Case Study 3: Acute Rheumatic Fever - Pathophysiology, Nursing Care, and Family-Centered Approach

This case study discusses the pathophysiology and clinical presentations of Acute Rheumatic Fever, the role of nurses in providing developmentally appropriate care, and the importance of family-centered care. It also highlights the effects of hospitalization on the child and family and the need for culturally competent care. The case study provides insights into the growth and development theories and the importance of educating adolescent patients on their illness.

Running head: CASE STUDY 3: ACUTE RHEUMATIC FEVER 1
CASE STUDY 3: ACUTE RHEUMATIC FEVER
NAME
INSTITUTION

CASE STUDY 3: ACUTE RHEUMATIC FEVER 2
CASE STUDY 3: ACUTE RHEUMATIC FEVER
Introduction
Acute Rheumatic Fever (ARF) describes a sequela of streptococcal infection-
characteristically after two to three weeks following group A streptococcal pharyngitis which
takes place most frequently among children and has cardiac, rheumatologic, and neurologic
manifestations. The ARF incident has dropped in advanced economies, and several physicians
have little or no practical experience with diagnosis alongside management of ARF. This paper
seeks to demonstrate the pathophysiology alongside main clinical presentations of ARF by
taking into account a particular case of Sue (case study 3), 14-year-old native girl, who was
diagnosed with ARF. Later, the paper would further focus on the nurse’ role in the provision of
suitable care to adolescents and members of their families taking into account the current nursing
practices.
Pathophysiology of Acute Rheumatic Fever
ARF is manifested by nonsuppurative inflammatory lessons of heart, joints, central
nervous system and subcutaneous tissue. The literature has demonstrated that, at least in
advanced economies, rheumatic fever proceeds pharyngeal infection with rheumatogenic group
A streptococci (Webb, Grant & Harnden, 2015). The rheumatic fever development risk
following a streptococci pharyngitis episode is estimated at 0.3 to 3 percent. Some studies have
also associated rheumatic fevers amongst the aboriginal population of Australia to streptococcal
skin infections (Burke & Chang, 2014).
The tissue injury occurring in rheumatic fever is accounted for by the molecular mimicry.
Both cellular and humoral host defense of a genetically vulnerable host remain engaged. The
immune responses of the patient, in this process for both T- and B-cell mediated cannot

CASE STUDY 3: ACUTE RHEUMATIC FEVER 3
distinguish between such microbes that invade and some host tissues. T helper1 alongside
cytokine Th17 seem to be central mediators of rheumatic heart disease. The resulting
inflammation might persist past acute infection and generates the rheumatic fever or protean
manifestation (Gewitz et al., 2015).
The initial step is a pharyngeal infection by Streptococcus pyogenes, proceeded by
antigens’ presentation to the immune B and T cell. The production of particular chronic and
acute stage antibodies (IgM and IgG) results from the CD4+ cells’ activation by lymphocytes.
Such antibodies alongside activated T cells react with structurally identical peptides or proteins
in tissues of the heart that is known as the cross-section.
Consequently, the heart will be inflamed. The joints will then develop swelling alongside
pain because of accumulation of immune complexes that antigen-antibody merger have formed.
The skin and chorea rashes or the nodules are the additional manifestations of such immune
activation, in basal ganglia alongside skin in that order. The M protein and N-acetyl-beta-D-
glucosamine antigens will mimic one another alongside the myosin in cardiac muscle.
Such molecules have an identical antigenic structure with myosin which is the human
muscle protein. Antibodies are formed hence reacting with human heart valve tissue. The CD4+
cells will stick to as well as burrow into endothelium of the valve due to VCAM-1 molecules
overexpression thereby activating the cellular immune response within the valve. The
inflammation of the valve tissue thus follows with new blood vessels’ growth.
The T cell’s availability thus ensues due to the surged supply of blood resulting from
such vessels. Several antigenic attraction spots will occur on the valve, on such proteins as
tropomyosin and vimentin thereby making T-cell attack stretch to further areas. The Aschoff
bodies or granulomas the form underneath endocardial heart layer. Calcification further takes

