Chapter 26: Rheumatic Fever (Children) Flashcards
Rheumatic Fever
group-A hemolytic streptococcal infection affecting multiple body systems such as heart, the joints, subcutaneous tissue, and at times, the nervous system
-a possible complication of strep throat infection or scarlet fever that can cause a wide range of secondary symptoms from joint inflammation to heart valve damage.
How does it arise?
typically arising as an acute pharyngitis
- two to 3 weeks after the initial infection, the organism invades the bloodstream and deposits on the valves of the heart (vegetation) causing permanent damage
- aortic and mitral valves frequently involved
- the mitral damage may result in mitral stenosis or mitral regurgitation
- aortic regurgitation also results from rheumatic fever
Occurs in who?
most often in children aged 5 to 15
Diagnosis
the signs and symptoms of RF coupled with a history of strep pharyngitis
5 major criteria (jones criteria) are present to give a diagnosis of RF
- arthritis (predominantly involving the large joints and is migratory (moves from joint to joint)
- Carditis (inflamed heart) and valvulitis (inflammation of blood vessels)
- Sydenham’s chorea (jerky purposeless movements of hand, changes in handwriting, emotional outbursts)
- Erythema marginatum (a circular red rash) with clearly demarcated raised edges seen most often on the trunk
- subcutaneous nodules (palpable nodules in the subcutaneous tissue)
4 Minor Criteria
- arthralgia
- fever
- elevated ESR or C-reactive protein
- prolonged PR interval
Prevention
- aimed at treating the initial strep infection early
- once a child has had RF, prompt recognition of a new infection will prevent a second RF attack and reduce the chances of progression of severity of heart disease
Nursing Care
-heart failure management
Medical Treatment
antibiotic administration and use of anti-inflammatory medications (aspirin)
Education and Discharge Instructions
- telling parents that children who have had RF may require a valve replacement during their lives
- a valve replaced in infancy or childhood must be replaced every 5 years to accommodate the child’s growth
- valves replaced during adolescence can last up to 10 years
ATI: Rheumatic Fever
inflammatory disease that occurs as a reaction to Group A beta-hemolytic streptococcus (GABHS) infection of the throat
ATI: Risk Factors
usually occurs within 2 to 6 weeks following an untreated or partially treated upper respiratory infection (strep throat) with GABHs
ATI: Expected Findings
-hx of recent upper respiratory infection
-fever
-tachycardia, cardiomegaly, new or changed heart murmur, muffled heart sounds, pericardial friction rub, and report of chest pain, which can indicate Carditis
-nontender, subcutaneous nodules over bony prominences
-large joints (knees, elbows, ankles, wrists, shoulders) with painful swelling, indicating polyarthritis
>findings can be present for a few days and then disappear without treatment, returning in another joint
-pink, nonpruritic macular rash on the trunk and inner surfaces of extremities that appears and disappears rapidly; erythema marginatum
-CNS involvement (chorea) including involuntary, purposeless muscle movements; muscle weakness; involuntary facial movements; difficulty performing fine motor movements; labile emotions; and random uncoordinated movements of the extremities
-irritability, poor concentration, and behavioral problems
ATI: Laboratory Tests
- Throat culture for GABHs: recommended screen all school-aged children who have sore throats
- Blood antistreptolysin O titer: elevated or rising titer; most reliable
- C-reactive protein (CRP): elevated in response to an inflammatory reaction
- Erythrocyte Sedimentation rate: elevated in response to an inflammatory reaction
ATI: Diagnostic Procedures
> Chest x-ray: assess for cardiomegaly
Cardiac Function:
-ECG to reveal presence of conduction disturbances and to evaluate the function of the heart and valves
-Echocardiography for pericardial effusions
-Nursing: position child correctly for procedure
