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Week 3 Flashcards

1
Q

structures of the upper airway

A
  • oronasopharynx
  • pharynx
  • larynx
  • upper trachea
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2
Q

structures of the lower airway

A
  • lower trachea
  • bronchi
  • bronchioles
  • alveoli
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3
Q

Infection rates: respiratory

A
  • infants < 3 mo: lower due to maternal antibodies
  • 3-6 mo: rate increases due to maternal antibodies decrease, own antibodies begins
  • toddler/preschool: viral infection rate remains high (exposure)
  • 5 years +: viral rate decreases, but incidence of mycoplasma pneumoniae & strep increase
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4
Q

influences to the response to respiratory tract infections

A
  • diameter of airway is smaller in young children
  • distance between structures is shorter causing organisms to move down respiratory tract quicker
  • shorter and open eustachian tube allows easy access of pathogens to middle ear
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5
Q

factors leading to increased risk of developing URI with decreased resistance

A
  • immune system deficiencies
  • malnutrition
  • anemia
  • fatigue
  • chilling of the body
  • allergies
  • preterm birth
  • asthma
  • cardiac anomalies
  • cystic fibrosis
  • daycare attendance
  • second hand smoke exposure
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6
Q

seasonal variations: respiratory

A
  • winter/spring: RSV season, Influenza A & B
  • Autumn/Early winter: mycoplasmal infection
  • Winter/cold weather: asthmatic bronchitis
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7
Q

respiratory assessment

A
  • respirations (rate, effortless, labored)
  • evidence of infection (fever, enlarged cervical lymph nodes)
  • cough
  • wheeze
  • cyanosis
  • chest pain (from coughing)
  • nasal mucus
  • halitosis
  • strep throat
  • viral infection
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8
Q

URIs

A
  • nasopharyngitis
  • pharyngitis
  • tonsillitis
  • otitis media
  • acute epiglottitis
  • LTB: laryngotracheobronchitis
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9
Q

Nasopharyngitis

A
  • “common cold”
  • caused by: rhinovirus, RSV, adenovirus, flu, parainfluenza virus
  • fever, nasal congestion, irritable, poor feeding, sneezing, cough, muscle aches
  • supportive care
  • AAP does NOT recommend use of decongestants for under 4yrs
  • prevention: frequent hand washing, cover mouth when sneezing, cough.
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10
Q

Pharyngitis

A
  • 80-90% viral
  • 10-20% due to Group A B-hemo strep
  • abrupt onset with fever
  • sore throat
  • headache
  • anterior cervical adenopathy
  • abdominal pain
  • the tonsils and pharynx may be inflamed and covered with exudate
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11
Q

diagnostic: pharyngitis

A
  • rapid strep test
  • if positive: GABHS (strep throat)
  • if negative: likely viral; should confirm with a throat culture
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12
Q

treatment: pharyngitis

A
  • Penicillin (oral or IM)
  • if allergic: erythromycin
  • can also treat with cephalosporins
  • at risk for rheumatic fever and acute glomerulonephritis if not properly treated
  • take entire course of AB! more at risk if partially treated.
  • not contagious after 24h on AB
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13
Q

Nursing management: pharyngitis

A
  • warm water gargles
  • education and stress need to complete entire 10 days of antibiotic
  • prevent exposure: avoid direct contact, cover mouth when cough/sneeze, do not drink/eat from same cup, handwashing
  • prevent reinfection: new toothbrush
  • return to school: after 24 hours on antibiotic and afebrile
  • not contagious after 24 hours on antibiotic
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14
Q

Tonsillitis

A
  • tonsils and adenoids serve as the body’s defense against infection
  • they could become a site for acute and chronic infection
  • tonsils are located on either side of the oropharynx
  • tonsillitis often occurs with pharyngitis
  • “kissing tonsils”: concern with airway
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15
Q

