NURS 5335 Fam 2 Module 2 ID Study Guide||Complete
Questions with Verified Solutions
Kawasaki Disease description
an acute, afebrile, immune mediated self limited disease of young children characterized by vasculitis
that leads to coronary artery aneurysms, especially in medium sized vessels, with multi system
involvement
Kawasaki Disease aka
Mucocutaneous lymph node syndrome
Kawasaki Disease vasculopathy 3 linked processes
-necrotizing arteritis
-subacute/chronic vasculitis, resulting in pericarditis and myocarditis around coronary arteries
-luminal myofibroplastic proliferative may lead to decrease in lumen diameter resulting in stenotic
vessels
Kawasaki Disease risk factors
-History of KD increases risk of recurrence
-Siblings of Japanese parents
-<5 years old
-Asian decent: Japanese or Korean
Kawasaki Disease Acute phase (1-2 weeks) Assessment Findings
-High fever for a least 5 that is unresponsive to ABX
-Oral mucosal lesions that may last 1-2 weeks
-Perineal rash
-Nontender cervical adenopathy
-Painful rash and edema to feet
-Possible MI
Kawasaki Disease Diagnostic criteria require 5 days of fever and 4 of the following
-Edema or erythema of the hands and feet
-Conjunctival injection
-Cervical lymphadenopathy
-Rash (nonvesicular an polymorphous) maculopapular, diffuse erythroderma, or erythema multiform like
-Exudative pharyngitis with diffuse oral erythema, strawberry tongue, crusting/cracking of lips and
mouth
Kawasaki Disease Subacute phase (2-8 weeks after onset) Assessment Findings
-Desquamation of palms, feet, periungual area, perineal area, coronary artery aneurysm, joint aches and
pain
,-Acute MI
-Pancarditis
-Diarrhea, jaundice, hepatosplenomegaly
-Aseptic meningitis
-Sterile pyuria
-Platelet count may rise to 10000000
Kawasaki Disease Convalescent phase (6-8 weeks after onset) Assessment Findings
Symptoms usually resolve and sedimentation rate returns to normal
Kawasaki Disease nonspecific S/S
-Beau's lines on nails
-Cough
-Rhinorrhea
-Pulmonary infiltrate
-Abdominal pain
-Hydrops of gallbladder
-Paralytic ileus
-Facial palsy
Kawasaki Disease lab findings
-CBC leukocytosis
-Lymphocytes usually drop in acute phase
-Anemia: normocytic and normochormic
-Elevated platelet count
-ESR >100
-CRP elevated
-Hyponatremia
-Ferritin may be elevated during acute phase
-ALT and AST elevated
Kawasaki Disease ECG findings
Prolonged PR interval, decreased QRS voltage, arrhythmias, and nonspecific ST and T wave changes
Kawasaki Disease diagnostics
-CXR with dilated heart and pleural effusion
-Echo with effusion and coronary aneurysms
-Pyuria and mild proteinuria
-Lumbar puncture may show mononuclear pleocytosis
Kawasaki Disease Non-Pharm Treatment
-Comfort measures
-Bedrest and limited physical activity
-Without treatment duration is about 12 days but all symptoms may not resolve for up to 6-8 weeks
,Kawasaki Disease goal of therapy in acute phase
In patients with coronary artery abnormalities you want to reduce inflammation and arterial damage
and prevent thrombosis
Kawasaki Disease Pharm Treatment
IVIG which may shorten acute phase and decrease prevalence of coronary artery abnormalities; best if
given within first 10 days
Kawasaki Disease ASA dosing
Give 80-100mg/kg/day in 4 divided doses until 14th day of illness then decrease to 3-5mg/kg/day
Kawasaki Disease why do you give concurrent ASA
Reduces risk of coronary artery involvement and relieves symptoms
Kawasaki Disease vaccination after IVIG
Live vaccines should be withheld for 11 months after receiving IVIG
Kawasaki Disease IVIG dosing
2000mg/kg x1 within 7-10 of onset over 10-12 hours
Kawasaki Disease IVIG considerations
-Extreme caution in patients with acute renal dysfunction or failure
-Must give with ASA
-Patients in shock appear to have high risk of IVIG resistance
Kawasaki Disease ASA considerations
-Avoid ibuprofen use
-Vaccination against flu and varicella necessary for long term use
