Rheumatic Fever Nursing Diagnosis and Care Plan

Last updated on February 20th, 2023 at 09:20 am

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.

Medications. The patient will need to undergo medication therapy which includes:

  • 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.
  • Anti-inflammatory and antipyretic drugs. These can be used to decrease inflammation, provide pain relief and reduce fever.
  • Corticosteroids. These are used to reduce inflammation for severe cases and those that are unresponsive to anti-inflammatory drugs.
  • Anti-convulsant medications. Anti-seizure drugs can be used to prevent seizures due to Sydenham chorea.

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 Diagnosis for Rheumatic Fever

Nursing Care Plan for Rheumatic Fever 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.

Rheumatic Fever Nursing 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 for Rheumatic Fever 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.

Rheumatic Fever Nursing 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 for Rheumatic Fever 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.

Rheumatic Fever Nursing 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.

Nursing Care Plan for Rheumatic Fever 4

Risk for Infection

Nursing Diagnosis: Risk for Infection related to  a possible chronic disease recurrence secondary to rheumatic fever

Desired Outcome: The patient will experience a decreased likelihood of reinfection.

Rheumatic Fever Nursing InterventionsRationale
Assess the patient’s knowledge and expertise on the daily oral administration of prescribed antibiotics or the monthly intramuscular injections.It can be difficult for the patient to comply with self-administering long-term antibiotic medication (for up to 5 years) as a prophylactic intervention. Therefore, assessing the patient’s knowledge and expertise in compliance with treatment can help the nurse identify how to best support the patient.
During the acute stage of the disease, keep an eye out for symptoms including chest pain, shortness of breath, weariness, cough, night sweats, friction rub, and galloping.Carditis symptoms and signs can increase the risk of repeated infections by causing vegetation to become fibrous at the valve regions, leading to endocarditis.
As directed, administer antibiotic therapy while the illness is still acute.Antibiotic therapy destroys the pathogenic bacteria by preventing the formation of their cell walls.
Explain the necessity of preventing recurrence, the requirement for protection before dental work or any invasive surgery, and the long-term antibiotic prescription.After the acute stage, treatment is started, and ongoing medical attention is required since rheumatic fever can reoccur. Many children who acquire the illness develop cardiac issues as adults.
Any upper respiratory infections, fever, joint pain, or non-compliance with antibiotic therapy should be reported to the doctor immediately.may indicate a return of the illness or the need to switch to a different drug.
Note any current medications the patient is taking, such as corticosteroids and antineoplastics.Immunosuppression is a side effect of some medicines and medical procedures.
Inquire about the patient’s vaccination record.

People who have not had enough vaccinations may not have developed sufficient immunity.
Every 4 hours, check the temperature of neutropenic patients.Patients may not respond to inflammation appropriately due to neutropenia. Fever is typically the only symptom they exhibit.
Keep an eye out for any swelling, purulent discharge, or symptoms of pain coming from wounds, injuries, catheters, or drains in the patient.

These infection warning symptoms are commonplace.
Encourage the sufferer to wash their hands as well. After cleaning, pat the hands dry with a paper towel.The transmission of infection can be stopped by washing hands frequently.
Encourage the patient to consume a healthy diet.To lower the danger of infection, it’s crucial to consume a balanced diet of protein, vitamins A, C, and E, zinc, and iron.
Help and encourage the patient to frequently change positions.It stops germs and secretions in the lungs and bronchial tree from stagnating.
When coming into contact with blood, mucus, or other bodily fluids, wear gloves. Wear goggles as necessary.It shields hands from contamination and stops the spread of bacteria that are already on the hands.
When placing a urinary catheter, strictly follow sterile procedures. Make sure catheters are maintained between each shift.One of the most frequent sites for nosocomial infections is the genito-urinary tract.
Limit the number of guests that are accepted.This lowers the chance that the patient will come into contact with microorganisms.
Teach the patient how to undertake tasks at home, such as changing their clothes and checking the IV site for infections.To ensure that they can continue to reduce the risk of infection even after they have been released, patients and caregivers must become proficient in these techniques.
Teach the patient how to appropriately take antibiotics.Antibiotic resistance can be aided by skipping or failing to take the prescribed dosage of antibiotics.
Examine whether the lines and drains are appropriate. Work together with the doctor to decide whether to stop using any lines or drains that are no longer required.For the patient’s benefit, drains or lines should be removed as soon as possible. The danger of infection is lower when there are fewer intrusive lines and devices.
Make sure the patient gets baths every day.The amount of germs on the skin’s surface is decreased by bathing. Applying lotion helps keep the skin intact and keeps it from rupturing.
Every two hours at the absolute minimum, turn the patient.

