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Pediatric

Aquired Cardiovascular Disease

QuestionAnswer
____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