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Pediatric
Aquired Cardiovascular Disease
| Question | Answer |
|---|---|
| ____is an inflammatory disease which may develop after a _____ streptococcal infection (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain. It commonly appears in children ages ___-___? What is the average age? | Rheumatic fever is an inflammatory disease which may develop after Group A beta streptococcal infection of the throat, can involve the heart, joints, skin, & brain. I commonly appears in children 5-15 years of age with an avarage age of 8. |
| How long after recover of strep throat/pharyngitis can Rheumatic fever develop | 10 to 20 days |
| T/F Rheumatic fever is an autoimmune disorder | True - antibodies made to fight streptococcus also react against the myocardium and joints. |
| Jones diagnostic criteria for Rhumatic fever includes: ____ major criteria and previous strep infection - or - ___ major and ____ minor criteria and hx of previous step infection | 2 major criteria + Hx of previous strep infection -or- 1 major and 2 minor criteria + Hx of previous strep infection |
| Major Jones Criteria for Rheumatic fever | carditis (maydevelop rehumatic heart disease; r/t damage to mitral & aortic valves), polyarthritis, erythema marginatum (non ichy rings on trunk), subcutaneous nodules (elbows/shoulders/bony parts), and chorea |
| Minor Jones criteria for Rheumatic fever | prev hx of rheumatic fever, athralgia (joint pain), fever, prolonged PR interval and elevated acute phase rx |
| What are the 4 diagnostic tests for Rheumatic fever and which one sets apart from Kawasaki Disease? | Erythrocyte sedimation rate, C-reactive protein, White blood count and Antistreptolysin O (ASO) titer which is not seen in Kawasaki |
| Group A beta hemolytic streptococcal secretes which enzyme (antigen) | streptolysin O |
| What does the immune system develop due to the stimulation of stretolysin O caused by strep? | anti-streptolysin O antibodies |
| An elevated titer of what indicates a recent strep infection | anti-streptolysin O antibodies |
| 2 medications to treat strep infection | penicillin and erythromycin (if allergic to penicillin) |
| prophylactic antibiotics for acute rheumatic fever: without carditis ____ years or until 21, with carditis ____ years or until adulthood, residual heart damage at least to age ____ | without carditis 5 yrs or until age 21 (whichever longer), with carditis 10 yrs or into adulthood (whichever longer), residual heart damage age 40 |
| What Anti-Inflammatory medication are used for pts with minimal or no carditis to control pain & suppress reheumatic activity for acute rheumatic fever? What is used with child with pancarditis, CHF, Valvular involvement with ARF (Acute Rheumatic Fever) | Asprin (without carditis) to control pain and suppress rheumatic activity and corticosteroids like prednisone (with carditis) |
| CHF meds for pt with acute rheumatic fever | diuretics, digoxin and K+ |
| Nursing intervention for acute rheumatic fever - close monitor for which cardiac status | !!!!systolic murmur!!!!!!; CHF; Tachycardia at rest |
| T/F a child with acute rheumatic fever and cardiac damage can resume physical activity as long as they have periods of rest | False - restricted physical activity |
| an acute multisystem vasculitis of infancy and early childhood | kawasaki disease |
| Incidence for Kawasaki disease | Highest incidence in Japan, young children (under 5), male |
| Etiology for Kawasaki Disease | unknown |
| fever in Kawasaki disease is normally higher or lower then rhuematic fever | higher (39.4C) - must have as part of diagnosis |
| 6 criteria (not findings) for Kawasaki disease (must have fever and at least 4 others) | fever, conjunctival infection, mouth and pharynx changes, peripheral extremity changes, erythematous rash and enlarged lymph nodes (more than 1.5cm dia) |
| How long is the acute, subacute and convalescent phases for Kawasaki disease? | Acute - onset-10days, Subacute - day 10-25, Convalescent - day 26 until resolved |
| Kawasaki Disease diagnostic findings (not criteria) | Leukocytes over 20,000, elevated ESR, elevated C-reactive protein, increased thrombocytosis (600M - 2MM), moderate anemia and ECG abnormalities |
| Which diagnostic findings (not criteria) are seen in Kawasaki disease that is not seen in rheumatic fever? | increased thrombocytosis and moderate anemia |
