A child comes with Rheumatic fever and a complaint of having fever associated joint pain. What will be the nurse's action?

Appeared in: NORCET-7 Mains-2024

Explanation

The primary intervention for the painful, inflamed joints (arthritis) of acute rheumatic fever is pharmacological.
Prescribed analgesics, specifically salicylates (like aspirin) and other NSAIDs, are the first-line treatment.
These medications are effective because they have both analgesic (pain-relieving) and anti-inflammatory properties, addressing the root cause of the joint symptoms.
A dramatic and rapid response to this treatment is a classic feature that helps confirm the diagnosis of rheumatic fever.

Option A: The joints in acute rheumatic fever are acutely inflamed, red, and hot. Applying external heat can worsen the inflammation and increase pain.
Option B: This describes an incorrect use of a bed cradle. A bed cradle is a frame that goes over the legs to keep the weight of bed linens from touching the painful joints.
Option C: Placing a support (like a rolled blanket or pillow) directly under the knee causes the joint to remain in a flexed position. This is a dangerous practice that can lead to flexion contractures and increases the risk of deep vein thrombosis (DVT) by compressing popliteal vessels.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing management of joint pain in Acute Rheumatic Fever to guide bedside assessment, documentation, and the next nursing action.
Pain management is a critical nursing priority in children with rheumatic fever to ensure comfort and promote rest, which is essential for cardiac health.
Nurses must be vigilant in monitoring for the most serious complication of rheumatic fever: carditis. This involves taking a sleeping pulse for a full minute and listening for new heart murmurs.
Patient and family education is vital, emphasizing the importance of completing the full course of antibiotics and adhering to long-term prophylactic antibiotics to prevent recurrence of RF and development of chronic rheumatic heart disease.

How to Approach the Question

First, identify the patient's diagnosis (Rheumatic Fever) and the primary complaint (fever and joint pain).
Recall that the joint pain in RF is an acute, inflammatory arthritis.
Evaluate each option based on principles of safety and therapeutic effectiveness for acute inflammation.
Option A (Heat): Eliminate this, as heat is contraindicated for acute inflammation.
Option C (Blanket under knee): Eliminate this, as it is a safety risk for contractures and DVT.
Option B (Bed cradle): Recognize that while a bed cradle is used, the action described is incorrect. This makes the option wrong.

Concept Tested & Keywords

Concept Tested: Nursing management of joint pain in Acute Rheumatic Fever.
Stem keywords: Rheumatic fever, child, joint pain, fever, nurse's action
Lead-in keywords: What will be
Clinical cues: Diagnosis of Rheumatic fever with associated joint pain indicates acute inflammatory arthritis, a major criterion for the disease.

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E6 Text Book Of Pediatric Nursing 3rd Panchali Pal — Part 2 (pp 239-476 of 713) p. 110-112

E6 Medicine Harrison 22e Part 2 p. 761-763

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