Family Centered Care For An Adolescent Girl With Acute Rheumatic Fever, Essay.

Pathophysiology of Acute Rheumatic Fever

Discuss about the Family Centered Care for an Adolescent Girl.

Rheumatic fever is a very common amongst the children and happens after a streptococcus throat infection. It is an inflammatory disease, which affects the heart, skin, joints and brain. Sometimes, the rheumatic fever leads to the damage of the heart valves. This type of heart disease is called Rheumatic heart disease (RHD).

The essay follows a case study of a 14 years old adolescent girl named Sue. This girl has been treated repeatedly for impetigo and streptococcal pharyngitis for the last two years. The girl receives IM antibiotics (Penicillin) in a local clinic. After missing her antibiotics multiple times, she was admitted to a local clinic with the classic ARF (Acute Rheumatic Fever) symptoms.

The purpose of this study is to discuss the pathophysiology of the disease and to evaluate the appropriate caregiving process in relation to the mentioned case study of the 14-year-old girl with ARF/RHD.

Rheumatic Fever occurs two to four weeks after a throat infection caused by the bacteria called Streptococcus pyrogenes. RHD affects more or less 15 million people per year and every year, the number of death ads up to as much as 230000 (Rhdaustralia.org.au, 2017). The symptoms of this disease include severe pain in the joints, fever, and involuntary muscle movement. Sometimes a non-itchy rash (Erythema marginatum) appears along with these symptoms. Sometimes RHD causes permanent damage to the heart and the patient may require valve replacement surgery because of this. The patient Sue, mentioned in the case study is suffering from ARD for more than two years and receives IM antibiotics to lessen the risk of developing RHD (Burke, & Chang, 2014).

The symptoms start to show one to three weeks after the occurrence of the streptococcal pharyngitis. The Rheumatic fever affects the connective tissues present around the heart arterioles. The proteins present on the cell wall of Streptococcus pyrogens shows molecular mimicry and causes inflammation by cross-reacting with the connective tissues. The cross reactivity is also termed as the molecular mimicry and is a Type 2 hypersensitivity reaction (Cunningham, 2014). The streptococcal infection induces the B cells to take the antigen to T cells (CD4+). This, in turn induces the CD4+ cells to become the helper T cells. These helper T cells in turn activate the B cell to become plasma cells. These plasma cells induce the antibodies to the bacterial cell walls. These antibodies react against the joints and the myocardium of the patient (Perricone et al., 2014).

Case study of Sue, a 14-year-old girl with ARF

The outer wall of the bacteria has branched polymers (M proteins) which mimics the valvular endothelium and myosin present in the heart.  The antibodies presented by the plasma cells recognize laminin, a protein that structures the basement membrane of the cardiac valves (Cunningham, 2012). Valves like tricaspic, mitral, aortic, and pulmonary, get more affected by the rheumatic fever.

In acute RHD, formation of the minor thrombi happens at the valve closure. In chronic RHD, the valve basement membrane thickens and valve fibrosis can be seen. These commonly results in stenosis and rarely causes regurgitation (Iung, & Vahanian, 2014).

The T cells which reacts with the bacterial M protein, infiltrates the endothelium tissues present in the valve, then it gets activated after binding with the interleukins and TNF(tumor necrosis factor). Th17, a kind of cytokine plays the most important role in the RHD development.

The chosen case study is of a 14-year-old patient named Sue, a resident of a remote community in Australia. The girl has a two year of history of streptococcal pharyngitis. The local health clinic gives her Penicillin G IM antibiotics in regular basis; however, she missed a few cycles of the antibiotics. The girl has been presented to the local health clinic after four days of reported fever with a two or 3-week-old history of sore throat. The doctor has diagnosed her with Acute Rheumatic Fever. Sue is a girl in her adolescence, which means she is at that age in which a person needs some privacy and enjoys being included in social interactions. Girls of this age take great pleasure enjoying their growing independence. The medical practitioners can discuss the clinical analysis with her and can include her in medical related discussion as this girl is approaching her adulthood in few years (Blakemore, & Robbins, 2012).

When the adolescents play roles in taking important decisions about themselves, it often approaches a good result. When children of the adolescence period tries to take a decision, the early development of the reward system of the brain along with the late development of brain’s own control system decreases the decision making ability of the children (Apa.org., 2017). Sue, the 14-year-old girl suffering from rheumatic fever already has a health problem bothering her and suffering a great pain. This will definitely create a conflict in the girl’s mind, whenever she will try to take a decision.

In the above-mentioned case study, the girl is suffering from Acute Rheumatic Fever (ARF), which often ends up creating a blockage and inflammation in the valves of the heart. Girls this age are generally physically active and actively attend school. However, Sue is not able to attend school due to her condition and has been receiving IM antibiotics for years. Her severe joint pain makes her somewhat physically inactive.

