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how to examine sick baby , approach to child medical examination , diagnosis of sick child , evaluation of sick baby , medical examination of children , child medical history and examination , care of children
Management Of Nephrotic Syndrome
Objectives
To briefly review the definition & etiology of nephroticsyndrome.
To understand the terminology pertaining to clinical course of nephroticsyndrome.
To understand the management of nephroticsyndrome:Specific management & Supportive care and management of complications
Management of congenital nephrotic syndrome
Rheumatic fever is an inflammatory disease that can develop when strep throat or scarlet fever isn't properly treated , it can caused rheumatic heart disease . Strep throat and scarlet fever are caused by an infection with group A beta hemolytic streptococcus bacteria.
THIS SLIDE IS PREPARED BY SURESH KUMAR FOR MY STUDENT SUPPORT SYSTEM TO WATCH THIS VIDEO VISIT YOUTUBE CHANNEL- Important links-
youtube channel
https://www.youtube.com/c/MYSTUDENTSUPPORTSYSTEM
facebook profile- https://www.facebook.com/suresh.kr.lrhs/
FACEBOOK PAGE- https://www.facebook.com/My-Student-Support-System-101733164924592
facebook group NURSING NOTES- https://www.facebook.com/groups/241390897133057/
FOR MAKING EASY NOTES YOU CAN ALSO VISIT MY BLOG –
BLOGGER- https://mynursingstudents.blogspot.com/
Instagram- https://www.instagram.com/mystudentsupportsystem_nursing/
Twitter- https://twitter.com/student_system?s=08
#glomerulonephritis,#congenitalanomalies,#childhealthnursing#anm,#gnm,#bscnursing
how to examine sick baby , approach to child medical examination , diagnosis of sick child , evaluation of sick baby , medical examination of children , child medical history and examination , care of children
Management Of Nephrotic Syndrome
Objectives
To briefly review the definition & etiology of nephroticsyndrome.
To understand the terminology pertaining to clinical course of nephroticsyndrome.
To understand the management of nephroticsyndrome:Specific management & Supportive care and management of complications
Management of congenital nephrotic syndrome
Rheumatic fever is an inflammatory disease that can develop when strep throat or scarlet fever isn't properly treated , it can caused rheumatic heart disease . Strep throat and scarlet fever are caused by an infection with group A beta hemolytic streptococcus bacteria.
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The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
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Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
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4. Multisystem disease resulting from autoimmune reaction to infection
with group A β haemolytic streptococci.
Some children present with fever and pains in the large joints, which
may move from one joint to another.
The infection can damage the heart valves (especially the mitral and
aortic valves), leading to respiratory distress and heart failure
4/2/2023 4
Introduction
5. Children with mild disease may have only a heart
murmur.
Severe disease can present with fever, fast or difficult
breathing and lethargy.
The child may have chest pain or fainting.
Those that present with heart failure have a rapid
heart rate, respiratory distress and an enlarged liver.
5
6. Epidemiology
In the early1960, acute rheumatic fever and its major
complication, rheumatic valvular heart disease, were
frequent worldwide.
Nowadays it almost disappeared in the western world,
however it is still prevalent in developing countries.
It is frequent in children aged between 5 and 15 years because
they are susceptible to Group A streptococcal pharyngitis.
6
7. ♣ Approximately 20% of all sore throats are due to Group A
streptococcal and only few (0.5 to 3%) develop acute rheumatic
fever.
♣ The risk depends on the host factors (age, genetic predisposition
and carriers), if untreated, and the streptococcal strain (M type).
♣ Streptococcal skin infection does not result in acute rheumatic
fever.
4/2/2023 7
8. ♣ Major risk factor for the frequent occurrence of acute
rheumatic fever in developing countries are
Climate (high temperature)
poverty
crowding
poor housing conditions and
inadequate health services (Shaper 1972).
♣
4/2/2023 8
9. Cytotoxicity theory-states the enzyme streptolysin O is
directly toxic to cardiac cells, but, its unable to explain the
substantial period (10-21 days) to develop ARF from GAS
pharyngitis.
Immune-mediated pathogenesis- molecular mimicry resulting
immunologic cross-reactivity between cardiac antigenic
epitopes and GAS cellular and extra cellular epitopes
4/2/2023 9
Pathogenesis
10. Antibodies to cardiac valve tissue cross-react with the N acetyl
glucosamine of group A streptococcal, and that these antibodies
may be responsible for
valvular damage,
muscle and pericardium (pancarditis),
joint synovium (arthritis),
nervous tissue (sydneham chorea),
skin (erythema marginatum) and
subcutaneous tissue (subcutaneous nodule).
4/2/2023 10
12. Latent period of ~3 weeks (1–5 weeks)
Exceptions are chorea and indolent carditis: prolonged latent periods
lasting up to 6 months
The prevalence of chorea in ARF varies substantially between
populations, ranging from <2% to 30%
Erythema marginatum and subcutaneous nodules are now rare, being
found in <5% of cases
The most common clinical presentation of ARF is polyarthritis and
fever
4/2/2023 12
Clinical presentation
13. Carditis- occurs in 40 to 80% of patients
It presents with fever, dyspnea and cough and the main signs
are tachycardia, mitral regurgitation murmur and cardiac
enlargment.
