2. Auto antibodies attack the myocardium, pericardium and cardiac valves
3. Aschoff's bodies (FIBRINDEPOSITS) develop on the valves, possibly leading to permanent valve dysfunction, especially of the mitral and aortic valves
4. Severe myocarditis may cause dilation of the heart and CHF
1. Diagnosed clinically through use of the Jones criteria from the American Heart Association – presence of 2 major and 2 minor manifestation
2. ECG to evaluate PR interval and other changes
3. Laboratory test listed above. In addition, group A streptococcal culture and/or anti streptolysin-O titer to detect streptococcal antibodies from recent infections
4. Chest x–ray for cardiomegaly, pulmonarycongestion or edema
Course of antibiotic therapies to completely eradicate streptococcal infection
1. Usually benzathine penicillin is given I.M in a single dose or a 10-day course of oral penicillin IV
3. Permanent damage to the aortic or mitral valve
which requires valve replacement
NURSING ASSESSMENT
1. Assess for signs of cardiac involvements by
auscultation
2. Monitor pulse for 1 full minute to determine heart
rate
3. Assess temperature
4. Observe involuntary movements
5. Assess child’s ability to feed self, dress and do other
activities if chorea or arthritis is present
6. Assess pain level using scale appropriate for child
7. Assess parents’ ability to coop with illness and care
for child
8. Assess need for home schooling while patient is on
bed rest
NURSING DIAGNOSIS:
❑ Decreased cardiac output
❑ acute and chronic pain
❑ risk for injury
Improving cardiac output
1. Explain to the child and the family the need for bed
rest during the acute phase and as long as CHF is
present, for milder cases, light indoor activity is allowed
2. In severe cases, organize care
3. Maintain cardiac monitoring if indicated
4. Administer course of antibiotic and be alert about
the adverse effect of drugs
5. Administer medication for CHF as directed
Relieving pain
1. Administer anti-inflammatory medication,
analgesics and antipyretic as needed.
2. Teach family the importance of maintaining dosage
schedule, continuing medication until signs and
symptoms of ARF have gone
3. Assist child with positioning for comfort and
protecting inflamed joints
4. Suggest diversional activities that do not require use
of painful joints
Protecting the child with chorea
1. Use padded side rails if chorea is severe
2. Assist with feeding and other fine-motor activities
as needed
3. Assist with ambulation if weak
4. Avoid the use of straws and sharp utensils
5. Make sure that child consumes nutritious diet
6. Be patient if speech is affected
7. Protect the child from stress
8. Administer Phenobarbital or other medication for
chorea as directed and observed drowsiness