NURS 5335 Fam 2 Module 2 ID Study Guide
(332 Terms in this set) Latest Update.
an acute, afebrile, immune mediated self-limited disease of young children
Kawasaki Disease description 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
-necrotizing arteritis
-subacute/chronic vasculitis, resulting in pericarditis and myocarditis around
Kawasaki Disease vasculopathy 3 linked
coronary arteries
processes
-luminal myofibroblast proliferative may lead to decrease in lumen diameter
resulting in stenotic vessels
-History of KD increases risk of recurrence
-Siblings of Japanese parents
Kawasaki Disease risk factors
-<5 years old
-Asian decent: Japanese or Korean
-High fever for a least 5 that is unresponsive to ABX
-Oral mucosal lesions that may last 1-2 weeks
Kawasaki Disease Acute phase (1-2 -Perineal rash
weeks) Assessment Findings -Nontender cervical adenopathy
-Painful rash and edema to feet
-Possible MI
-Edema or erythema of the hands and feet
-Conjunctival injection
Kawasaki Disease Diagnostic criteria -Cervical lymphadenopathy
require 5 days of fever and 4 of the -Rash (nonvehicular an polymorphous) maculopapular, diffuse erythroderma, or
following erythema multiform like
-Exudative pharyngitis with diffuse oral erythema, strawberry tongue,
crusting/cracking of lips and mouth
-Desquamation of palms, feet, periungual area, perineal area, coronary artery
aneurysm, joint aches and pain
-Acute MI
Kawasaki Disease Subacute phase (2-8 -Pan carditis
weeks after onset) Assessment Findings -Diarrhea, jaundice, hepatosplenomegaly
-Aseptic meningitis
-Sterile pyuria
-Platelet count may rise to 10000000
Kawasaki Disease Convalescent phase (6- Symptoms usually resolve and sedimentation rate returns to normal
8 weeks after onset) Assessment Findings
-Beau's lines on nails
-Cough
-Rhinorrhea
-Pulmonary infiltrate
Kawasaki Disease nonspecific S/S
-Abdominal pain
-Hydrops of gallbladder
-Paralytic ileus
-Facial palsy
Page 1 of 21
, -CBC leukocytosis
-Lymphocytes usually drop in acute phase
-Anemia: normocytic and normochromic
-Elevated platelet count
Kawasaki Disease lab findings -ESR >100
-CRP elevated
-Hyponatremia
-Ferritin may be elevated during acute phase
-ALT and AST elevated
Prolonged PR interval, decreased QRS voltage, arrhythmias, and nonspecific ST
Kawasaki Disease ECG findings
and T wave changes
-CXR with dilated heart and pleural effusion
-Echo with effusion and coronary aneurysms
Kawasaki Disease diagnostics
-Pyuria and mild proteinuria
-Lumbar puncture may show mononuclear pleocytosis
-Comfort measures
-Bedrest and limited physical activity
Kawasaki Disease Non-Pharm Treatment
-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 In patients with coronary artery abnormalities, you want to reduce inflammation
phase and arterial damage and prevent thrombosis
IVIG which may shorten acute phase and decrease prevalence of coronary artery
Kawasaki Disease Pharm Treatment
abnormalities; best if given within first 10 days
Give 80-100mg/kg/day in 4 divided doses until 14th day of illness then decrease to
Kawasaki Disease ASA dosing
3-5mg/kg/day
Kawasaki Disease why do you give Reduces risk of coronary artery involvement and relieves symptoms
concurrent ASA
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
-Extreme caution in patients with acute renal dysfunction or failure
Kawasaki Disease IVIG considerations -Must give with ASA
-Patients in shock appear to have high risk of IVIG resistance
-Avoid ibuprofen use
Kawasaki Disease ASA considerations -Vaccination against flu and varicella necessary for long term use
-Obtain CrCl prior to use and avoid if CrCl <10
Use in patients who don't respond to standard therapies; requires pediatric
Kawasaki Disease steroid use
cardiologist
Kawasaki Disease IVIG resistant treatment Methotrexate or cyclophosphamide
options
Kawasaki Disease Infliximab used for refractory cases with coronary aneurysms; available to kids >6
are used when increased risk for thrombus or with significant coronary
Kawasaki Disease antiplatelet meds involvement
DOC clopidogrel
are used in patients with large aneurysms and are at a high risk for thrombus
Kawasaki Disease anticough
DOC warfarin or heparin
Kawasaki Disease consult with pediatric cardiologist
-Usually frequent for the first 2 months
