{
  "name": "Acute Rheumatic Fever",
  "slug": "acute-rheumatic-fever",
  "url": "https://nursingplex.com/care-plans/acute-rheumatic-fever",
  "category": "Infectious Diseases",
  "summary": "Post-streptococcal inflammation with carditis risk; rest, antibiotics and cardiac monitoring.",
  "nursing_diagnoses": [
    "Acute pain",
    "Hyperthermia",
    "Risk for decreased cardiac output"
  ],
  "overview": [
    "Acute rheumatic fever is an inflammatory, autoimmune complication that follows an untreated or inadequately treated group A streptococcal pharyngitis, typically two to four weeks after the initial throat infection. Antibodies produced against the streptococcal bacteria cross-react with tissues in the heart, joints, skin and central nervous system because of molecular similarities, producing a multisystem inflammatory illness rather than a direct infection.",
    "The heart is the organ of greatest concern because rheumatic carditis can permanently scar the heart valves — most often the mitral valve — leading to chronic rheumatic heart disease years later. The Jones criteria guide diagnosis, combining major manifestations such as carditis, polyarthritis, chorea, erythema marginatum and subcutaneous nodules with minor findings like fever, elevated inflammatory markers and prolonged PR interval, supported by evidence of a recent strep infection.",
    "Nursing management centers on eradicating the streptococcal infection, controlling inflammation, protecting the heart, and preventing recurrence, since repeated episodes cause cumulative and increasingly severe valve damage. Long-term secondary prophylaxis with antibiotics is often needed for years, making patient and family education about adherence essential."
  ],
  "key_facts": [
    {
      "label": "Trigger",
      "text": "Group A beta-hemolytic streptococcal pharyngitis, usually two to four weeks before symptom onset."
    },
    {
      "label": "Diagnosis",
      "text": "Jones criteria: major criteria (carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules) plus minor criteria and evidence of prior strep infection."
    },
    {
      "label": "Migratory arthritis",
      "text": "Large joints become painful and swollen one at a time, each resolving within days as another joint becomes affected."
    },
    {
      "label": "Greatest long-term risk",
      "text": "Rheumatic carditis causing chronic mitral or aortic valve damage, sometimes not apparent until years later."
    },
    {
      "label": "Prevention",
      "text": "Prompt antibiotic treatment of strep throat prevents rheumatic fever; secondary prophylaxis prevents recurrence in those already affected."
    }
  ],
  "nursing_priorities": [
    "Eradicate residual streptococcal infection with a full course of antibiotics.",
    "Reduce inflammation and control fever and joint pain.",
    "Monitor closely for signs of carditis and heart failure.",
    "Promote rest to reduce cardiac workload during the acute inflammatory phase.",
    "Assess and manage chorea, which affects coordination and safety.",
    "Provide comfort measures for arthritis and skin manifestations.",
    "Establish a plan for long-term secondary antibiotic prophylaxis."
  ],
  "assessment": {
    "subjective": [
      "Recent sore throat, often several weeks prior, sometimes unrecognized or untreated",
      "Migrating joint pain that moves from one large joint to another",
      "Fatigue, malaise and generalized weakness",
      "Chest discomfort, palpitations or a sense of the heart racing",
      "Clumsiness, involuntary movements or emotional lability (chorea)",
      "Fever and night sweats"
    ],
    "objective": [
      "Migratory polyarthritis affecting large joints (knees, ankles, elbows, wrists) with warmth, redness and swelling",
      "New heart murmur, muffled heart sounds, or signs of heart failure such as tachycardia and crackles",
      "Erythema marginatum — pink, non-itchy rash with a clear center and raised, snake-like border on the trunk and limbs",
      "Subcutaneous nodules over bony prominences",
      "Sydenham chorea: involuntary, purposeless movements, muscle weakness and emotional lability",
      "Elevated temperature",
      "Elevated ESR and C-reactive protein, positive throat culture or elevated antistreptolysin O titer",
      "Prolonged PR interval on ECG"
    ],
    "related_factors": [
      "Untreated or inadequately treated group A streptococcal pharyngitis",
      "Autoimmune cross-reactivity between streptococcal antigens and cardiac, joint and neural tissue",
      "Crowded living conditions and limited access to healthcare increasing risk of untreated strep infections",
      "Genetic susceptibility to an exaggerated immune response",
      "Prior episode of rheumatic fever increasing risk of recurrence with subsequent strep infections"
    ]
  },
  "goals": [
    "The client will complete the full prescribed course of antibiotic therapy.",
    "The client will exhibit reduced joint pain and inflammation.",
    "The client will show no signs of new or worsening cardiac involvement.",
    "The client will maintain safety despite chorea-related movement difficulties.",
    "The client and family will verbalize the importance of long-term secondary prophylaxis.",
    "The client will maintain adequate rest during the acute inflammatory period."
