Case Study: Family-Centered Care for an Adolescent Girl with ARF/RHD

This report presents a case study focusing on a 14-year-old adolescent girl, Sue, diagnosed with Acute Rheumatic Fever (ARF) and at risk of developing Rheumatic Heart Disease (RHD). The study explores the pathophysiology of the disease, detailing the inflammatory process triggered by Streptococcus pyogenes and its impact on the heart valves. It emphasizes the importance of family-centered care, particularly given Sue's circumstances: living in a remote Australian community, being the eldest of six siblings, and the need for her family to make critical decisions about her treatment, which involves potential hospitalization far from home. The report examines the challenges and considerations in providing care, including the girl's adolescent needs for privacy and social interaction, the family dynamics, and the collaborative decision-making required among healthcare providers, Sue, and her family. It highlights the need for healthcare professionals to be mindful of the girl's vulnerability and the potential disruption to her family life during treatment, concluding that a family-centered approach is crucial for effective nursing care in such situations.

Running head: FAMILY CENTERED CARE FOR AN ADOLESCENT GIRL
Family centered care for an adolescent girl
Name of the Student
Name of the University
Author note

1FAMILY 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

2FAMILY CENTERED CARE FOR AN ADOLESCENT GIRL
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).
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

3FAMILY CENTERED CARE FOR AN ADOLESCENT GIRL
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.
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

4FAMILY CENTERED CARE FOR AN ADOLESCENT GIRL
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

5FAMILY CENTERED CARE FOR AN ADOLESCENT GIRL
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.

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References:
Apa.org. (2017). Confidentiality in the treatment of adolescents. http://www.apa.org.
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neuroscience, 15(9), 1184-1191.
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