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Dołączył: 29 Paź 2010
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 Wysłany: Śro 8:21, 15 Gru 2010 Temat postu: moncler doudoune 1 case of Kawasaki disease care _ |
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1 case of Kawasaki disease care in septic
Kawasaki disease is an allergic disease of unknown etiology, and sepsis, and Kawasaki disease are usually treated as independent of each other to describe the disease and differential diagnosis. Admitted to our hospital in May 2008 2 cases of septicemia in children with Kawasaki disease, after a careful treatment and care, her condition improved and was discharged in children, are as follows. Example: Male, 1 years and 3 months, because of fever and rash 1 d admission, physical examination: T 39.6 ℃, apathetic, the body visible red papules, neck, groin, and peanuts to the beans can be size of the lymph nodes, soft, activities can be, no hard conjunctival congestion and swelling of limbs, liver Youlei under 2 cm, blood WBC 10.4 G / L, N 76.4%, Hb 125 g / l, PLT 384 G / L, to cefuroxime resistance to infection. 4 days after admission temperature is normal, basic skin rash subsided, at this time hemolytic blood culture showed Staphylococcus aureus, vancomycin, clindamycin sensitive to anti-infection treatment, the children appeared 7 days after admission conjunctival hyperemia,[link widoczny dla zalogowanych], hand, foot and hard swelling, membrane peeling, ESR of 49 mm / h, PLT rose to 414 G / L, echocardiography showed coronary artery widened, the left coronary artery was 0.31 cm, the right coronary artery was 0.32 cm, the anti-infection that is to be on the basis of aspirin and immunoglobulin treatment, hospitalized 21 d, normal ESR review, echocardiography the right coronary artery was normal (0.18 cm), the left coronary artery was 0.31 cm,[link widoczny dla zalogowanych], with a drug discharged. 1 1.1 Nursing care of fever in children with persistent high fever, body temperature should be monitored regularly. Physical temperature above 38.5 ℃ cooling, cool stickers to give head cooling, head cold wet compress and so ineffective, they can with other antipyretic drugs, and give plenty of water to prevent excessive sweating,[link widoczny dla zalogowanych], causing blood pressure decline caused by collapse. The higher number of sweat, sweat dry in time, the replacement of cotton underwear, keep the skin clean and dry, to encourage children drink more water, lack of drinking water were added, under doctor's orders in a timely manner intravenous supplement. 1.2 Kawasaki disease mostly affects oral care mucosa, resulting in oral secretions decrease, the performance of the oral mucosa in children with congestion, vermilion, dry, chapped lips, and then oral ulcers, pain, poor appetite, so to keep children with oral cleaning is particularly important. Washed with normal saline cotton mouth, 2 times / d or 3 times / d. Dry lips coated liquid paraffin. Children with ulcers, erosions, sixteen prescribed angle montmorillonite coated to protect the mucosa. 1.3 children in the acute phase of skin care and body appear scattered in the hard red skin rashes and swollen limbs, in the 7 ~ 10 d after the onset of end Zhi Zhi film like peeling occurs, so that children cut nails, avoid scratching the skin, on the half-off application of clean scissors, cut off crusts, and can not be forced to tell their families and children avulsion, let off on their own, to prevent bleeding and secondary infection. Keep the skin clean and dry, change clothes every day, and after cleaning the buttocks, to prevent secondary infection of the skin. 1.4 nursing drug treatment of the disease within 10 d at the onset of the patients did not receive treatment, 20% to 25% may have cardiac damage [1]. Treatment of this disease is mainly against the anti-vascular inflammation and platelet aggregation, commonly used are aspirin and intravenous immunoglobulin employing short gammaglobulin. Early gammaglobulin can reduce the incidence of coronary artery aneurysms in children. Antibiotic treatment of sepsis in the general principle is that, once diagnosed earlier drug use,[link widoczny dla zalogowanych], may be effective immediately empirical use of antibiotics and side effects, drug susceptibility results to be pathogen specific return and if the choice of antibiotics has been effective with a 3 ~ 5 d difference can be dressing based on susceptibility results, if clinically effective antibiotic of choice, even if susceptibility test results are not sensitive and do not need dressing. Treatment should be sufficient, generally 10 ~ 14 d, there are complications should be treated more than 3 weeks [2]. 1.5 Nursing aspirin for the cyclooxygenase inhibitor aspirin, inhibit platelet cyclooxygenase,[link widoczny dla zalogowanych], prevents platelet aggregation and thrombosis, early use of aspirin to relieve acute symptoms of a certain effect. Aspirin in large doses or long-term use can cause drug-induced ulcers and liver damage and other adverse reactions, in order to reduce the stimulation of aspirin on gastric mucosa, should be taken after meals. Should closely observe whether the gastrointestinal symptoms such as nausea, vomiting, stool volume and nature of color.
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