Nursing Care of Children with Acute Rheumatic Fever and Severe Myocarditis: the Role of Pediatric Critical Care Nurses

Abstract

Rheumatic fever in children is an inflammatory condition that develops following infection with Group A β-hemolytic Streptococcus, most commonly occurring after upper respiratory tract infections such as pharyngitis or tonsillitis. Following the infection, an abnormal immune response (autoimmune reaction) may occur, resulting in multisystem inflammation. Clinical manifestations include arthritis, chorea (involuntary movements), subcutaneous nodules, and erythematous skin rashes. Recurrent or persistent infections may lead to inflammation of the heart and heart valves, causing valvular regurgitation or stenosis, most frequently involving the mitral valve. Physical examination often reveals a cardiac murmur, while echocardiography may demonstrate cardiomegaly and valvular abnormalities. Laboratory findings typically show elevated erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and antistreptolysin O (ASO) titers, indicating inflammatory activity and recent streptococcal infection. Major complications include heart failure and chronic valvular regurgitation, which may be life-threatening in pediatric patients. The critical roles of nurses in caring for pediatric patients with rheumatic fever in the pediatric intensive care unit include: (1) rapidly assess clinical conditions, particularly heart failure, fluid overload, and hypoxia; (2) ensure the administration of prescribed antibiotics, prevention of complications, provision of supportive care, and activity restriction to reduce inflammation and myocardial workload, along with close monitoring for symptoms such as dyspnea, chest pain, joint pain, and abnormal movements; (3) promptly report of any clinical deterioration to support the physician team’s clinical decision - making; (4) collect relevant medical history, including recurrent episodes of pharyngitis or incomplete antibiotic therapy; (5) facilitate laboratory investigations, including preparation for blood sampling, echocardiography, and electrocardiography (ECG); and (6) provide family education regarding the importance of diagnostic evaluation and treatment adherence to enhance cooperation in treatment. Effective nursing care enables healthcare providers to reduce disease severity, prevent long-term disability, promote patient safety, and improve the long-term quality of life of pediatric patients.