Tonsillitis: clinical manifestations

A
  • same as pharyngitis (fever, sore throat, h/a)
  • inflammation of tonsils and adenoids can cause difficulty eating and breathing
  • hypertrophy can cause hypoxia, snoring, pulmonary HTN
  • adeno-tonsillectomy indicated if 3+ infections/year (other: apnea, FTT, not eating/drinking).
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16
Q

Nursing mgmt: Tonsillitis

A
  • warm water gargles
  • mild analgesics (acetaminophen)
  • post-surgical intervention: ice collar, monitor bleeding, nausea, vomiting, fluid intake, pain management, vital signs
  • signs of bleeding/hemorrhage: risk occurs 7-10 after surgery (when scab begins to fall off from post surgical tissue healing)
    • drooling bright red blood
    • frequent swallowing (child is attempting to clear airway of blood by swallowing)
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17
Q

T&A: diet post op

A
  • after fully alert: cool water, crushed ice, flavored ice pops, cool diluted juices (avoid fluids with red or brown and avoid citrus juices)
  • first to second post op day: soft foods, soups, mashed potatoes (avoid mild and ice cream- coats the mouth and if child coughs, may initiate bleeding)
  • avoid rough, scratchy foods and spicy foods
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18
Q

Otitis Media

A
  • acute is most frequent diagnosis in outpatient pediatric clinics in the US
  • defined by presence of fluid in the middle ear with inflammation
  • most prevalence in infancy (6-24mo)
  • incidence declines with age
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19
Q

risk factors: Otitis Media

A
  • age: 6-18mo due to anatomy of eustachian tube (short and straight)
  • day care: spread of respiratory infections among children
  • formula fed infants: children that are breast fed have fewer episodes likely due to immunologic protective factors and positioning
  • exposure to cigarette smoke: enhances attachment of pathogens in the middle ear space
  • pacifier use: higher incidence (4mo cutoff)
  • underlying disease (cleft palate, down syndrome, allergic rhinitis)
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20
Q

Otitis Media: pathogen

A
  • bacterial: Streptococcus pneumoniae, Hermophilus influenzae, Moraxella catarrhalis
  • viral: rhinovirus, RSV, coronaviruses
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21
Q

Otitis Media: symptoms

A
  • antecedent event: URI, nasal congestion, allergies
  • fever
  • otalgia (ear pain)
  • hearing loss (older kids)
  • otorrhea: ear purulent discharge
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22
Q

Otitis Media: treatment

A
  • oral antibiotics (high dose Amoxicillin) for 10 days

- if no improvement (fever, ear pain) in 2-3 days may need AB changed

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23
Q

Otitis Media: nursing management

A
  • family teaching: avoid risk factors
  • pain and fever mgmt: Ibuprofen or acetaminophen, topical ear drops (benzocaine)
  • stress completion of AB
  • prevention: immunizations, breast feeding, avoid propping the bottle, discontinue pacifier, prevent exposure to cigarette smoke
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24
Q

Croup syndromes

A
  • acute epiglottitis

- acute LTB

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25
Q

Acute epiglottitis: incidence

A
  • significant decrease in children after the addition of Hib vaccine to routine immunization schedule in the US
  • most commonly affected in 2-8yo
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26
Q

Acute epiglottitis

A
  • aka supraglottitis
  • inflammation of the epiglottis and adjacent supraglottis
  • without treatment can progress to life-threatening airway obstruction
  • Haemophilus influenzae type b (Hib) is the most common infectious cause
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27
Q

Acute epiglottitis: CM

A
  • abrupt onset
  • sore throat, pain or swallowing
  • fever
  • tripod: insists on sitting upright and lean forward, chin thrust out, mouth open and tongue protruding
  • drooling of saliva
  • irritable, restless, anxious
  • retractions may be evident
  • mild hypoxia to frank cyanosis
  • 3 D’s: dysphagia, drooling, distress
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28
Q

