Nursing Management of Children with Rheumatic Fever PDF

Nursing Management of children with Rheumatic Fever.R /Faten Fathi ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing Definition Rheumatic fever is an inflammatory disease of connective tissues involving mainly the joints and heart and less frequently central nervou...

Nursing Management of children with Rheumatic Fever.R /Faten Fathi ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing Definition Rheumatic fever is an inflammatory disease of connective tissues involving mainly the joints and heart and less frequently central nervous system, skin and subcutaneous tissues. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing  Causes A complication of group A β -hemolytic streptococcal upper respiratory tract infection (GABS). ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing  Assessment Criteria Jones’ criteria (W.H.O Recommendations) Major Criteria Minor Criteria.Carditis -.Fever (38 – 39 co) - - - Polyarthritis - Arthralgia (pain joint) (migratory) without arthritic changes. - Chorea - Unexplained epistaxis. - Erythema - Abdominal pain. marginatum. - Weakness, fatigue, - Subcutaneous anorexia pallor and weight nodules. loss. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing Rheumatic Carditis Mitral and aortic valves are the most affective valves ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing  Rheumatic Arthritis Migratory and affecting more than one joint. It occurs during the first 1 - 2 weeks of the febrile period and lasts for a few days in certain affected joint before moving to other joints. The affected joints will be swollen, red, hot and painful. It affects the large joints, such as, knees, hips, shoulders, wrists and elbows. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing  Rheumatic Chorea (Sydenham’s chorea, St. Vitus Dance) It affects the central nervous systems. Involuntary, sudden, irregular muscular movements of the extremities. Involuntary facial grimaces. Emotional instability. Speech disturbance. Severe muscle weakness. Anxiety can exaggerate muscle movements. Fine motor activity is relieved by rest. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing  Subcutaneous Nodules It occurs rarely, but occurs often in individuals who have severe Carditis or repeated acute rheumatic fever. Nodules are small (0.5 – 1cm) firm without any tenderness or attachment to skin. They can be palpated over the extensor surfaces of joints, knees, elbows, ankles or the scalp. They are resolved without treatment. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing Erythema Marginatum It is undifferentiated macules on the trunk.and inner aspect of the extremities The lesions are non-pruritic. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing  Diagnostic Procedures To diagnose Rheumatic Fever, it is necessary to have: According to Jones’ criteria: Two major criteria (evidence of preceding GABS). One major and 2 minor criteria and evidence of GABS. Elevated antistreptolysin – O (A. S. O) titer. (Normal value 200 – 400, if it is over 400 is considered abnormal). Elevated erythrocyte sedimentation rate. C – Reactive protein. Electrocardiograph. Radiographs. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing  Nursing Car The objectives of nursing care are: 1.Encourage compliance with drug regimens 2.Facilitate recovery from the illness 3.Provide emotional support 4.Prevent the disease ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing Encourage compliance with drug regimens Encourage compliance to therapeutic plan. When compliance is poor, monthly injections may be substituted for daily oral administration of antibiotics. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing  Facilitate recovery from the illness Assist the child and parents to understand the need for the amount of bed rest ordered by the physician. Bed rest is recommended to minimize the effect of inflammatory process on all body systems, especially the heart. If the metabolic needs oxygen consumption and expected cardiac response can be very low, the damage to the heart muscle and valve tissue may be restricted to what has already occurred. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing For fever: Encourage fluids intake to prevent dehydration but avoid over-hydration because hypervolemia places increased demands on heart. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing Diet: As soon as the child is willing to eat, a liquid or soft diet is given in small frequent amounts to minimize the effort of chewing. The diet is gradually increased to meet the child’s nutritional requirements. Overfeeding is to be avoided to decrease the heart load. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing For pain: Decrease pain from carditis or polyarthritis by administration of anti inflammatory agents, such as, aspirin.  Alternate warm and cold soaks to affected joints to reduce swelling and inflammation and reduce pain. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing  For Chorea: The nurse must prevent injury by:  Assisting him during walking.  Feeding him to prevent injury.  Raise bed rails to prevent falling out of bed.  Restraining the child to prevent falling from chair, padding on side of beds or chair.  Let finger foods, use of spoon, no knife or folk. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing  Provide Emotional Support: The nurse must:  Explain the disease and treatment to child and parents.  Find ways for bed activities, i.e., quiet play home and hospital.  Allow parents to carry normal routine at home.  Encourage classmates, siblings and peers to show their concern by card, letters, visits, ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing etc.  Prevent the Disease: The nurse must: Be alert for any child with signs and symptoms of streptococcal sore throat. After streptococcal infection has diagnosed, antibiotic should be given. A single dose of benzathine penicillin injection is the most reliable form of therapy. Oral penicillin or erythromycin may be given daily for 10 days. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing  Educate parents about the importance of giving the antibiotics for 10 days and support them to eradicate the disease.  Massive screening program with throat cultures can eradicate the disease by early detection of cases and prompt treatment. ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing ‫ – كلية الشمال للتمريض األهلية‬North private college of Nursing