Which of the following instructions would Nurse Courtney include in a teaching plan that focuses on initial prevention for Sheri who is diagnosed with rheumatic fever?
A. Treating streptococcal throat infections with an antibiotic
B. Giving penicillin to patients with rheumatic fever
C. Using corticosteroid to reduce inflammation
D. Providing an antibiotic before dental work
Correct Answer: A. Treating streptococcal throat infections with an antibiotic.
Rheumatoid fever results from improperly treated group beta-hemolytic streptococcal infections, usually pharyngitis. Therefore, prompt treatment of streptococcal throat infections with an antibiotic is a key preventive measure. Recurrent episodes generally affect older children and can occur into young adulthood. Because RHD often results from cumulative damage, the peak prevalence of RHD occurs in an individual’s twenties and thirties, though the burden of RHD in children and adolescents remains substantial.
Option B: Initial prevention is not possible once the child has rheumatic fever. However, the child will be treated with penicillin to prevent a recurrence of streptococcal infections. It is important to educate patients about seeking treatment for sore throats, as well as emphasizing the role of dental care.
Option C: A corticosteroid may be used to reduce inflammation during treatment of rheumatic fever, not as a preventive measure. The first aim of management of ARF is to confirm the diagnosis, for which a high index of suspicion is needed, especially in patients presenting with acute arthritis in geographic settings where ARF is endemic.
Option D: An antibiotic is given to children with cardiac disease to prevent carditis, not rheumatic fever. Beyond diagnosis, the priorities in management of ARF are the eradication of the group A streptococcus from the throat and commencement of secondary prophylaxis; symptomatic treatment of arthritis and/or arthralgia; management of carditis and/or heart failure; management of chorea; and patient and family education.