Nursing Paper Example on Rheumatic Fever

Rheumatic fever is an inflammatory disease that can develop as a complication of inadequately treated strep throat or scarlet fever, caused by the group A Streptococcus bacteria. It primarily affects children between the ages of 5 and 15 but can occur in people of any age. The disease can lead to long-term complications, particularly heart valve damage, making early diagnosis and treatment critical. While less common today due to improved living conditions and antibiotics, rheumatic fever still poses a serious health threat in many parts of the world, particularly in low-income regions.

Nursing Paper Example on Rheumatic Fever

Causes

Rheumatic fever occurs as a result of an abnormal immune response to a throat infection with group A Streptococcus bacteria. After the initial infection, the body’s immune system mistakenly attacks its own tissues, including the heart, joints, skin, and brain. The exact reason why this happens is not fully understood, but it is believed that some individuals have a genetic predisposition that makes them more susceptible to developing rheumatic fever after a strep throat infection.

(Nursing Paper Example on Rheumatic Fever )

Signs and Symptoms

The symptoms of rheumatic fever usually appear 2 to 4 weeks after the initial strep throat infection. These symptoms can vary widely and may affect multiple parts of the body, including:

Fever: A high fever is common and may persist throughout the acute phase of the disease.
Joint Pain (Polyarthritis): Swollen, red, and painful joints, particularly the knees, ankles, elbows, and wrists. The pain often migrates from one joint to another.
Carditis: Inflammation of the heart is one of the most serious complications, leading to rheumatic heart disease. Symptoms include chest pain, shortness of breath, and palpitations.
Chorea (Sydenham’s chorea): Involuntary movements, especially in the hands, feet, and face, resulting from the inflammation of the nervous system.
Erythema Marginatum: A rash with pink rings, usually on the trunk or upper parts of the arms and legs.
Subcutaneous Nodules: Painless, firm lumps under the skin, typically located over bony prominences such as the elbows or knees.
Fatigue: General weakness and tiredness are common, especially in those with severe carditis.

Etiology

Rheumatic fever is the result of an autoimmune response triggered by a group A Streptococcus infection, most commonly strep throat or, less often, scarlet fever. Not everyone who contracts strep throat will develop rheumatic fever. Factors that increase the risk include:

Genetic Susceptibility: Certain genetic markers are believed to increase the likelihood of developing rheumatic fever after a strep infection.
Poor Treatment of Strep Throat: Individuals who do not receive timely or adequate antibiotic treatment for strep throat are at higher risk of developing rheumatic fever.
Age: Rheumatic fever is most common in children aged 5 to 15 years.
Environmental Factors: Overcrowded living conditions, poor hygiene, and limited access to healthcare increase the risk of strep infections and rheumatic fever.

(Nursing Paper Example on Rheumatic Fever )

Pathophysiology

Rheumatic fever occurs when the immune system, following a group A Streptococcus infection, cross-reacts with host tissues, particularly the heart, joints, and brain. This immune response involves molecular mimicry, where the antibodies directed against the bacterial M protein also bind to the body’s tissues, leading to inflammation.

The heart is the most commonly affected organ, with the inflammation often leading to pancarditis (inflammation of all layers of the heart). Chronic inflammation in the heart can lead to rheumatic heart disease (RHD), characterized by permanent damage to the heart valves, particularly the mitral valve. The damage can cause mitral valve stenosis or regurgitation, impairing blood flow and leading to long-term cardiac complications.

In the joints, the immune response results in the accumulation of inflammatory cells, leading to pain and swelling. The inflammation is generally transient and does not cause permanent joint damage, although it can be extremely painful.

Sydenham’s chorea, which affects the nervous system, occurs when inflammation affects the basal ganglia, a part of the brain responsible for coordinating movement. The condition can result in uncontrolled, jerky movements, which can persist for months.

Diagnosis

The diagnosis of rheumatic fever is based on a combination of clinical findings and laboratory tests, with the Jones Criteria being widely used. To meet the criteria, the patient must have evidence of a recent strep infection and fulfill either two major or one major and two minor criteria.

