Rheumatic Fever & Kawasaki Syndrome
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| Rheumatic Fever | serious inflammatory connective tissue disorder
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| rheumatic fever follows | an infection of some strains of group A beta hemolytic streptococci
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| rheumatic fever affects the | heart, joints, brain and skin
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| the exact cause of rheumatic fever is | unknown
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| rheumatic fever can occur at any age but is more common in children between ages | 6-15
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| 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
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| 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)
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| erythema marginatum | skin rash
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| minor manifestations of rheumatic fever | joint pain, fever, previous rheumatic fever, abnormal heart beat, blood testing indicating inflammation, new heart murmurs
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| diagnosing rheumatic fever | presence of 2 of the major criteria OR presence of 1 major plus 2 minor criteria
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| In all cases of rheumatic fever evidence of a preceding _____________ infection is key to making a dx. | strep throat
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| lab test for rheumatic fever diagnosis | antistrptolysin-O titer
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| 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
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| most people recover fully after 6 weeks, T or F? | True
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| In rare cases, heart damage is so extensive it leads to congestive heart failure(CHF), T or F? | True
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| A rheumatic valve has fibrous rolled edges, T or F? | True
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| clinical tx for rheumatic fever | antibiotics(pcn,sulfadiazine or erythromycin), ASA, NSAID's, steroids(used for severe cariditis w/CHF)
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| 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
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| monthly injections of long acting ____________ for a period of up to 5 yrs, if carditis is present maybe up to __________yrs | penicillin, 40 yrs
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| long term antibiotics are used in rheumatic fever to... | reduce the chance of another attack
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| 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
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| Kawasaki Syndrome | an acute febrile, systemic inflammatory illness
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| cause of kawasaki syndrome is | unknown, but maybe an infectious agent such as a virus
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| 2 leading causes of acquired heart disease in US | Kawasaki syndrome and rheumatic fever
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| kawasaki syndrome is most common in | children under age 5
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| kawasaki syndrome can occur in any race but is more common in those with ___________ancestry | asian
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| greatest incidence of kawasaki's syndrome occurs in.... | winter and spring
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| lowest incidence of kawasaki's syndrome occurs in... | summer
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| kawasaki's syndrome is usually preceded by an... | upper respiratory infection
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| kawaski's syndrome affects... | small arteries including the coronary arteries
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| 3 stages kawasaki's syndrome occurs in... | acute, subacute, and convalescent
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| 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
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| 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)
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| coronary artery damage can lead to | aneurysms, MI's or ischemic heart disease
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| 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
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| 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
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| 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
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| 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
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| myocardium, valves and pericardium can become inflamed in kawaskai's syndrome, T or F? | True
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| What can develop in kawasaki's syndrome? | arrhythmias
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| 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)
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| 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,
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| Flu vaccine can prevent Reyes syndrome from ASA, T or F? | True
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