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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.

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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 by-a) 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.

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2.Relieving pain by-

a) 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 by-

a )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.