A Clinical Case Report on Mitral Stenosis with Mental Retardation with Anemia with Sepsis

Introduction: Mitral stenosis (MS) may be a variety of valvular heart disease.  Mitral stenosis is characterized by a narrowing of the mitral valve's orifice. Rheumatic fever is the most common cause of mitral stenosis today, yet the stenosis may appear clinically important just once in a lifetime [1].  Intellectual disability, with a prevalence of approximately 1 chronicle, may be a lifelong neurodevelopment disorder that impacts international cognitive talents and function perform or daily living skills [2]. 
Clinical Findings:  Breathlessness, weakness, high blood pressure, pulmonary thrombus, anemia, disability to talk, face discoloration, not proper communication, weight loss. 
Diagnostic Evaluation: Blood investigation Hb -9.1gm,mch-82.3fl,mch-29.6piegon,mchc-36%,  Total RBC count-5.31million/cu.mm RDW- 12.7% ,hct 35%, Total WBC count- 13,300cu.mm ,monocytes -4%, Granulocytes- 85%, Lymphocytes -10%, Esonophils-1%,Basophilis -0% , Total platelets conut-11.3, cu. mm. Urea 32mg/dl, creatinine-0.9mg/dl,sodium-131mmol/dl , potassium 5.1 mmol/L. Despite the fact that the patient was not diabetic, the random blood sugar test revealed a level of 160 mg/dL. RBC increase, 2D echo impression thrombus present in heart, Intellectual disabilities present, high blood pressure, urine albumin present, 
Therapeutic Intervention: Blood transfusion, and medical treatment. 
Conclusion: 48 years old female was admitted to medicine ICU diagnosed with the case of mitral stenosis with mental retardation with anemia with sepsis and she had complained of Breathlessness, weakness, high blood pressure, pulmonary embolism, anemia, disability to talk, face discoloration, not proper communication, weight loss. patient show great improvement after getting the treatment and the treatment was still going on still my last date of care. The patient and her family underwent psychological stress, which was resolved to an extent by being an active listener and providing proper counseling.


INTRODUCTION
Mitral valve stenosissometimes called mitral stenosisis a narrowing of the heart's mitral valve. This abnormal valve doesn't open properly, blocking blood flow into the main pumping chamber of your heart (left ventricle). Mitral valve stenosis can make you tired and short of breath, among other problems [1]. During diastole, In most cases, the mitral valve is about 5 cm2 in size. Mitral stenosis is caused by a decrease in area of less than 2 cm. Increased cardiac output demand, such as during exercise or pregnancy, is too much for the heart to handle. [2] Mental retardation (MR) is a widespread neurodevelopmental condition characterized by severely impaired cognitive and adaptive abilities. It is described as having an IQ of less than70, as well as deficiencies in two or more adaptive behaviors that affect day-to-day living. DSM-V defines reasoning, problem-solving, planning, abstract thinking, and judgment as intellectual functioning. [3] Anemia is a condition in which the overall number of red blood cells (RBCs) or hemoglobin in the blood is reduced, [4]or the blood's ability to carry oxygen is reduced. The symptoms of anemia that develops slowly are frequently unclear and include fatigue, weakness, shortness of breath, and a reduced ability to exercise.

Confusion,
lightheadedness, loss of consciousness, and increased thirst are common signs of anemia that develops quickly. Confusion, lightheadedness, loss of consciousness, and increased thirst are common signs of anemia that develops quickly[5].

PATIENT IDENTIFICATION
A female 48 years admitted to medicine ICU on 08 Jun 2021 diagnosed as the case of mitral stenosis with mental retardation with anemia with sepsis, her weighs 36 Kgs with a height of 140 cms.

Present Medical History
Her complaints of Breathlessness, weakness, high blood pressure, pulmonary thrombus, anemia, disability to talk, face discoloration, not proper communication, and weight loss.

Past Medical History
Patient has a history of weight loss last 15 days before the admission, which the patient's relatives reported (document not available for the diagnosis) and treated it at home. Anemia with mitral stenosis, board discussion was done on 1/6/21 and later her blood investigation and computerized tomography, report confirmed to have mitral stenosis with anemia with mental retardation, sepsis on 09/06/2021. Till that duration, she was admitted to the hospital from time to time for the blood transfusion.

Past Interventions and Outcome
Breathlessness, being the chief complaint of the patient, was suspected to have left pulmonary thrombus from 2D echo and computerize tomography report, which was later diagnosed as mitral stenosis with anemia with mental retardation with sepsis, through the blood investigation and computerize tomography, report on 09/06/2021. Also, the patient had a 9.1gm% hemoglobin level at the time of admission, for blood was transfused in corresponding days, which was found effective as the HB% was noted as 11.2 gm% on 10/6/2020 from 9.7 gm% on 8/6/2021.