-Obtain CrCl prior to use and avoid if CrCl <10
Kawasaki Disease steroid use
Use in patients who don't respond to standard therapies; requires pediatric cardiologist
Kawasaki Disease IVIG resistant treatment options
Methotrexate or cyclophosphamide
Kawasaki Disease Infliximab used
for refractory cases with coronary aneurysms; available to kids >6
Kawasaki Disease antiplatelet meds
are used when increased risk for thrombus or with significant coronary invovlement
DOC clopidogrel
, Kawasaki Disease anticoags
are used in patients with large aneurysms and are at a high risk for thrombus
DOC warfarin or heparin
Kawasaki Disease consult
with pediatric cardiologist
Kawasaki Disease follow up
-Usually frequent for the first 2 months
-Obtain echo in acute phase and then 6-8 weeks after onset of illness
Cat Scratch Disease description
subacute tender lymphadenitis that develops after contact with a cat; caused by bartonella henselae
Cat Scratch Disease complications
hepatitis, neurological complications, or stellate retinitis
Cat Scratch Disease derm evolution
-Red macule at contact site and evolves into a nonpuritic papule, vesicle, or pustule 3-5 days after
exposure
-papule evolves into a fluid filled vesicle and crust 2-3 days
-papule may ulcerate with skin becoming erythematous, indurated, and tender
Cat Scratch Disease S/S
-Malaise, anorexia, aches, headache, fever
-Unilateral lymphadenopathy 1-2 weeks after scratch that is self limited and may last 2-8 weeks
Cat Scratch Disease diagnosis requires 3 of the 4 of the following
-Lympadenopathy in the absence of other reasons
-Postive B. henselae titer or skin test
-Known cat contact with pustule or papule on site
-Lymph node biopsy with bacilli present; necorsis
Cat Scratch Disease non-pharm treatment
-Local heat application to painful nodes
-Limit vigorous activity
-Biopsy of node
Cat Scratch Disease pharm treatment
-Analgesics
-No clear evidence that ABX treatment improves outcome usually resolves in 2-6 months without
treatment
Questions with Verified Solutions
Kawasaki Disease description
an acute, afebrile, immune mediated self limited disease of young children characterized by vasculitis
that leads to coronary artery aneurysms, especially in medium sized vessels, with multi system
involvement
Kawasaki Disease aka
Mucocutaneous lymph node syndrome
Kawasaki Disease vasculopathy 3 linked processes
-necrotizing arteritis
-subacute/chronic vasculitis, resulting in pericarditis and myocarditis around coronary arteries
-luminal myofibroplastic proliferative may lead to decrease in lumen diameter resulting in stenotic
vessels
Kawasaki Disease risk factors
-History of KD increases risk of recurrence
-Siblings of Japanese parents
-<5 years old
-Asian decent: Japanese or Korean
Kawasaki Disease Acute phase (1-2 weeks) Assessment Findings
-High fever for a least 5 that is unresponsive to ABX
-Oral mucosal lesions that may last 1-2 weeks
-Perineal rash
-Nontender cervical adenopathy
-Painful rash and edema to feet
-Possible MI
Kawasaki Disease Diagnostic criteria require 5 days of fever and 4 of the following
-Edema or erythema of the hands and feet
-Conjunctival injection
-Cervical lymphadenopathy
-Rash (nonvesicular an polymorphous) maculopapular, diffuse erythroderma, or erythema multiform like
-Exudative pharyngitis with diffuse oral erythema, strawberry tongue, crusting/cracking of lips and
mouth
Kawasaki Disease Subacute phase (2-8 weeks after onset) Assessment Findings
-Desquamation of palms, feet, periungual area, perineal area, coronary artery aneurysm, joint aches and
pain
,-Acute MI
-Pancarditis
-Diarrhea, jaundice, hepatosplenomegaly
-Aseptic meningitis
-Sterile pyuria
-Platelet count may rise to 10000000
Kawasaki Disease Convalescent phase (6-8 weeks after onset) Assessment Findings
Symptoms usually resolve and sedimentation rate returns to normal
Kawasaki Disease nonspecific S/S
-Beau's lines on nails
-Cough
-Rhinorrhea
