4 Acute Rheumatic Fever Nursing Care Plans

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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:

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

Nursing Diagnosis

  • Hyperthermia

May be related to

  • Illness or inflammatory disease

Possibly evidenced by

  • Increase body temperature above normal range
  • Hot, flushed skin
  • Chills
  • Tachycardia, tachypnea

Desired Outcomes

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  • Child will demonstrate temperature within the normal range and be free of chills.
Nursing InterventionsRationale
Assess temperature, heart rate, and blood pressure frequently.A temperature of 101°F (38.3°C) or above is noted along with redness, pain, and swelling of the joints; HR and BP increase as hyperthermia progresses.
Administer nonsteroidal anti-inflammatory drug (NSAIDs) as prescribed; Observe for any untoward effects of NSAIDs.Reduces inflammation and pain; Side effects of NSAIDs may include abdominal pain, tinnitus, dizziness, headache, stomach ulcer, GI bleeding.
Administer a course of penicillin therapy or a single intramuscular dose of benzathine penicillin.A complete antibiotic treatment of penicillin eliminates group A streptococcus infection.
Provide a tepid sponge bath.Helps reduce the occurrence of fever.
Modify the child’s environment such as room temperature and bed linens as indicated.Room temperature may be accustomed to near normal body temperature and blankets and linens may be adjusted as indicated to regulate the temperature of the client.
Eliminate excess clothing and covers.Exposing skin to room air decreases warmth and increases evaporative cooling.
Maintain bed rest especially during the acute febrile phase.Conserves energy and reduces metabolic rate.
Teach child and family members about the signs and symptoms of hyperthermia and help in identifying factors related to the occurrence of fever; discuss the importance of increased fluid intake to avoid dehydration.Providing health teachings to the patient and family aids in coping with disease condition and could help prevent further complications of hyperthermia.
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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

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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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