The nurse sees a child in an ambulatory setting because of rheumatic fever. What assessment findings would the nurse expect to find revealed by the health history? Select all that apply.

Choice A rationale Elevated C-reactive protein, a marker of inflammation, is a common finding in rheumatic fever, a systemic inflammatory condition resulting from an immune response to Group A β-hemolytic streptococcus. The normal range for CRP is typically 38.5°C or 101.3°F), is a very common manifestation of acute rheumatic fever (ARF) and is one of the minor criteria used for diagnosis. The fever results from the systemic inflammatory process triggered by the autoimmune response to the preceding streptococcal infection. It indicates the acute phase of the systemic illness. Choice C rationale Chorea, specifically Sydenham chorea, is a major manifestation of rheumatic fever, characterized by involuntary, purposeless, and rapid movements, especially of the face and extremities. This neurological sign occurs later in the course of the disease and is a result of inflammation and vasculitis affecting the basal ganglia of the central nervous system. It is a defining feature of the illness. Choice D rationale Subcutaneous nodules are a major, though less common, manifestation of rheumatic fever. These small, firm, painless swellings usually appear over bony prominences, tendons, or joints, most often on the wrists, elbows, and ankles. They indicate a severe inflammatory process involving connective tissue, typically lasting a few weeks before resolving spontaneously without residual damage. Choice E rationale Abdominal pain is generally not a primary or characteristic feature of rheumatic fever. The major symptoms typically involve the joints (polyarthritis), heart (carditis), skin (erythema marginatum, nodules), and nervous system (chorea). While non-specific symptoms can occur, abdominal pain is more suggestive of other conditions, such as appendicitis or gastroenteritis. Choice F rationale Bradycardia, an abnormally slow heart rate, is not a typical finding in acute rheumatic fever. The inflammation of the heart muscle (carditis) and pericardium in ARF more commonly leads to tachycardia (fast heart rate) or, less often, rhythm disturbances, but not usually bradycardia. Tachycardia often disproportionate to the degree of fever is a classic sign of carditis.