Acute epiglottitis: treatment

A
  • suspected epiglottitis is a medical emergency
  • prompt recognition and treatment are critical
  • maintenance of airway is the focus
  • examination should occur in setting where airway can be secured immediately (OR, ED, ICU)
  • if suspect this, DON’T INSPECT MOUTH
  • antibiotics
  • humidified supplemental oxygen (if indicated)
  • artificial airway (endotracheal intubation, nasotracheal intubation)
  • nebulized epinephrine
  • corticosteroids
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29
Q

Acute epiglottitis: prevention

A
  • routine childhood immunizations (hib)
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30
Q

Acute epiglottitis: nuring management

A
  • recognize s/s
  • comforting/calming measures to decrease child’s anxiety
  • avoid throat inspection
  • administer humidified mist, oxygen, nebulized epinephrine, oral/parental medications as needed
  • assist with intubation as required
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31
Q

Acute LTB

A
  • most common croup syndrome
  • mostly affects children <5yo
  • parainfluenza virus types 2 and 3
  • RSV, influenze A & B, M. pneumoniae
  • usually preceded by a URI
  • gradually descends to structures
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32
Q

Acute LTB: CMs

A
  • gradual onset of low-grade fever
  • barky, seal-like cough
  • inflammation of larynx and trachea causes inspiratory stridor and retractions, nasal flaring
  • hoarseness
  • can progress to respiratory failure (obstruction)
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33
Q

Acute LTB: treatment

A
  • maintaining airway
  • high humidity with cool mist
  • cool humidifiers or breathing cool humid air outside are effective in reducing mucosal edema
  • mist: sitting in the bathroom filled with steam generated by running warm water from the shower
  • avoid steam vaporizers to prevent scald burns
  • fever reduction, antipyretics
  • dexamethasone to reduce swelling
  • nebulized epi
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34
Q

Acute LTB: nursing mgmt

A
  • assessment of respiratory status
  • recognition of deteriorating respiratory condition
  • administration of cool humidified mist, nebulized epinephrine, oral corticosteroids
  • inform parents of status, decrease anxiety
  • teach parents signs of resp. distress
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35
Q

Lower airway infections

A
  • Bronchitis (RSV, Bronchiolitis)
  • Pneumonias
  • Asthma
  • Cystic Fibrosis
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36
Q

Bronchitis

A
  • inflammation of the trachea and bronchi
  • frequently associated with URI
  • viral agents 6yo
  • dry, hacking nonproductive cough
  • self-limiting (5-10 days)
  • rest, antipyretics, humidity
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37
Q

Bonchiolitis (RSV)

A
  • acute viral infection at the bronchiolar level
  • winter and early spring
  • RSV is the most frequent cause of hospitalization in children <1yo
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38
Q

Bonchiolitis (RSV): CMs

A
  • usually begins with URI
  • low grade fever, OM, conjunctivitis
  • cough, wheezing, pharyngitis, poor feeding
  • can progress to cyanosis retractions, tachypnea
  • lot of de-satting, o2 decrease
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39
Q

Bonchiolitis (RSV): diagnostic

A
  • nasal or nasopharyngeal secretions
  • rapid immunofluorescent antibody (DFA)
  • enzyme-linked immunosorbent assay (ELISA) for RSV antigen
  • contact precautions
  • good to know ahead of time before placing in a room with another immunocompromised child
40
Q

Bonchiolitis (RSV): treatment

A
  • cool humidified oxygen
  • fluid hydration
  • hospitalized if: underlying lung or heart condition, dehydration, respiratory distress
  • bronchodilators may provide short term benefits (may or may not work)
41
Q

Bonchiolitis (RSV): prevention

A
  • avoid exposure to tobacco smoke
  • restrict day care during RSV season for high-risk infants (pre-me, cardiac, lung conditions)
  • hand washing
  • Immunoprophylaxis (synagis) to high risk groups (prematurity, significant congenital heart disease, bronchopulmonary dysplasia) IM q1m x 5
42
Q

