Rheumatic Fever

Rheumatic fever is a systemic inflammatory autoimmune disease occurring after a group A beta-hemolytic streptococcal infection: pharyngitis, strep throat, scarlet fever, tonsillitis, approximately 2-6 weeks prior. Rheumatic fever can involve the heart, joints, skin, and brain and most often seen in children and young adults.

Signs and Symptoms:

• Fever
• Joint pain, migratory polyarthritis
• Joint swelling; redness, or warmth
• Abdominal pain
• Skin rash (erythema marginatum)
• Aschoff bodies, inflammatory hemorrhagic bullous lesions located on the myocardium usually found on autopsy
• Sydenham’s chorea also called St.Vitus Dance—emotional instability, muscular weakness and rapid, uncoordinated jerky movements affecting primarily the face, feet, and hands
• Epistaxis (nosebleeds)
• Carditis
• Subcutaneous nodules located on extensor surfaces of knees, elbows, and knuckles
• Cardiac murmur

Treatments:

• Anti-inflammatory medications such as aspirin or corticosteroids;
• Antibiotic therapy (penicillin, erythromycin), includes the continuous use of low dose antibiotics to prevent recurrence; supportive therapy for other symptoms

Nursing Interventions:

• Assess and monitor for risk factors
• Monitor vital sign
• Assess laboratory values for elevated erythrocyte sedimentation rate, C-reactive protein
• Assess and monitor heart sounds and ECG
• Administer pain medication as prescribed
• Administer antibiotics as prescribed
• Maintain bed rest during acute stage
• Maintain fluid balance
• Provide emotional support
• Provide client and family education especially for prophylactic antibiotic therapy to reduce the risk of recurrent rheumatic fever
• Instruct client and family in proper and prompt treatment of strep throat and scarlet fever
• Provide client and family education