Health Symptoms and Conditions Quiz

Nursing Management of Children with Rheumatic Fever

• Definition: Rheumatic fever is an inflammatory disease affecting connective tissues, mainly affecting joints and the heart, and less frequently the central nervous system, skin, and subcutaneous tissues.

Causes

• Group A β-hemolytic streptococcal (GABHS) upper respiratory tract infection (URI) is the primary cause.

Assessment Criteria (Jones' Criteria)

• Major Criteria:
  • Carditis (inflammation of the heart)
  • Polyarthritis (migratory joint inflammation)
  • Chorea (involuntary muscle movements)
  • Erythema marginatum (characteristic skin rash)
  • Subcutaneous nodules (small, painless lumps under the skin)
• Minor Criteria:
  • Fever (38-39°C)
  • Arthralgia (joint pain without inflammation)
  • Unexplained epistaxis (nosebleeds)
  • Abdominal pain
  • Weakness, fatigue, anorexia, pallor, and/or weight loss

Rheumatic Carditis

• The mitral and aortic heart valves are the most commonly affected valves.

Rheumatic Arthritis

• Migratory, affecting more than one joint during the first 1-2 weeks of the febrile period.
• Affected joints are swollen, red, hot, and painful.
• Large joints such as knees, hips, shoulders, wrists, and elbows are primarily affected.

Rheumatic Chorea (Sydenham's Chorea)

• Affects the central nervous system.
• Characterized by involuntary, sudden, irregular muscle movements.
• Anxiety can exacerbate these movements.
• Rest often relieves movements.

Subcutaneous Nodules

• Develop rarely in children with severe or repeated rheumatic fever.
• Generally small (0.5-1 cm), firm, and not tender.
• Often found over the extensor surfaces of joints (e.g., elbows, knees).

Erythema Marginatum

• Consists of undifferentiated macules (spots).

• Typically found on the trunk and inner aspects of extremities.

• Lesions are non-pruritic (not itchy).

• Diagnostic Procedures

• Requires two major criteria or one major and two minor criteria, along with evidence of a preceding GABHS infection.

• Laboratory tests:

  • Elevated antistreptolysin-O (ASO) titer (normal 200-400; above 400 is abnormal).
  • Elevated erythrocyte sedimentation rate (ESR).
  • C-reactive protein (CRP)
  • Electrocardiogram (ECG)
  • X-rays or radiographs.

Nursing Care Objectives

• Encourage compliance with drug regimens (e.g., antibiotics).
• Facilitate recovery from the illness.
• Provide emotional support.
• Prevent further disease development

Drug Regimens

• Encourage adherence to prescribed therapy.
• Consider monthly injections instead of daily oral antibiotics if compliance is poor.

Facilitating Recovery

• Educate the child and parents regarding the need for bed rest to minimize the inflammatory process impact, especially on the heart.
• If metabolic and cardiac demands are low, tissue damage may be minimal.

Managing Fever

• Encourage fluid intake to prevent dehydration.
• Avoid overhydration as it can overburden the heart.

Diet

• Initially, provide liquid or soft foods in small, frequent portions to minimize chewing effort.
• Gradually increase the diet to meet nutritional requirements.
• Avoid overfeeding to reduce heart load.

Pain Management

• Administer anti-inflammatory agents (e.g., aspirin) to alleviate pain from carditis or polyarthritis.
• Alternate warm and cold compresses on affected joints to reduce swelling and pain.

Preventing Injury (Chorea)

• Assist the child during walking.
• Provide the child with soft foods (finger foods, spoons, avoid knives).
• Raise bed rails to prevent falling.
• Consider restraining the child if necessary, but with padding for safety.

Emotional Support

• Explain the illness and treatment to both the child and parents.
• Encourage ways to carry out regular bed activities (quiet play) while in the hospital or at home.
• Allow the parents to continue normal routines wherever possible.
• Encourage contact from other children (classmates, siblings, peers).

Disease Prevention

• Remain alert to children who display symptoms of streptococcal sore throat.
• Upon diagnosis of streptococcal infection, administer antibiotics (single dose benzathine penicillin injection or daily oral penicillin or erythromycin for 10 days).
• Educate parents about the importance of completing the full course of antibiotics to eradicate the disease.
• Support the parents and advocate for the implementation of massive screening programs and throat cultures for early detection and treatment to prevent future cases.

Test your knowledge on various health symptoms and conditions. This quiz covers topics such as skin disorders, nodules, epistaxis, and appropriate bed activities. Challenge yourself to understand the classifications and characteristics of these medical terms.