Clinical Findings
Breathlessness, weakness, High blood pressure, pulmonary thrombus, anemia, disability to talk, face discoloration, not proper communication, weight loss.

Physical Examination
It was found that the patient had left pulmonary thrombus and anemia from CT scan and blood investigation, on thorough examination from head to foot, a chest abnormal sound is present, was noted the breathlessness, on further palpation it was found, high blood pressure, pulmonary thrombus, anemia, disability to talk, face discoloration, not proper communication, weight loss.

Medical management
Blood transfusion, Tab Vitamin-C 500mg and tab. Zincovit OD x 9 days, Syrup Polybion 2tsp BD x 9 days.

Nursing management
This case belonged to medicine department, therefore nursing care played a vital role in every aspect. Table 1. Acute pain related to decrease myocardial blood flow

Nursing Interventions
Rationale Assess the level of pain then record and report it to doctor.
To know the level of pain and frame further interventions. Consult and co-ordinate with health care team members of various department included in the case.
2. To confirm the final diagnosis with staging and prepare nursing diagnosis to provide effective care. Administer the analgesics as per doctor order.
3. To provide symptomatic pain relief. To collect the baseline data about weight loss with the pain perception. 2. Check the physician's order and administer antiemetic and supplementary medicines.
2. To avoid regurgitation and enhance the health of the patient.

Nursing Intervention
Rationale 3. Consult the dietician and provide a diet pattern to the patient's family to follow.
3. To provide the patient with a healthy diet in order to cope up with daily activities.

DISCUSSION
Over a 9-year period, this therapy has kept the patient's hemoglobin levels at 9.1 to11.6 g/dL. Until the time of writing in 2020, she had received a maximum of six blood transfusions in a year. Despite the fact that there has been a consistent and modest increase since 2019.Throughout, my quality of life has been excellent, with plenty of activities, a regular lifestyle, and no pain.
This example reveals that LS endocarditis can cause not only mitral regurgitation but also mitral stenosis due to prolonged inflammation resulting in mitral valve leaflet thickening and fusion. Comprehensive echocardiogram, including stress echocardiography, is crucial in this regard. [6].
Prior to in-hospital intravenous fluid delivery, there was no significant change in Hb levels between sepsis patients and controls in this trial. Anemia was common, although there was no difference in occurrence between groups (26 percent in sepsis versus 24 percent in controls)Females, on the other hand, had a larger percentage of patients with anemia in sepsis patients than in controls (23 percent versus 12 percent ).A limited fraction of patients (5%) had absolute hemoconcentration, [7] with no difference between groups. The decline in Hb levels in both groups was significant and rapid within a few hours of arrival. It's worth noting that in sepsis patients, the fall in Hb concentration in response to intravenous fluid delivery was greater than in controls (1[0.5-1.7] versus 0.5[0.1-1.1] mmol/l). This decrease was linked to the volume of intravenous fluid administered, renal failure, and sepsis itself in a multivariate analysis. Three possible mechanisms can explain the decline in Hb concentration after intravenous fluid injection, which may occur individually or simultaneously. To begin with, the sepsis group may have had considerably more severe hemoconcentration at baseline than the non-sepsis group. Fluid injection in this situation 'corrects' a seemingly normal Hb concentration at baseline, showing an absolute red blood cell volume deficiency. Second, the much increased creatinine in the sepsis group could be due to renal failure and the body's inability to compensate for hypervolemia by increasing urine output.
[8]Finally, sepsis can lead to an increase in intravascular volume. The reduction of vasomotor tone may be to blame for the rise in intravascular space. Intravenous fluid administration is required in this situation to compensate for a decrease in cardiac output, which contributes to the normal hyperkinetic state and, as a result, a decrease in Hb concentration. Additionally, during sepsis, the glycocalyx sheds. [9]

CONCLUSION
A female patient aged 48 years old was admitted in medicine ICU patient first visit in yavtmal hospital and yavtmal hospital refer in AVBRH hospital The patient complaint is Breathlessness, Weakness, weight loss, high blood pressure, Intellectual disabilities, and risk factor is acute rheumatic fever, Infection, Beta hemolytic streptococcal infection, high blood pressure, low hemoglobin levels, symptoms include weakness, chest pains, body pain. Treatment with blood transfusion, primary treatment for patient, Choice of reconstruction method depends on various factors. It is also very important to take preventive measure like avoid going to dusty area patient show great improvement after getting the treatment and the treatment was still going on still my last date of care. The patient and her family underwent psychological stress, which was resolved to an extent by being an active listener and providing proper counseling. After the medical treatment patient condition was improved. And after administration of blood her hemoglobin was increased to 12.1 gm%.

CONSENT AND ETHICAL APPROVAL
As per international standard or university standard guideline patients consent and ethical approval has been collected and preserved by the authors.