Rheumatic fever is a serious inflammatory disease that can develop after an infection with Streptococcus bacteria (strep throat). This nursing diagnosis focuses on identifying and treating symptoms, preventing complications, and managing long-term cardiac effects.
Causes (Related to)
Rheumatic fever can affect patients in various ways, with several factors contributing to its development and progression:
- Untreated or inadequately treated Group A Streptococcal infection
- Genetic predisposition to autoimmune responses
- Delayed or missed antibiotic treatment
- Age (most common in children 5-15 years)
Risk Factors include:
- Previous history of rheumatic fever
- Family history of rheumatic fever
- Living in crowded conditions
- Limited access to healthcare
- Poor socioeconomic status
Environmental factors including:
- Inadequate housing conditions
- Poor sanitation
- Limited access to medical care
- Geographic locations with high strep infection rates
Signs and Symptoms (As evidenced by)
Rheumatic fever presents with distinctive signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Joint pain that migrates between joints
- Chest pain
- Fatigue and weakness
- Shortness of breath
- Fever
- Heart palpitations
- Emotional lability
- Muscle aches
Objective: (Nurse assesses)
- Temperature elevation (>101°F/38.3°C)
- Tachycardia
- Heart murmurs
- Erythema marginatum (pink rash)
- Subcutaneous nodules
- Sydenham’s chorea (involuntary movements)
- Joint swelling and redness
- Elevated ASO titers
- Elevated ESR and CRP
Expected Outcomes
The following outcomes indicate successful management of rheumatic fever:
- The patient will remain free from cardiac complications
- The patient will demonstrate improved joint mobility
- The patient will maintain a normal temperature
- The patient will show no signs of chorea
- The patient will comply with long-term antibiotic prophylaxis
- The patient will verbalize understanding of the disease process
- The patient will maintain adequate activity tolerance
Nursing Assessment
Monitor Vital Signs
- Check temperature, pulse, respiratory rate, and blood pressure
- Note any cardiac irregularities
- Document the presence of murmurs
- Monitor for signs of heart failure
Assess Joint Involvement
- Document the location and severity of joint pain
- Monitor joint swelling and redness
- Assess range of motion
- Note migration patterns of arthritis
Evaluate Cardiac Status
- Auscultate heart sounds
- Monitor for new murmurs
- Assess activity tolerance
- Check for signs of heart failure
- Monitor ECG changes
Check for Neurological Symptoms
- Assess for chorea
- Monitor emotional changes
- Document behavioral alterations
- Evaluate muscle control
Monitor Treatment Response
- Track antibiotic compliance
- Assess inflammation markers
- Monitor symptom improvement
- Document side effects
Nursing Care Plans
Nursing Care Plan 1: Risk for Decreased Cardiac Output
Nursing Diagnosis Statement:
Risk for Decreased Cardiac Output related to inflammatory process affecting heart valves as evidenced by tachycardia, heart murmurs, and decreased exercise tolerance.
Related Factors:
- Valvular inflammation
- Myocardial involvement
- Altered cardiac rhythm
- Increased cardiac workload
Nursing Interventions and Rationales:
- Monitor vital signs and cardiac rhythm
Rationale: Identifies early signs of cardiac dysfunction - Assess for signs of heart failure
Rationale: Enables early intervention for cardiac complications - Implement activity restrictions
Rationale: Reduces cardiac workload
Desired Outcomes:
- The patient will maintain stable cardiac output
- The patient will demonstrate improved exercise tolerance
- The patient will remain free from heart failure symptoms
Nursing Care Plan 2: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to joint inflammation as evidenced by verbal reports of pain, joint swelling, and limited mobility.
Related Factors:
- Inflammatory process
- Joint swelling
- Tissue damage
- Movement limitations
Nursing Interventions and Rationales:
- Administer anti-inflammatory medications
Rationale: Reduces inflammation and pain - Apply heat/cold therapy
Rationale: Provides comfort and reduces inflammation - Position affected joints properly
Rationale: Minimizes stress on joints
Desired Outcomes:
- The patient will report decreased pain levels
- The patient will demonstrate improved joint mobility
- The patient will use pain management techniques effectively
Nursing Care Plan 3: Hyperthermia
Nursing Diagnosis Statement:
Hyperthermia related to inflammatory response as evidenced by elevated temperature and increased metabolic rate.
Related Factors:
- Inflammatory process
- Autoimmune response
- Increased metabolic demands
- Systemic infection
Nursing Interventions and Rationales:
- Monitor temperature regularly
Rationale: Tracks fever progression - Implement cooling measures
Rationale: Helps reduce body temperature - Encourage adequate hydration
Rationale: Prevents dehydration
Desired Outcomes:
- The patient will maintain a normal temperature
- The patient will demonstrate adequate hydration
- The patient will report improved comfort
Nursing Care Plan 4: Activity Intolerance
Nursing Diagnosis Statement:
Activity Intolerance related to joint pain and cardiac involvement as evidenced by fatigue and decreased exercise capacity.
Related Factors:
- Joint pain
- Cardiac involvement
- Fatigue
- Muscle weakness
Nursing Interventions and Rationales:
- Plan activities with rest periods
Rationale: Prevents overexertion - Assist with ADLs as needed
Rationale: Conserves energy - Monitor activity response
Rationale: Prevents complications
Desired Outcomes:
- The patient will demonstrate improved activity tolerance.
- The patient will maintain a balance between rest and activity
- The patient will perform ADLs independently
Nursing Care Plan 5: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to susceptibility to recurrent streptococcal infection as evidenced by history of rheumatic fever.
Related Factors:
- Previous streptococcal infection
- Compromised immune response
- Environmental exposure
- Inadequate primary prevention
Nursing Interventions and Rationales:
- Administer prophylactic antibiotics
Rationale: Prevents recurrence - Monitor for signs of infection
Rationale: Enables early intervention - Teach infection prevention
Rationale: Reduces risk of reinfection
Desired Outcomes:
- The patient will remain free from streptococcal infection
- The patient will demonstrate an understanding of prevention measures
- The patient will comply with prophylactic treatment
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
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- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Murray R, Mowat R, Foster MJ, Blamires J. Nursing practices to optimise rheumatic fever prevention in a high-risk country: An integrative review. J Clin Nurs. 2024 Aug;33(8):2905-2921. doi: 10.1111/jocn.17141. Epub 2024 Mar 28. PMID: 38549261.
- Rheumatic fever and rheumatic heart disease. World Health Organ Tech Rep Ser. 2004;923:1-122, back cover. PMID: 15382606.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
