Nursing Care Plan (NCP) for Rheumatic Fever

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Outline

Pathophysiology

When a strep throat infection is untreated or is not completely treated, it can result in an autoimmune condition called rheumatic fever. This autoimmune response causes inflammation in the body that attacks the joints, heart, skin and central nervous system. Risk factors that may increase the chance of developing rheumatic fever include a genetic predisposition, certain strains of Group A strep bacteria, and poor sanitation.

Etiology

Group A streptococcus bacteria causes strep throat infections and contains a protein that is similar to proteins found naturally in specific tissues in the joints, heart and skin. Following a strep infection, the immune system continues to target these proteins and begins to attack the healthy tissues of the body resulting in inflammation. Permanent damage to the body, especially to the heart and heart valves, may result without adequate treatment.

Desired Outcome

Patient will be free from infection; patient will be free from pain; patient will not have permanent tissue damage

Rheumatic Fever Nursing Care Plan

Subjective Data:

  • Painful or tender joints
  • Chest pain
  • Fatigue
  • Unusual behaviors or outbursts

Objective Data:

  • Fever
  • Red, swollen joints
  • Rash
  • Subcutaneous nodules
  • Heart murmur
  • Uncontrollable body movements (hands, feet, face)

Nursing Interventions and Rationales

  • Assess and monitor vital signs

 

Get a baseline to determine effectiveness of interventions. Fever is a primary symptom. Blood pressure and heart rate may be elevated from fever or from involvement of the heart.

 

  • Perform complete physical assessment

 

Provides baseline.  Note redness of the skin or rash, swelling of the joints, or presence of subcutaneous nodules.

 

  • Assess motor and neurologic function

 

Patients often have chorea (irregular movements may be noted in the face or extremities and may cause changes in speech)

 

  • Assess pain with appropriate pain scale and manage with non-pharmacological routes

 

FACES and FLACC scales may be used.

Joint pain is most common and may be relieved by applying cool compresses or heat, repositioning or relaxation techniques.

 

  • Monitor lab tests

 

Blood tests may be run, such as C-reactive protein or ESR to determine inflammation.

Monitor for presence of strep antibodies or cardiac enzymes as appropriate.

 

  • Obtain ECG and echocardiogram

 

These tests are used to determine amount of cardiac involvement of the disease. They can detect electrical or functional abnormalities such as faulty valves and help determine course of treatment.

 

  • Administer medications appropriately
    • Antibiotics
    • Anti-inflammatories
    • Anticonvulsants

 

  • Primary goal is to effectively treat the infection and reduce symptoms.
  • Antibiotics – given to treat remaining strep infection, may be given orally or IM.
  • Anti-inflammatories – given to relieve pain, treat fever and reduce inflammation.
  • Anticonvulsants- given to treat involuntary movements (chorea)

 

  • Provide patient and parent education regarding home care and prevention of future disease or complication

 

  • The best way to prevent rheumatic fever is to fully treat strep infections as they occur. Incomplete or no treatment can lead to rheumatic fever.
  • Patient will need routine follow up with cardiology as symptoms of valve damage may not fully appear until later in life.
  • Encourage good hygiene as studies have shown higher occurrence in areas of overcrowding and poor sanitation.

Writing a Nursing Care Plan (NCP) for Rheumatic Fever

A Nursing Care Plan (NCP) for Rheumatic Fever starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

Okay, let’s get into this nursing care plan for rheumatic fever. So rheumatic fever occurs when a strep throat infection is untreated or not completed. Uh, it can result in an autoimmune condition such as rheumatic fever that has an immune response that causes the inflammation in the body, in the text or joints, the heart, the skin, and the central nervous system. Some risk factors that may increase the chance of developing rheumatic fever include a genetic predisposition, certain strains of group A strep bacteria and poor sanitation. Some nursing considerations that we want to keep in mind are that we want to manage these people’s pain. These patients have a lot of pain, especially in the joints. We want to monitor their vital signs. There are a couple of labs that we want to draw. We want to get an EKG for cardiac involvement, and we want to administer any medications that are ordered. The desired outcome from this patient is that the patient is going to be free from infection. The patient’s going to be free from pain and the patient will not have any permanent tissue damage. 

So this patient with rheumatic fever comes in and they’re going to say, the first thing is pain. These patients have painful joints. The other subjective data that is going to present with the patient is chest pain. And that’s in the case of cardiac involvement and then also unusual behaviors or outbursts. Some things that we’re going to observe here is this patient can present with a fever, red, swollen joints, a rash, the subcutaneous nodules, a heart murmur, and also uncontrollable body movements. That’s going to include the hands, feet and face. So nursing considerations and interventions, we want to start by assessing and monitoring their vital signs because with a rheumatic fever, they are going to have a fever. That’s the primary symptom. They also are going to have increased BP and increased heart rate, and that’s going to come from the fever or if there’s any cardiac involvement. 

The next thing we want to do after assessing those vital signs is we want to do a head to toe complete physical assessment. This is going to give us our baseline. Be sure that you note on the patient and your documentation any redness or rash that may appear also noting any swelling of joints or presence of subcutaneous nodules. We’re going to look at their lab tests and the results, because we’re going to have to run blood such as C-reactive protein or ESR. This is going to determine inflammation. So we’re going to be on top of that as well. Any medications that we need to administer? So we are going to help with med management, okay. That’s going to include antibiotics, anti-inflammatories and anticonvulsants. The primary goal of this is to effectively treat the infection and reduce the symptoms. 

Finally, we are going to assess their motor and neurological function. Patients with this often have chorea, which is irregular movements. They may be noted in the face or extremities, and it may cause changes with speech. The reason why we want to assess this. And so that way we can stop it and keep the disease process from progressing. Now onto the key points, the pathophysiology behind a rheumatic fever; it’s strep throat infection that is not completely treated. It can result in this autoimmune condition, subjective data that the patient will provide us is they’re going to complain of painful or tender joints. They’re going to have some chest pain, and they may also complain of fatigue. Objective, we’re going to note fever, rash, and we may hear a heart murmur where we also take some of the things that we want to be mindful of is to know when there’s some inflammation, as we are going to draw the CRP and the ESR laboratory to determine inflammation and some home care and very important for this patient to make sure that they fully treat strep infections. They’re going to follow up with the cardiologists in the case of any cardiac involvement. They want to make sure that they have some good oral hygiene, because that is also somewhere, where the source of infection can lead to. We love you guys, and we want you to go out and be your best self today. As always, happy nursing.

 

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