2

Question 1

Posterior fontanel closes
Anterior fontanel closes

Answer 1

6 to 8 weeks
12-18 mos

Question 2

Rheumatic Fever
Expected Findigs

Answer 2

○ Hx of recent upper respiratory infection
○ Fever
○ Tachycardia, cardiomegaly, new or changed heart murmur, muffled heart sounds,
pericardial friction rub, and report of chest pain, which can indicate carditis.
○ Nontender, subcutaneous nodules over bony prominence.
○ Large joints with painful swelling, indicating polyarthritis.
○ Pink, nonpruritic macular rash on the trunk and inner surfaces of extremities that appears
and disappear rapidly, indicating erythema marginatum.
○ Chorea (nervousness, behavioral changes, decreased attention span)

Question 3

Kawasaki Disease
Expected Findings
Acute phase

Answer 3

Onset of high fever, lasting 5 days to 2 wks, that is unresponsive to antipyretics
Irritability
Red eyes without drainage
Bright red, chapped lips
Strawberry tongue with white coating or red bumps on the posterior aspect
Red oral mucous membranes with inflammation including the pharynx
Swelling of hands and feet with red palms and soles
Nonblistering rash
Bilateral joint pain
Cardiac: myocarditis,

Question 4

Subacute phase

Answer 4

Resolution of fever and gradual subsiding of other manifestations
Irritability (can last for 2 mos)
Peeling skin around the nails, on the palms and soles
Temporary arthritis (can last for several weeks)

Question 5

Nursing Care

Answer 5

Assess for heart failure (decreased UO, gallop heart rhythm, tachycardia, respiratory
distress).
Monitor I & O
Daily weight
IV fluids to prevent dehydration.
Offer clear liquids and soft, non-acidic foods.
Administer IV gamma globulin.
■ Within the first 10 days of illness.
■ Repeat for pts who remain febrile.
Administer aspirin.

Question 6

Cystic Fibrosis
Respiratory Findings

Answer 6

Stasis of mucus (increased risk of infections)
Early manifestations: wheezing or rhonchi, dry, nonproductive cough
Increased involvement
-Dyspnea
Paroxysmal cough
-Obstructive emphysema and atelectasis on chest x-ray
○ Advanced involvement
-Cyanosis
-Barrel-shaped chest
-Clubbing of fingers and toes
-Bronchitis or bronchopneumonia

Question 7

Cystic Fibrosis