What information the nurse should consider while collecting the history of a child with suspected rheumatic f… - RRB Nsg. Superintendent-21 July 2019 (Shift-2nd)

RRB Nsg. Superintendent-21 July 2019 (Shift-2nd)

Child Health Nursing (Pediatrics)

Easy

Appeared in: RRB Nsg. Superintendent-21 July 2019 (Shift-2nd)

Explanation

Rheumatic fever is an autoimmune inflammatory reaction that occurs as a delayed complication of a Group A Beta-Hemolytic Streptococcal (GABHS) infection.
The most common preceding infection is streptococcal pharyngitis (a sore throat).
There is typically a latent period of 2 to 4 weeks between the sore throat and the onset of rheumatic fever symptoms, making a recent history of pharyngitis a critical diagnostic clue.

Option A: While fever is a minor criterion for rheumatic fever, a fever starting only 2 days ago is a non-specific finding common to many acute illnesses and does not fit the typical latent period.
Option B: Vomiting is a general symptom of gastrointestinal upset or various systemic illnesses and is not a specific or characteristic feature of rheumatic fever.
Option C: Anorexia (lack of interest in food) is a common constitutional symptom seen in numerous childhood diseases and lacks the diagnostic specificity needed to suspect rheumatic fever.

Visual 1: Diagram: The Jones Criteria for diagnosing acute rheumatic fever, separating major and minor criteria.
Visual 2: Image: Erythema marginatum, showing the characteristic non-pruritic, pink rash with a clear center on the trunk or limbs.
Visual 3: Image: Subcutaneous nodules, illustrating the small, firm, painless lumps found over bony prominences.

Clinical Relevance

Nursing practice connection: Use the key finding related to History taking and key signs of Rheumatic Fever to guide bedside assessment, documentation, and the next nursing action.
Prompt identification of a recent streptococcal infection is crucial because early antibiotic treatment can prevent the progression to acute rheumatic fever and subsequent rheumatic heart disease, a major cause of acquired heart valve damage.
Nurses play a key role in educating families about the importance of completing the full course of antibiotics for strep throat to prevent these severe complications.
What if? If the child had a history of a skin infection (impetigo) instead of pharyngitis, the risk would be for post-streptococcal glomerulonephritis, not rheumatic fever. Rheumatic fever is specifically linked to pharyngeal strains of Group A Streptococcus.

How to Approach the Question

First, read the question to identify the core clinical problem: collecting a history for 'suspected rheumatic fever'.
Recall the pathophysiology of rheumatic fever. The key concept is that it is a post-infectious syndrome.
Identify the specific preceding infection associated with rheumatic fever, which is Group A streptococcal pharyngitis.
Evaluate the options to see which one directly relates to this key etiological factor. A 'recent episode of pharyngitis' is the most direct and important historical clue.
Eliminate the other options by recognizing them as non-specific symptoms (fever, vomiting, anorexia) that can occur in many illnesses and do not point specifically to rheumatic fever.

Concept Tested & Keywords

Concept Tested: History taking and key signs of Rheumatic Fever
Stem keywords: history, child, suspected rheumatic fever
Lead-in keywords: What information
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Negative lead-in flag: false

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