New murmur, tachycardia, chest pain, or signs of heart failure indicate carditis — report promptly.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A child presents with a sandpaper-like rash, fever, and a strawberry tongue. The nurse recognizes these findings as characteristic of which infection?
Answer: A. Scarlet fever, caused by group A streptococcus, produces a fine, sandpaper-textured rash, high fever, and a strawberry tongue. It is treated with antibiotics such as penicillin to prevent rheumatic fever.
Question 2 of 5
A school-age child is diagnosed with acute rheumatic fever after a streptococcal throat infection. The nurse monitors for which serious cardiac complication?
Answer: A. Carditis, especially mitral valve damage, is the most serious complication of acute rheumatic fever and can lead to permanent valvular heart disease (rheumatic heart disease). The nurse monitors for murmurs, tachycardia, and signs of heart failure.
Question 3 of 5
A toddler has a high fever for 3 days that abruptly resolves, followed by a rose-pink maculopapular rash on the trunk. Which condition does the nurse suspect?
Answer: B. Roseola (exanthem subitum, caused by human herpesvirus 6) is characterized by a high fever for several days that ends abruptly, followed by a rose-pink rash starting on the trunk. The child often appears well once the rash appears.
Question 4 of 5
An older adult with pneumonia may not show a typical fever. Which atypical presentation of infection should the nurse watch for in older adults?
Answer: A. Older adults often present atypically with new confusion, functional decline, falls, or decreased appetite rather than a high fever, because of a blunted immune and thermoregulatory response. A high spiking fever with rigors is the classic, not atypical, presentation.
Question 5 of 5
A child is diagnosed with mumps. Which complication should the nurse monitor for, particularly in postpubertal males?
Answer: A. Orchitis (inflammation of the testes) is a recognized complication of mumps, especially in postpubertal males, and can rarely affect fertility. The nurse monitors for testicular swelling, pain, and fever.
Keep the streak going with more questions like these, each with a full rationale.
What is rheumatic fever?
It can damage the heart, joints, skin, and nervous system, and is the leading cause of acquired valve disease (especially mitral stenosis). Prompt antibiotic treatment of strep throat prevents it.
Key points to remember
- Develops 2-3 weeks after an untreated group A streptococcal pharyngitis.
- Carditis is the most serious manifestation and can permanently scar heart valves.
- Major Jones criteria include carditis, migratory polyarthritis, chorea, subcutaneous nodules, and erythema marginatum.
- Diagnosis is supported by elevated ASO titer and evidence of recent strep infection.
- Long-term prophylactic penicillin prevents recurrence and further valve damage.
- Treating strep throat with full-course antibiotics prevents rheumatic fever.
Common causes
- Untreated group A strep
- Autoimmune rxn 2-3 wks later
Signs & symptoms
- JONES: Joints, carditis
- Nodules, erythema, chorea
- Fever, ↑ASO titer, ↑ESR
Nursing priorities
- Administer prescribed antibiotics (penicillin) to eradicate streptococcus and complete the full course.
- Provide anti-inflammatory therapy (aspirin/NSAIDs) and monitor for relief of joint inflammation.
- Assess cardiac status: heart sounds, murmurs, rhythm, and signs of heart failure.
- Promote rest during the acute inflammatory and carditis phase.
- Educate on lifelong prophylactic antibiotics to prevent recurrence.
Labs & values
Patient teaching
- Always complete the full course of antibiotics for strep throat to prevent rheumatic fever.
- Take prophylactic antibiotics long term as prescribed to prevent recurrence.
- Report sore throats promptly for evaluation and treatment.
- Inform providers of rheumatic fever history before dental/invasive procedures due to valve risk.
Red flags: report now
- New murmur, tachycardia, chest pain, or signs of heart failure indicate carditis — report promptly.
- Sudden involuntary jerky movements (Sydenham chorea) require evaluation.
- Recurrent sore throats untreated risk repeat episodes and cumulative valve damage.
References
Clinical references for this topic
