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

Risk for Infection

Nursing Diagnosis

May be related to

  • Chronic recurrence of disease

Possibly evidenced by

  • [not applicable]

Desired Outcomes

  • Child will experience an absence of occurrence of reinfection.
  • Child will be afebrile; no complaints of discomfort.
  • Child will take medications as ordered.
Nursing InterventionsRationale
Assess parents’ knowledge and skills in the administration of prescribed antimicrobials; daily oral administration or monthly intramuscular injections.Providing long-term antibiotic therapy (as long as 5 years) as a preventive measure may be challenging.
Monitor for chest pain, shortness of breath, fatigue, cough, night sweats, friction rub, gallop during the acute stage of the disease.Signs and symptoms of carditis, which may result in endocarditis causing vegetation that becomes fibrous at the valve areas that is at increased risk of recurrent infections.
Administer antibiotic therapy during the acute phase of disease as prescribed.Inhibits cell wall synthesis of microorganisms, destroying the causative pathogen.
Instruct in the long-term antibiotic regimen, the need for protection prior dental work or any invasive procedure, and inform of importance to prevent recurrence.Therapy begins after the acute phase and medical supervision is needed for life as rheumatic fever may recur; a high percentage of children who incur the disease have cardiac complications later in life.
Notify the physician immediately for any upper respiratory infections, elevated temperature, joint pain, or non-compliance to antibiotic therapy.May indicate recurrence of the disease or need to change or adjust medication.


Recommended 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.