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Cardiovascular system

Fever vs. disease.

Rheumatic fever
follows a group A
beta-hemolytic
streptococcal
infection. Rheumatic
heart disease refers
to the cardiac
manifestations of
rheumatic fever.

Rheumatic fever and

rheumatic heart disease
Commonly recurrent, acute rheumatic fever is
a systemic inflammatory disease of childhood
that follows a group A beta-hemolytic
streptococcal infection. Rheumatic heart
disease refers to the cardiac manifestations
of rheumatic fever and includes pancarditis
(myocarditis, pericarditis, and endocarditis)
during the early acute phase and chronic valvular disease later.
Long-term antibiotic therapy can minimize recurrence of rheumatic fever, reducing
the risk of permanent cardiac damage and
eventual valvular deformity. However, severe
pancarditis occasionally produces fatal heart
failure during the acute phase. Of the clients
who survive this complication, about 20% die
within 10 years.
This disease strikes most often during
cool, damp weather in the winter and early
spring. In the United States, its most common
in the northern states.

CAUSES
Hypersensitivity reaction to a group A
beta-hemolytic streptococcal infection

ASSESSMENT FINDINGS
Carditis
Temperature of 100.4 F (38 C) or greater
Migratory joint pain or polyarthritis
Skin lesions such as erythema marginatum
(in only 5% of clients)
Transient chorea (can develop up to
6 months after the original streptococcal
infection)

DIAGNOSTIC TEST RESULTS

Blood tests show elevated WBC count
and ESR as well as slight anemia during
inflammation.
Cardiac catheterization evaluates valvular
damage and left ventricular function in severe
cardiac dysfunction.
Cardiac enzyme levels may be increased in
severe carditis.
Chest X-rays show normal heart size
(except with myocarditis, heart failure, or
pericardial effusion).

313419NCLEX-RN_Chap03.indd 60

C-reactive protein is positive (especially

during the acute phase).
Echocardiography helps evaluate valvular damage, chamber size, and ventricular
function.
ECG shows prolonged PR interval in 20%
of clients.

NURSING DIAGNOSES
Activity intolerance
Decreased cardiac output
Risk for infection

TREATMENT
Bed rest (in severe cases)
Surgery: corrective valvular surgery (in
cases of persistent heart failure)

Drug therapy
Antibiotics: erythromycin (Erythrocin),
penicillin (Pfizerpen)
NSAIDs: aspirin, indomethacin (Indocin)

INTERVENTIONS AND RATIONALES

Before giving penicillin, ask the client if
hes ever had a hypersensitivity reaction to
it. Even if the client has never had a reaction to penicillin, warn that such a reaction is
possible to adequately inform the client about
possible treatment complications.
Tell the client to stop taking the drug and
to immediately report the development of a
rash, fever, chills, or other signs of allergy at
any time during penicillin therapy to prevent
anaphylaxis.
Instruct the client to watch for and report
early signs of heart failure, such as dyspnea
and a hacking, nonproductive cough, to prevent further cardiac decompensation.
Stress the need for bed rest during the
acute phase and suggest appropriate, physically undemanding diversions. These measures
decrease oxygen demands of the heart.
After the acute phase, encourage family
and friends to spend as much time as possible
with the client to minimize boredom.
If the client has severe carditis, help him
prepare for permanent changes in his lifestyle
to promote positive coping strategies.
Warn the client to watch for and immediately report signs of recurrent streptococcal
infection sudden sore throat, diffuse throat

4/8/2010 7:01:51 PM