| Most serious complication of Kawasaki Disease | Coronary artery abnormalities (Coronary artery aneurysms and myocardial infarctions) |
| Tx for Kawasaki Disease | IV IgG, ASA (first for fever 80-100mg/kg/day then for antiplatelet 3-5 mg/kg/day) |
| T/F antibiotics are given for Kawasaki Disease | False - not beneficial |
| The inclusion of corticosteroids in aspirin-containing regimens for the initial treatment of ____ reduces the incidence of coronary aneurysms. | Kawasaki Disease (handout indicates otherwise - didn't make sence so I found research on the internet that supports reduction of coronary aneurysms) |
| If a child has Kawasaki Disease, why should they be concerned with varicella or influenza | b/c the child is taking asprin and influenza or chickenpox while taking aspirin, can cause a serious complication called Reye's syndrome. |
| How can a child get CHF with Kawasaki Disease? | Swelling of the heart muscle. The swelling can make the heart muscle pump blood poorly. |
| How long should a live virus vaccine be delayed after IV IgG tx for Kawasaki Disease? | 6 months |
| If a child is not treated with IV IgG for Kawasaki Disease what is the chance they will develop coronary artery aneurysms? | 20% |
| T/F recurrence of Kawasaki disease is common | False approx 3% recurrence |
| Coronary artery abnormalities with Kawasaki Disease | myocardial ischemia, coronary artery aneurysms, myocardial infarction and potential for sudden death |
| Kawasaki disease is also known as the ____ syndrome | lymph node |
| In Acute Rheumatic Fever it is important to get a ___ if a child has a sore throat without signs of ____? | It is important to get a throat culture if child has sore throat without signs of viral illness. |
| T/F Acute rehumatic fever is seen in children under 2 and in the thrid year of life? | False it is not seen in children under 2 and is Rare in 3rd year of life |
| In Rheumatic Heart Disease damaged valves cause ___ to blood flow and myocardium has to pump against ___ resistance? | Damaged valves cause obstruction to blood flow and myocardium has to pump against increased resistance |
| Erythrocyte sedimentation rate; C-reactive protein; WBC count; and Antistreptolysin (ASO) titer are all Dx test for ___? | Acute Rheumatic Fever |
| With ARF What type of activities can a pt do if they are on bedrest? | Quiet diversional activities |
| Administer meds as ordered, alleviate discomfort-analgesics, minimize handling; and provide safety precautions are all nursing interventions with? | ARF Acute Rheumatoid Fever |
| Discharge planning of Kawasaki disease is Aspirin administration. What do you want to minimize? What Vital Sign do you want to monitor? | Minimize gastric distress-give with food, milk or large glass of water and Monitor their temperature |
| Discharge planning of Kawasaki disease is Aspirin administration. What side effects of asprin do you want to monitor for? | Petechiae, Bleeding gums, Tinnitus, Hematuria, Hematochezia (bloody stools), Hematemesis |
| In Discharge planning of kawasaki disease what is the #1 most important thing to teach a parent? | Teach family CPR |
| What do you want to teach the family to report to the health care provider in discharge planning of kawasaki disease? | Exposure/development of varicella or influenza; signs & Sx of CHF; Chest pain, dyspnea, extreme lethargy, syncope |
| Long term care especially importent w/ severe coronary disease; teach family CPR; Potential activity restriction; Admin influenza vaccine; & Delay live virus vaccines until at least 6 months after IVIG (ex. Viricella & MMR) are all follow-up care in __? | Kawasaki Disease |
| What does an elevated titer of ASO indicate? | indicates recent strep infection |
| Why in Acute Rheumatic fever is important to teach the pt the importance of compliance to antibiotics? | Prevent further cardiac damage; long term antibiotics; standard bacterial endocarditis prohylaxis |
| What in discharge teaching of ARF is important to teach about physical activity? | Unrestricted if no cardiac damage; restricted if cardiac problems (eg cardiomegaly, aortic/mitral regurgitation) |
| What do you need to theach the discharged pt of ARF about Birth control? | Warn against use of IUDs-source of potential infection and bacterial endocarditis; Diaphragm and some oral contraceptive agents are safe |
Created by:
cgwayland
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