with undiagnosed heart diseases that have been in existence for quite some time and those with new cases are mostly handled with primary care giver and obstetricians. Timely diagnosis is very important, however this greatly depend on their care givers or obstetricians’ awareness. The threat posed by rheumatic heart diseases necessitates development of a proper a cardiac history or family history and extensive check ups of pregnant women. Physiological changes during pregnancy can lead to women developing symptoms that mimic those of heart diseases such as   rheumatic heart disease.  A good example of this includes among others shortness in breath, systolic ejection murmurs, fatigue and oedema. In circumstances such as this, the obstetric caregiver’s awareness on maters of heart diseases becomes very useful in distinguishing between symptoms resulting from normal pregnancy and those caused by a heart disease.  Electro –cardiography and echocardiography should be performed whenever rheumatic heart disease is suspected.  Women who are diagnosed with rheumatic heart disease prior to pregnancy should be given good pre-conception counseling by a specialist. More important however is the need to address this issue early for instance early assessment risks incase of pregnancy in teenagers suffering from any kind of heart disease once they are sexually active.  Such early guidance is very important since it facilitates reduction of the risk posed to both the mother and the fetus when pregnancy is finally conceived.

Of all women teenagers are in more need of information concerning contraceptives combined hormonal contraceptives are very effect. They contain both progesterone and oestrogen which makes them more effective and reliable. Unfortunately oestrogen encourages thrombogenicity making women weaker as well as exposing them to the risk of thrombocity. Certainly the need for proactive counseling as well guidance is also very important since poor choice of contraceptives can aggravate the condition and lead to even more fatal conditions. The time at which teenagers’ visits a specialist for advice is very critical. But it is necessary that the get advice concerning pregnancy. Alternatively, nurses who have specialized in such cases can help provide advice the young women. In many cases teenagers between the ages of 16-18 are never interested in getting the whole information; however, specialist should always ensure that specific amount critical information is shared during the girls’ first visits. Such information can include critical information concerning the risk of pregnancy whether they are pregnant or not, effective and safe use of contraceptives. Conversely, they should be advised to visit cardiologists to be fed on important pre-pregnancy information prior to conceiving.  However, it of utmost importance that the specialist takes the patients thought the whole content of discussion concerning all the specifics about rheumatic heart disease.   Maternal risk, fetal risk and the probability of inheritance of the diseases should also be discussed.

Proper planning of pregnancy can be very important in reducing the posed to both the mother and the fetus.  Such planning starts with a proper examination prior to pregnancy. Such an examination basically includes, examination physically, electrocardiogram, exercise testing, oxygen saturation, and echocardiogram. Echocardiographically MRI can also be very useful especially in cases where the other methods are not effective.  Findings by the tests above provide crucial information for making for calculating the risk both the mother and the baby are exposed to.  Some critical heart condition may require surgical operations. It is wise to chose medication correctly since some medication may affect the mother, the baby or both. In this regard the dosage should be kept at the minimum level possible to ensure maternal and fetal safety.   Proper communication between the mother and the doctor is necessary. In some hospital multidisciplinary teams are used to attend to women with rheumatic hear t disease once pregnancy is established. As such pregnant women should make a point to visit a cardiologist during the first month of pregnancy and ones in every subsequent trimester (National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand, 2006, p. 33)

Link between Heathers health status, health education and health promotion activities

Education and health promotion activities can be vey helpful in helping to reduce the instances of complications arising from rheumatic heart disease.  Education and promotion activities mainly crate awareness within the community/ population concerning rheumatic heart disease.  Once people have basic  information about the condition, they will more willing participate in the management of the disease since information capacitates them to indentify possible rheumatic heart disease case and hence seek further information, diagnosis and early treatment.  However, in many place especially among the Aboriginal population of Australia such information is not readily available (Mincham & Plant 2002, p. 419). The case of heather could be a product of this scenario.  A qualitative analysis of the opinions of patients suffering from rheumatic heart disease in Kimberly, Australia revealed the many people did not have proper information concerning the condition. Some of the locals consider it as a secondary prophylaxis.  An interview with a patient in this location revealed that most of the patients had shallow understanding of their condition despite having received explanation s possibly from their doctors or care gives.  Most of the patients however, participate in the management programs as a result of close association with their care givers. For instance patients depended on the nurses to remind them of their injections and ensure that they take medications or injections when they are supposed to (Mincham, et al, 2003, p. 263).  For instance, an adult patient admitted threat she relied on a neighbor nurse for the purposes of medication. The proximity of their homes made it easy to communicate and the nurse made sure that she always got her injections. The health staff and the services they provide are very critical in the management of rheumatic heart disease. Disparities in the two can be seen between the urban centers and rural areas. In urban centers, patients have quick and easy access to health staff and facilities hence receive appreciable service. Conversely the rural populations do not enjoy quality service as compared to the urban counterparts. The rural communities have far much limited resources in terms of health facilities and service. Unlike their urban counter parts that can reject a particular service and opt for another, the rural folks have a limited range of choice (Mincham, et al, 2003, p. 264). Many patients are dissatisfied by the service given by various health facilities. In some area the caregivers are normally too slow or reluctant to act and many patients treat this as rudeness. Also common is misplacement of patient records by the care takers. Some of these staff is always not willing to discuses their condition with patients.

