Nursing Care Plan for Rheumatic Fever in Children

Nursing Care Assessment

Based on the information Nelson (2000), the data could focus on assessment of nursing care, among others:

1. Focus data :

• Increased body temperature usually occur in the afternoon.
• A history of respiratory tract infection.
• Decreased blood pressure, increased pulse rate, respiration increases.
• Non-productive cough.
• Epistaxis.
• Abdominal pain.
• Arthralgia.
• Loss of appetite.
• Losing weight.

2. Specific manifestations:

Carditis:

• tachycardia
• cardiomegaly
• voice murmurs
• changes in heart sound
• ECG changes (PR lengthwise)
• precordial pain
• pericardial friction rub

Polyarthritis

• joint swelling, heat, redness, tenderness.
• spread on the knee joint, elbow, shoulder, arm.

Subcutaneous nodules:

• swelling of the skin, soft palpable.
• coming shortly, in general readily absorbed.
• found on the extensor surfaces of the joints

Chorea:

• irregular movements of the extremities, involuntary.
• involuntary facial expressions
• speech disorders
• emotional lability
• muscle weakness
• muscle tension when anxious, lost when the break.

Erythema marginatum:

• reddish macular common on the torso and palms.
• the macula can not be permanently relocates à
• the macula is non pruritus

Nursing Diagnosis for Rheumatic Fever in Children

1. Knowledge Deficit : parents / child related to treatment, the activity restriction, the risk of cardiac complications.

Goal: complications did not occur and parents understand the child's disease.

Interventions:

• Auscultation of heart sounds to detect changes in rhythm.
• Give antibiotics according to the program.
• Restriction of activity to the clinical manifestations of rheumatic fever does not exist, and provide rest periods.
• Provide play therapy is appropriate and does not make patients tired.
• Give knowledge on mother and child about the disease and treatment procedures.

2. Ineffective individual coping related to disease conditions.

Goal: child understands about treatment procedures and can be cooperative, individual kooping effective.

Interventions:

• Assess the desire to play according to the age and condition.
• Create a schedule of activity and rest.
• Teach for participation in activities of daily necessities.
• Teach children / parents do not realize that the movement is associated with chorea and temporary.

4. Pain related to polyartritis.

Goal: lost and diminished pain.

Expected outcomes: child can control pain and mild pain scale of 2-3.

Interventions:

• Assess pain scale (1-10).
• Giving analgeik, anti-inflammatory and antipyretic according to the program.
• Repositioning to reduce joint stress.
• Give warm and cold treatment on a sore joint.
• Teach technique of distraction / relaxation for example; relaxation techniques and fantasy.

5. Risk for injury related to streptococcal infection.

Goal injury did not occur.

Interventions:

• Monitor the temperature every 4 hours during treatment.
• Give antibiotics according to the program.
• See also in discharge planning.
• Rest patients of activities that can make you tired.