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

Activity Intolerance

Nursing Diagnosis

May be related to

  • Decrease cardiac output
  • Muscle weakness

Possibly evidenced by

  • Prolonged bed rest
  • Imposed activity restriction
  • Imbalanced oxygen supply and demand

Desired Outcomes

  • Child can work within the limits of tolerance for that perfectly measured.
Nursing InterventionsRationale
Assess the child’s mobility and physical activity level.Provides baseline information for formulating nursing goals during goal setting.
Assess and evaluate nutritional health status of the client.Adequate energy reserves are needed during activity.
Monitor pulse rate, blood pressure; observe for dyspnea, use of accessory muscles, and skin color before and after activity.Identifies the cardiopulmonary status of the client needed to help determine the ability to tolerate an activity.
Provide emotional support and positive attitude regarding abilities.Appropriate supervision during early efforts can enhance confidence.
Encourage adequate rest periods in between activity.Allows optimal performance during n activity.
Assist with activities of daily living as needed such as eating, bathing, dressing, elimination.Decreases oxygen consumption and boosts confidence in performing a task.
Encourage and teach the child with active range-of-motion exercises.Helps improve joint function and prevent muscle atrophy.
Instruct child to resume activity gradually once asymptomatic at rest and indicators of acute inflammation have resolved.Help pace the child’s energy and provide for maximum comfort.

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:


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.