Throat culture for group A beta-hemolytic streptococci and blood sample for titter of streptococcal antibodies ( antistreptolysin O, or ASO titer) to support evidence of recent streptococcal infection.
Complete blood count, ESR, and C-reactive protein for changes described above.
Baseline ECG and echocardiogram may be done to evaluate valve function.
Chest x-ray for cardiomegaly or heart failure.
Antibiotics to treat streptococcal infection – generally I.M. penicillin or erythromycin in penicillin allergy.
Corticosteroids for patients with carditis complicated by heart failure to prevent permanent cardiac damage.
Salicylates or nonsteroidals for patients with arthritis (but not while on high-dose corticosteroids because of risk of GI bleeding) and antipyretics to control fever, after diagnosis has been established.
Phenobarbital, diazepam if chorea is present.
Prophylactic antibiotics for at least 5 years after ARF.
Monitor temperature frequently, and patient’s response to antipyretics.
Monitor the patient’s pulse frequently, especially after activity to determine degree of cardiac compensation.
Auscultate the hear periodically for development of new heart murmur or pericardial or pleural friction rub.
Observe for adverse effects of salicylate or nonsteroidal anti-inflammatory drug (NSAID) therapy, such as stomach upset, tinnitus, headache, GI bleeding, and altered mental status.
Monitor the patient’s response to long-term activity restriction.
Restrict sodium and fluids and obtain daily weights as indicated.
Administer medications punctually and at regular intervals to achieve constant therapeutic blood levels.
Explain the need to rest (usually prescribed for 4 to 12 weeks, depending on the severity of the disease and health care provider’s preference) and assure the patient that bed rest will be imposed no longer than necessary.
Assist the patient to resume activity very gradually once asymptomatic at rest and indicators of acute inflammation have become normal.
Provide comfort measures.
Provide safe, supportive environment for the child with chorea.
Observe for the disappearance or any major or minor manifestations of the disease and report signs of increased rheumatic activity as salicylates or steroids are being tampered.
Encourage continuous prophylactic antimicrobial therapy to prevent recurrence.