High fever 104 F Chorea involuntary jerking of extremities faceaffect speech

High fever 104 f chorea involuntary jerking of

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High fever (104 F) Chorea (involuntary jerking of extremities & face/affect speech) Carditis (inflammation of the heart/Mitral valve/Damage) Poly arthritis/arthralgia Erythema marginatum (annular, raised rash on body) Occasional Abdominal pain May develop subQ nodules (over bones & tendons) Made up of collagen fibers Not a good sign (usually means damage to the heart)
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Nursing management of rheumatic: Initial 10-day- 2 week course of Penicillin then monthly IM injections of Penicillin through adulthood (until in 40s) If rheumatic fever in infancy may get penicillin till 20 years old If rheumatic fever at 18 may get penicillin till 40 years old Prophylactic penicillin injection given monthly for many years to prevent another strep infection & further damage to the heart! Steroids for arthritis & inflammation NSAIDs for joint pain/inflammation Acetaminophen & NSAIDs for fever Kawasaki Disease Tends to affect infants & young children Kawasaki Is a systemic vasculitis Inflammation of all the vessels throughout the body Includes the heart & its vessels!!!! Cause remains unknown: Speculation we think it’s an overreaction of the body’s immune system to a recent infection (any infection not specific) Child was sick immune system kicked in, freaked out & attacked the body Kawaski most common in people of Asian descent (not only Asians) Inflammation of coronary arteries can lead to aneurysm Biggest concern with kawasaki disease At risk for blood clots from weakened aneurysms Affects skin & changes mucus membranes Rash all over Dry cracked bleeding lips Swollen hands & feet with peeling skin
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Nursing assessment: To Diagnose as kawasaki must meet 5 criteria along with fever: A Fever >5 days, recent infection & 4 out of 5 of the criteria listed Bilateral Conjunctivitis (bilateral pink eye ) Swollen pores,big red tongue Cracked lips(Strawberry tongue) Peeling skin on hands & feet (desquamation) Rash over entire body (polymorphous rash) Swollen lymph nodes (cervical lymphadenopathy) History of a recent infection of any sort Can lead to aneurysm and blood clots Highly irritable Inflamed nightmare (miserable/uncomfortable)
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Nursing management Monitor cardiac status: Monitor for heart failure (Carditis can lead to HF) Will need IV fluids to keep kids hydrated r/t Strawberry tongue and peeling of mucous membranes May not want to eat/drink Strict I+O Main treatment for Kawasaki disease: IV IG (intravenous immunoglobulin) Works as anti-inflammatory/Reduces inflammation of vessels Helps reduce duration of fever Helps to prevent aneurysms High Dose of ASA ( aspirin): Kawasaki is the one condition we give ASA to in kids Helps with inflammation b/c it is an NSAID Be on the lookout for Reyes Syndrome Aspirin helps with inflammation but also helps reduce blood clots: No need for NSAID because aspirin does the same with the addition of blood clot formation Promote comfort: Tylenol for fever/discomfort Minimal stimulation environment (minimize loud noises/bright lights) Popsicles for mouth pain Provide child/family education: Do not give ibuprofen when ASA given both NSAIDs Teach importance of IVIG therapy Importance of ASA therapy: No ibuprofen
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