Grading of pulses Grading of pulses: The Amplitude of the pulse is described on a scale of 0 to 4: 4. Bounding, aneurysmal
3. Full, increased 2. Expected 1. Diminished, barely palpable 0. Absent, not palpable Examination findings of a child with Kawasaki disease Examination findings of a child with Kawasaki disease (Dains et al, 2016, p. 2015) (Ball et al, 2016, p. 349) (an acute small vessel vasculitis illness of uncertain cause affecting young males more often that females; the critical concern is cardiac involvement in which coronary artery aneurysms may develop) High spiking remittent, persist fevers – 100.4 to 104 (38 to 40 °C) despite use of ℉ empirical antibiotic and antipyretic treatment o Fever lasts 5 to 25 days, mean 10 days o Patients develop rash, which resembles scarlet fever Seizures may be present Initial Diagnosis requires for fever to last 5 days with at least 4 of the following present, in absence of an infection o Bilateral conjunctival hyperemia o Mouth lesions: dry fissured lips and injected pharynx or strawberry tongue o Change in peripheral extremities, edema, erythema, desquamation of skin at 10 to 14 days o Nonvesicular erythematous rash o Cervical lymphadenopathy Long term complications of CAD, coronary occlusion or MI (Dains et al, 2016) Subjective Data o (systemic vasculitis) Weight loss, fatigue, myalgias as well as arthritis Objective findings o Fever, conjunctival injection, strawberry tongue, edema of the lands and feet, lymphadenopathy and polymorphous nonvesicular rashes o Examination findings of a patient with peripheral edema
Examination findings of a patient with peripheral edema (Dains et al, 2016, p. 166) (Ball et al, 2015, p.344) Edema of the lower extremities can be a sign of increased right heart filling pressure caused by primary lung disease or left ventricular failure o 1+ slight pitting, no visible distortion, disappears rapidly o 2+ a somewhat deeper pit than 1+, but again no readily detectable distortion, disappears in 10 to 15 seconds o 3+ noticeably deep pit that may last more than a minute dependent extremity looks fuller and swollen o 4+very deep pit that lasts as long as 2 to 5 minutes ; dependent extremity is grossly distorted Thickening and ulceration of the skin is frequently associated with deep venous obstruction or venous valvular incompetence o Have patient with varicose veins stand on toes 10 times in succession, palpate the legs to feel for venous distention. If distention of the veins is visible for more than a few seconds venous insufficiency is suspected In children the location of peripheral edema is age dependent o Young infant’s edema occurs as hepatomegaly and periorbital or flank edema Angioedema with generalized or local urticaria can be evidence of anaphylaxis Check skin perfusion- capillary refill o Color return to the skin in 2 seconds – normal findings Feel the skin for diaphoresis- due to respiratory muscles working at maximum level to overcome increased resistive and elastic forces o
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- Summer '15
- pulse, Physical examination, intercostal space