Question

A 7-year-old child has been diagnosed with rheumatic fever. Which of the following physical findings would the nurse expect to assess?

1) Vesicular rash over the face and chest
2) Warm and swollen knees and elbows
3) Palpable mass in the upper right quadrant of the abdomen
4) Yellow pigmentation of the sclera of the eyes

Answer 1

For a child diagnosed with rheumatic fever, the expected physical finding is warm and swollen knees and elbows due to the condition's characteristic joint inflammation.

Step-by-step explanation:

In cases of rheumatic fever, a 7-year-old child is likely to exhibit a variety of symptoms due to the immune-mediated inflammatory response. One significant physical finding in such a patient would be warm and swollen joints, particularly in the larger joints like knees and elbows. This inflammation is part of the diagnostic criteria for rheumatic fever and is caused by a cross-reaction between antibodies to bacterial surface proteins (from a prior infection with Streptococcus pyogenes) and proteins found in the synovial tissues of the joints.

Heart valve damage, which may present as a heart murmur, is another key consequence of rheumatic fever, though it may not be as immediately evident as joint swelling during the initial assessment of the child. The involvement of large joints like the knees and elbows in rheumatic fever is reversible and can be treated with anti-inflammatory medications. However, chronic damage to heart valves requires more complex management and is a significant concern in rheumatic fever.