Posted: May 1st, 2022

Week 9 Discussion Comment CC: “fever ranging from 101 – 104.7 for 7 days”

Dialogue #1

Subjective
CC: “fever beginning from 101 – 104.7 for 7 days”
HPI: 18 month earlier female is accessible in alongside together with her mother with grievance of this being the seventh day alongside together with her working fever. The fevers range from 101 to 104.7. Mom took her to the ER on the 4th day of working a fever. Throughout the ER they drew blood and urine cultures which had been unfavorable, CBC, and CMP.
ROS: Mother admits to fever x 7 days. She took her to the ER on the 4th day. Blood and urine cultures resulted unfavorable.
MEDICAL HISTORY: none well-known
OBJECTIVE:
Vitals: Temperature: 101.5 ranges Fahrenheit, Coronary coronary heart worth: 120 beats/minute, Respiratory worth: 20 breaths/minute, Blood pressure: 90/40
Bodily examination: She has injected conjunctiva, palmar redness, magenta-coloured lips, purple macula, excoriating rashes inside the diaper area
Labs and diagnostic examination: CBC and CMP was ordered inside the ER. CRP, ESR, ALT, AST. Laboratory parameters are used for the Assessment and Assessment of circumstances of victims for any inflammatory sickness. The severity of irritation in KD is mirrored by inflammatory parameters; thus, laboratory findings are helpful for diagnosing incomplete KD and evaluating victims for early prediction of IVIG non-responsiveness (Lee, Rhim, & Kang, 2015). A extreme white blood cell rely and the presence of anemia and irritation are indicators of Kawasaki sickness.
ASSESSMENT
Major Assessment: Kawasaki sickness Medical manifestations of KD embrace prolonged fever,10-11 days, conjunctival injection, oral lesions, polymorphous pores and pores and skin rashes, extremity modifications, and cervical lymphadenopathy, all of which comprise diagnostic requirements (Lee, Rhim, & Kang, 2015). Electrocardiogram measure impulses of your child’s heartbeat. Kawasaki sickness may trigger coronary coronary heart rhythm points.
Differential Assessment: Group A streptococcal Pharyngitis. Fever, headache, rash, and tiny purple spots on the realm behind the roof of the mouth (easy or arduous palate). If untreated, strep throat may trigger issues, much like kidney irritation or rheumatic fever. Rheumatic fever can lead to painful and contaminated joints, a particular type of rash, or coronary coronary heart valve damage.
Stevens-Johnson Syndrome (SJS) and toxic epidermal necrosis (TEN) are very essential pores and pores and skin circumstances which will happen due to illness or as negative effects to medicines. Unexplained widespread pores and pores and skin ache. A purple or purplish rash that spreads. Blisters in your pores and pores and skin and the mucous membranes of the mouth, nostril, eyes and genitals. Shedding of pores and pores and skin inside days after blisters variety.
Treatment: To chop again the prospect of issues, it is best to start out remedy for Kawasaki sickness as shortly as attainable to lower fever and irritation and cease coronary coronary heart damage. Infusion of an immune protein (gamma globulin) intravenously can lower the prospect of coronary artery points. Extreme doses of aspirin would possibly help cope with irritation. Aspirin may even decrease ache and joint irritation, along with in the reduction of the fever. Kawasaki remedy is a unusual exception to the rule that claims aspirin shouldn’t be given to youngsters. Aspirin has been linked to Reye’s syndrome, a unusual nevertheless doubtlessly life-threatening scenario, in youngsters recovering from chickenpox or flu. Children should be given aspirin solely beneath the supervision of a doctor. As quickly because the fever goes down, your child would possibly should take low-dose aspirin for not lower than six weeks and longer if he or she develops a coronary artery aneurysm. Aspirin helps cease clotting. Monitoring nicely being of the middle at frequent intervals, sometimes at six to eight weeks after the illness began, after which as soon as extra after six months (Pilania, Bhattarai, & Singh, 2018).
Education: You will have to keep up the adjust to up appts after remedy. First adjust to up inside 2 weeks and repeat EKG. Then as soon as extra 6 to eight weeks after their fever first started. Reside viral vaccines should be postponed not lower than 11 months after IVIG, on account of IVIG may trigger the vaccines to be ineffective. Adjust to a coronary coronary heart nutritious food regimen and lifestyle. Ranges of ldl cholesterol should be checked every 5 years (Healthful Children, 2020).
ANTICIPATORY GUIDANCE: Adjust to coronary coronary heart nutritious food regimen. Search early remedy recurrent fevers and keep adjust to ups to look at the middle after remedy.
Dialogue #2