-Pulmonary infiltrate
-Abdominal pain
-Hydrops of gallbladder
-Paralytic ileus
-Facial palsy
Kawasaki Disease lab findings
-CBC leukocytosis
-Lymphocytes usually drop in acute phase
-Anemia: normocytic and normochormic
-Elevated platelet count
-ESR >100
-CRP elevated
-Hyponatremia
-Ferritin may be elevated during acute phase
-ALT and AST elevated
Kawasaki Disease ECG findings
Prolonged PR interval, decreased QRS voltage, arrhythmias, and nonspecific ST and T wave changes
Kawasaki Disease diagnostics
-CXR with dilated heart and pleural effusion
-Echo with effusion and coronary aneurysms
-Pyuria and mild proteinuria
-Lumbar puncture may show mononuclear pleocytosis
Kawasaki Disease Non-Pharm Treatment
-Comfort measures
-Bedrest and limited physical activity
-Without treatment duration is about 12 days but all symptoms may not resolve for up to 6-8 weeks
,Kawasaki Disease goal of therapy in acute phase
In patients with coronary artery abnormalities you want to reduce inflammation and arterial damage
and prevent thrombosis
Kawasaki Disease Pharm Treatment
IVIG which may shorten acute phase and decrease prevalence of coronary artery abnormalities; best if
given within first 10 days
Kawasaki Disease ASA dosing
Give 80-100mg/kg/day in 4 divided doses until 14th day of illness then decrease to 3-5mg/kg/day
Kawasaki Disease why do you give concurrent ASA
Reduces risk of coronary artery involvement and relieves symptoms
Kawasaki Disease vaccination after IVIG
Live vaccines should be withheld for 11 months after receiving IVIG
Kawasaki Disease IVIG dosing
2000mg/kg x1 within 7-10 of onset over 10-12 hours
Kawasaki Disease IVIG considerations
-Extreme caution in patients with acute renal dysfunction or failure
-Must give with ASA
-Patients in shock appear to have high risk of IVIG resistance
Kawasaki Disease ASA considerations
-Avoid ibuprofen use
-Vaccination against flu and varicella necessary for long term use
-Obtain CrCl prior to use and avoid if CrCl <10
Kawasaki Disease steroid use
Use in patients who don't respond to standard therapies; requires pediatric cardiologist
Kawasaki Disease IVIG resistant treatment options
Methotrexate or cyclophosphamide
Kawasaki Disease Infliximab used
for refractory cases with coronary aneurysms; available to kids >6
Kawasaki Disease antiplatelet meds
are used when increased risk for thrombus or with significant coronary invovlement
DOC clopidogrel
, Kawasaki Disease anticoags
are used in patients with large aneurysms and are at a high risk for thrombus
DOC warfarin or heparin
Kawasaki Disease consult
with pediatric cardiologist
Kawasaki Disease follow up
-Usually frequent for the first 2 months
-Obtain echo in acute phase and then 6-8 weeks after onset of illness
Cat Scratch Disease description
subacute tender lymphadenitis that develops after contact with a cat; caused by bartonella henselae
Cat Scratch Disease complications
hepatitis, neurological complications, or stellate retinitis
Cat Scratch Disease derm evolution
-Red macule at contact site and evolves into a nonpuritic papule, vesicle, or pustule 3-5 days after
exposure
-papule evolves into a fluid filled vesicle and crust 2-3 days
-papule may ulcerate with skin becoming erythematous, indurated, and tender
Cat Scratch Disease S/S
-Malaise, anorexia, aches, headache, fever
-Unilateral lymphadenopathy 1-2 weeks after scratch that is self limited and may last 2-8 weeks
Cat Scratch Disease diagnosis requires 3 of the 4 of the following
-Lympadenopathy in the absence of other reasons
-Postive B. henselae titer or skin test
-Known cat contact with pustule or papule on site
-Lymph node biopsy with bacilli present; necorsis
Cat Scratch Disease non-pharm treatment
-Local heat application to painful nodes
-Limit vigorous activity
-Biopsy of node
Cat Scratch Disease pharm treatment
-Analgesics
-No clear evidence that ABX treatment improves outcome usually resolves in 2-6 months without
treatment
