10/4/2017
Definition
Client with Rheumatic Fever
and Rheumatic Heart Disease
Norfidah Binti Mohamad
Pathophysiology
 Rheumatic fever thought to result from abnormal
immune response to M proteins on group A
beta-hemolytic streptococcal bacteria
 Immune response results in inflammation in
connective tissues on heart, joints, and skin
a. Carditis: in all layers of heart tissue in 50%
persons with rheumatic fever
b. Endocardial inflammation results in fibrous
scarring of valve leaflets causing deformity
Risk factors
Environmental and economic factors-
1. damp whether
2. crowded living
3. malnutrition
4. immunodeficiency
5. poor access to health care
 Rheumatic fever is systemic inflammatory disease
caused by immune response to pharyngeal
infection by group A beta-hemolytic streptococci
 Rheumatic fever is self-limiting disorder usually
occurring between 5 – 15 years of age
 10 % persons with rheumatic fever develop
rheumatic heart disease
 Rheumatic heart disease damages heart valves
and is major cause of mitral and aortic valve
disorder
Rheumatic heart disease (RHD)
 Slowly progressive valvular deformity following
acute or repeated episodes of rheumatic fever
 Usually affects valves on left side of heart
especially mitral valve
 Stenosis of valve: narrowed fused valve
obstructs forward blood flow
 Regurgitation occurs with incompetent valve
(fails to close properly) and allows blood to
flow back through
Manifestations of rheumatic fever
(2 – 3 weeks post strep infection)
1. Initially fever, migratory joint pain (knees, hips,
ankles, elbows)
2. Erythema marginatum:
 temporary skin rash characterized by red
circumscribed lesions with blanched centers on
trunk and proximal extremities
3. Manifestations of carditis:
 chest pain, tachycardia, pericardial friction rub or
manifestations of heart failure; may develop S3, S4
or murmur, cardiomegaly, pericardial effusion
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Erythema marginatum
 Throat culture:
 positive for group A beta-hemolytic
streptococcus in 25– 40% of clients
with acute rheumatic fever
Medications
 Penicillin antibiotic of choice to treat
infection; course of 10 days
 If client allergic to penicillin, erythromycin
or clindamycin prescribed
10/4/2017
Diagnostic Tests
 History and physical examination
 CBC and erythrocyte sedimentation rate (ESR):
 WBC and ESR are elevated signifying the
inflammatory process
 Antistreptolysin titer (ASO):
 test for streptococcal antibodies; rises within 2
months of onset and is positive with rheumatic
fever
Collaborative Care
1. Eradicating the streptococcal infection
2. Managing manifestations of disease
3. Limiting activities, generally
 Prophylactic antibiotic therapy continued
for 5 – 10 years to prevent recurrences
(Penicillin G, 1.2 million units I.M. every 3
– 4 weeks prophylaxis of choice; oral
antibiotics may be used)
 Joint pain and fever treated with aspirin or
other NSAID; corticosteroids may be used
for severe pain with inflammation or
carditis
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Nursing Care/Health Promotion
 Prompt identification and treatment of
streptococcal throat infections
 Understanding that full course of
antibiotics should be completed
 Activity Intolerance
1. Activities are limited during acute phase of
carditis to reduce workload of heart
2. Gradual activity progression encouraged as
condition improves
3. Allow visits from friends/ family. Diversional
activities (reading, listening, playing card,
watching)
10/4/2017
Nursing Diagnoses
 Acute Pain
1. Assess the severity of pain
2. Administer anti-inflammatory agents as
ordered. Report any manifestations of
aspirin toxicity (tinnitus, vomiting and GI
bleed). Administer with food, milk or
antacids (minimize gastric irritation)
3. Place a bed cradle at foot of bed. Provide
warm, moist compresses for local pain relief.
Home Care
 Most clients recuperate at home and need teaching
for acute care and prevention of recurrences
 Client must complete full course of antibiotic therapy
and continue antibiotic prophylaxis
 Recognition of streptococcal sore throat and early
manifestations of heart failure and seek medical
attention
 Follow prescribed activity and diet (usually high
carbohydrate, high protein with possible sodium
restriction)