Rheumatic Fever

Is an inflammatory disease that can develop as a complication of

inadequately treated strep throat or scarlet fever. Strep throat and
scarlet fever are caused by an infection with streptococcus bacteria.

Is most common in 5- to 15-year-old children, though it can develop in

younger children and adults.

Also fever can cause permanent damage to the heart, including

damaged heart valves and heart failure.
Causes

Rheumatic fever can occur after an infection of the throat with a

bacterium called group A streptococcus. Group A streptococcus
infections of the throat cause strep throat or, less commonly, scarlet
fever. Group A streptococcus infections of the skin or other parts of
the body rarely trigger rheumatic fever.
S/Sx:

Rheumatic fever symptoms vary. You can have few symptoms or

several, and symptoms can change during the course of the
disease. The onset of rheumatic fever usually occurs about two to
four weeks after a strep throat infection.
signs and symptoms which result from inflammation in the heart, joints,
skin or central nervous system can include:

Fever
Painful and tender joints most often in the knees, ankles, elbows and
wrists
Pain in one joint that migrates to another joint
Red, hot or swollen joints
Small, painless bumps (nodules) beneath the skin
Chest pain
Heart murmur
Fatigue
Medical Care

Management and prevention of acute rheumatic fever (ARF) can be

divided into the following 4 approaches.
Treatment of the group A streptococcal infection that led to the
disease
General treatment of the acute episode
Cardiac management
Propylaxic
Surgical care

Surgical care is not typically indicated in ARF. Surgical intervention is

required only to treat long-term valvular cardiac sequelae of ARF
that cause stenosis.
Risk Factor

Factors that can increase the risk of rheumatic fever include:

Family history. Some people carry a gene or genes that might make
them more likely to develop rheumatic fever.
Type of strep bacteria. Certain strains of strep bacteria are more likely
to contribute to rheumatic fever than are other strains.
Environmental factors. A greater risk of rheumatic fever is associated
with overcrowding, poor sanitation and other conditions that can
easily result in the rapid transmission or multiple exposures to strep
bacteria.
NURSING INTERVENTIONS

Monitor temperature frequently, and patients response to

antipyretics.
Monitor the patients pulse frequently, especially after activity to
determine degree of cardiac compensation.
Auscultate the hear periodically for development of new heart
murmur or pericardial or pleural friction rub.
Observe for adverse effects of salicylate or nonsteroidal anti-
inflammatory drug (NSAID) therapy, such as stomach upset, tinnitus,
headache, GI bleeding, and altered mental status.
 Monitor the patients response to long-term activity restriction.
Restrict sodium and fluids and obtain daily weights as indicated.
Administer medications punctually and at regular intervals to
achieve constant therapeutic blood levels.
Explain the need to rest (usually prescribed for 4 to 12 weeks,
depending on the severity of the disease and health care providers
preference) and assure the patient that bed rest will be imposed no
longer than necessary.
Assist the patient to resume activity very gradually once
asymptomatic at rest and indicators of acute inflammation have
become normal.
Provide comfort measures.
 Provide safe, supportive environment for the child with chorea.
Observe for the disappearance or any major or minor
manifestations of the disease and report signs of increased
rheumatic activity as salicylates or steroids are being tampered.
Encourage continuous prophylactic antimicrobial therapy to
prevent recurrence.