Importance of family-centered care in managing ARF

The 14-year-old Sue lives in a remote and rural community area in Australia. Her family comprises of her mother and six younger siblings. She is the eldest child of her mother. If a child falls ill and is admitted to a hospital, this affects the whole family. Generally, while treating a child/ infant and adolescent, the healthcare providers always approaches a family centered care model. The general principles of this model include sharing objective, unbiased and open information and respecting the diversity and cultural differences. The decisions should be entirely made by collaborating with the family (Festini, 2014). The girl lives in the remote area and receives treatment from the local health clinic. The nearest hospital, which can provide her the proper cardiology review and echocardiogram (ECG), is 800 km away. According to the doctor who was attending Sue in the health clinic, Sue should move there to receive proper treatment. The family centered care system is required in this context as Sue is the oldest of the children in her family without a father and her mother has to attend six young children without help (Barry & Edgman-Levitan, 2012). The doctor, nurse, mother and Sue herself has to collaborate to take a final decision about her treatment (Gowda et al., 2012). The family has to decide who will take care of Sue and who will take care of her siblings. With the help of the collaborative approach, Sue and her mother has to decide how they are going to manage all these (Ball, Bindler, & Cowen, 2013).

If she decides to go to the hospital, which is 800 km away, the life of her younger siblings will definitely get affected. As her family does not have a father and she has to help her mother by taking care of her younger siblings, her absence will affect her entire family. Her mother has to take care of Sue, because of her heart problem and ARH. Her extended family such as her grandparents/uncles/aunts has to take care of the younger children for her mother as her mother has to go with Sue, whenever she is admitted to the hospital.

The hospitalization of the girl will affect the settings of the entire family. Her mother has to go with her in the hospital to take care of her. Sue has to stay at the hospital for her treatment and for that, she has to stay away from her siblings. She may terribly miss her siblings as she is used to them staying close to her and she may miss her school friends. The hospital setting may seem strange to her as it can be assumed that she has never seen a hospital and the local health clinic is too small to have a hospital setting, albeit the health clinic included her and her siblings in the secondary prophylaxis program. The nurses of the hospital have to be extra careful, as she might be vulnerable because of her health condition and the strange hospital environment.

The disease of Rheumatic fever is very common and a fatal disease which happens because of a pathogen. This disease causes permanent damage to the heart by causing inflammation in the heart muscles. To give Sue, the proper ARF/RHD treatment, the family and the healthcare providers (doctors and the nurses) has to collaborate and work together in the Family centered approach. The family and the healthcare officials has to include her in the in the decision-making and should respect her opinion. The care-givers of the nearest hospital, where Sue is going to be treated from, has to be careful with her as she is new in the hospital setting and she is going to be away from her family. Sue’s mother should ask help from her extended family to help her managing the situation. The article concludes that the family centered approach is the best healthcare approach for nursing in a setting, which involves an adolescent child. 

References:

Apa.org. (2017). Confidentiality in the treatment of adolescents. https://www.apa.org. Retrieved 1 September 2017, from https://www.apa.org/monitor/mar02/confidentiality.aspx

Ball, J. W., Bindler, R. C., & Cowen, K. J. (2013). Child health nursing. Prentice Hall.

Barry, M. J., & Edgman-Levitan, S. (2012). Shared decision making—the pinnacle of patient-centered care. New England Journal of Medicine, 366(9), 780-781.

Blakemore, S. J., & Robbins, T. W. (2012). Decision-making in the adolescent brain. Nature neuroscience, 15(9), 1184-1191.

Burke, R. J., & Chang, C. (2014). Diagnostic criteria of acute rheumatic fever. Autoimmunity reviews, 13(4), 503-507.

Cunningham, M. W. (2012). Streptococcus and rheumatic fever. Current opinion in rheumatology, 24(4), 408.

Cunningham, M. W. (2014). Rheumatic fever, autoimmunity, and molecular mimicry: the streptococcal connection. International reviews of immunology, 33(4), 314-329.

Festini, F. (2014). Family-centered care. Italian journal of pediatrics, 40(1), A33.

Gowda, C., Schaffer, S. E., Dombkowski, K. J., & Dempsey, A. F. (2012). Understanding attitudes toward adolescent vaccination and the decision-making dynamic among adolescents, parents and providers. BMC Public Health, 12(1), 509.

Iung, B., & Vahanian, A. (2014). Epidemiology of acquired valvular heart disease. Canadian Journal of Cardiology, 30(9), 962-970.

Perricone, C., Rinkevich-Shop, S., Blank, M., Landa-Rouben, N., Alessandri, C., Conti, F., ... & Valesini, G. (2014). The autoimmune side of rheumatic fever. Israel Medical Association Journal, 16(10), 654-655.

Rhdaustralia.org.au. (2017). Burden of Disease. Rheumatic Heart Disease Australia. Retrieved 1 September 2017, from https://www.rhdaustralia.org.au/burden-disease