This document provides an overview of rheumatic fever, including its causes, risk factors, manifestations, diagnosis, treatment, and nursing management. Rheumatic fever is an inflammatory disease that occurs after a streptococcal throat infection, usually within 2-6 weeks. It commonly affects the heart, joints, skin, and brain in children ages 5-15. The main risk is permanent heart damage known as rheumatic heart disease. Treatment involves antibiotics to eliminate strep bacteria, anti-inflammatory drugs, and long-term preventative antibiotics to reduce the risk of recurrence. Nursing care focuses on treatment compliance, recovery support, education, and prevention.

1. RHEUMATIC FEVER
Prepared by
Raveen Ismael Abdullah
B.CS.in Nursing
Hawler medical university
Supervised by :
Dr.Shokir Saleem.I
College of nursing
2016-2017

2. Outline
• Rheumatic fever definition
• Causes
• Risk factors and complications
• major and minor manifestations
• RF Diagnosis and differential diagnosis
• Medical and nursing Management

3. Objectives
By end of seminar audiences will be able to :
• Identify the child with RF symptoms
• Understand the steps of medical management
for treating cases with rheumatic fever .

5. Introduction
• Rheumatic fever (RF) is a poorly understood
inflammatory disease that occurs after infection
with group A β-hemolytic streptococcal(GABHS)
pharyngitis.
• Rheumatic fever is most common in 5- to 15-
year-old children, though it can develop in
younger children and adults.

6. • It is a self-limited illness that involves the joints,
skin, brain, serous surfaces, and heart.
• Cardiac valve damage (referred to as rheumatic
heart disease) is the most significant
complication of RF.
• The mitral valve is most often affected.
Introduction Cont

7. causes
• Strong evidence supports a relationship
between upper respiratory tract infection with
GABHS and subsequent development of
RF(usually within 2–6 weeks).

8. Risk factors
• Family history. Some people carry a gene or genes that
might make them more likely to develop rheumatic
fever.
• Type of strep bacteria. Certain strains of strep bacteria
are more likely to contribute to rheumatic fever than
are other strains.
• Environmental factors. A greater risk of rheumatic
fever is associated with overcrowding, poor sanitation
and other conditions that can easily result in the rapid
transmission or multiple exposures to strep bacteria

9. Complications
• Rheumatic heart disease is permanent damage to
the heart caused by rheumatic fever.
• It usually occurs 10 to 20 years after the original
illness.
• Problems are most common with the valve
between the two left chambers of the heart
(mitral valve), but the other valves can be
affected.

10. Complications
The damage can result in:
• Valve stenosis. This narrowing of the valve decreases
blood flow.
• Valve regurgitation. This leak in the valve allows blood
to flow in the wrong direction.
• Damage to heart muscle. The inflammation associated
with rheumatic fever can weaken the heart muscle,
affecting its ability to pump.

13. Major manifestations
Carditis
• Tachycardia out of proportion to degree of fever
• Cardiomegaly
• New murmurs or change in preexisting murmurs
• Muffled heart sounds
• Chest pain
• Changes in ECG (especially prolonged PR interval)

14. Polyarthritis
• Swollen, hot, red, painful joint(s)
• After 1 to 2 days, different joint(s) affected
• Favors large joints—knees, elbows, hips, shoulders,
wrists
Erythema Marginatum
• Erythematous macules with clear center and wavy,
well-demarcated border
• Transitory
• Nonpruritic
• Primarily affects trunk and extremities (inner surfaces)
Major manifestations

15. Erythema Marginatum

16. Chorea (St. Vitus Dance, Sydenham Chorea)
• Sudden aimless, irregular movements of
extremities
• Involuntary facial grimaces
• Speech disturbances
• Emotional lability
• Muscle weakness (can be profound)
• Muscle movements exaggerated by anxiety and
attempts at fine motor activity;
• relieved by rest
Major manifestations

17. Chorea

18. Subcutaneous Nodes
• Non tender swelling
• Located over bony prominences
• May persist for some time and then gradually
resolve
Major manifestations

19. Minor Manifestations
Clinical Findings
• Arthralgia
• Fever
Laboratory Findings
Elevated acute-phase reactants
• ESR
• CRP
• Prolonged PR interval
Supporting Evidence of Antecedent Group A Streptococcal Infection
• Positive throat culture or rapid streptococcal antigen test result
• Elevated or rising streptococcal antibody titer

21. Diagnosis
Laboratory Studies
• No single specific laboratory test can confirm the
diagnosis of acute rheumatic fever (ARF).
Throat culture
• Throat culture remains the criterion standard for
confirmation of group A streptococcal infection.
Blood cultures
• Blood cultures are obtained to help rule out
infective endocarditis, bacteremia, and
disseminated gonococcal infection.

