TABLE 37-12 NURSING ASSESSMENT Rheumatic Fever and Rheumatic Heart Disease

Subjective Data Important Health Information

Past health history: Recent streptococcal infection, previous history of rheumatic fever or rheumatic heart disease

Functional Health Patterns

Health perceptionhealth management: Family history of rheumatic fever; malaise Nutritional-metabolic: Anorexia, weight loss Activity-exercise: Palpitations; generalized weakness, fatigue; ataxia Cognitive-perceptual: Chest pain; widespread joint pain and tenderness (especially large joints)

Objective Data General

Fever

Integumentary
Subcutaneous nodules and erythema marginatum

Cardiovascular
Tachycardia, pericardial friction rub, mufed heart sounds; murmurs; peripheral edema

Neurologic
Chorea (involuntary, purposeless, rapid motions; facial grimaces)

Musculoskeletal
Signs of monoarthritis or polyarthritis, including swelling, heat, redness, limitation of motion (especially of knees, ankles, elbows, shoulders, wrists)

Possible Diagnostic Findings

Cardiomegaly on chest x-ray; prolonged PR interval on ECG; valve abnormalities, chamber dilation, and pericardial effusion on echocardiogram; antistreptolysin-O titer, positive throat culture, positive rapid antigen test for group A streptococci; ESR, CRP, leukocytosis
CRP, C-reactive protein; ECG, electrocardiogram; ESR, erythrocyte sedimentation rate.