■ 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)
● 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
● 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) ○
● 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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