4 Acute Rheumatic Fever Nursing Care Plans

July 16, 2018

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 (NCP) for acute rheumatic fever:

Acute Pain

Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

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 Interventions	Rationale
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.