A nurse is assessing a child who has streptococcal pharyngitis and has been admitted with suspected rheumatic fever. Which of the following findings should the nurse identify as an indication of rheumatic fever (Select All that Apply.)

A. While rheumatic fever can involve the heart (carditis), it typically affects the heart valves rather than causing arrhythmias like atrial fibrillation in children. The cardiac manifestations usually present as a new or changing murmur, tachycardia, or pericardial rub, rather than rhythm disturbances. Therefore, atrial fibrillation is not a reliable indicator of rheumatic fever in pediatric patients. B. Elevated blood urea nitrogen (BUN) and creatinine indicate renal dysfunction such as in glomerulonephritis. Rheumatic fever primarily affects the heart, joints, skin, and central nervous system, not the kidneys. Laboratory findings specific to rheumatic fever often include elevated ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), and evidence of recent streptococcal infection rather than kidney function abnormalities. C. These movements are characteristic of Sydenham chorea, a major manifestation of rheumatic fever. Sydenham chorea presents as rapid, purposeless, irregular movements of the hands, feet, and face. Children may also exhibit emotional lability, difficulty with fine motor tasks, and fatigue. It reflects inflammation in the basal ganglia following a streptococcal infection and is a key diagnostic clue in rheumatic fever. D. Hair loss is not associated with rheumatic fever and does not serve as a clinical marker for the disease. E. Chest pain in a child with suspected rheumatic fever often indicates carditis, which is a major criterion for diagnosis. Carditis may involve inflammation of the endocardium, myocardium, or pericardium, leading to tachycardia, a new or changing murmur, cardiomegaly, or pericardial rub. Children may also exhibit dyspnea, fatigue, and signs of congestive heart failure in severe cases. Recognizing chest pain as a symptom is critical for early management to prevent long-term valvular damage. F. Decreased urine output is not a common manifestation of rheumatic fever. Oliguria typically suggests renal pathology rather than cardiac or inflammatory involvement seen in rheumatic fever.