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: 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
Possibly evidenced by
- Verbal description of pain
- Guarding and protective behavior of painful joints
- Warmth at affected joints
- 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.
|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.|
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Communicable and Infectious Diseases Care Plans
Care plans related to communicable and infectious diseases:
- Acquired Immunodeficiency Syndrome (AIDS) (HIV Positive) | 13 Care Plans
- Acute Rheumatic Fever | 4 Care Plans
- Dengue Hemorrhagic Fever | 2 Care Plans
- Herpes Zoster (Shingles) | 4 Care Plans
- Influenza (Flu) | 5 Care Plans
- Pulmonary Tuberculosis | 5 Care Plans
Pediatric Nursing Care Plans
Nursing care plans for pediatric conditions and diseases:
- Acute Glomerulonephritis | 4 Care Plans
- Acute Rheumatic Fever | 4 Care Plans
- Apnea | 4 Care Plans
- Brain Tumor | 3 Care Plans
- Bronchiolitis | 5 Care Plans
- Cardiac Catheterization | 4 Care Plans
- Cerebral Palsy | 7 Care Plans
- Child Abuse | 4 Care Plans
- Cleft Lip and Cleft Palate | 6 Care Plans
- Congenital Heart Disease | 5 Care Plans
- Congenital Hip Dysplasia | 4 Care Plans
- Croup Syndrome | 5 Care Plans
- Cryptorchidism (Undescended Testes) | 3 Care Plans
- Cystic Fibrosis | 5 Care Plans
- Diabetes Mellitus Type 1 (Juvenile Diabetes) | 4 Care Plans
- Dying Child | 4 Care Plans
- Epiglottitis | 5 Care Plans
- Febrile Seizure | 4 Care Plans
- Guillain-Barre Syndrome | 6 Care Plans
- Hospitalized Child | 5 Care Plans
- Hydrocephalus | 5 Care Plans
- Hypospadias and Epispadias | 4 Care Plans
- Intussusception | 3 Care Plans
- Juvenile Rheumatoid Arthritis | 4 Care Plans
- Kawasaki Disease | 6 Care Plans
- Meningitis | 7 Care Plans
- Nephrotic Syndrome | 5 Care Plans
- Osteogenic Sarcoma (Osteosarcoma) | 4 Care Plans
- Otitis Media | 4 Care Plans
- Scoliosis | 4 Care Plans
- Spina Bifida | 7 Care Plans
- Tonsillitis and Adenoiditis | 4 Care Plans
- Umbilical and Inguinal Hernia | 4 Care Plans
- Vesicoureteral Reflux (VUR) | 5 Care Plans
- Wilms Tumor (Nephroblastoma) | 4 Care Plans
Recommended books and resources:
- Nursing Care Plans: Diagnoses, Interventions, and Outcomes
- Nurse's Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
- Nursing Diagnoses 2015-17: Definitions and Classification
- Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR)
- Manual of Psychiatric Nursing Care Planning
- Maternal Newborn Nursing Care Plans
- Delmar's Maternal-Infant Nursing Care Plans, 2nd Edition
- Maternal Newborn Nursing Care Plans