Kawasaki Disease follow up
-Obtain echo in acute phase and then 6-8 weeks after onset of illness
Page 2 of 21
, subacute tender lymphadenitis that develops after contact with a cat; caused by
Cat Scratch Disease description
bartonella ensilage
Cat Scratch Disease complications hepatitis, neurological complications, or stellate retinitis
-Red macule at contact site and evolves into a nonpruritic papule, vesicle, or
pustule 3-5 days after exposure
Cat Scratch Disease derm evolution
-papule evolves into a fluid filled vesicle and crust 2-3 days
-papule may ulcerate with skin becoming erythematous, indurated, and tender
-Malaise, anorexia, aches, headache, fever
Cat Scratch Disease S/S -Unilateral lymphadenopathy 1-2 weeks after scratch that is self-limited and may
last 2-8 weeks
-Lymphadenopathy in the absence of other reasons
Cat Scratch Disease diagnosis requires 3 -Positive B. ensilage titer or skin test
of the 4 of the following -Known cat contact with pustule or papule on site
-Lymph node biopsy with bacilli present; necrosis
-Local heat application to painful nodes
Cat Scratch Disease non-pharm treatment -Limit vigorous activity
-Biopsy of node
-Analgesics
Cat Scratch Disease pharm treatment -No clear evidence that ABX treatment improves outcome usually resolves in 2-6
months without treatment
Cat Scratch Disease when to sue ABX -Immunocompromise patients susceptible to systematic disease
-Azithromycin
-Bactrim
Cat Scratch Disease ABX options -Doxy
-Erythromycin
-Cipro
Acute, spreading, superficial infection of the skin and subcutaneous structures;
Cellulitis description
characterized by erythema, edema, warmth, and pain
is a superficial form of cellulitis with marked dermal and lymphatic involvement;
Erysipelas description skin is swollen and raised with clear demarcation; GAS usually agent; usually
affects face and LE
-Staph aureus
-MRSA
Cellulitis Etiology -GAS
-H. influenza which is more common in children and commonly associated with
URI
-Trauma
-Undertreated or untreated funiculitis
-Burns
-DM
Cellulitis risk factors -URI in children
-Immunocomplex
-Bug bite
-Laceration
-Advanced age >80
Page 3 of 21
(332 Terms in this set) Latest Update.
an acute, afebrile, immune mediated self-limited disease of young children
Kawasaki Disease description 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
-necrotizing arteritis
-subacute/chronic vasculitis, resulting in pericarditis and myocarditis around
Kawasaki Disease vasculopathy 3 linked
coronary arteries
processes
-luminal myofibroblast proliferative may lead to decrease in lumen diameter
resulting in stenotic vessels
-History of KD increases risk of recurrence
-Siblings of Japanese parents
Kawasaki Disease risk factors
-<5 years old
-Asian decent: Japanese or Korean
-High fever for a least 5 that is unresponsive to ABX
-Oral mucosal lesions that may last 1-2 weeks
Kawasaki Disease Acute phase (1-2 -Perineal rash
weeks) Assessment Findings -Nontender cervical adenopathy
-Painful rash and edema to feet
-Possible MI
-Edema or erythema of the hands and feet
-Conjunctival injection
Kawasaki Disease Diagnostic criteria -Cervical lymphadenopathy
require 5 days of fever and 4 of the -Rash (nonvehicular an polymorphous) maculopapular, diffuse erythroderma, or
following erythema multiform like
-Exudative pharyngitis with diffuse oral erythema, strawberry tongue,
crusting/cracking of lips and mouth
-Desquamation of palms, feet, periungual area, perineal area, coronary artery
aneurysm, joint aches and pain
-Acute MI
Kawasaki Disease Subacute phase (2-8 -Pan carditis
weeks after onset) Assessment Findings -Diarrhea, jaundice, hepatosplenomegaly
-Aseptic meningitis
-Sterile pyuria
-Platelet count may rise to 10000000
Kawasaki Disease Convalescent phase (6- Symptoms usually resolve and sedimentation rate returns to normal
8 weeks after onset) Assessment Findings
-Beau's lines on nails
-Cough
-Rhinorrhea
-Pulmonary infiltrate
Kawasaki Disease nonspecific S/S
-Abdominal pain
-Hydrops of gallbladder
-Paralytic ileus
-Facial palsy
Page 1 of 21
, -CBC leukocytosis
-Lymphocytes usually drop in acute phase
-Anemia: normocytic and normochromic
-Elevated platelet count
Kawasaki Disease lab findings -ESR >100
-CRP elevated
-Hyponatremia