Some patients however do not trust the care giver and there opt not to seek treatment. This is most due to luck of confidence that the doctor will maintained what they hear from the patient as private or confidential.  Communities in remote area sometimes have to travel to the urban centers for health service.  However, those from urban centers find the facilities in the countryside to be of poor quality.

Role the nurse plays with an adolescent patient with cardiac disease

The nurses play a very critical role in the management of adolescent with rheumatic heart diseases irrespective of whether they are pregnant or not . In the first place, nurses can be very instrumental in identifying patient through recognizing the symptoms characterized by rheumatic heart disease.  Nurses can help diagnose the condition and recommend patients to cardiologist.

Nurses can further act as specialist and provide guidance and counseling services to teenager with this hear condition.  The nurse can make the teenagers wholly aware of their condition and the alternative medication program s that are available. Guidance and counseling critically determines whether the patients will take their condition positively. Heather can seek the service of a nurse to guide her on medications and monitor her through pregnancy (Pieper, 2008, p. 403).

Teenagers also need advice and counseling concerning rheumatic heart disease and pregnancy. Those who are pregnant should be made aware of the risks that their health condition poses to their lives and to the unborn ladies. The nurse can guide the young mother on the appropriate type of medication that will ensure the safety of their health and that of the fetus.  On the other hand the nurse can guide those teenagers who are not yet pregnant ton the safe and effect utilization of contraceptives.  There are numerous contraceptives that can be used by such teenagers; however some can still pose greater danger to their heart condition. Therefore, the advice of an expert such as a nurse can be very helpful in helping teenagers use proper contraception techniques (Pieper, 2008, p. 403).

Another role that a nurse can play is to ensure that the sick teenagers adhere to treatment.  Keeping the treatment routine can be very challenging can be vary challenging and many patients skip their medication more frequently. However, a nurse can be very helpful in ensuring that a patient sticks to the routine. This can be very simple when dealing with patients that are hospitalize. The nurse can check on the patient at regular intervals to ensure that the patient has taken his or her medicine. However, it is very difficult to monitor out patient to ensure that they take the prescribed medicine as prescribed.  The distance barrier is way too long and such patients will have to relay on their memory to remember to take their mediation. Alternatively, siblings, parents and friends can play a very important role in ensuring that the patients take their medication in the absence of the nurse. 

Also nurses facilitate the monitoring to the patients condition noting any positive condition or negative ones. This helps to find out how a patient is responding to medication and whether there is need to change medication to a stronger drug. 

Finally, nurses help in the management to the patients’ record. While performing their duty of monitoring patients the nurse note down all the changes in the patient condition and responses to various medicines. Such information is compiled into the patients’ data bases and may be used for the purposes of future decision making by specialists concerning the best alternative or course of action if the patients’ condition worsens.

Conclusion

Rheumatic heart disease is a dangerous that need proper intervention to reduce its number of infections like it happened in the industrialized countries in the 20th century. The disease if very dangerous to pregnant women as it can lead maternal death or fetal death of both. To prevent these women should be advised to seek early diagnosis, treatment and advice. Such services should also target teenagers who are sexually active it is also wise to appreciate the link that exists between rheumatic heart disease, health education and health promotion services.  Poor health education and health care services serve to increase vulnerabilities and deaths. Therefore, it is wise to improve the provision of education and health service especially in the rural area occupied by the Aboriginal.  In ensuring the cases are diagnosed early and that education and health service are adequately provided, the role of nurse should be given great recognition.  Nurse have a critical role in management of rheumatic heart disease and more so in handling teenagers with this condition.

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