The options to the questions are to be posted in following the SOAP NOTE FORMAT beneath. You are to include the headings and subheadings beneath in your reply:
SUBJECTIVE
CC: seven-day historic previous of fever beginning from 101 to 104.7 ranges Fahrenheit.
HPI: An eighteen-month-outdated child, nicely-identified to your observe, presents to the ER with a seven-day historic previous of fever beginning from 101 to 104.7 ranges Fahrenheit
ROS: Eyes- sclera optimistic for Injected conjunctiva, lips magenta, purple macula, extremities- palmar erythema, groin/genitalia optimistic for excoriating rash.
MEDICAL HISTORY – none, 18 month- earlier, no completely different historic previous provided
OBJECTIVE
VITALS
Temperature: 101.5 ranges Fahrenheit
Coronary coronary heart worth: 120 beats/minute
Respiratory worth: 20 breaths/minute
Blood pressure: 90/40

PHYSICAL EXAM
• Injected conjunctiva
• Palmar redness
• Magenta-coloured lips
• Purple macula
• Excoriating rashes inside the diaper area

LABS & DIAGNOSTIC RESULTS -urine and blood cultures (unfavorable), CBC and CMP completed in ER. Further testing helpful to include CRP and ESR. CBC and blood cultures to guage presence of an an infection, and oxygenation standing, notably to rule out endocarditis which will very nicely be related to the scenario. CPR (c reactive protein) is elevated in response to irritation, sooner than ESR does. CRP ranges between zero.Three and three.zero level out extreme risk for trauma, an an infection or inflammatory sickness. ESR (erythrocyte sedimentation worth) moreover displays irritation severity in symptomatic victims with ongoing sickness processes that need further investigation. In an 18 month-outdated child the ESR should be beneath 10 (Pagana & Pagana, 2018).

ASSESSMENT
PRIMARY DIAGNOSIS – Kawasaki Sickness M30.Three- a excessive and systemic kind of vasculitis with persistent fever over 4 days, bilateral injection of conjunctiva, progressive pores and pores and skin rash, oral mucosa swelling advert erythema with rashes on fingers and toes. The sickness is lethal if left untreated and requires quick consideration to forestall the complication of cardiac damage and coronary artery sickness (Tanaka et al, 2020). The affected individual launched with all of these indicators to the ER, making this the primary Assessment.
DIFFERENTIAL DIAGNOSIS
Streptococcal scarlet fever A38.9- Streptococcal infections can manifest with fever and subsequent rash of the physique and is the most common an an infection presenting with fever and rash in youngsters. Group A streptococcus (GAS) pathogen in youngsters presents with indicators of scarlet fever, tonsillitis, extreme fever, rheumatic fever, and glomerulonephritis. Penicillin (PCN) is usually used to cope with the an an infection, and erythromycin is utilized in victims with PCN allergy. Most circumstances are dealt with with antibiotics good success and spine of indicators (Li et al, 2020).
Viral an an infection B34.9- viruses may trigger quite a lot of rashes in youngsters. Infections with seen rases embrace measles, zika, roseola, rubella, hand-foot and mouth or unknown/unclassified infections. Most are self-limiting and require comfort measures and do not progress (Castro & Ramos-e-Silva, 2020).

PLAN
TREATMENT- intravenous immunoglobulin (IVIG), intravenous prednisolone (PSL) and in some circumstances extreme dose aspirin if indicated for cardiac modifications much like aneurysm or coronary artery sickness. Cautious monitoring of I&O, train and atherosclerosis is vital. The prospect of pores and pores and skin damage may be a component and wishes continued monitoring as part of the care plan (Zhong, 2020).

EDUCATION-Educating of put up remedy care to the mom and father is vital. Meals plan stuffed with nutritional vitamins and proper leisure after remedy is critical. The importance of adjust to up handle prevention of coronary coronary heart sickness is essential instructing goal. Indicators of coronary aneurysms or decreased cardiac output much like lethargy, pallor, respiration downside, decreased urge for meals and decreased output should be confused to be reported to doctor immediately. Cautious wound care and rash remedy should be completed to forestall pores and pores and skin an an infection and cellulitis (Tanaka et al, 2020).

ANTICIPATORY GUIDANCE- As a result of the Nurse Practitioner caring for the affected individual, the next step on this Assessment is to have cautious adjust to up for cardiac issues related to Kawasaki sickness and any secondary infections much like pneumonia, cellulitis or endocarditis (Zhong et al, 2020).

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