RHEUMATIC FEVER

SUPERVISION BY
DR.NAGWA
DONE BY ENAS NEYAZ
DEFINITION:

 It is an acute autoimmune disease that occurs as a sequel

of group a beta hemolytic streptococcal infection. It
characterized by inflammatory lesions of connective
tissue and endothelial tissue, primarily affecting the
joints and heart.
CAUSES

 The exact cause of rheumatic fever is not clear, although most

authorities favour the theory that the disease results from an 
autoimmune reaction, involving the production of antibodies
that attack the body’s own tissues. The autoimmune reaction
is believed to be triggered by components of the streptococci (
antigens) whose structure resembles that of molecules found
in human tissue (“self antigens”). Because of this
resemblance, the antibodies that recognize streptococcal
antigens may mistakenly react with similarly shaped antigens
of certain cells of the body—such as those of the heart. By
binding to these self antigens, the antibodies cause the tissue
damage characteristic of rheumatic fever
EXPLAINING THE MANY TYPES OF RHEUMATIC
DISEASE:

1-Tissue injury or disease in a joint:

Many different kinds of arthritis comprise a portion of the
rheumatic diseases. Examples of arthritic diseases
include osteoarthritis, rheumatoid arthritis, juvenile
rheumatoid arthritis, ankylosing spondylitis, gout,
infectious arthritis, reactive arthritis, bursitis and
tendinitis.
 A-Osteoarthritis:
It is a degenerative joint disease.
Osteoarthritis primarily affects cartilage. Cartilage is the tissue that cushions the ends of bones within the
joint. Osteoarthritis occurs when the c cartilage begins to wear and break down. Bony spurs (pointy bulges of bone)
may form at the edges of the joint.
Osteoarthritis causes joint pain, reduced joint motion, loss of function, and disability. The disability results
most often when disease affects the spine and weight-bearing joints like the hips and knees
B-Rheumatoid arthritis:
It is an inflammatory disease of the synovium, or the lining of the joint. Symptoms include pain, stiffness,
swelling, deformity and loss of function in the joint. The inflammation most often affects the joints of the hands
and feet. Rheumatoid arthritis tends to occur equally on both sides of the body. This symmetry helps to distinguish
rheumatoid arthritis from other types of arthritis.
C-Ankylosing spondylitis:
It is the type of arthritis that affects the spine. The tendons and ligaments around the bones and joints in
the spine become inflamed, causing stiffness and pain in the lower back.
D-Gout:
It is a type of arthritis that causes by the deposition of sodium urate crystals in joints and tendons that
provokes an acute inflammatory response. It occurs in some people whose blood uric acid abnormally high due to
either overproduction or detective excretion by the kidneys.
In many cases only one joint is involved and it is typically red, hot and painfull. The sits most commonly
affected are the metatarsophalangeal joint of the big toe, ankle, knee, wrist and elbow joints.
E-Bursitis:
It involves inflammation of the bursae, or small fluid-filled sacs that help reduce friction between bones and
other moving structures in the joint. Injury or infection of the bursae can cause the inflammation, pain and
tenderness that limit the movement of the joints.
F-Tendonitis:
It is inflammation of tendons, or the tough cords of tissue that connect muscle to bone. Overuse, injury or
other rheumatic conditions can cause tendinitis. Symptoms include pain, tenderness and restricted movement.
SYMPTOMS:

 Rheumatic fever symptoms may vary. Some people may have several symptoms, while others
experience only a few. The symptoms may also change during the course of the disease. The
onset of rheumatic fever usually occurs about two to four weeks after a strep throat infection.
 
