|Pathology & Etiology: | | | |Rheumatic fever is an acute inflammatory disease of the heart potentially involving all layers of the heart. Resulting from scaring and deformity of the heart | |valves. (Lewis, 2011) | |Rheumatic fever may develop after an infection with Streptococcus bacteria (such as strep throat or scarlet fever). The disease can affect the heart, joints, skin,| |and brain. (National Center for Biotechnology Information, National Institute Health, 2012) | |Rheumatic fever is common worldwide and is responsible for many cases of damaged heart valves.
It is not common in the United States, and usually occurs in | |isolated outbreaks. The latest outbreak was in the 1980s. (National Center for Biotechnology Information, National Institute Health, 2012) | |Rheumatic fever mainly affects children ages 6 -15, and occurs approximately 20 days after strep throat or scarlet fever. (National Center for Biotechnology | |Information, National Institute Health, 2012) | |Case Study: | |A 25 year old rock-n-roll singer complains of a sore throat with swollen lymph nodes and fever.
She has also experienced nausea and vomiting. Her lifestyle | |consisted of heavy alcohol use and cigarette smoking. She was also under constant stress, sleep deprivation, and malnutrition. She is under the assumption that the| |symptoms are merely consequences of her rock and roll lifestyle. She took over-the-counter medication to ease the symptoms, including lozenges to soothe her throat| |and aspirin to reduce her fever. With such a busy concert schedule, she did not feel that the symptoms were serious enough to seek medical help.
| |Three weeks later, the woman complains of joint pain in her knees and ankles, with slight chest pain and shortness of breath. Again, the woman attributes the | |symptoms to her lifestyle and the energy she puts into performances, and does not seek medical attention. She further self medicates with an anti-inflammatory. | |A number of years later, the band attempted to put on a reunion concert. During the show, the patient collapsed on stage and was rushed to the hospital.
Her blood | |pressure was 102/64 mmHg and her EKG showed atrial fibrillation with a prolonged PR interval. Her chest X-ray indicated carditis (inflammation of the heart). The | |patient was coherent and complained of chest pain and shortness of breath. Upon observation, a whistle was heard between S2 and S1. Light rales were also heard | |during respiration. | | | |(National Center for Biotechnology Information, National Institute Health, 2012) | |Risk Factors: |Prognosis: | |Family history.
Some people may carry a gene or genes that make them more likely to |Rheumatic fever is likely to come back in people who don’t take low-dose | |develop rheumatic fever. |antibiotics continually, especially during the first 3 -5 years after the | |Type of strep bacteria. Certain strains of strep bacteria are more likely to |first episode of the disease. Heart complications may be severe, | |contribute to rheumatic fever than are other strains. |particularly if the heart valves are involved. | |Environmental factors.
A greater risk of rheumatic fever is associated with |(National Center for Biotechnology Information, National Institute Health, | |overcrowding, poor sanitation, and other conditions that may easily result in the |2012) | |rapid transmission or multiple exposures to strep bacteria. | | |(National Center for Biotechnology Information, National Institute Health, 2012) | | | | | |Diagnostic Tests: |S/S | |Because this disease has different forms, no one test can firmly diagnose it. Your |Abdominal pain | |doctor will perform a careful exam, which includes checking your heart sounds, skin, |Fever | |and joints.
|Heart (cardiac) problems, which may not have symptoms, or may result in | |Tests may include: |shortness of breath and chest pain | |Blood test for recurrent strep infection (such as an ASO test) |Joint pain, arthritis (mainly in the knees, elbows, ankles, and wrists) | |Complete blood count |Joint swelling; redness or warmth | |Electrocardiogram |Nosebleeds (epistaxis) | |(National Center for Biotechnology Information, National Institute Health, 2012) |Skin nodules | | |Skin rash (erythema marginatum) | | |
Skin eruption on the trunk and upper part of the arms or legs | | |Eruptions that look ring-shaped or snake-like | | |Sydenham chorea (emotional instability, muscle weakness and quick, | | |uncoordinated jerky movements that mainly affect the face, feet, and hands)| | |(National Center for Biotechnology Information, National Institute Health, | | |2012) | | | | |Surgery: N/A | | | | | | | | |Treatment(s): | | |
If you are diagnosed with acute rheumatic fever you will be treated with antibiotics. | | |(National Center for Biotechnology Information, National Institute Health, 2012) | | | |Nursing Implications: | | | | | |Health promotion | | |Acute intervention | | |Ambulatory and home care | | |Good nutrition | | |Hugienic practices | | |Adequate rest | | |(Lewis, 2011) | |Medications: | | |Anti-inflammatory medications such as aspirin or corticosteroids reduce inflammation | | |to help manage acute rheumatic fever.
| | |You may have to take low doses of antibiotics (such as penicillin, sulfadiazine, or | | |erythromycin) over the long term to prevent strep throat from returning | | |(National Center for Biotechnology Information, National Institute Health, 2012) | | (9 point s– 1 point / each area of this form with proper terminology) (1 point – Reference to all above areas – minimum of one scholarly article)
References: Lewis, S. L. (2011). Medical Surgical Nursing. St. Louis: Elsevier. National Center for Biotechnology Information, National Institute Health. (2012). Retrieved from http://ncbi. nlm. nhi. gov: http://www. ncbi. nlm. nih. gov/pubmedhealth/PMH0004388/.