Rheumatic Fever

Rheumatic Fever Nursing Diagnosis Interventions and Care Plans

Rheumatic Fever NCLEX Review Care Plans

Nursing Study Guide on Rheumatic Fever

Rheumatic fever is an inflammatory disease that results from an improperly treated strep throat or scarlet fever due to an infection caused by Streptococcus bacteria.

Despite the fact that strep throat is a common condition in many developing countries, it is rarely to arise in the United States and other developed countries. 

Rheumatic fever can affect younger children and adults. However, it often affects children age between 5 and 15 years old.

Rheumatic fever involves inflammation of the joints and skin and may cause permanent injury to the heart.

It can damage the heart valves and heart failure. The treatments for this disease include alleviating symptoms, reducing inflammation and preventing its recurrence.

Signs and Symptoms of Rheumatic Fever

The onset of symptoms for rheumatic disease typically occurs about 2-4 weeks after a strep throat infection. It varies per person and can change throughout the course of the disease. These symptoms include:

  • Fever
  • Painful and tender joints often localized in the knees, ankles, elbows and wrist
  • Pain in one joint that moves to another joint
  • Redness and swelling of joints that feels warm to touch
  • Small, painless bumps beneath the skin
  • Chest pain
  • Heart murmur
  • Fatigue
  • Flat or slightly raised, painless rash with a ragged edge
  • Sydenham chorea -Jerky, uncontrollable body movements; often seen in the hands, feet and face
  • Outbursts of unusual behavior, such as crying or laughing inappropriately

Causes and Risk Factors of Rheumatic Fever

The main cause of rheumatic fever is improperly treated throat infection brought about by group A Streptococcus.

The said bacteria cause strep throat or scarlet fever. There is no clear relationship between strep infection and rheumatic fever; however, researchers believe that a person’s immune system response is involved.

The strep bacteria contain a protein that is similar to certain tissues of the body and can deceive the immune system.

As the body normally reacts to a previous throat infection, the resemblance in tissues causes the immune system to also attack its own tissue, usually the ones found in the heart, joints, skin and central nervous system causing inflammation.

The following are considered as a risk factor for having Rheumatic fever:

  • Genetic Factors and Family history. Some people carries a gene that makes them more susceptible to developing rheumatic fever
  • Type or strain of strep bacteria. It is said that the M18 strains of streptococcus bacteria are the ones that trigger rheumatic fever
  • Environmental factors. As with other infections, poor hygiene and sanitation, as well as being in crowded places can increase exposure and transmission

Frequent episodes of strep throat or scarlet fever not treated properly among children increases their chance of acquiring rheumatic fever.

However, if prompt treatment was given, the risk for having the disease decreases.

Complications of Rheumatic Fever

  1. Inflammation. Rheumatic fever causes a generalized inflammation in the body that can last for a few weeks up to several months and long-term complications, in some cases.
  2. Rheumatic Heart Disease. Another complication of rheumatic fever is rheumatic heart disease, a condition which involves permanent damage to the valves of the heart. It occasionally develops 10 to 20 years after acquiring the disease. However, in severe cases, permanent injury to the heart may happen while the child is still symptomatic.

The mitral valve, located between the heart’s upper chamber, is the area most commonly affected.

Once injured, it can lead to leak in and narrowing of the valve and can damage the heart muscle.

Atrial fibrillation and heart failure can also occur in later life.

Diagnosis of Rheumatic Fever

Rheumatic fever has no definitive test. Diagnosis will be based upon physical assessment, medical history and results of certain tests such as:

  • Blood tests such as C-reactive protein and erythrocyte sedimentation rate to check for inflammation and Streptococcal antibody test.
  • Electrocardiogram
  • Echocardiogram

However, if the strep infection is already detected in the throat swab test, the doctor may not request for additional blood test anymore.

Treatment of Rheumatic Fever

The treatment plan for rheumatic fever aims to eradicate the streptococcal bacteria, alleviate symptoms, control inflammatory response, and prevent the condition from recurring.

  1. Medications. The patient will need to undergo medication therapy which includes:
  2. Antibiotics. To treat the infection and to get rid of the remaining strep bacteria, the doctor will likely prescribe penicillin-based antibiotics. Antibiotic therapy will most likely to continue through age 21 or until the child completes the five-year course treatment. This is done as a preventive measure to prevent rheumatic fever from recurring.
  3. Anti-inflammatory and antipyretic drugs. These can be used to decrease inflammation, provide pain relief and reduce fever.
  4. Corticosteroids. These are used to reduce inflammation for severe cases and those that are unresponsive to anti-inflammatory drugs.
  5. Anti-convulsant medications. Anti-seizure drugs can be used to prevent seizures due to Sydenham chorea.
  6. Long-term care. Heart damage may take years to manifest and may indicate the need for long-term care and regular heart examinations. The doctor will discuss the type of follow up and long-term care appropriate for the patient. It is important to declare past history during medical exams as the child grows old. The doctor may also make a referral to a pediatric cardiologist, a heart specialist, for further evaluation. It is also recommended to be on bed rest and limit activities to prevent worsening of symptoms and recover fully. Strict bed rest is required for children who have inflammation of the cardiac tissues. The length of bed rest depends on the degree of inflammation which can last for a few weeks up to a few months.

Nursing Care Plans for Rheumatic Fever

Nursing Care Plan 1

Nursing Diagnosis: Hyperthermia related to inflammatory disease secondary to rheumatic fever as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.

        Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.

InterventionsRationales
Assess the patient’s vital signs at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs administered.
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed antibiotic and anti-pyretic medications.Use the antibiotic to treat rheumatic fever, which is the underlying cause of the patient’s hyperthermia. Use the antipyretic medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.

Nursing Care Plan 2

Nursing Diagnosis: Alteration in comfort related to hyperthermia.

Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range and will verbalize feeling more comfortable.

InterventionsRationales
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed antibiotic and anti-pyretic medications.Use the antibiotic drug to treat rheumatic fever, which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.
Offer a cooling blanket to the patient.To facilitate the body in cooling down and to provide comfort.

Nursing Care Plan 3

Nursing Diagnosis: Activity intolerance related to decreased cardiac output secondary to rheumatic fever, as evidenced by arthralgia, fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion

Desired Outcome: The patient will demonstrate active participation in necessary and desired activities and demonstrate increase in activity levels.

InterventionsRationales
Assess the patient’s activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.To create a baseline of activity levels and mental status related to fatigue and activity intolerance.
Encourage progressive activity through self-care and exercise as tolerated. Alternate periods of physical activity with 60-90 minutes of undisturbed rest.Patients with rheumatic fever require strict bed rest at the initial stage of diagnosis and treatment and can then be allowed to do light activities of daily living and light exercises as tolerated. 
Teach deep breathing exercises and relaxation techniques.  To allow the patient to relax and to facilitate effective stress management.  
Refer the patient to physiotherapy / occupational therapy team as required.To provide a more specialized care for the patient in terms of helping him/her build confidence in increasing daily physical activity.
Assess the patient’s nutritional status and modify accordingly. Refer to dietitian team if required.To incorporate energy-giving foods to boost energy for daily activities and exercises.

Other nursing diagnoses:

  • Acute Pain
  • Risk for Infection
  • Deficient Knowledge

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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