22. Diagnosis
Antibody titer tests
• The antibody titer is a test that detects the presence
and measures the amount of antibodies within a
person’s blood.
• The amount and diversity of antibodies correlates to
the strength of the body’s immune response.
Acute-phase reactants, erythrocyte sedimentation rate,
and C-reactive protein
• These tests are nonspecific, but they may be useful in
monitoring disease activity.

23. Imaging Studies
Chest radiography
• Chest radiography can reveal cardiomegaly and CHF in patients with
carditis.
Echocardiography
• Echocardiography may demonstrate valvular regurgitant lesions in
patients with ARF who do not have clinical manifestations of
carditisin rheumatic heart disease.
• In patients with chronic rheumatic heart disease,
electrocardiography may show left atrial enlargement secondary to
mitral stenosis.
Other common tests
• rheumatoid factor, antinuclear antibody (ANA), Lyme serology, blood
cultures, and evaluation for gonorrhea.
Diagnosis

24. Differential Diagnoses
• Gonococcal Arthritis
• Juvenile Idiopathic Arthritis
• Lyme Disease
• Mixed Connective-Tissue Disease
• Physical Medicine and Rehabilitation for Systemic
Lupus Erythematosus
• Reactive Arthritis
• Rheumatoid Arthritis
• Septic Arthritis
• Sickle Cell Anemia

25. goals of medical management
(1) eradication of hemolytic streptococci.
(2) prevention of permanent cardiac damage.
(3) palliation of the other symptoms.
(4) prevention of recurrences of RF.
• Penicillin is the drug of choice or an alternative in penicillin-
sensitive children Salicylates are used to control the
inflammatory process, especially in the joints, and reduce
the fever and discomfort.
• Bed rest is recommended during the acute febrile phase
but need not be strict.

26. Treatments
Treatments include:
Antibiotics. penicillin or another antibiotic to
eliminate remaining strep bacteria.
Anti-inflammatory treatment.
•pain reliever, such as aspirin or naproxen (Naprosyn),
to reduceinflammation, fever and pain.
•If symptoms are severe or child isn't responding to the
anti-inflammatory drugs, doctor might prescribe a
corticosteroid.

27. Anticonvulsant medications.
For severe involuntary movements caused by Sydenham
chorea such as: valproic acid (Depakene) or
carbamazepine (Carbatrol, Tegretol, others).
Prophylactic treatment
against recurrence of RF (secondary prevention) is
started after the acute therapy and involves monthly
intramuscular injections of benzathine penicillin G (1.2
million units), two daily oral doses of penicillin
(200,000 units), or one daily dose of sulfadiazine (1 g)
Treatments

28. • In RF with carditis, prophylaxis is recommended
for 5 years or until age 21 years.
• In the setting of carditis,prophylaxis is
recommended for 10 years or until 21 years old.
• In the setting of RF with carditis and residual
heart disease, prophylaxis can continue until
the age of 40 years
Treatments

29. The objectives of nursing care for the
child with RF
(1) Encourage compliance with drug regimens.
(2) facilitate recovery from the illness.
(3) provide emotional support.
(4) prevent the disease.

30. Nursing goals during treatment
sessions
Treatment of endocarditis requires long-term parenteral drug therapy.
(1) preparation of the child for IV infusion, usually with an intermittent
infusion device and several veni punctures for blood cultures.
(2) observation for side effects of antibiotics, especially inflammation
along veni puncture sites.
(3) observation for complications, including embolism and HF.
(4) education regarding the importance of follow-up visits for cardiac
evaluation, echocardiographic monitoring,and blood cultures.

31. • 1. Rheumatic Fever: Background,
Pathophysiology, Epidemiology. 2017 Jun 29
[cited 2017 Jul 4]; Available from:
http://emedicine.medscape.com/article/2365
82-overview