A complication of an attack of

rheumatic fever

Characterized by swelling of
joints & inflammation of ♥ valves

Evidenced by painful inflammation

& swelling as the joints of the
ankles, knees, & wrists are
infected one by one; the
development of large, irregular
skin rashes & fever
Rheumatic Fever

Inflammatory disease that may

develop 2-3 weeks after a group A
Streptococcal infection (strep
throat or scarlet fever) believed
to be caused by antibody cross-
reactivity & can involve the
heart, joints, skin, & brain.
Acute rheumatic fever commonly
appears in children between ages
5-15 with only 20% of first time
attacks occurring in adults.
WHY IS RHEUMATIC
FEVER CONCERN??
 Inflammatory Disease

Connective tissues

♥ joints skin brain

♥ Damage

♥ valves Scar

♥ overload

Congestive ♥
resolve or permanent failure
Group A Streptococcus
pyogenes → untreated
strep throat → rheumatic
fever → rheumatic ♥
disease
Group A Streptococcal pyogenes → cell wall composed
of branched polymers → “M protein” that are highly
antigenic. The
Ntibodies & “M protein” → cross react → cardiac
myofiber protein myosin, ♥ muscle glycogen & smooth
muscle cells of arteries→ inducing cytokine release &
tissue destruction.
Direct attachment→ complement & Fc receptor-
mediated recruitment of neutrophils &
macrophages→inflammation occurs
* AGE
* HISTORY OF STREP
THROAT PROCESS
* POVERTY
* OVERCROWDING
Rheumatic fever:
Major criteria:
Migratory polyarthritis
Carditis
Subcutaneous nodules
Erythema marginatum
Sydenham’s chorea (St. Vitus’ dance)

Minor criteria:
Fever
Arthralgia
Raised Erythrocyte sedimentation rate or C reactive protein
Leukocytosis
ECG showing features of ♥ block
Supporting evidence of Streptococcal infection
Previous episode of rheumatic fever or inactive ♥ disease
Rheumatic ♥ Disease:
• Breathlessness
• Heart murmurs
• Fatigue
• Palpitations
• Chest pain
• Fainting attacks
Symptoms depend on w/c side
of the ♥ is involved…

SHORTNESS
LEFT OF BREATH
SIDED ♥ WITH
MITRAL FAILURE CRACKLES
VALVE OR
WHEEZING
IN THE
LUNGS
Severity of symptoms depend on the
size & location of lesion in the ♥…

VIRULENCE
SYSTEMATIC PROPORTION OF INVADING
SYMPTOMS ORGANISM
 Throat Culture – diagnose presence of
group A beta-hemolytic streptococcal
infection

The specimen for throat culture is obtained by wiping the patient's throat
with a cotton swab. The patient is asked to tilt the head back and open the
mouth wide. With the tongue depressed and the patient saying "ah," the
care provider wipes the back of the throat and the tonsils with a sterile
swab. The swab is applied to any area that appears either very red or
discharging pus. The swab is removed gently without touching the teeth,
gums, or tongue. It is then placed in a sterile tube for immediate delivery to a
laboratory. Obtaining the specimen takes less than 30 seconds. Laboratory
results are usually available in two to three days. The swabbing procedure
may cause gagging but is not painful. The doctor makes a note for the
laboratory to indicate if any disease organisms other than strep are
suspected, because some require special growth conditions in the
Nsg. Responsibilities

 Sore throat, or a history of one within 5

wks is the first symptoms of possible
rheumatic fever

 throat cultures should be taken before the

patient is given any fluids or antibiotic
medications.

the patient's immunization history should be

checked to evaluate the possibility that
diseases other than strep are causing the sore
throat.

The care provider should wash the hands

carefully after taking the specimen to prevent
the spread of any infectious organisms.
Rapid Antigen Detection Test – Used for
group A beta-hemolytic streptococcal which
may be used until throat culture results are
available
ECG – Show sinus tachycardia, sinus
bradycardia, sinus dysrhythmia, first degree
♥ block, & atrial fibrilation or atrial
flutter
Medications
Rheumatic fever:
1. Penicillin (benzathine penicillin)
- 10-day course of oral penicillin
- 3-4 wks prevent reoccurrence of rheumatic
fever & rheumatic ♥ failure
C: Penicillin
A: eliminate group A beta-hemolytic streptococci
completely from the child’s body
I: Strep infections prophylaxis & therapy of
secondary bacterial infections, syphilis, strep skin
infections

Nsg. Responsibilities
 Ask for allergies
 Don’t inject into or near an artery or nerve
 Special precaution to overgrowth of
nonsusceptible organisms
Oral Ibuprofen (Advil)

C: (NSAIDs)
A: Reduce inflammation & joint pain
I: Temporary relief of minor aches & pains due
to common cold, flu, sore throat, headache, tooth
ache, muscular ache, backache, minor pain of
arthritis, pain of menstrual cramp, reduction of
fever

