1. NARAINA NURSING COLLEGE,
PANKI, KANPUR
SUBJECT – CHILD HEALTH NURSING
PRESENTATION ON – RHEUMATIC FEVER
Presented by –
Vishwa pratap singh,
Bsc nursing , 4th year

2. DEFINITION
It is a non-supurative sequela of Group A, ß-
hemolytic streptococcal (GABHS) throat
infection. The disease involves the joint (hence
the word “rheumatic”), heart, skin,
subcutaneous tissue and the brain.
RHEUMATIC FEVER is a multisystem disease. It
is caused by bacterium called Group-A Beta
hemolytic streptococcal(GAS).

3. EPIDEMIOLOGY
 Rheumatic fever is a major cause of acquired heart
disease in children world wide, with the disease
occurring most frequently in underdeveloped countries
where access to medical care is limited and children live
in poverty and unsanitary crowded conditions.
 The incidence rate 4-5/1000 among the children of age
group 4-15 years.

4. RISK FACTOR
1. Age and sex: - Children between 04-15 years of age are
affected more commonly. First attack of acute rheumatic
fever is rare in children < 3 years.
2. Socioeconomic status: - Rheumatic fever is common in
areas of high poverty, poor living conditions and Over
crowded and unsanitary. living conditions.
3. Season: - Rainy season.
4. Genetic : Due to consanguine marriage.
5. Poor nutrition

5. PATHOGENESIS
Risk factor
Susceptible Host
GABHS
GABHS producing m-protein
which is similar to host
protein
This m-protein cross
react with host cell
Cross reaction induce
inflammation (joints,
heart, brain, skin)
Symptoms appear
Remark –
The exact
mechanism
streptococcal throat
infection results in
rheumatic fever is
unknown.

6. CLINICAL FEATURES
Major criteria
1.Carditis - Pericarditis , myocarditis , endocarditis. Murmur
sound.
2.Polyarthritis - It is inflammation of joints with sever pain,
decreased activity, mostly knee and elbow joints.
3.Chorea - involuntary rapid movements, muscle weakness,
impaired coordination of facial muscle , speech
disturbance.
4.Subcutaneous nodule - Painless nodule over the extensor
surface of joints.
5.Erythema marginatum - It is pink macular non-itching
rash , found over the trunk, extremities but never on
face.

7. MINOR CRITERIA
1.Fever- more than 39.5 C.
2.Arthralgia – pain in joints. Approx in 90% cases.
Other features
Abdominal pain
Headache
Fatigability
General weakness
Tachycardia
Malaise
Sweating
Vomiting
Skin rashes
Erythema
Epistaxis
Anemia
Pleuritis
Weight loss

8. 01 Initial episode of
rheumatic fever
Two/one major and two minor features
+ evidence of a preceding GABHS
02 Recurrent attack Two/one major and two/three minor
features + evidence of a preceding
GABHS
DIAGNOSTIC EVALUATION
Investigation
• Echocardiogram
• Artificial subcutaneous nodule test
• Endomyocardial biopsy
• Chest X-ray
• ECG
• Blood test
• Swab culture
Assessment

9. Medical management
• Bed rest for at least 6 to 8 weeks.
• Nutrition .
Management
Sr. Drug Dose Route Frequency Action
01 Procaine
penicillin
4 lakh
unit
IM BD Antibiotic
02 Aspirin 120mg/
kg
Orally OD NSAID
03 Prednisolone 60mg orally OD Steroid

10. NURSING MANAGEMENT
Nursing diagnosis
Increased body temperature related to infection as
evidenced by patient.
Nursing interventions
 Assess the vital sign of the patient.
 Provide comfortable environment.
 Provide sponge bath to the patient.
 Provide cool and calm environment.
 Administer antipyretic drug.

11. NURSING MANAGEMENT
Nursing diagnosis
Inability to move related to joint pain as evidenced by
physical examination.
Nursing interventions
 Assess the vital sign of patient.
 Assess the level of pain , site, frequency.
 Provide comfortable position.
 Administer analgesic as prescribed by doctor.
 Provide physical therapy.
 Frequently assess the patient condition.

12. BIBLIOGRAPHY
 Rimple Sharma, essential of pediatric nursing, edition
3rd 2021, published by jaypeebrothers medical
publisher, page no. 251-252.
 Parul datta, pediatric nursing, edition 5th 2022,
published by jaypeebrothers medical publisher, page
no. 306-307.