The nurse in the emergency room is assessing a child suspected of having rheumatic fever. According to the Jones criteria, what may indicate the presence of rheumatic fever?


• The Jones criteria state that the diagnosis of rheumatic fever can be made with two major criteria or one major with two minor criteria along with 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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