Acquired Cardiac Conditions

Question 1

Rheumatic Fever

Answer 1

Follows infection by some strains of group beta-hemolytic streptococci
May lead to permanent heart valve damage

Question 2

Bacterial (infective) Endocarditis

Answer 2

Inflammation of lining, valves, & arterial vessels
Streptococcus or Staphylococcus
Prevention important; e.g., prophylactic antibiotics before dental procedures

Question 3

Kawasaki Disease

Answer 3

Unique to kids
Mucocutaneous Lymph Node Syndrome
Acute systemic inflammatory illness
Widespread inflammation of small & medium size blood vessels (coronary arteries most susceptible)
May lead to dilation of coronary arteries & aneurysm formation
Most common cause of acquired heart disease in children in US and Japan
Etiology unknown
Primary cause theorized to be infection with organism or toxin but not spread person-to-person
Most often late winter & early spring

Question 4

Diagnostic Criteria for Kawasaki

Answer 4

Fever for at least 5 days, unresponsive to antipyretics & antibiotics
Must have 4 of the following:
1. changes in extremities:
acute - erythema or palms & soles, edema of hands & feet
subacute - peeling of hands & feet in 2nd and 3rd week
2. polymorphous rash
3. bilateral conjunctival inflammation without exudate
4. Changes in lips & oral cavity
- erythema, dryness & cracking of lips, oropharyngeal reddening, or “strawberry tongue”
5. Cervical lymphandenopathy, usually unilateral

Question 5

Labs to diagnose Kawasaki

Answer 5

CRP and ESR

Question 6

Acute Stage of Kawasaki Disease

Answer 6

Fever, conjunctival hyperemia, red throat, strawberry tongue, swollen hands & feet, rash, enlargement of cervical lymph nodes, +++ irritable

Question 7

Subacute Stage of Kawasaki Disease

Answer 7

cracking lips & fissures, desquamation of skin on tips of fingers & toes, joint pain, arthritis, cardiac disease, & thromboytosis; irritability continues

Question 8

Convalescent stage

Answer 8

Appears normal but lingering signs of inflammation
Increased ESR
6-8 weeks after onset, all blood values return to normal
Cardiac involvement: MI, coronary artery aneurysm

Question 9

treatment & management of Kawasaki Disease

Answer 9

Medication: IVIG and Aspirin (helps with fever)
Nursing Care: assessment of S&S; tolerance of medication, promote comfort, passive ROM, discharge teaching re: aspirin and cardiac follow up