Rheumatic Fever Overview

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Questions and Answers

What is a primary consequence of left-sided heart failure that can lead to right-sided heart failure?

High levels of oxygen in the blood

Thickening of the heart muscle

Increased blood flow to the kidneys

Diminished ejection fraction resulting in fluid accumulation in the lungs (correct)

Which of the following conditions is NOT a known cause of heart failure?

Diabetes

Regular exercise (correct)

High blood pressure

Coronary artery disease

Which nursing intervention is recommended to prevent atelectasis in patients with heart failure?

Restrict fluid intake significantly

Provide high-calorie meals at once

Administer diuretics at bedtime

Encourage deep-breathing exercises every 1 to 2 hours (correct)

Which symptom would you expect to see in a patient with advancing left-sided heart failure?

Cool temperature of the skin Signup and view all the answers

What should be done to monitor fluid retention in a patient with heart failure?

Document daily weight changes Signup and view all the answers

In which scenario would it be appropriate to administer oxygen to a heart failure patient?

When respiratory distress is noted or oxygen saturation is low Signup and view all the answers

Why is it best to administer diuretics early in the morning for heart failure patients?

To prevent sleep disturbances caused by nighttime diuresis Signup and view all the answers

Which of the following heart rhythms is particularly concerning for heart failure patients?

Atrial fibrillation Signup and view all the answers

Which of the following is NOT a symptom of left-sided heart failure?

Pitting edema of ankles Signup and view all the answers

What is an important aspect of chronic management for a patient with rheumatic heart disease?

Educating the patient about the disease process and potential complications Signup and view all the answers

What is considered a psychological and emotional aspect of care in managing acute rheumatic heart disease?

Addressing the patient's emotional distress and anxiety Signup and view all the answers

Which of the following is a common consequence of right-sided heart failure?

Nocturia due to diuresis while supine Signup and view all the answers

How does heart failure primarily affect the function of the left ventricle?

Alters the size, shape, and function impacting its ability to pump oxygenated blood Signup and view all the answers

Which layers of the heart can be involved in rheumatic fever?

All layers including endocardium, myocardium, and pericardium Signup and view all the answers

In cases of rheumatic heart disease, which type of medical attention should a patient seek?

If symptoms of excessive fatigue or dyspnea on exertion appear Signup and view all the answers

What symptom is specifically associated with the progression of left-sided heart failure?

Cough that typically occurs at night Signup and view all the answers

What is the most common age range for acute rheumatic fever to occur?

5 to 15 years Signup and view all the answers

Which of the following valves is most commonly affected by rheumatic fever?

Mitral and aortic valves Signup and view all the answers

What is a potential complication of untreated rheumatic fever in patients?

Development of valvular heart disease Signup and view all the answers

Which symptom is NOT commonly associated with rheumatic fever?

Constant high fever above 104°F Signup and view all the answers

Which of the following is a predisposing factor for developing rheumatic fever?

Inadequate treatment of streptococcal sore throats Signup and view all the answers

How is rheumatic fever generally diagnosed?

Through one major and two minor criteria or two major and one minor criteria Signup and view all the answers

What is a non-cardiac symptom of rheumatic fever?

Muscle aches Signup and view all the answers

Which connective tissue conditions can be involved in rheumatic fever?

Polyarthritis and skin subcutaneous nodules Signup and view all the answers

What is the primary cause of polyarthritis as a symptom?

Beta-hemolytic streptococcal infection Signup and view all the answers

Which diagnostic measure is most likely elevated in a patient with rheumatic fever?

Erythrocyte sedimentation rate Signup and view all the answers

Which of the following is NOT a typical manifestation of chorea?

Acute pain in joints Signup and view all the answers

What are subcutaneous nodules primarily associated with in rheumatic fever?

Heart valve damage Signup and view all the answers

Which of the following is considered primary prevention for rheumatic fever?

Immediate treatment of streptococcal pharyngitis Signup and view all the answers

What is a likely complication resulting from acute rheumatic fever?

Chronic rheumatic heart disease Signup and view all the answers

Which medication is primarily used to treat residual beta-hemolytic streptococcal infections in rheumatic fever?

Benzathine penicillin Signup and view all the answers

What symptom is characteristic of erythema marginatum?

Recurring pinkish-red rash Signup and view all the answers

Study Notes

Rheumatic Fever

Inflammatory disease of the heart affecting all layers (endocardium, myocardium, and pericardium)
Leads to rheumatic heart disease, a chronic condition characterized by scarring and deformity of heart valves
Most common in childhood, between 5 and 15 years old
Triggered by group A beta-hemolytic streptococcal infection of the pharynx

Predisposing Factors

Socioeconomic factors
Familial history
Overcrowding
Untreated or inadequately treated streptococcal sore throats
Poor nutrition and general health decline

Cardiac Involvement

Affects all layers of the heart
Valves can become necrotic and insufficient
Mitral and aortic valves are most commonly affected
Tricuspid valve less commonly involved, and pulmonic valve rarely

