Cardiac+Round+3

//**Cardiac Round 4:**// //**Acquired Heart Disease:**// Rheumatic Fever Kawasaki Disease Infective Endocarditis

**Rheumatic fever (ARF)** media type="youtube" key="cQ8ORDjU9HU" width="546" height="408"

Follows streptococcal pharyngitis Thought to be an auto immune response 3 organ systems affected
 * Heart
 * Central nervous system
 * Joints

Major Manifestations: Carditis Polyarthritis Sydenham’s Chorea <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Erythema marginatum <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Subcutaneous nodules

<span style="color: #e03838; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Minor Manifestations: <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Arthralgia <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Fever <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Elevated erythrocyte sedimentation rate (ESR) <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Elevated C-reactive protein (CRP) <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Prolonged PR on ECG

<span style="color: #e03838; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Supporting evidence: <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Positive throat culture <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Elevated streptococcal antibody titer <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Possibly new systolic murmur

<span style="color: #e03838; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Treatment: <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Bedrest <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Antibiotics PCN <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Prophylactic antibiotics later prior to invasive surgery <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">High dose aspirin/antacids <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Outpatient/ family teaching

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Example of Sydenham's Chorea

media type="youtube" key="RnxqqW_nH0k" width="504" height="377"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">P.A.N.D.A. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Pediatric <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Autoimmune <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Neuropsychiatric <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Disorders <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Associated with <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Streptococcal infections

media type="youtube" key="jFdf558PK80" width="560" height="315"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Rheumatic Fever

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">media type="youtube" key="0J6Tf3cv8sg?version=3" height="408" width="560"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">"Scarlet fever is a fever caused by Group A beta hemolytic Streptococcus bacteria which cause infection, particularly strep throat. This bacteria produces toxins. These toxins cause rashes in the body which are more evident under the arms and in the groin. Their face also becomes reddish while the area around the lips is pale. The treatment for scarlet fever is antibiotics such as penicillin or erythromycin. If not treated, it can cause rheumatic fever and sepsis which should be avoided.
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Difference between Scarlet fever and rheumatic fever since they are both caused by strep? **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Rheumatic fever, on the other hand, is a complication of scarlet fever particularly the strep throat. It is also caused by a Group A Strep infection. This occurs after a month of having strep throat. The signs of rheumatic fever are arthritis or painful, swollen joints and fever. The usage of antibiotics can prevent rheumatic fever from occurring after a strep infection. If the toxins from the strep throat descend into the heart, it can cause rheumatic [|heart] disease. In the long term, it may damage the heart valves that may cause heart failure. This requires immediate surgery to the valves of the heart. So to prevent this, prevention is better than the cure.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Rheumatic fever affects young people usually from ages 5 and above up to 17 years old. Scarlet fever also affect the young people, but babies should be monitored as well if they are diagnosed with it. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Scarlet fever is diagnosed through blood tests. The results show leukocytosis, neutrophilia, high ESR, and C-Reactive protein. It also shows elevated anti-streptolysin O titer. Rheumatic fever is diagnosed through Jones Criteria made by Dr. Duckett Jones in 1944. This was then revised by the American Heart Association with the help of other groups. The Jones Criteria is made up of major and minor criteria. Rheumatic fever is confirmed with the presence of one major criterion plus two minor criteria and presence of infection, or two major criteria plus two minor criteria and presence of infection." Read more: [|Difference Between Rheumatic Fever and Scarlet Fever | Difference Between | Rheumatic Fever vs Scarlet Fever] [|http://www.differencebetween.net/science/health/difference-between-rheumatic-fever-and-scarlet-fever/#ixzz3qxx81UAB] <span style="color: #e03838; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Multi system vasculitis, proclivity toward coronary arteries media type="youtube" key="kBo1DT4uEsE" width="616" height="346" <span style="color: #e03838; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Manifestations: <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Conjunctival redness, photophobia <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Erythematous rash <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Oral changes, strawberry tongue, cracking lips, diffuse red oropharyngeal mucosa <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Lymphadenopathy (unilateral cervical nodes) <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Changes in the hands and feet, edematous, desquamation (peeling)
 * <span style="color: #e03838; font-family: 'Times New Roman',Times,serif; font-size: 180%;">Kawasaki Disease: **

<span style="color: #e03838; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Treatment: <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Intravenous immune globulin <span style="color: #e03838; font-family: 'Times New Roman',Times,serif; font-size: 130%;">***Aspirin*** <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Occasionally Methylprednisolone <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Anticoagulation if giant aneurysms

<span style="color: #e03838; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Nursing Management: <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">S&S of CHF <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Administration of IG ( same as blood product administration)

<span style="color: #e03838; font-family: 'Times New Roman',Times,serif; font-size: 140%;">Supportive nursing care: <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">soft foods <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">lip balm <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">lotions <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">adequate intake output <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">child life <span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">Family teaching

<span style="font-family: 'Times New Roman',Times,serif; font-size: 120%;">media type="youtube" key="a635TBE2syo?version=3" height="377" width="504"


 * <span style="color: #e03838; font-family: 'Times New Roman',Times,serif; font-size: 180%;">Infective Endocarditis: **

<span style="color: #bc1a1a; font-family: 'Times New Roman',Times,serif; font-size: 18px;">References:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 14pt;">O'Brien, P., & Baker, A. L. (2009). Chapter 25: The child with cardiovascular dysfunction. In M. J. Hockberry & D. Wilson (Eds.), Wong's essentials of pediatric nursing (8th ed., pp. 861-910). St. Louis, MO: Mosby Elsevier.

[|Difference Between Rheumatic Fever and Scarlet Fever | Difference Between | Rheumatic Fever vs Scarlet Fever] [|http://www.differencebetween.net/science/health/difference-between-rheumatic-fever-and-scarlet-fever/#ixzz3qxx81UAB]

<span style="color: #bc1a1a; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Videos: Rhematic fever https://youtu.be/cQ8ORDjU9HU

St Vitis Dance https://youtu.be/RnxqqW_nH0k

PANDA https://youtu.be/jFdf558PK80

<span style="color: #bc1a1a; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Kawasaki https://youtu.be/kBo1DT4uEsE