Nursing Care Plan for Rheumatic Fever

Pathophysiology

When a strep throat infection is untreated or is not completely treated, it can result in an autoimmune condition called rheumatic fever. This autoimmune response causes inflammation in the body that attacks the joints, heart, skin and central nervous system. Risk factors that may increase the chance of developing rheumatic fever include a genetic predisposition, certain strains of Group A strep bacteria, and poor sanitation.

Etiology

Group A streptococcus bacteria causes strep throat infections and contains a protein that is similar to proteins found naturally in specific tissues in the joints, heart and skin. Following a strep infection, the immune system continues to target these proteins and begins to attack the healthy tissues of the body resulting in inflammation. Permanent damage to the body, especially to the heart and heart valves, may result without adequate treatment.

Desired Outcome

Patient will be free from infection; patient will be free from pain; patient will not have permanent tissue damage

Rheumatic Fever Nursing Care Plan

Subjective Data:

  • Painful or tender joints
  • Chest pain
  • Fatigue
  • Unusual behaviors or outbursts

Objective Data:

  • Fever
  • Red, swollen joints
  • Rash
  • Subcutaneous nodules
  • Heart murmur
  • Uncontrollable body movements (hands, feet, face)

Nursing Interventions and Rationales

  1. Assess and monitor vital signs

  2. Get a baseline to determine effectiveness of interventions. Fever is a primary symptom. Blood pressure and heart rate may be elevated from fever or from involvement of the heart.

  3. Perform complete physical assessment

  4. Provides baseline.  Note redness of the skin or rash, swelling of the joints, or presence of subcutaneous nodules.

  5. Assess motor and neurologic function

  6. Patients often have chorea (irregular movements may be noted in the face or extremities and may cause changes in speech)

  7. Assess pain with appropriate pain scale and manage with non-pharmacological routes

  8. FACES and FLACC scales may be used.

    Joint pain is most common and may be relieved by applying cool compresses or heat, repositioning or relaxation techniques.

  9. Monitor lab tests

  10. Blood tests may be run, such as C-reactive protein or ESR to determine inflammation.

    Monitor for presence of strep antibodies or cardiac enzymes as appropriate.

  11. Obtain ECG and echocardiogram

  12. These tests are used to determine amount of cardiac involvement of the disease. They can detect electrical or functional abnormalities such as faulty valves and help determine course of treatment.

  13. Administer medications appropriately

    • Antibiotics
    • Anti-inflammatories
    • Anticonvulsants
    • Primary goal is to effectively treat the infection and reduce symptoms.
    • Antibiotics – given to treat remaining strep infection, may be given orally or IM.
    • Anti-inflammatories – given to relieve pain, treat fever and reduce inflammation.
    • Anticonvulsants- given to treat involuntary movements (chorea)

  14. Provide patient and parent education regarding home care and prevention of future disease or complication

    • The best way to prevent rheumatic fever is to fully treat strep infections as they occur. Incomplete or no treatment can lead to rheumatic fever.
    • Patient will need routine follow up with cardiology as symptoms of valve damage may not fully appear until later in life.
    • Encourage good hygiene as studies have shown higher occurrence in areas of overcrowding and poor sanitation.


References

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