Nursing 213

N213: Health Differences Across the Lifespan 3 Study Guide cause alterations in the connective tissues. Complications most often involve the heart, but lasting arthritis can also result. Signs and symptoms of rheumatic fever: • Joint pain • Heart murmur • Redness in joints • Weakness • CNS involvement: twitching, facial grimaces, speech disturbance • Fever • Rash (erythema marginaturm) • Subcutaneous nodules • CHF • Emotional lability Nursing assessment for rheumatic fever: • Head to toe general assessment o Check temperature o Neurological assessment o Visualize throat for redness o Skin assessment o Listen to heart sounds • Inquire about recent history of streptococcal infection or sore throat • Review laboratory reports o CBC with differential o Sedimentation rate (ESR) o Throat culture for streptococcal infection o Positive C-reactive protein o Antistreptolysin-O titers (ASLO) o EKG Nursing diagnosis for rheumatic fever: • Risk for altered body temperature related to streptococcal infection • Pain related to inflammation of joints • Altered nutritional status related to throat pain • Activity intolerance related to cardiac involvement, secondary to antigen-antibodies • Knowledge deficit related to disease process and treatment Nursing interventions for rheumatic fever: • Monitor vital signs and neurological status

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