RHEUMATIC FEVER

• PRESENTED BY
• KIRAN KUMARI YADAV
• M.SC. NURSING 1ST YEAR
INTRODUCTION

 Rheumatic fever is an inflammatory disease that may develop after an

infection with Streptococcus bacteria (such as Strep throat or scarlet
fever).
 This disease is a multisystem inflammatory disease which can affect the
heart, joints, skin and brain.
 It is an immunologically mediated.
 It can be acute or chronic.
DEFINITION OF RHEUMATIC FEVER

Rheumatic fever is an inflammatory disease that can develop

when strep throat or scarlet fever are caused by an infection

with Group A beta hemolytic streptococcus bacteria.

 EPIDIMIOLOGY
Age group :5-15 yrs.
Gender: male=female

common: In poor socio-economic strata

Common in the developing countries like India, Pakistan

Prevalence in INDIA: 0.6/1000.
Incidence more during fall, winter & early spring.
 
ETIOLOGY & RISK FACTORS
 Group A beta-hemolytic streptococcus.
 Genetic Influence
 Upper respiratory tract infection(streptococcal)
 Poor socio-economic status
 Seasonal variation
 Climate
 Hereditary predisposition

 Previous history of Rheumatic fever

CLINICAL MANIFESTATION
 Rheumatic fever according to DUCKETT JONE’S CRITERIA
MAJOR MANIFESTATIONS

 Carditis (MR, MS, AR,TR,)

 Arthritis

 Chorea

 Erythema marginatum

 Subcutaneous nodules
ERYTHEMA MARGINATUM
SUBCUTANEOUS NODULES
MINOR MANIFESTATIONS

 Fever (101*-104*f)/chills

 Headache /sinusitis

 Malaise/Arthralgia

 Abdominal pain (more common in children)

 sore throat (sudden onset)

 enlarged lymph nodes

LABORATORY
Increased ESR, CRP
Prolonged P-R interval.
ESSENTIAL CRITERIA
Evidence of antecedent streptococcal infection
Positive throat culture
DIAGNOSTIC EVALUATION

 History collection
 Physical examination
 Complete blood count
 Differential count
 Haemoglobin %
 ESR
 C-reactive protein
CONT..
 Positive throat culture
 Rapid streptococcal antigen detection test
 Chest X-ray – cardiomegaly and pulmonary congestion
 ECG- prolongation P-R interval

 ECHO- cardiac dilation, valve abnormalities

MEDICAL MANAGEMENT
1.Treatment of group A streptococcal infection
a. Procaine penicillin- 4 Lakhs unit s intramuscularly twice daily for 10
days.
b. Oral Penicillin-V- 250 mg 6 hrly for 10 days.
c. Benzedrine penicillin G-1.2 million unit(>27 kg) or 0.6 million
units(<27 kg) intramuscularly single dose after sensitivity test.
d. Azithromycin oral -12.5 mg/kg/day once daily for 5 days.
e. Cephalexin oral – 15-20mg/kg/dose twice daily for 10 days.
SUPPRESSIVE THERAPY

a. Aspirin 100mg/kg/day in four divided doses is given orally for

3-5 days

b. Steroids- prednisolone 1-2 mg/kg/day

3. SUPPORTIVE THERAPY

a. Bed- rest

b. hospitalization: for chorea, Carditis, arthritis

 c.Treatment of cardiac complication

 
NURSING MANAGEMENT

Assessment

 Assess the history of recent sore throat and upper respiratory tract

infection.

 Physical examination begin with a careful review of all system.

 Observe for elevated temperature& pulse, & carefully examine for

erythema marginatum, subcutaneous nodules, swollen or painful joints or

sign of chorea.
NURSING DIAGNOSIS

 Hyperthermia related to illness or inflammatory disease as evidenced by

fever with chills.
 Acute pain related to arthralgia as evidenced by joint pain, edema, redness.
 Activity intolerance related to muscle weakness as evidenced by prolonged
bed rest.
 Risk for injury related to chorea.
 Ineffective health management related to lack of knowledge concerning
possible disease sequale and the need for long term prophylactic antibiotic
therapy.
NURSING INTERVENTION

 Providing complete bed rest.

 Maintaining normal body temperature by managing fever.
 Providing bland diet with adequate fluid intake with salt restriction diet .
 Monitoring intake- output strictly.
 Administrating anti-inflammatory and analgesic medicine as prescribed
 Providing comfortable position.
CONT..

 Removing hard and sharp objects from the patient bedside.

 Assisting the patient in ambulation and other fine motor activities

 Administrating drugs to control the chorea.

 Explaining the duration of treatment, its importance and compliance,

activity restriction, follow-up and improvement of living standard.

 Instructing about preventive measures.

PREVENTION
• Primordial/ Primary prevention
 Improvement in living conditions
 Improvement of sanitation in and around the house
 Prevention of overcrowding
 Improvement in the socio-economic condition
Specific protection
• No vaccine is available.
• Chemoprophylaxis in case of pharyngitis i.e. benzathine
Secondary prevention

Early diagnosis and treatment

• School health survey

• High risk group surveillance

• Detections and treatment

• Disability limitations

• consists of giving intensive treatment with aspirin for joint pain,

prednisolone for Carditis, lifelong Benzathine penicillin
REHABILITATION

Social Vocational Psychological

COMPLICATION OF RHEUMATIC FEVER

 Rheumatic heart disease

 Arrhythmias
 Congestive cardiac failure
 Infective endocarditis
 Valvular disease
 Recurrent infection

 Sydenham chorea
CONCLUSION
Rheumatic fever is a disease that can occur following an untreated
streptococcus bacterial infection. Without treatment , rheumatic fever can
lead to serious complication such as rheumatic heart disease. Its sign and
symptoms are Carditis, arthritis, chorea, erythemamarginatum, and
,subcutaneous nodules. The prevention are Prevention Health promotion:
Primordial prevention includes improvement in living conditions,
improvement of sanitation in and around the house, prevention of
overcrowding, specific protection include No vaccine is available and
chemoprophylaxis in case of pharyngitis i.e. benzathine and the secondary
prevention includes No vaccine is available, hemo prophylaxis in case of
pharyngitis i.e. benzathine and secondary prevention i.e. Early diagnosis
and treatment.
 
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Elsevier Publication, 2nd edition (2014), page no;855-858.
 Lakshmanaswamy. Aruchaamy, Clinical Pediatrics, History taking and Care
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