Bonchiolitis (RSV): nursing mgmt

A
  • contact and droplet precautions in hospitalized infant to prevent spread
  • hand washing
  • maintain airway
  • suction nares with normal saline drops
  • ensure adequate fluid intake
  • administer bronchodilator meds
  • encourage continuation of breast feeding
43
Q

bacterial pneumonia: children under 4

A
  • infants <95%)
  • cough, fever, tachypnea, malaise, crackles, decreased breath sounds, rales
  • treatment with Amoxicillin
44
Q

Pneumonias

A
  • inflammation of pulmonary parenchyma
  • occurs more frequently in infancy and early childhood
  • viral or bacterial
45
Q

bacterial pneumonia: children 5+

A
  • atypical: m. pneumoniae and Chlamydophlia pneumoniae are the most common pathogens
  • fall and winter months
  • treated with erythromycin, clarithromycin, and azithromycin
  • hospitalization is rare
46
Q

bacterial pneumonia: nursing mgmt

A
  • identify illness
  • promote adequate oxygenation
  • mediation administration: antipyretics, antibiotics, nebulized medications
  • monitor resp. status
  • maintain adequate hydration
  • encourage childhood immunizations to prevent bacterial pneumonia (PCV)
47
Q

asthma

A

a chronic inflammatory disease of the airways characterized by:

  • variable and recurring symptoms of cough, wheezing, dyspnea, and chest tightness (usually related to a specific triggering event)
  • airway obstruction
  • bronchial hyper-responsiveness
  • underlying inflammation
48
Q

hyperreactivity: asthma

A

airway (bronchial) smooth muscle contracts in response to irritants or allergens
- smoke, pollen, mold, dust, exercise, emotions, changes in weather, roaches, air pollution, colds, animals, foods, etc.
Made worse by many of the pro-inflammatory markers (mast cells, macrophages, etc…)

49
Q

obstruction: asthma

A
  • swelling/inflammation
  • mucus hyper-secretion and mucus plugging
  • spasm of the smooth muscle of the bronchi and bronchioles
  • airway remodeling which may include structural changes to the airway, i.e. thickening of the muscle, fibrosis
  • leads to air-trapping
50
Q

etiology: asthma

A
  • atopy: the genetic predisposition for the development of immunoglobulin E
  • viral respiratory infections: are one of the most important causes of asthma exacerbation, may also contribute to the development of asthma
  • genetics
51
Q

s/s: asthma

A
  • wheezing
  • prolonged expiratory phase
  • coughing
  • chest tightness
  • SOB
  • retractions
  • may progress to cyanosis
  • nasal flaring
52
Q

wheezing: asthma

A
  • a musical, high pitched sound caused by turbulent airflow
  • caused by air going through a narrow opening
  • can be “end-expiratory” or occur any time in respiratory cycle
  • diminished breath sounds during an asthma exacerbation= medical emergency
  • can go quickly from respiratory arrest to cardiac arrest
53
Q

cough: asthma

A
  • hacking, dry, nonproductive; can become rattling and productive
  • caused by stimulation of mechanical and chemical receptors in the airway
  • hallmarks of asthma is “night cough”
  • also consider asthma if cough recurs seasonally, or if it occurs as a response to specific exposures
54
Q

pulmonary function test: asthma

A
  • measures forced air expiration to look for signs of obstruction and reversibility
  • FVC is forced vital capacity, total amt of air that can be exhaled after maximal inspiration
  • FEV1 is fev in 1 second (reduced in asthma)
55
Q

assessing control: asthma

A 
ongoing (q1-6m)
based on:
- symptoms
- nighttime awakenings
- interference with normal activity
- SABA use for symptoms control
- Lung function
classifications of control: well, not well, very poorly controlled
56
Q

exercise induced bronchospasm

A
  • exercise may be the only precipitant of asthma symptoms for some patients
  • exercise can be a trigger in children with a h/o asthma
  • EIB usually occurs during or minutes after vigorous activity, reaches its peak 5-10 minutes after stopping the activity
  • diagnosed with an exercise challenge test
  • inhaled beta2 agonists will prevent EIB in more than 80% patients. use SABA shortly before exercise. a warm up period may reduce the degree.
57
Q

short-acting B-2 agonist (SABA)