By preventing skin deterioration, frequent repositioning shields the body from infection-causing germs.
Teach the patient, their loved ones, and the caregiver to wash their hands before and after going to the restroom, eating, performing self-care, and treating wounds.Maintaining good hand hygiene between these jobs lowers the possibility of spreading diseases from one place to another and potentially ingesting germs.
Inform the patient and family about the dangers of infection.Understanding the factors that raise the risk of infection heightens awareness and improves treatment for the patient, caregivers, and family.
Teach the processes that the patient and their caretaker will need to follow following discharge.This could involve treating wounds, giving intravenous medication, or giving shots. To guarantee proficiency in carrying out procedures, demonstrations and return-back demonstrations may be helpful. Knowing how to do a process correctly lowers the risk of infection and improves patient safety, especially if it requires sterility.

Nursing Care Plan for Rheumatic Fever 5

Acute Pain (Joint)

Nursing Diagnosis: Acute Pain (Joint) secondary to inflammation related to rheumatic fever

Desired Outcome: The patient will verbalize relief of pain by verbalizing a score of less than 3 on a scale of 1 to 10.

Rheumatic Fever Nursing InterventionsRationale
Assess and evaluate the patient’s sense of pain using an appropriate scale every two to four hours.Provide details regarding the patient’s level of pain.
A high-pitched cry, irritation, restlessness, refusal to move, a grimace on the face, or aggressive or dependent conduct are examples of changing behaviors that should be evaluated.Age-related nonverbal pain descriptions are difficult for some patients to express; fear and anxiety brought on by pain alter behavioral responses.
Examine the affected joints, the intensity of the discomfort, and the range of motion.Information on reversible joint involvement, which typically affects big joints including the knees, hips, wrists, and elbows; an increase in the number of afflicted joints over time.
Apply salicylates and give sustained-release anti-inflammatory drugs as directed, and explain to the patient that the medication will lessen the discomfort before going to bed or an hour before the patient plans to move.This provides rest and comfort while relieving pain and joint inflammation.
Encourage the use of non-pharmacological therapies such as heat application, cutaneous stimulation, relaxation, and visualization.To offer other pain-reduction strategies.
Provide a small pillow and a firm mattress or bed board. As necessary, use a bed cradle to raise the bedding.Large pillows and soft, sinking mattresses make it difficult to maintain good body alignment, putting stress on vulnerable joints. Pressure on swollen or sore joints is lessened by elevating the bedclothes.
Encourage the patient to find a comfortable position in bed or a chair. Encourage bed rest as needed.Total bed rest may be required (until objective and subjective improvements are detected) in cases of severe disease or acute exacerbation to prevent joint pain or injury.
Placing and observing the use of braces, splints, trochanter rolls, pillows, and sandbags.Maintain a neutral position while relieving sore joints. Note: Wearing splints can lessen pain and perhaps prevent joint damage, but prolonged inactivity can impair joint mobility and function.
Encourage regular position changes. Help the patient move around while they are in bed by supporting the damaged joints from above and below and avoiding jerky movements.This prevents joint stiffness and general tiredness. reduces joint mobility and pain by stabilizing the joint.
Keep track of the frequency, not the severity, of morning stiffness.The duration more closely reflects the severity of the illness.
Encourage the patient to take a warm bath or shower before bed or when they first wake up. Several times per day, apply warm, moist compresses to the affected joints. Check the water temperature in the shower, bath, and other fixtures. Heat reduces pain, encourages muscle relaxation, and eases morning stiffness.Dermal damage may happen, and heat sensitivity may be reduced. Encourage the patient to take a warm bath or shower before bed or when they first wake up. Several times per day, apply warm, moist compresses to the affected joints.
Give a light massage.This lowers muscle tension and encourages relaxation.
Encourage the use of stress-reduction methods such as controlled breathing, biofeedback, visualization, guided imagery, and self-hypnosis. Make therapeutic contact.This enhances coping skills, promotes relaxation, and gives a feeling of control.
Participate in diversionary activities that are suitable for the patient’s case.

