rheumatic fever (rf), a systemic inflammatory disease that may develop as a delayed reaction to an inadequately treated infection of the upper respiratory tract by group A beta-hemolytic streptococci. The disease usually occurs in young school-age children and may affect the brain, heart, joints, skin, or subcutaneous tissues. Also called acute articular rheumatism. See also rheumatic heart disease. ▪ OBSERVATIONS: The onset of rheumatic fever is usually sudden, often occurring 1 to 5 symptom-free weeks after recovery from a sore throat or scarlet fever. Early symptoms generally include fever, joint pain, nosebleeds, abdominal pain, and vomiting. The major manifestations of this disease include migratory polyarthritis affecting numerous joints and carditis, which causes palpitations, chest pain, and, in severe cases, symptoms of cardiac failure. Sydenham’s chorea is usually the sole late sign of rheumatic fever and may initially be manifested as an increased awkwardness and tendency to drop objects. As the chorea progresses, irregular body movements may become extensive, occasionally involving the tongue and facial muscles, resulting in incapacitation. Other developments may include transient erythema marginatum with circular lesions and subcutaneous rheumatic nodules on various joints and tendons, the spine, and the back of the head. There is no specific diagnostic test for rheumatic fever. The development of serum antibodies to streptococcal antigens is a positive diagnostic sign. Affected individuals may also develop leukocytosis, moderate anemia, and proteinuria. C-reactive protein, evaluated in a specimen of blood, is abnormally high in concentration. Recurrences of rheumatic fever are common. Except for carditis, all the manifestations of the disease usually subside without any permanent effects. Mild cases may last 3 to 4 weeks. Severe cases with associated arthritis and carditis may last 2 to 3 months. ▪ INTERVENTIONS: Management of rheumatic fever includes bed rest and severe restriction of normal activity. Penicillin is often administered, even if throat cultures are negative, and steroids or salicylates may be used, depending on the severity of any associated carditis and arthritis. ▪ PATIENT CARE CONSIDERATIONS: Symptoms largely determine the type of nursing care. The nurse is alert to signs of toxicity associated with salicylate, steroid, and antibiotic therapies. The nurse also monitors the patient’s fluid status with regard to cardiac function, helps minimize joint pains by properly positioning the patient, and gives emotional support.