A
  • Albuterol/Xopenex
  • inhaled MDI (pump) or nebulizer (infants)
  • MDI must use spacer
  • causes relaxation of airway smooth muscle
  • for acute relief of symptoms, rapid onset, short duration (3-4h)
58
Q

Long-acting B-2 agonist (LABA)

A
  • Salmeterol/Formoterol
  • for long-term control
  • Must be used with an ICS
  • slower onset, long duration (12h)
  • not “rescue”
59
Q

Inhaled corticosteroids: asthma

A
  • Budesonide/Fluticasone
  • Anti-inflammatory drugs used at lowest possible dose, used long term to control symptoms and reduce bronchial hyper responsiveness
  • can lose 1-2 inches of adult height
60
Q

Systemic corticosteroids: asthma

A
  • oral or IV anti-inflammatory
  • for acute exacerbation not improving on albuterol alone
  • 3-10d course typical
  • frequent use can have systemic effects
61
Q

Leukotriene receptor antagonist (LTRA)

A
  • Montelukast (Singulair)
  • block broncho-constrictive mediator
  • chewable tablet, sprinkles
62
Q

preventative measures: asthma

A
  • know what triggers are
  • avoid common respiratory irritants
  • reduce exposure to dust mites
  • encasing mattresses and pillows in allergen impermeable covers
  • remove carpets
  • clean regularly (wash all beddings in hot water weekly, use a damp rag or mop to thoroughly clean dusty surfaces)
  • remove stuffed animals from bedroom
63
Q

Monitoring asthma: peak flow meter

A
  • make sure device is at 0
  • stand up
  • take deep breath
  • place meter in mouth and close lips around mouthpiece
  • blow out as hard and fast as possible
  • do not cough or put tongue in opening
  • repeat process 2 more times
  • take best reading
64
Q

interpreting peak expiratory flow rates

A
  • predicted vs. personal best
  • Green (80-100% of pb)
  • Yellow (50-80%)
  • Red (below 50%)
65
Q

asthma action plan interpretation

A
  • green zone: good control. continue as usual.
  • yellow zone: caution. give rescue meds.
  • red zone: danger. give meds, get to ER
66
Q

Nursing management of asthma: acute

A
  • administration of o2, medication, IV hydration
  • frequent VS, o2 sat, respiratory assessment (q1-2h)
  • be alert to progression of respiratory status (wheezing to decreased breath sounds)
  • provide reassurance to patient and family
67
Q

Nursing management of asthma: long-term care

A 
EDUCATION
- avoid allergens
- medication administration
- asthma action plan intervention
- peak flow/spirometry
Monitor child's progress with asthma care
68
Q

how to use MDI correctly

A
  • prime inhaler before first use
  • shake inhaler for 5 seconds before each use
  • use a spacer
  • rinse mouth out with water, spit out
69
Q

cystic fibrosis

A
  • autosomal recessive
  • altered CF gene causes breakdown in transport of Cl and Na ions across epithelial membrane
  • affects all exocrine (mucus producing) glands
70
Q

CF pathophysiology

A

Multi-system involvement

  • respiratory system
  • pancreas
  • liver
  • small intestine
  • skin
  • reproductive tract
71
Q

CF: pulmonary involvement

A
  • progressive lung disease due to infection, inflammation, and mucous plugging
  • leading cause of morbidity and mortality
  • colonized w/ staph aureus early in life, then Pseudomonas, MRSA, and others
  • progressive air trapping, bronchiectasis, and atelectasis
72
Q