It refocuses attention, stimulates the mind, builds self-confidence, and makes one feel more generally well
Assist with physical therapy like whirlpool baths and paraffin gloves.This provides steady heat to ease discomfort and increase the range of motion in the troubled joints.
When necessary, apply cold packs or ice.Acute episodes of discomfort and edema may be reduced by the cold.
Instruct users on how to use and keep an eye on the TENS unit’s effects, if one is being used.Continuous low-level electrical stimulation prevents pain signals from being transmitted.

Nursing Care Plan for Rheumatic Fever 6

Deficient Diversional Activity

Nursing Diagnosis: Deficient Diversional Activity secondary to prolonged illness and hospitalization related to rheumatic fever

Desired Outcome: The patient will engage in diversionary activities within 24 hours of the intervention and report feeling less bored.

Rheumatic Fever Nursing InterventionsRationale
Determine the patient’s capacity for activity.The amount of activity patients can engage in within the parameters of their condition will depend on their activity tolerance.
Examine the patient for indications of interest in something to read or do, of afternoon naps, and of expressed difficulty engaging in leisure activities as a result of being in the hospital.To encourage the patient to have a more active lifestyle despite being admitted.
Encourage loved ones to visit within the patient’s tolerance limits and to engage the patient in activities that the patient finds interesting.To improve the patient’s quality of daily life by engaging in activities with significant others.
Boost the patient’s involvement in self-care.Patients with rheumatic fever are encouraged to consistently undertake in-bed exercises, and keep track of their intake and output, and other related tasks to give them a sense of control, purpose, and fulfillment, which is likely to minimize boredom.
Encourage the patient to engage in suitable diversionary activities, such as puzzles, model kits, crafts, and computer games and activities, as their endurance increases. Also suggest that the patients significant other engage in hobbies, crafts, and personal grooming at home.Generally speaking, good diversions include watching television, using the computer, listening to the radio or books on tape, and playing cards or board games.
Allow the patient to see outside activity by helping him or her sit in a chair near a window as the patient’s condition improves, give the patient the chance to sit in a solarium so that he or she can visit other patients, and if possible, take the patient outside for a little while.Boredom and a passive lifestyle while hospitalized due to rheumatic fever can be decreased by engaging in conversation, being outdoors, and meeting new people.
Assess the need for consultation with occupational therapy, a psychiatric nurse, social services, and spiritual services.These recommendations may include further diversionary activities.

Start with simple chores that don’t require much focus, and then go on to more difficult ones as the patient’s condition allows.At first, the patient could find difficult tasks aggravating. Physiologic issues like anemia and discomfort might make it harder to concentrate.
Compile a database by analyzing the patient’s typical support networks and intimate connection patterns. Ascertain the patient’s interests from both the patient and their significant other.This will enable the nurse to look into entertaining activities that can be suitable for the healthcare environment and the patient’s level of activity tolerance.
Permit past events or memories to be discussed.This might be a good choice for carrying out tasks the patient wants to do while recovering.
Decorate the patient’s environment with mementos and pictures of loved ones.This stimulates the visual sense.
Plan tolerable activities at low levels throughout the day with the patient.These pursuits encourage intellectual stimulation and lessen the boredom. Examples include having access to Wi-Fi, books, laptop computers, iPods, iPads, and iPhones. Other alternatives include offering writing tools for small periods of activity, computer games, television, books, or periodicals about the patient’s hobbies or other interests.

More Rheumatic Fever Nursing Diagnosis

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. (2022). 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. (2020). 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


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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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Anna Curran. RN, BSN, PHN

Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.

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