MARKING KEY- RHEUMATIC FEVER

A .Define Rheumatic fever (5%)

RF is an inflammatory disease that occurs after infection with group A- beta-haemolytic

streptococcal pharyngitis involving the joint, skin, brain, serons surfaces and the heart.

B. Explain five (5) Major manifestatious of RF (20%) (4% for each of the five).

i. Polyarthritis
 Caused by oedema, infection and effusion in joint tissue.
 It is reversible and migratory favouring large joints – knees, elbows, hips,
shoulders and wrists.
 The affected joint is swollen, hot, red and painful.
ii. Erythema marginatum.
 It is a distinct erythematous macule with a clear centre and wavy, well-
demarcated boarder.
 Often found on the trunk and non-pruritic.
iii. Subcutaneous Nodules
 Non tender swelling over bony prominences.
 May persist for sometime then gradually resolve
 They are rare
iv. Chorea (St. Vitus Dance, Sydenham Chorea)
 Sudden aimless irregular movement of extremities
 Involuntary facial grievances.
 Speech disturbances.
 Muscle weakness
 Muscle movement exaggerated by anxiety.

C. Discus the management until discharge (50%)

Medical treatment (15%)

- History (1%)
- Physical Examination (2%)
- Investigations (2%)
o Throat swab to isolate the GABHS.
o ECG- Abnormal waves.
o ESR- elevated- Non Specific
o Chest xray – cardiomegaly.
o Rapid streptococcal antigen test – elevated

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- Drugs. (10%)
o Benzylpenicillin 50,000 iu/kg qidX10 days IV. or Penicillin V 50mg/kg QID X 10
[Link] if allergic
o Erythromycin 20-40mg 1kg qid X 10 days.
o Prednisolone5mg X 5 days for anti-inflammation
o Brufen 250mg tid X 5 days for fever and pain.

Nursing care (35%)

- Objectives (2%) for any two

o Encourage compliance with drug regimen.
o Facilitate recovery from illness
o Provide emotional support.
o Prevent recurrence of the disease.

- Environment3%
o Nurse in well ventilated warm room foe adequate oxygenation and to
promote comfort.
o The rooms should be quite to ensure rest of Natasha.
o Provide comfortable well-made bed to ensure rest and comfort.

- Bed rest. 2%
o Natasha will be on bed rest for all her days that she will be in the ward to
ensure adequate rest of the heart and to prevent further damage to the
heart.
o Activity adds strain to the heart. She can resume duties and school after
steroid therapy.

- Relief of pain. 3%
o Good positioning can help in joint pain.
o Semi- fowlers’ position promotes comfortable.
o Cotton wool bandages could be applied on the painful joints to relieve pain.
o Bedcradle be used to lift the weight to beddings.

- Observations 5%
o Vital signs observations. Temperature to monitor fever and tepid sponge
accordingly. Pulse rate to monitor for tachycardia and if too high then inform
the medical officer.
o Sleeping pulse tends to be very high in rheumatic fever.
o Watch for dehydration due to sweating and encourage fluids.
o Watch for eating habits and encourage her to eat.

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 o Give drugs as ordered and watch for effects and side effects.
- Drug administration. 4%
o Give the antibiotic as ordered to eradicate the invading infection.
o Watch for effect and side effects and report accordingly.
o Give antipyretics, steroids as ordered.
o Administer intravenous fluids as ordered and care of intravenous line be
done as well as recording on the fluid balance chart.

- Psychological care. 4%
o Explain the disease process to Natasha and the parents for them to have a
clear picture of the illness and to allay her anxiety.
o Explain the presence of strange features of the disease and how they come
about.
o Answer any queries or refer accordingly.
o Explain the importance of rest to reduce hearts workload.

- Nutrition. 4%
o High protein, high carbohydrates and vitamin c diet for tissue repair,
protection against further infection and for energy.
o Encourage Natasha to take a lot of nutritious fluids to replace the lost
through sweat.
o If the heart is involved, she should take low sodium diet.

- Elimination 2%
o Encourage normal elimination by giving enough fluids as constipation may
cause strain on the heart.

- Exercises. 2%
o Range of motion exercises are done to prevent contractures.
o These are done during bed bath in order to allow enough time to rest
thereafter.

- Hygiene. 3%
o Bed bath in acute stage for body’sintegrity and to allow rest of heart.
o Thereafter, big bath can be done.
o Mouth care because fever affects mouth.
o Nail care and hair care for self esteem and protect against injury and
infection of lice respectively.

- Health education. 3%

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 o Explain disease process to the family and the patient.
o Emphasis on the importance of rest or about 6 weeks until ESR is normal.
o Explain the action of drugs being taken.
o To prevent or protect against throat infection by avoiding dusty and
overcrowded places.

D. I. E. C. On prevention of complications (25%)

i. Throat infection antibiotic therapy. 5%

 Aggressive treatment of throat infection is very important because persistent throat
infection can lead to further attacks of rheumatic fever causing further damage to
the [Link] infection should be prevented too.

ii. Prophylaxis against beta haemolyticstreptococcal infection. 5%

 This is achieved by monthly injection of Benzathine penicillin. The parents should be
informed on the importance.

iii. Dental care. 5%

 Educate on the importance of dental care as these can lead to rheumatic fever with
severe cardiac involvement.

iv. Importance of bed rest. 5%

 Rest preserves the rest of the heart because it reduces on its workload. LET Natasha
and the family understand the importance of rest until she is told she can resume
her normal activities.

v. Compliance with treatment regimen 5%

 Monthly injections.