CF: pancreas involvement

A
  • if pancreatic insufficiency, then deficient enzymes to absorb fats and develop malabsorption, oily stools, cramping
  • Vitamin A,D,E, and K deficiencies (can’t absorb)
  • later can develop pancreatic endocrine dysfunction: CF related diabetes
  • pancreatitis
73
Q

CF: other systems

A

Liver
- biliary sludging, potentially leading to gallstones and cirrhosis
Intestinal
- Meconium ileus at birth, and/or distal intestinal obstruction syndrome (DIOS) later
Skin: leads to dehydration
- lose salt in sweat, so become hyponatremic, hypochloremic, metabolic acidosis

74
Q

CF: reproductive involvement

A

Males:
- absent or blocked vas deferens
- 98% of males are sterile
Females:
- thick and sticky vaginal and cervical mucous
- sperm are blocked from reaching the egg in the uterus

75
Q

CF: Clinical Manifestations

A 
General
- FTT
- salty tasting skin
Respiratory
- frequent pulmonary infections, chronic cough, bronchiectasis, atelectasis, hyperinflation, hypoxia, retractions, wheezing/crackles/rhonchi 
Extremities
- clubbing
GI
- meconium ileus in newborns, greasy stools, foul smelling stools, rectal prolapse, anorexia
Reproductive
- infertility in males
Depression
Nasal Polyps
76
Q

Diagnosing CF

A
  • NYS newborn screen started testing for CF in 2002
  • elevated sweat chloride test
  • DNA identification of mutant genes
77
Q

CF: pulmonary management

A
  • airway clearance (PT) (Acapella, ChestVest)
  • inhaled antibiotics
  • mucolytics
  • Azithromycin (risk for recurrent mycoplasma pneumonias)
  • +/- asthma tx
  • +/- anti-inflammatories (NSAIDS)
78
Q

CF: GI management

A
  • Pancreatic supplementation
  • Nutrition
  • ADEK vitamins
  • GERD management
  • Glucose tolerance testing/Diabetes management
  • Actigal for biliary stasis: dissolves gallbladder stones, helps remove and/or dissolve bile ducts obstruction
79
Q

CF: Nursing management

A
  • assist with diagnostic testing
  • treatments: o2, nebs, CPT
  • medication administration: vitamins, insulin, pancreatic enzymes, antibiotics, antifungal, anti-inflammatory
  • provide emotional support
  • encourage well balanced nutrition (high in calorie and protein)
  • assist with nighttime enteral feedings
  • maintain PICC line/Broviac
  • compliance with management, liaison between school, home, specialists
80
Q

infant clinical history and red flags for CV disorders

A
  • feeding patterns: poor feeding, poor weight gain, sweating with feeds
  • breathing patterns: sustained tachypnea (60-70 all the time)
  • prenatal/birth history: maternal illness, alcohol or drug exposure, prematurity
81
Q

toddler/school age/adolescent red flags: CVD

A

activity level: fatigue, unable to keep up with peers

82
Q

classification of congenital heart disease

A

Acyonotic:
- increased pulmonary blood flow: atrial or ventricular septal defect, patent ductus arteriosus, AV canal
- obstruction to blood flow from ventricles: aortic stenosis, pulmonic stenosis, coarctation of aorta
Cyanotic:
- decreased pulmonary blood flow: tetrology of Fallot, tricuspid atresia
- mixed blood flow: transposition of great arteries, total anomalous pulmonary venous return, truncus arteriosus, hypoplastic left heart syndrome

83
Q

defects with increased pulmonary blood flow

A
  • atrial septal defect
  • ventricular septal defect
  • atrioventricular canal defect
  • patent ductus arteriosus
84
Q

ASD

A
  • hole in atrial septum
  • blood shunts LA to RA
  • clinical presentation: if small, may be asymptomatic, if large s/s CHF
  • treatment: cardiac cath to fix hole, open heart surgery
85
Q

VSD

A
  • hole in ventricular septum
  • blood shunts LV to RV
  • clinical presentation: s/s CHF, characteristic holosystolic murmur (swooshing beginning of S1 to end of S2)
  • treatment: cardiac cath, open heart surgery
86
Q

