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Nursing 3 Exam 4

Rheumatic Fever & Kawasaki Syndrome

Rheumatic Fever serious inflammatory connective tissue disorder
rheumatic fever follows an infection of some strains of group A beta hemolytic streptococci
rheumatic fever affects the heart, joints, brain and skin
the exact cause of rheumatic fever is unknown
rheumatic fever can occur at any age but is more common in children between ages 6-15
common s/s of a strep infection sore throat, red and swollen tonsils, fever, h/a, muscle aches, many times, however, the initial strep infection may not cause any sumptoms
major manifestations of rheumatic fever 1-3 wks after an untreated streptococcal infection, hallmark signs or rheumatic fever may occur, caridits, arthritis, subQ nodules, skin rash, sydenham chorea(st. Vitus dance)
erythema marginatum skin rash
minor manifestations of rheumatic fever joint pain, fever, previous rheumatic fever, abnormal heart beat, blood testing indicating inflammation, new heart murmurs
diagnosing rheumatic fever presence of 2 of the major criteria OR presence of 1 major plus 2 minor criteria
In all cases of rheumatic fever evidence of a preceding _____________ infection is key to making a dx. strep throat
lab test for rheumatic fever diagnosis antistrptolysin-O titer
complications of rheumatic fever during a 1st attack about 1/2 of people develop heart inflammation, in some cases there may be scarring of 1 or more of the heart's valves, permanent heart damage is known as rheumatic heart disease
most people recover fully after 6 weeks, T or F? True
In rare cases, heart damage is so extensive it leads to congestive heart failure(CHF), T or F? True
A rheumatic valve has fibrous rolled edges, T or F? True
clinical tx for rheumatic fever antibiotics(pcn,sulfadiazine or erythromycin), ASA, NSAID's, steroids(used for severe cariditis w/CHF)
Long term antibiotic prophylaxis american heart assoc recommends daily or monthly antibiotic prophylaxis continuing long term, perhaps for life. Low dose antibiotics, esp in 1st 3-5 yrs after initial attack
monthly injections of long acting ____________ for a period of up to 5 yrs, if carditis is present maybe up to __________yrs penicillin, 40 yrs
long term antibiotics are used in rheumatic fever to... reduce the chance of another attack
nursing management for rheumatic fever prevention, during acute phase VS q 4hrs, auscultate heart sounds, observe for changes in skin & joints, administer antibiotics and ASA as ordered, plan quiet activities, educate parents regarding future sore throats and long term antibiotics
Kawasaki Syndrome an acute febrile, systemic inflammatory illness
cause of kawasaki syndrome is unknown, but maybe an infectious agent such as a virus
2 leading causes of acquired heart disease in US Kawasaki syndrome and rheumatic fever
kawasaki syndrome is most common in children under age 5
kawasaki syndrome can occur in any race but is more common in those with ___________ancestry asian
greatest incidence of kawasaki's syndrome occurs in.... winter and spring
lowest incidence of kawasaki's syndrome occurs in... summer
kawasaki's syndrome is usually preceded by an... upper respiratory infection
kawaski's syndrome affects... small arteries including the coronary arteries
3 stages kawasaki's syndrome occurs in... acute, subacute, and convalescent
acute phase of kawasaki's syndrome can last 2wks:irritability,persistent fever(>102 x 5days),severe redness in the eyes,red throat,swollen hands and feet(poss red/purplish color), rash on trunk&perineal area,unilateral enlargement of the cervical lymph node, diarrhea,hepatic dysfunction
subacute phase 2 wks after fever, cracking lips and strawberry tongue, peeling of the skin on the tips of fingers and toes, joint pain, cardiac dx(do echo), thrombocytosis(increased platelets)
coronary artery damage can lead to aneurysms, MI's or ischemic heart disease
convalescent phase of kawasaki's syndrome occurs at about 6-8 wks after dx onset, child appears normal, lingering signs of inflammation may be present
diagnosing kawasaki's syndrome there is no specific diagnostic test, occurs when a high spiking fever over 102 is present x5 days or more along w/4 of the 5 criteria not explained by another disease process
fiver criteria of kawasaki's syndrome B/L conjunctivitis w/out exudate, dry,swollen cracked lips and a strawberry tongue, dermatitis of the extremities, intense palmar & plantar erythema w/peeling, dermatitis of trunk w/rash, acute cervical lymphadenopathy
complications of kawasaki's syndrome if tx'ed w/in 10 days of the 1st symptom, usually no heart problem develops, if untreated can lead to vasculitis of the coronary arteries
myocardium, valves and pericardium can become inflamed in kawaskai's syndrome, T or F? True
What can develop in kawasaki's syndrome? arrhythmias
clinical treatment for kawasaki's syndrome IV immunoglobulins(purified antibodies), ASA, high doses of ASA given while the fever is high, corticosteroids may be give(if fever persists and a second dose of immunoglobulins are ineffective)
Nursing Management for Kawasaki's syndrome monitor temp Q 4hrs and prior to each dose of ASA, carefully assess extremities for edema, redness & peeling Q 8hrs, examine eyes for conjuctivitis & mucous membranes for inflammation, assess heart sounds carefully,
Flu vaccine can prevent Reyes syndrome from ASA, T or F? True
Created by: jbittner