  ],
  "interventions": [
    {
      "title": "1. Eradicating infection and controlling inflammation",
      "points": [
        "Administer the full prescribed course of penicillin or an appropriate alternative to eliminate residual streptococcal organisms, even after symptoms improve.",
        "Give anti-inflammatory agents such as aspirin or NSAIDs as ordered to control fever and joint inflammation, monitoring for gastrointestinal or bleeding side effects.",
        "Monitor temperature, joint swelling and inflammatory markers to track response to treatment.",
        "Explain that antibiotics treat the underlying infection while anti-inflammatories manage symptoms; both are necessary."
      ]
    },
    {
      "title": "2. Cardiac monitoring and workload reduction",
      "points": [
        "Auscultate heart sounds regularly for new or changing murmurs, which may indicate developing valve involvement.",
        "Monitor for signs of heart failure — tachycardia, tachypnea, crackles, edema, fatigue with feeding or exertion — especially in children.",
        "Enforce bed rest during the acute febrile and inflammatory phase to reduce cardiac workload, liberalizing activity gradually as inflammation resolves and cardiac status stabilizes.",
        "Obtain and trend serial ECGs and echocardiograms as ordered to assess for carditis and valve function.",
        "Prepare the family for the possibility that cardiac damage may not be reversible and may require lifelong monitoring."
      ]
    },
    {
      "title": "3. Managing joint pain and skin manifestations",
      "points": [
        "Position affected joints comfortably and support them during movement without applying excessive pressure.",
        "Apply prescribed anti-inflammatory or analgesic measures and reassess pain regularly, since migratory arthritis can shift rapidly.",
        "Avoid unnecessary joint manipulation during acute swelling.",
        "Monitor and describe the erythema marginatum rash and subcutaneous nodules without disturbing them unnecessarily."
      ]
    },
    {
      "title": "4. Managing chorea and safety",
      "points": [
        "Assess the severity of involuntary movements and their impact on the child's ability to write, walk or self-feed safely.",
        "Pad bed rails or provide a safe, low-stimulation environment if movements are severe.",
        "Reassure the family that chorea is usually self-limited and resolves as the underlying inflammation subsides, although it can take weeks to months.",
        "Assist with activities of daily living during periods of significant motor involvement while encouraging as much independence as safely possible."
      ]
    },
    {
      "title": "5. Long-term prevention and education",
      "points": [
        "Explain the necessity of long-term secondary antibiotic prophylaxis, which may continue for years or into adulthood depending on the severity of carditis.",
        "Reinforce prompt treatment of any future sore throat to prevent recurrence.",
        "Coordinate follow-up echocardiography to monitor for chronic valve disease.",
        "Discuss the need for antibiotic prophylaxis before certain dental or surgical procedures if valve damage has occurred."
      ]
    }
  ],
  "patient_teaching": [
    "Complete the entire prescribed antibiotic course exactly as directed, even after you feel better.",
    "Continue any long-term preventive antibiotics as scheduled; stopping early increases the risk of another episode and further heart damage.",
    "Seek prompt medical evaluation and treatment for any future sore throat.",
    "Understand that joint pain typically resolves without lasting damage, but heart involvement can be permanent and requires ongoing follow-up.",
    "Expect chorea, if present, to improve gradually; reduce stress and provide a calm environment during recovery.",
    "Attend all scheduled follow-up appointments and echocardiograms to monitor heart valve health.",
    "Inform any future healthcare or dental provider about a history of rheumatic fever, since antibiotic prophylaxis may be needed before certain procedures."
  ]
}