Major Criteria:

Carditis
Polyarthritis
Chorea
Erythema marginatum
Subcutaneous nodules

Minor Criteria:

Fever
Arthralgia (joint pain)
Elevated acute phase reactants (ESR, CRP)
Prolonged PR interval on ECG

Additional diagnostic tools include:

Throat Swab Culture: To confirm the presence of group A Streptococcus.
Antistreptolysin O (ASO) Titer: Elevated ASO levels indicate a recent streptococcal infection.
Echocardiogram: To assess heart valve damage or inflammation.

(Nursing Paper Example on Rheumatic Fever )

Treatment Regimens

The treatment of rheumatic fever focuses on eradicating the strep infection, controlling inflammation, and preventing long-term complications, particularly rheumatic heart disease.

Antibiotics: Penicillin is the first-line treatment to eliminate the streptococcal bacteria. Long-term antibiotic prophylaxis may be necessary to prevent recurrent infections. Monthly penicillin injections are often recommended for several years after an initial attack.
Anti-inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, are used to reduce joint pain and inflammation. In severe cases, corticosteroids may be prescribed to reduce inflammation in the heart.
Bed Rest: In severe cases, particularly those with carditis, bed rest may be necessary to reduce the strain on the heart.
Chorea Management: Medications like anticonvulsants or benzodiazepines may be used to manage the involuntary movements associated with Sydenham’s chorea.
Valve Surgery: For those who develop significant heart valve damage, surgical intervention such as valve repair or replacement may be necessary.

Prevention

The most effective way to prevent rheumatic fever is to promptly treat group A streptococcal infections with appropriate antibiotics, particularly in children who are most at risk. Additional preventive measures include:

Throat Cultures: Ensuring accurate diagnosis of strep throat with a throat culture to guide treatment.
Antibiotic Prophylaxis: Patients who have had rheumatic fever may require long-term antibiotic prophylaxis to prevent recurrence, especially if they develop rheumatic heart disease.
Improving Living Conditions: Reducing overcrowding and improving access to healthcare in high-risk areas can decrease the incidence of strep infections and rheumatic fever.

Complications

Rheumatic fever can lead to several serious complications, the most significant of which is rheumatic heart disease (RHD). This condition involves permanent damage to the heart valves, leading to valve stenosis or regurgitation, which can cause heart failure, arrhythmias, or infective endocarditis. Rheumatic heart disease is the leading cause of death in individuals with a history of rheumatic fever. Other complications include chronic arthritis, particularly in individuals who experience multiple episodes of polyarthritis.

Patient Education

Patient education is critical in managing and preventing the recurrence of rheumatic fever. Important points include:

Adherence to Antibiotic Therapy: Patients must complete their antibiotic regimen for strep throat and may need long-term prophylaxis.
Regular Follow-Up: Patients should have regular follow-ups with their healthcare provider to monitor for signs of recurrent infections or heart complications.
Recognizing Symptoms: Educating patients and parents about the signs of strep throat and early symptoms of rheumatic fever can ensure timely treatment.
Healthy Living Conditions: Improving hygiene and living conditions, especially in crowded environments, reduces the risk of group A streptococcal infections.

Conclusion

Rheumatic fever is a preventable and treatable disease that poses a significant health risk, particularly in low-resource settings. Early treatment of streptococcal infections and prompt management of rheumatic fever are crucial to prevent serious complications like rheumatic heart disease. Through a combination of antibiotics, anti-inflammatory medications, and patient education, the disease can be effectively managed, and long-term outcomes can be improved.

References

Mayo Clinic. Rheumatic Fever. https://www.mayoclinic.org/diseases-conditions/rheumatic-fever/symptoms-causes/syc-20354588
Centers for Disease Control and Prevention (CDC). Rheumatic Fever. https://www.cdc.gov/groupastrep/diseases-public/rheumatic-fever.html
World Health Organization (WHO). Rheumatic Fever and Rheumatic Heart Disease. https://www.who.int/cardiovascular_diseases/publications/trs923/en/
Carapetis, J. R., Steer, A. C., Mulholland, E. K., & Weber, M. (2005). “The global burden of group A streptococcal diseases.” The Lancet Infectious Diseases, 5(11), 685-694. https://doi.org/10.1016/S1473-3099(05)70267-X

Nursing Paper Example on Rheumatic Fever