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The diagnosis of acute lymphoblastic leukemia is confirmed. The hematologic values include: white blood cell count of 6,000 cells/ml with a low blast cells, platelet count of 50,000, hemoglobin of 6 g/dl, and hematocrit of 16%. Which of these measures should be included in the patient's plan of care?

Explanation

•Jones criteria states that the diagnosis of rheumatic fever can be made with 2 major criteria, or 1 major and 2 minor criteria, along with the evidence of a streptococcal infection.

•Major criteria include polyarthritis, carditis, subcutaneous nodules, erythemic rash, and chorea.

•Minor criteria include fever, elevated ESR, elevated C-reactive protein, leukocytosis, arthralgia, and a prolonged PR interval.

• Rheumatic fever is an autoimmune disease that occurs as a reaction to a group A beta-hemolytic streptococcal infection.

•Inflammation from the immune response leads to fibrin deposits on the endocardium and valves, in particular the mitral valve, and in the major body joints. The disease often follows an attack of pharyngitis, tonsillitis, scarlet fever, ”strep throat,” or impetigo.

•Chest radiography revealing cardiomegaly and pulmonary congestion, hyponatremia, hyperkalemia, and ventricular hypertrophy are signs of Congestive heart failure.

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