Question

The home health nurse is visiting a 30-yr-old patient recovering from rheumatic fever without carditis. Which statement by the patient indicates a need for further teaching?

a. "I will need prophylactic antibiotic therapy for 5 years."
b. "I can take aspirin or ibuprofen to relieve my joint pain."
c. "I will be immune to future episodes of rheumatic fever after this infection." d. "I should call the health care provider if I am fatigued or have difficulty breathing."

Answer 1

The statement indicating the need for further teaching is the patient's belief that they will be immune to future episodes of rheumatic fever after one infection. Individuals who have had rheumatic fever are at a higher risk of recurrence, not immune.

Step-by-step explanation:

The statement made by the patient recovering from rheumatic fever without carditis that indicates a need for further teaching is: "I will be immune to future episodes of rheumatic fever after this infection." This statement is incorrect because individuals who have experienced rheumatic fever are not immune to future infections. In fact, they are at higher risk for recurrent attacks upon re-exposure to Streptococcus pyogenes, the bacteria responsible for this condition. This risk is especially pronounced during the first 3-5 years following an attack. Prophylactic antibiotic therapy, such as benzathine benzylpenicillin, is often recommended over a period of time to prevent reinfection.

Using aspirin or ibuprofen to relieve joint pain as the patient suggested ("I can take aspirin or ibuprofen to relieve my joint pain.") is generally acceptable because these are non-steroidal anti-inflammatory drugs (NSAIDs) that can alleviate the symptoms of joint pain associated with acute rheumatic fever. However, they should be used under the guidance of a healthcare provider. The recommendation to call the health care provider if experiencing fatigue or difficulty breathing ("I should call the health care provider if I am fatigued or have difficulty breathing.") is correct, as these symptoms could indicate a worsening of the condition or the development of carditis.

Regarding the need for prophylactic antibiotic therapy for 5 years ("I will need prophylactic antibiotic therapy for 5 years."), the American Heart Association recommends administering benzathine benzylpenicillin every 3 or 4 weeks, although the precise duration of prophylaxis may vary depending on individual risk factors. Further guidance from a health care provider is necessary to determine the exact duration of prophylaxis.