Defects with decreased pulmonary blood flow

A
  • Tetralogy of Fallot

- Tricuspid atresia

87
Q

Tetralogy of Fallot

A 
typically 4 defects:
- VSD
- pulmonary stenosis
- overriding aorta
- RV hypertrophy
Clinical presentation
- "pink tet": pink at birth followed by some cyanosis (but not always)
- cyanotic tet
Treatment
- open heart surgery: palliative shunt to increase pulmonary blood flow, complete repair
88
Q

Digoxin

A
  • weigh risk vs. benefit
  • focus on bradycardia and hyperkalemia
  • consistent administration: 1 hr before or 2 hrs after meals (absorbs better on empty stomach)
  • IV: administer over 5-10min
  • do not administer if HR <70 in children
  • maintain potassium levels: 1/2 banana per day
89
Q

Lasix

A
  • teach parents about I/O
  • pay attention to orthostatic hypotension, electrolyte disturbances, dehydration
  • administration: may be administered with food or milk to decrease GI distress
  • hearing evaluation if hx high dosages
90
Q

Acquired heart diseases

A
  • infective endocarditis
  • Kawasaki disease
  • rheumatic fever
  • hyperlipidemia
  • arrhythmias
  • pulmonary artery HTN
  • cardiomyopathy
91
Q

Kawasaki Disease

A
  • unknown etiology: may be related to an infectious disease and underlying abnormalities in the immune system by an infectious insult
  • acute, generalized systemic vasculitis involving blood vessels throughout the body (pref. coronary arteries)
  • usually self-limited
  • without treatment 15-25% will develop coronary artery aneurysms.
92
Q

Kawasaki disease diagnosis

A

high fever ( > 102 F 39 C) persisting at least 5 days AND presence of at least 4:

  • changes in extremities: erythema of palms and soles, peeling
  • nonspecific polymorphous rash
  • bilateral nonexudative conjunctivitis
  • changes in lips and oral cavity (strawberry tongue)
  • cervical lymphadenopathy
  • echo: pick up coronary artery abnormalities
  • if 4+ criteria present, can be diagnosed on 4th day of illness
93
Q

Kawasaki disease treatment

A
  • aspirin: high dose in acute phase, low dose for 6-8 weeks if no coronary involvement
  • IVIG
  • steroids for those who fail to respond to initial therapy
    no coronary involvement:
  • echo
  • risk assessment q5years. known to habe higher BP and altered lipid metabolism.
    with coronary involvement:
  • small aneurysms: low dose ASA 1 year
  • large: ASA, possibly warfarin
  • 50% resolve post onset
94
Q

Acute Rheumatic Fever

A
  • delayed sequela of GABHS infection
  • big problem in developing countries
  • exaggerated immune response to bacteria in a susceptible host
  • family history of ARF, low SES, b/t 6-15yo
95
Q

Jones criteria for diagnosing ARF

A 
evidence of preceding GABHS infection (+ throat cx/rapid test or + strep antibody titer) PLUS 2 major criteria or 1 major, 2 minor
MAJOR:
- carditis
- polyarthritis
- Sydenham's chorea (dance)
- erythema marginatum
- subcutaneous nodules
MINOR:
- fever
- arthralgia
- increased CRP, ESR
- prolonged PR interval
96
Q

treatment of ARF

A

Primary prevention
- treat acute GABHS tonsillitis/pharyngitis infections appropriately
- antibiotics (PCN, Erythromycin)
Goals of treatment
- symptom relief
- rest
- eradication of GABHS
Secondary prevention
- pts who have had ARF and develop subsequent GABHS infx are at high risk for recurrent ARF with progression to or worsening of RHD
- should continue until 21yo or 10y from a most recent acute attack, possibly lifelong depending on degree of cardiac involvement

Peds (6 decks)

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