Nsg. Responsibilities
> to be taken 6-8 hourly
> To be taken immediately after meals
Corticosteroid (Methylprednisolone)

C: Corticosteroid
A: Decrease inflammation, mainly by stabilizing
leukocytes lysomal membranes suppresses
immune response; stimulates bone marrow; &
influences protein, fat, & carbohydrate
metabolism

Nsg. Responsibilities
Watch for allergic reaction
Give once-daily dose in the morning
Give oral food when possible
Surgical
If ♥ valve damage → surgical repair or
replacement of the valve may be considered

* Valvoplasty – surgical repair of ♥ valve

Nsg. Dx

Acute Pain R/T migratory inflammatory of joints

Nsg. Intervention
Encourage verbalization of feelings of pain
Provide quiet environment
Provide comfort measures like massage or change of
position
Encourage relaxation exercise like music or television
Encourage socialization
 
Outcomes
Child will demonstrate use of relaxation skills & diversional
activities indicated
Nsg. Dx

Hyperthermia R/T inflammatory process AEB increased body

temperature

Nsg. Intervention
Promote cool environment
Promote TSB
Advice increase fluid intake of 6-8 glass a day
 
Outcomes:
Will demonstrate behaviors showing free from complication
w/ a lowered temperature
Nsg. Dx

Situational low self-esteem R/T chorea movements

secondary to rheumatic fever

Nsg. Intervention:
Provide toys or games that do not require fine coordination
life stuff toys or song games
Encourage rest
Provide bed side rails
Assist in feeding until independence is acquired

Outcomes:
Child expresses continues to feed & dress self w/ help as
needed
Estimated Mortality Rate from Incidence
& Death Statistics
Incidence: 11, 571
Death: 3, 676

Complications:
 Endocarditis
 Bacterial Endocarditis
 Heart Failure
Research:

Can Rheumatic ♥ Disease be Prevented?

the best way to prevent rheumatic ♥ disease is to
seek immediate medical attention to a strep throat and not
let it progress to rheumatic fever

Specific treatment for rheumatic ♥ disease will determine

by child’s physician based on:
1. Child’s overall health & medical history
2. Extent of the disease
3. Child’s tolerance for specific medications, procedures,
or therapies
4. Expectations for the course of the disease
5. Opinion or preference
 
The best treatment for rheumatic ♥ disease is prevention.
Antibiotics can usually treat strep throat & stop acute
rheumatic fever from developing.
ScienceDaily (Mar. 2, 2009) — Each year, around 15
million children fall ill with rheumatic heart disease
worldwide; half a million of them die as a consequence. At
the beginning of the medical cases of these children
stands a simple throat infection with streptococcus –
spherical bacteria responsible for causing a range of
different infections. However, it is only certain
streptococcal strains that trigger a whole chain of
reactions in the body that culminates in the life-
threatening rheumatic heart disease. These bacteria carry
a special protein sequence, the so-called PARF motif, on
their surface. "PARF means 'peptide associated with
rheumatic fever'," explains Nitsche-Schmitz. "It is a small
section from a bacterial surface protein , which is used by
the streptococcus to adhere to our cells and cause
disease." If children with a streptococcus infection in the
throat receive no or inadequate antibiotic treatment, then
the surviving bacteria with the PARF sequence on their
surface will adhere to their collagen.
Collagen is present throughout the body – as a major
component of bone and cartillage it determines shape and
structure of our body  and it strengthens the connective
tissue of the skin, the heart valves and blood vessels with
its high resistance to tensile forces. Adhesion of PARF-
bearing streptococci  to  collagen confuses our immune
system and our body's defence system not only targets
the bacteria, but also healthy and vital collagen. The auto-
immune disease rheumatic fever breaks out. If this in turn
also fails to be treated correctly, the consequence is
rheumatic heart disease: the heart valves, rich in
collagen, become inflamed and cease to function.
THANK YOU!!!

REPORTER:

KIRSTEN E. PAPERA
BSN 3-2
What should you know
Follow your medication program carefully. The drugs are designed to prevent
serious complications.
Make sure that all healthcare providers are aware of your condition. You will
need antibiotic treatment prior to any dental or surgical procedures.
Work with your physician on an effective exercise program, then follow it daily.
Regular exercise strengthens the heart and lowers blood pressure. Walking and
golfing, for example, are excellent forms of exercise for those suffering from
rheumatic heart disease. However, you should consult your doctor before
engaging in other, more rigorous forms of exercise such as basketball or
strength training workouts.
Eat a well balanced, heart-healthy diet low in fat, salt, and cholesterol.
Maintain a healthy weight. Too much weight can put added stress on your
heart.
Learn to control stress by adopting new ways to relax such as deep breathing
exercises, muscle relaxing techniques, meditation, or yoga.
Get at least seven hours of sleep each night and nap during the day if you feel
tired.
Quit smoking. If you are having trouble quitting, ask your doctor for help or for
additional resources that can assist you.