-Ferritin may be elevated during acute phase
-ALT and AST elevated
Prolonged PR interval, decreased QRS voltage, arrhythmias, and nonspecific ST
Kawasaki Disease ECG findings
and T wave changes
-CXR with dilated heart and pleural effusion
-Echo with effusion and coronary aneurysms
Kawasaki Disease diagnostics
-Pyuria and mild proteinuria
-Lumbar puncture may show mononuclear pleocytosis
-Comfort measures
-Bedrest and limited physical activity
Kawasaki Disease Non-Pharm Treatment
-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 In patients with coronary artery abnormalities, you want to reduce inflammation
phase and arterial damage and prevent thrombosis
IVIG which may shorten acute phase and decrease prevalence of coronary artery
Kawasaki Disease Pharm Treatment
abnormalities; best if given within first 10 days
Give 80-100mg/kg/day in 4 divided doses until 14th day of illness then decrease to
Kawasaki Disease ASA dosing
3-5mg/kg/day
Kawasaki Disease why do you give Reduces risk of coronary artery involvement and relieves symptoms
concurrent ASA
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
-Extreme caution in patients with acute renal dysfunction or failure
Kawasaki Disease IVIG considerations -Must give with ASA
-Patients in shock appear to have high risk of IVIG resistance
-Avoid ibuprofen use
Kawasaki Disease ASA considerations -Vaccination against flu and varicella necessary for long term use
-Obtain CrCl prior to use and avoid if CrCl <10
Use in patients who don't respond to standard therapies; requires pediatric
Kawasaki Disease steroid use
cardiologist
Kawasaki Disease IVIG resistant treatment Methotrexate or cyclophosphamide
options
Kawasaki Disease Infliximab used for refractory cases with coronary aneurysms; available to kids >6
are used when increased risk for thrombus or with significant coronary
Kawasaki Disease antiplatelet meds involvement
DOC clopidogrel
are used in patients with large aneurysms and are at a high risk for thrombus
Kawasaki Disease anticough
DOC warfarin or heparin
Kawasaki Disease consult with pediatric cardiologist
-Usually frequent for the first 2 months
Kawasaki Disease follow up
-Obtain echo in acute phase and then 6-8 weeks after onset of illness
Page 2 of 21
, subacute tender lymphadenitis that develops after contact with a cat; caused by
Cat Scratch Disease description
bartonella ensilage
Cat Scratch Disease complications hepatitis, neurological complications, or stellate retinitis
-Red macule at contact site and evolves into a nonpruritic papule, vesicle, or
pustule 3-5 days after exposure
Cat Scratch Disease derm evolution
-papule evolves into a fluid filled vesicle and crust 2-3 days
-papule may ulcerate with skin becoming erythematous, indurated, and tender
-Malaise, anorexia, aches, headache, fever
Cat Scratch Disease S/S -Unilateral lymphadenopathy 1-2 weeks after scratch that is self-limited and may
last 2-8 weeks
-Lymphadenopathy in the absence of other reasons
Cat Scratch Disease diagnosis requires 3 -Positive B. ensilage titer or skin test
of the 4 of the following -Known cat contact with pustule or papule on site
-Lymph node biopsy with bacilli present; necrosis
-Local heat application to painful nodes
Cat Scratch Disease non-pharm treatment -Limit vigorous activity
-Biopsy of node
-Analgesics
Cat Scratch Disease pharm treatment -No clear evidence that ABX treatment improves outcome usually resolves in 2-6
months without treatment
Cat Scratch Disease when to sue ABX -Immunocompromise patients susceptible to systematic disease
-Azithromycin
-Bactrim
Cat Scratch Disease ABX options -Doxy
-Erythromycin
-Cipro
Acute, spreading, superficial infection of the skin and subcutaneous structures;
Cellulitis description
characterized by erythema, edema, warmth, and pain
is a superficial form of cellulitis with marked dermal and lymphatic involvement;
Erysipelas description skin is swollen and raised with clear demarcation; GAS usually agent; usually
affects face and LE
-Staph aureus
-MRSA
Cellulitis Etiology -GAS
-H. influenza which is more common in children and commonly associated with
URI
-Trauma
-Undertreated or untreated funiculitis
-Burns
-DM
Cellulitis risk factors -URI in children
-Immunocomplex
-Bug bite
-Laceration
-Advanced age >80
Page 3 of 21