 Rheumatic fever signs and symptoms — which result from inflammation in the heart, joints, skin
or central nervous system — may include:
 Abdominal pain

 Fever

 Heart (cardiac) problems, which may not have symptoms, or may result in shortness of breath
and chest pain
 Joint pain, arthritis (mainly in the knees, elbows, ankles, and wrists)

 Joint swelling; redness or warmth

 Nosebleeds (epistaxis)

 Skin nodules

 Skin rash (erythema marginatum)

 Skin eruption on the trunk and upper part of the arms or legs
 Eruptions that look ring-shaped or snake-like
 Sydenham chorea (emotional instability, muscle weakness and quick, uncoordinated jerky
movements that mainly affect the face, feet, and hands)
NURSING DIAGNOSIS
-Physical examamination
1-Checking the joints for signs of inflammation
2-Examining the skin for nodules under the skin or a rash
3-Listening to the heart for abnormal rhythms, murmurs or
muffled sounds that may indicate inflammation of the
heart
4-Conducting a series of simple movement tests to detect
indirect evidence of inflammation of the central nervous
system.
-BLOOD TESTS

 Blood test for recurrent strep infection antistreptolysin O

(ASO) titer is a blood test to measure antibodies against
streptolysin O, a substance produced by group
A Streptococcus bacteria).
-Complete blood count
-Electrocardiogram and Echocardiograghy
-Sedimentation rate (ESR)

 Several major and minor criteria have been developed to help

standardize rheumatic fever diagnosis. Meeting these criteria,
as well as having evidence of a recent streptococcal infection,
can help confirm that you have rheumatic fever.
THE MAJOR CRITERIA FOR DIAGNOSIS INCLUDE:

-Arthritis in several joints (polyarthritis)

-Heart inflammation (carditis)
-Nodules under the skin (subcutaneous skin nodules)
-Rapid, jerky movements (chorea, Sydenham chorea)
-Skin rash (erythema marginatum)
THE MINOR CRITERIA INCLUDE:

-Fever
-High ESR
-Joint pain
-Other laboratory findings
COMPLICATIONS

-Inflammation caused by rheumatic fever may last for a few weeks to

several months. In some cases, the inflammation may cause long-term
complications.
-Valve stenosis. This condition is a narrowing of the valve, which results in
decreased blood flow.
-Valve regurgitation. This condition is a leak in the valve, which allows
blood to flow in the wrong direction.
-Damage to heart muscle. The inflammation associated with rheumatic
fever can weaken the heart muscle, resulting in poor pumping function.
-Damage to the mitral valve, other heart valves or other heart tissues can
cause problems with the heart later in life. Resulting conditions may
include:
-Atrial fibrillation, an irregular and chaotic beating of the upper chambers
of the heart (atria)
-Heart failure, an inability of the heart to pump enough blood to the body
MANAGEMENT:

 Bed rest during the treatment course

 Course of medications:

1-Antibiotics. The doctor will prescribe penicillin or another antibiotic to

eliminate any remaining strep bacteria that may exist in your child's
body.
2-Anti-inflammatory treatment. Your doctor will prescribe a pain
reliever, such as aspirin or naproxen (Anaprox, Naprosyn, others), to
reduce inflammation, fever and pain. If symptoms are severe or your
child isn't responding to the anti-inflammatory drugs, your doctor may
prescribe a corticosteroid, such as prednisone.
3-Anticonvulsant medications. If the involuntary movements of
Sydenham chorea are severe, your doctor may prescribe an
anticonvulsant.
 In secondary phase, in some cases need mitral valve replacement
surgery.
NURSING MANAGEMENT

1-Decrease cardiac output related to carditis.

2-Reduce pain related to arthritis
3-Risk for injury related to chorea.
NURSING CARE PLANE

 Improving cardiac output

1-Explain to family need full bed rest during treatment course during the acute phase.
2-Maintain cardiac monitoring if indicated
3-Administer course of antibiotics as directed.
4-Administer medications for heart failure as directed.
5-Monitor intake and output, blood pressure, and heart rate.

 Relieving pain
1-Adminster anti inflammatory medications, analgesics, and antipyretics as prescribed
2-Teach family the importance of maintaining dose schedule, continuing medication until
all signs and symptoms have gone.
3- Assist child with positioning for comfort and protecting inflamed joints.
 
 Protecting the child with chorea

1-Use padded side rails if chorea is sever.

2-Assist with feeding and other activities as needed.
3-Administer Phenobarbital or other medication as directed.