CASE STUDY 3: ACUTE RHEUMATIC FEVER 4
place a share of such information and is connected the osteopontin levels. Additional
inflammation markers like CRP alongside oxidation protein products that are raised in a patient
with RHD’s blood.
Evaluating nurses’ role to deliver developmentally appropriate nursing care
Nurses play an important role in symptom management to alleviate the complication of
the illness. To accomplish this, nurses must comprehend the illness pathophysiology as well as
have patients’ development stage, age as well as other associated variables of the patients which
would assist them in offering patient-focused or individualized care (Dunkel & Harbke, 2017).
The physical maturity alongside the overall development of children is distinguished from those
of adolescents which influence the process of healing, metabolism of medication as well as
pathophysiologic processes. As indicated in the case study 3, Sue is a 14-year old girl and hence,
falls in the adolescent bracket, in which the social, physical, cognitive as well as personality
development range from childhood (He et al., 2016).
Some developmental indications entail surge in height and weight and so on. Girls attend
their puberty between thirteen and sixteen of age as well as the level alongside the activity of the
pituitary-released hormones surge (Maier & Kommer, 2016). However, such alterations, as well
as hormonal changes in the adolescents, influence their behavior and accomplishment, whereas
they are increasingly busy developing their corresponding personal identity. This calls for
tremendous psychological, as well as social support and nurses, play an imperative role in this
respect by making sure that the privacy of the patients are guaranteed as they provide healthcare
and respect their ethical identities.
Growth and Development Theories

CASE STUDY 3: ACUTE RHEUMATIC FEVER 5
The theories of development and growth might be useful for this given case study. The
theory advanced by Erickson relating to the psychosocial development alongside Piaget's theory
remains relevant. As indicated in the Piaget’s theory, the adolescents’ thought process in the
course of the formal operational stage might be regarded systematic progressively, mature,
abstract, logical as well as reflective (Bjorklund & Causey, 2017). This demonstrates that
adolescents might take own life decisions, and hence they require involvement in their care plan.
Therefore, the adolescent is regarded as an essential age bracket whereby they become
mature both cognitively and physically. According to Erickson theory of psychological
development, the adolescents give primary attention to their formation of identity, self-identity
search and hence leading to the independence sense from their corresponding parents, and
occasionally surges dependence on their peers (Malone et al., 2016). This might hardly be life-
threatening when adolescents are swayed away by their relevant peers.
A typical example in this setting might be peer pressure to consume alcohol, smoking,
and substance abuse which affect the adolescent’s health to a higher degree. It is a fact that
nearly seventy percent of young adolescents affected with this illness are further massive
smokers. Therefore, it might be stated that Sue needs to be educated by the care practitioner or
professional that might teach her how the illness is affecting her health as well as urging her to
stop the predisposition factors (Darling-Fisher & Leidy, 2015). It has been mentioned in the
previous studies that educating the adolescent patient on a given disease promote their better
understanding that continued assistance improve their QoL.
Family-Centered Care
Family-centered care is further imperative when caring for adolescent patients. This both
family members and parents are primary and immediate contact points for adolescents that them

CASE STUDY 3: ACUTE RHEUMATIC FEVER 6
to pose better understanding and knowledge regarding their children and adolescent. This kind of
approach stays effective because it encompasses building a partnership among the family
members, care professionals as well as children (Greene, 2017). Openness communication with
parents regarding the care concerns of their children outlines the importance of rapport and trust
building. The family-centered care’s fundamental factors regard family as both culturally
responsive as well as stable assistance and support (Hill, Knafl & Santacroce, 2017).
Based on Sue’s case, it might be highlighted that she and her family need to get proper
care and must be accorded the best opportunity to access essential healthcare resources. This is
because of an insufficient report on values, lifestyle and customs of the Aboriginal and Torres
Strait Islander alongside their impact on healthcare practices Davidson, 2017 (). It has been
highlighted that health care providers that look after the natives in Australia must remain
culturally sensitive, empathic, recognize native family structure, land, community, family and
health history. Thus, family-centered care remains a central portion of multidisciplinary team
whereby health associated and additional concerns which affect QoL are solved successfully
(Festini, 2014).
Effects of Hospitalization of the Child on the Child and Family
Hospitalization negatively and positively influences the family and children.
Hospitalization promotes patient care and makes patients understand why it is imperative to seek
medical advice. On the flip side, hospitalization/admission might surge stress on the patient,
insufficient support of which might affect the QoL of adolescents and their corresponding
members of the family. Occasionally, it is observed that members of the family become anxious
because of the context which results in hospitalization (Franck et al., 2015). Thus, getting engaged

CASE STUDY 3: ACUTE RHEUMATIC FEVER 7
in adolescent care alongside being increasingly informed allow parents to lower their stress
levels.
Conversely, the absence of stress among parents might affect the health of their children.
The role of family members could be changed when parents are distributing their respective
work responsibilities as well as equally taking care of their other kids, negligence of which might
affect the remaining siblings’ health (Knight, 2017). Thus, it is significant that healthcare
providers encourage and support the access of parents to healthcare resources to meet similar
demands and needs. Adolescents together with their parents might be ushered in members of the
same age and suffering from single health concerns, whereby they can share and discuss their
concerns and experience (Demetriou, Shayer & Efklides, 2016). It might also assist them to
comprehend progression of illness, efficient coping strategies alongside healthy-lifestyle
selections/choices. This gives better health outcomes.
The adolescents and members of the family will be referred to other suitable health
professionals that guarantee better healthcare provision. For example, a healthy diet could be
prepared by nutritionist create proper diet chart for the illness affected adolescents thereby
boosting their immunity power as well as save them from the sudden loss of weight through cell
rejuvenation (Rémond et al., 2015). The considerate aerobic exercises might assist Sue to remain
active as well direct their energies towards daily living tasks rather than getting deprived daily,
as a result of a long-run disease. Whereas people live with such enduring illness, it is the
responsibility of healthcare providers to teach them practical coping mechanisms so that they can
survive for the balance of their corresponding lives while still uncompromising QoL.
Conclusion