Extracardiac Involvement

Systemic lesions, especially affecting connective tissue
Joints: Polyarthritis (migratory, affecting large joints, causing pain, redness, swelling, and warmth)
Skin: Subcutaneous nodules (small, hard, painless swellings, mainly over body prominences)
Central Nervous System: Chorea (disorder characterized by weakness, ataxia, incoordination, and involuntary movements)
Lungs: Fibrinous pleurisy and rheumatic pneumonitis

Clinical Manifestation

Common symptoms: swollen, tender, and red joints (especially large joints like knees, ankles, elbows); chest pain; abnormal heartbeat; fatigue; fever; flat, red rash with a jagged edge; unexplained headaches; involuntary movements in hands, feet, or other body parts; muscle aches; small bumps under the skin; swollen, red tonsils
Diagnosis based on two major and one minor criteria, or one major and two minor criteria
Erythema marginatum: pinkish-red recurring rash starting on the trunk, spreading to other areas
Subcutaneous nodules: small, hard, painless swellings, mostly over body prominences

Diagnostic Measures

Antistreptolysin-O titer (ASLO titer) > 250 IU/ml
Erythrocyte sedimentation rate: elevated (15mm/1hr or 50mm/2hr)
C-reactive protein: positive
Throat culture: may be positive for streptococcal, but often negative
White blood cell count: elevated

Complications of Rheumatic Fever

Chronic rheumatic heart disease: long-term consequence of acute rheumatic fever
Valvular structural changes: can occur months to years after an acute episode

Medical and Pharmacological Management

Diagnosis through: history and physical examination, ASLO titer, throat culture, erythrocyte sedimentation rate, C-reactive protein, white blood cell count, chest X-ray, echocardiography
Medical management: bed rest, penicillin (benzathine penicillin 1.2 million units or procaine penicillin 600,000 units IM daily for 10 days) to treat residual streptococcal infection, aspirin for inflammation, corticosteroids if aspirin is ineffective
Nursing management: health promotion and maintenance (primary prevention: early detection and treatment of group A beta-hemolytic streptococcal pharyngitis; secondary prevention: prophylactic antibiotics to prevent recurrence, lifelong treatment for those with rheumatic carditis, monthly injections of benzathine penicillin G); acute intervention (optimal rest, pain management, joint positioning, heat application, psychological support); chronic management (patient education about the disease process, possible sequel, need for prophylactic antibiotics, potential for valvular heart disease, seeking medical attention for symptoms like fatigue, dizziness, palpitations, or dyspnea)

Heart Failure

Clinical syndrome resulting from progressive alterations in ventricular size, shape, and function, impacting the heart's ability to fill and pump enough oxygenated blood to meet the body's metabolic demands.

Left-Sided Heart Failure

Affects left ventricle's filling and pumping function
Congestion mainly in the lungs, due to blood backing up into pulmonary veins and capillaries
Symptoms include: shortness of breath, dyspnea on exertion, tachypnea, orthopnea, cyanosis, pulmonary edema, hemoptysis; dry or unproductive cough, especially at night; fatigability (from low cardiac output), nocturia, insomnia, dyspnea; tachycardia.

Right-Sided Heart Failure

Affects right ventricle's pumping function
Signs and symptoms related to elevated pressures and congestion in systemic veins and capillaries
Symptoms include: edema of ankles, unexplained weight gain, liver congestion (upper abdominal pain), distended jugular veins, increased central venous pressure (CVP), pulmonary hypertension, abnormal fluid in body cavities (pleural space, abdominal cavity), splenomegaly, anorexia and nausea, nocturia, weakness.

Relationship between Left and Right-Sided Heart Failure

Left-sided heart failure can lead to right-sided heart failure.
Reduced ejection fraction in the left ventricle causes fluid backup into the lungs.
This puts extra stress on the right side of the heart, eventually leading to right-sided heart failure.

Causes of Heart Failure

Often occurs after another condition weakens the heart.
Common causes include: coronary artery disease and heart attack, high blood pressure, faulty heart valves, heart muscle damage, myocarditis, congenital heart defects, arrhythmias, diabetes, HIV, thyroid disorders.

Management of Heart Failure

Nursing interventions: promote physical and emotional rest to reduce the workload of the heart; monitor for progression of left-sided heart failure; frequent blood pressure readings; auscultate heart sounds and monitor cardiac rhythm; assess for reduced peripheral tissue perfusion (cool skin, facial pallor, poor capillary refill); administer medications as directed; auscultate lungs for crackles and wheezes; reposition the patient every 2 hours; encourage deep breathing exercises to prevent atelectasis; frequent small meals; administer oxygen; diuretics early in the morning to avoid nighttime diuresis; record input and output; weigh patient daily.

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Description

Explore the complexities of rheumatic fever, an inflammatory heart disease primarily affecting children aged 5 to 15. This quiz covers its causes, symptoms, and the potential chronic consequences, including rheumatic heart disease. Understand the connection between streptococcal infections and this serious condition.