4 Acute Rheumatic Fever Nursing Care Plans


Acute rheumatic fever is an inflammatory autoimmune disease that occurs 2 to 6 weeks following an untreated or undertreated group A beta-hemolytic streptococcal infection. It affects the heart, joints, central nervous system (CNS), and skin. It is prevented by prompt treatment of the infection through a prophylaxis of antibiotics within 9 days of onset of streptococcal infection before further complications can develop. Because rheumatic heart disease does not occur after only one attack and children are susceptible to recurrent attacks of rheumatic fever, it is vital that an initial episode is diagnosed and treated, and that long-term prophylactic therapy (5 years or more) is given following the acute phase.

The signs and symptoms of rheumatic fever are classified into major manifestations (polyarthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum) and minor manifestations (fever, arthralgia, ECG and laboratory changes) according to the revised Jones criteria. The diagnosis is based upon the presence of 2 major manifestations, or 1 major and 2 minor manifestations, supported by evidence of a preceding group a streptococcal infection is indicative of acute rheumatic fever.

Nursing Care Plans

Nursing care planning goals for a child with acute rheumatic fever include reducing pain, conserving energy, promoting activity tolerance, and providing education about the disease, treatment and preventive measures needed to avoid recurrence and possible complications.

Here are four (4) nursing care plans and nursing diagnosis for acute rheumatic fever:

  1. Acute Pain
  2. Hyperthermia
  3. Activity Intolerance
  4. Risk for Infection

Acute Pain

Nursing Diagnosis

May be related to

  • Inflammation
  • Arthralgia

Possibly evidenced by

  • Verbal description of pain
  • Guarding and protective behavior of painful joints
  • Warmth at affected joints
  • Edema
  • Redness

Desired Outcomes

  • Child will verbalize less pain by using a scale of 1 to 10.
  • Child will appear relaxed without guarding.
  • Child’s joints will not become inflamed, red, or warm.
Nursing InterventionsRationale
Assess the child’s pain perception using an appropriate scale every 2 to 3 hours.Provides information about the pain level of the child.
Assess changes in behavior, such as high-pitched cry, irritability, restlessness, refusal to move, facial grimace, aggressive or dependent behavior.Nonverbal pain descriptions that are age-related as child or infant may be unable to describe pain; fear and anxiety associated with pain cause changes in behavioral responses.
Examine affected joints, degree of joint pain, level of joint movement.Provides data about pathologic changes in joints; reversible joint involvement usually affecting large joints, such as knees, hips, wrists, and elbows; an increase in numbers of affected joints occurs over a period of time.
Administer salicylates and anti-
inflammatory medications as prescribed, and advise child that the medication will decrease the pain; administer a sustained-
action analgesic before bedtime or 1 hour before anticipated movement.
Relieves pain, inflammation in joints and provide rest and comfort.
Elevate involved extremities above heart level.Improves circulation to the heart to alleviate edema.
Maintain bed rest during the acute stage
of the disease.
Promotes relief of joint pain caused by movement.
Advise positional changes every 2 hours while maintaining body alignment.Prevents contractures and promotes comfort.
Apply bed cradle under outside covers
over painful joints.
Avoids pressure on painful parts.
Assist in gentle handling and supporting of body parts.Prevents extra pain to affected parts.
Provide toys, games for quiet, sedentary play.Provides diversionary activity to distract from the pain.
Encourage the use of nonpharmacologic interventions such as imagery, relaxation, distraction, cutaneous stimulation, heat application.Provides additional measures to decrease pain perception.
Stress the importance of limited activity or amount of joint movement allowed.Prevents increase or exacerbation of pain.
Teach parents and child of the need for analgesia and that it will help him/her to feel better.Controls pain, and allows for uninterrupted sleep and activity within the tolerance level.
Reassure parents and child that joint involvement is temporary, that pain and edema will subside, and that joints will return to normal size.Reduces anxiety related to fear of irreversible damage.
Educate parents in proper body positioning and handling of affected parts.Promotes comfort and avoids pain and contractures during bed rest.


Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses as reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of it’s evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions show how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

Other nursing care plans for pediatric conditions and diseases:

Other nursing care plans for cardiovascular system disorders:


Paul Martin is a registered nurse with a bachelor of science in nursing since 2007. Having worked as a medical-surgical nurse for five years, he handled different kinds of patients and learned how to provide individualized care to them. Now, his experiences working in the hospital is carried over to his writings to help aspiring students achieve their goals. He is currently working as a nursing instructor and have a particular interest in nursing management, emergency care, critical care, infection control, and public health. As a writer at Nurseslabs, his goal is to impart his clinical knowledge and skills to students and nurses helping them become the best version of themselves and ultimately make an impact in uplifting the nursing profession.
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