CASE STUDY 3: ACUTE RHEUMATIC FEVER 8
It can be mentioned that ARF is a chronic disease which affects both wellbeing and
health of the infected person. The healthcare providers must remain supportive and assist such
patients to easily access sufficient care linked to resources so that they can meet their healthcare
needs effectively. The healthcare providers must give culturally competent care as well as
maintain quality healthcare system. They must make adolescent together with their respective
members of family fathom the significance of family-focused care which might assist them to
maintain wellbeing and health through their separate lives.

CASE STUDY 3: ACUTE RHEUMATIC FEVER 9
References
Bjorklund, D. F., & Causey, K. B. (2017). Children's thinking: Cognitive development and
individual differences. SAGE Publications.
Burke, R. J., & Chang, C. (2014). Diagnostic criteria of acute rheumatic fever. Autoimmunity
reviews, 13(4-5), 503-507.
Darling-Fisher, C., & Leidy, N. (2015). The Modified Erikson Psychosocial Stage Inventory.
Davidson, J. E. (2017). Family-Centered Care. AACN advanced critical care, 28(2), 136.
Demetriou, A., Shayer, M., & Efklides, A. (Eds.). (2016). Neo-Piagetian theories of cognitive
development: Implications and applications for education. Routledge.
Dunkel, C. S., & Harbke, C. (2017). A review of measures of Erikson’s stages of psychosocial
development: Evidence for a general factor. Journal of Adult Development, 24(1), 58-76.
Festini, F. (2014, December). Family-centered care. In Italian journal of pediatrics (Vol. 40, No.
1, p. A33). BioMed Central.
Franck, L. S., Wray, J., Gay, C., Dearmun, A. K., Lee, K., & Cooper, B. A. (2015). Predictors of
parent post-traumatic stress symptoms after child hospitalization on general pediatric
wards: A prospective cohort study. International Journal of Nursing Studies, 52(1), 10-
21.
Gewitz, M. H., Baltimore, R. S., Tani, L. Y., Sable, C. A., Shulman, S. T., Carapetis, J., ... &
Mayosi, B. M. (2015). Revision of the Jones Criteria for the diagnosis of acute rheumatic
fever in the era of Doppler echocardiography: a scientific statement from the American
Heart Association. Circulation, 131(20), 1806-1818.
Greene, R. R. (2017). Eriksonian theory: A developmental approach to ego mastery. In Human
behavior theory and social work practice (pp. 91-118). Routledge.

CASE STUDY 3: ACUTE RHEUMATIC FEVER 10
He, V. Y., Condon, J. R., Ralph, A. P., Zhao, Y., Roberts, K., de Dassel, J. L., ... & Carapetis, J.
R. (2016). Long Term Outcomes from Acute Rheumatic Fever and Rheumatic Heart
Disease: A Data-Linkage and Survival Analysis Approach. Circulation,
CIRCULATIONAHA-115.
Hill, C., Knafl, K. A., & Santacroce, S. J. (2017). Family-Centered Care From the Perspective of
Parents of Children Cared for in a Pediatric Intensive Care Unit: An Integrative
Review. Journal of pediatric nursing.
Knight, Z. G. (2017). A proposed model of psychodynamic psychotherapy linked to Erik
Erikson's eight stages of psychosocial development. Clinical psychology &
psychotherapy, 24(5), 1047-1058.
Maier, A., & Kommer, V. (2016). Acute rheumatic fever. Deutsche medizinische Wochenschrift
(1946), 141(6), 418-420.
Malone, J. C., Liu, S. R., Vaillant, G. E., Rentz, D. M., & Waldinger, R. J. (2016). Midlife
Eriksonian psychosocial development: Setting the stage for late-life cognitive and
emotional health. Developmental psychology, 52(3), 496.
Rémond, M., Atkinson, D., White, A., Brown, A., Carapetis, J., Remenyi, B., ... & Maguire, G.
(2015). Are minor echocardiographic changes associated with an increased risk of acute
rheumatic fever or progression to rheumatic heart disease?. International journal of
cardiology, 198, 117-122.
Webb, R. H., Grant, C., & Harnden, A. (2015). Acute rheumatic fever. bmj, 351, h3443.