RH

•  An autoimmune disease that occurs as a reaction to a group, A beta-hemolyticstreptococcal infection. -RHEUMATIC FEVER
• A beta-hemolyticstreptococcal - causes RH fever
• the disease often follows an attack of pharyngitis, tonsillitis, scarlet fever, strepthroat or impetigo - RH fever
• It is a diffuse inflammatory disease of the connective tissue primarily involvingthe heart, blood vessels, joints, subcutaneous tissue and the CNS - RH fever
• 95% of children with acute rheumatic fever, an elevation of one or more anti- streptococcal antibodies, an indication of a recent streptococcal infection It occurs most often in children 6 to 15 years of age with a peak incidenceat 8years  Most common in poor, crowded, urban areas - epidemiology of RH fever
• Chaorea - (sudden involuntary movement of the extremities and face that affectsspeech ) is a striking symptom
•  Carditis - (an inflammation of all parts of heart primarily mitral valves)
• Erythema marginatum -(a macular rash found predominantly on the trunk)
•  Subcutaneous nodules-(small, non-tender lumps/swelling over the joints)
• Polyathritis- (tender painful joints(elbows, knees ankles, wrist))
• Arthralgia - joints steffness
• Fever with history of sore throat  Arthralgia  Abdominal pain  Elevated erythrocyte sedimentation rate or positive C-reactive protein  Prolonged P-R interval  preceding strep infection: history of recent scarlet fever, positive sore throat culture for group a streptococci - minor signs and symptoms of RH fever
• chorea, carditis, erthema marginatum, subcutaneous nodules and polyathritis- major symptoms or Rh fever
• erythema marginatum cause by Group A streptoccus
• EVIDENCE OF GROUP A STREPTOCCOCAL PHARYNGITIS - diagnose by positive throat culture or rapid streptococcal antigentest, or an elevated or rising streptoccocal antibody titre [ samples taken 2 weeks a part ]
• rh fever prevention -Prevention:  Treat promptly strep throat infection with a full course of appropriate antibiotics.  Keep sores clean and covered  Wash hands regularly  Watch out for symptoms in children between 5-14 y.o.  Eat a healthy diet
• meds for RH fever- Penicillin is a drug of choice for eradication of streptococcus (250 mg twicedaily)
• true -Erythromycin may be used in penicillin-allergic children
• Anti-inflammatory agents such as aspirin and corticosteroids for significant carditis
• Children who have had RF are susceptible to recurrent attacks risk further cardiac damage, and require secondary prophylaxis for 5 years or throughage21 to 25 years which ever is longer
• Those who have RH disease should continue prophylaxis for at least 10 years and until age 40 years
• Nursing Assessment

  1. Obtain a complete up-to-date history from the child and the caregiver

  2. Ask about a recent sore throat or upper respiratory infection

  3. Find out when the symptoms began, the extent of the illness, and what if any treatment was obtained

  4. Begin with a careful review of all systems, and note the child's physical condition

  5. Observe for any signs that may be classified as major or minor manifestations

  6. Observe for elevated temperature and pulse

  7. Carefully examine for erythema marginatum, subcutaneous nodules, swollen or painful joints, or signs of chorea
• Rh fever 1st intervention - Provide comfort and reduce pain. Position the child to reduce joint pain; warm baths and gentle range-of-motion exercises help to alleviate some of he joint discomforts; use pain indicator scales with children so they are able to express the level of their pain.
• Promote energy conservation- Provide rest periods between activitiestohelp pace the child’s energies and provide for maximumcomfort; if thechild has chorea, inform visitors that the child cannot control these movements, which are as upsetting to the child as they are to others.
• Prevent injury- Protect the child from injury by keeping the side rails upand padding them; do not leave a child with chorea unattended in a wheelchair, and use all appropriate safety measures.
• Provide diversional activities and sensory stimulation - For those who do not feel very ill, bed rest can cause distress or resentment; be creative in finding diversional activities that allow bed rest but prevent restlessness and boredom, such as a good book; quiet games can provide some entertainment, and plan all activities with the child’s developmental stage in mind.