Chapter 26: Rheumatic Fever (Children) Flashcards

1
Q

Rheumatic Fever

A

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.

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2
Q

How does it arise?

A

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
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3
Q

Occurs in who?

A

most often in children aged 5 to 15

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4
Q

Diagnosis

A

the signs and symptoms of RF coupled with a history of strep pharyngitis

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5
Q

5 major criteria (jones criteria) are present to give a diagnosis of RF

A
  • 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)
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6
Q

4 Minor Criteria

A
  • arthralgia
  • fever
  • elevated ESR or C-reactive protein
  • prolonged PR interval
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7
Q

Prevention

A
  • 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
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8
Q

Nursing Care

A

-heart failure management

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9
Q

Medical Treatment

A

antibiotic administration and use of anti-inflammatory medications (aspirin)

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10
Q

Education and Discharge Instructions

A
  • 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
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11
Q

ATI: Rheumatic Fever

A

inflammatory disease that occurs as a reaction to Group A beta-hemolytic streptococcus (GABHS) infection of the throat

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12
Q

ATI: Risk Factors

A

usually occurs within 2 to 6 weeks following an untreated or partially treated upper respiratory infection (strep throat) with GABHs

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13
Q

ATI: Expected Findings

A

-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

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14
Q

ATI: Laboratory Tests

A
  • 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
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15
Q

ATI: Diagnostic Procedures

A

> 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

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16
Q

ATI: Jones Criteria

A
child should demonstrate the presence of two major criteria or presence of one major and two minor criteria following an acute infection with GABHs infection
>Major:
-Carditis
-Subcutaneous Nodules
-Polyarthritis
-Rash (erythema marginatum)
-Chorea

> Minor:

  • fever
  • arthralgia
17
Q

ATI: Nursing Care

A
  • encourage bed rest during acute illness
  • administer antibiotic therapy as prescribed
  • nutritionally balanced meals
  • assess for chorea (nervousness, behavioral changes, decreased attention span)
18
Q

ATI: Antibiotic Prophylaxis

A

either

  • two daily oral doses of penicillin V
  • monthly IM injection of penicillin G
  • daily oral dose of sulfadiazine