Definition: Acute Rheumatic fever is an acute autoimmune collagen disease occurs as a hypersensitivity reaction to group.Abeta hemolytic streptococcal infection.

It is characterized by inflammatory lesions of connective tissue and endothelial tissue. Pathophysiology of the disease: The exact etiopathogenesis of ARF is not well understood.Preceding streptococcal infection may not always clinically manifest. It is considered as a sort of clinically manifest.There is an antigen-antibody reaction usuall following streptococcal sore throat. Antibody titer elevated in majority of the patients,although the streptococci have never been isolated from rheumatic lesions in joints,heart or in the blood stream. The autoantibodies attack the myocardium,pericardium and cardiac valves. Aschoffs bodies develop on the valves dysfunction.Severe myocarditis may result dilation of the heart heart failure. The antibodies may react with striated muscle, vascular smooth muscle and nervous tissue resulting joint inflammation .involuntary movements as chorea and lesions in blood vessels and other connective tissues. CLINICAL MANIFESTATIONS: 1.Carditis: It is an early manifestationsof rheumatic fever as pancarditis i.e, parcarditis, myocarditis and endocarditis. 2.Polyarthritis:It is usuall fitting or migratory type of joint inflammation with pain .decrease active movements, warm, tenderness redness and swelling. 3.Chorea: It is purposeless involuntary ,rapid movements, usually associated with muscle weakness, incoordination, involuntary facial grimace, speech disturbance. 4.Subcuutaneous nodules:It is found as firm painless nodule over the extension surface of certain joint,occiput and vertebral column. 5.Fever:Increase the body temperature is common findings.

6.Arthralgia DOAGNOSTIC EVALUATION: 1.The presence of two major or one minor criteria plus evidence of a preceding streptococcal infection is essential for labeling a case as rheumatic fever. 2.Doppler echocardiography is considered as an important diagnostic approach. 3.Artificial subcutaneous nodule test. 4.Chest X-rays. 5.Eletrocardiography. MANAGEMENT 1.Bedrestis important in the management of children with rheumatic fever.It is needed for at least 6-8 weeks till the rheumatic activity is disaooeared. 2.Nutrition diet to be provided with sufficient amount of protein,vitamins,Salt restriction is not necessary unless CCF is present. 3.Antibiotic therapy.penicillin is administered after skin test to eradicate streptococcal infection. 4.Aspirin is administered as suppressive therapy to control pain and inflammation of joints. 5.Steroid therapy is given as suppressive therapy along with aspirin. 6.Management of chorea can be done with diazepam. NURSING MANAGEMENT: Nursing assessment is vital for the care of the child with rheumatic fever.It should include special attention to vital signs, cardiac monitoring ,pain assessment. Nursing Intervention 1. Improving cardiac output bya) Providing rest as long rheumatic activity and heart failure persist. b) Organising nursing care with uninterrupted rest modifying activities. c) Maintaining normal body temperature by managing fever. d) Providing bland diet with adequate nutrition and fluid intake withsalt restriction in case of CCF. e) Administering medication as prescribed with necessary precautions.

2.Relieving pain bya) Administering anti-inflammatory analgesics as prescribed and assessing features asprin toxicity. b) Providing comfortable position and support to the inflamed joints. 3) Protecting the child from injury bya )Removing hard and sharp objects from the childs reach. b) Assisting the child in feeding ,ambulation and other fine motor activities and chanalization of the stress. c) Administration of drugs to control the chores. 4)Health teaching for maintenance of health and prevention of complications: a) Explaining the duration of treatment its importance and compliance ,activity restriction,follow-up.