In severe cases there are signs of heart failure
Aortic regurgitation may occur with the mitral regurgitation
Other signs are arrhythmia and pericarditis
4/2/2023 13
14. Arthritis is the commonest manifestation
It is migratory and involves several larger joints (knee, ankle,
elbow and wrist)
The affected joint is swollen, red warm and exquisitely tender.
These signs disappear within 24 hours if anti-inflammatory drug
(salicylates,NSAIDs)is given.
It may resolve completely without any residual sequel.
4/2/2023 14
15. Chorea: in 10-15% of patient
♣ is purposeless jerky, repetitive movements particularly
involving the hands and face.
♣ Early manifestations are emotional liability (easily induced
crying and inattention) and deterioration in handwriting.
♣ Occurs at the same time or following other features. It
usually occurs several months after the sore throat.
4/2/2023 15
16. Erythema marginatum – is a serpiginious rash over the
chest and trunk
It disappears in hours or days.
Subcutaneous nodule – is small painless nodules which
occur more frequently on the
extensor surface of large joints (elbow, wrist and knee)
and spine.
Other minor manifestations are fever and arthralgia.
16
17. Laboratory Findings
Laboratory findings may include:
Increased acute phase reactants – elevated ESR and C-reactive
protein
CXR – may show cardiomegaly
Evidence of preceding streptococcal infection
elevated antistreptolysin O antibody (ASO) titer
throat culture
Other tests - ECG, Echocardiography
17
18. Major
manifestati
ons
Carditis
Polyarthritis
Chorea
Erythema marginatum
Subcutaneous nodules
Minor
manifestati
ons
fever,
polyarthralgia
Electrocardiogram: prolonged P-R interval
4/2/2023 18
Diagnosis
19. Supporting evidence of a
preceding streptococcal
infection within the last 45 days
Elevated or rising anti-
streptolysin O or other
streptococcal antibody, or
A positive throat culture, or
Rapid antigen test for group A
streptococcus, or
Recent scarlet fever
4/2/2023 19
20. Diagnostic Categories Criteria
Primary episode of RF Two major or one major and two
minor manifestations plus
evidence of preceding group A
streptococcal infection
Recurrent attack of RF in a
patient without established
RHD
Two major or one major and two
minor manifestations plus
evidence of preceding group A
streptococcal infection
Recurrent attack of RF in a
patient with established RHDb
Two minor manifestations plus
evidence of preceding group A
streptococcal infectionc
DIAGNOSIS: MODIFIED JONE’S CRITERIA
4/2/2023 20
21. Rheumatic chorea Other major manifestations or
evidence of group A
streptococcal infection not
required
Insidious onset rheumatic
carditisb
Chronic valve lesions of RHD
(patients presenting for the
first time with pure mitral
stenosis or mixed mitral valve
disease and/or aortic valve
disease)
Do not require any other
criteria to be diagnosed as
having RHD
4/2/2023 21
23. Treatment of ARF
Antibiotic Therapy:Treatment with of Group A
streptococcal pharyngitis
10 days of orally administered penicillin or erythromycin
or a single IM injection of benzathine penicillin if<30kg
600,000IU and if >30kg 1.2M IU to eradicate GABHS from the
upper respiratory tract
Afterwards, the patient should be started on long-term
antibiotic prophylaxis
4/2/2023 23
24. Anti-inflammatory Therapy:
Anti-inflammatory agents (salicylates, corticosteroids) should
be withheld if arthralgia or atypical arthritis is the only clinical
manifestation of presumed acute rheumatic fever
Acetaminophen can be used
Patients with typical migratory polyarthritis & with carditis
without cardiomegaly or congestive heart failure:
treatment with oral salicylates, 100 mg/kg/day in 4 divided doses
PO for 3-5 days, followed by 75 mg/kg/day in 4 divided doses
PO for 4-8 wk
4/2/2023 24
25. Patients with carditis & cardiomegaly or congestive heart
failure:
treatment with corticosteroids
Prednisone 2 mg/kg/day in 4 divided doses for 2-6 wk
followed by a tapering of the dose that reduces the dose by
5 mg/24 hr every 2-3 days.
At the beginning of the tapering of the prednisone dose,
aspirin should be started at 75 mg/kg/day in 4 divided doses to
complete 12 wk of therapy
4/2/2023 25
26. Supportive therapies for patients with moderate to severe
carditis include digoxin, fluid & salt restriction, diuretics
& oxygen
The cardiac toxicity of digoxin is enhanced with
myocarditis
4/2/2023 26
27. Sydenham Chorea
Occurs after the resolution of the acute phase of the disease
Anti-inflammatory agents are usually not indicated
Sedatives: phenobarbital (16-32 mg every 6-8 hr PO) is the
drug of choice
If phenobarbital is ineffective, then haloperidol (0.01-
0.03 mg/kg/24 hr divided bid PO) or chlorpromazine
(0.5 mg/kg every 4-6 hr PO) should be initiated
Long-term antibiotic prophylaxis
4/2/2023 27
28. PREVENTION
PRIMARY-10 days course of amoxicillin or single i.m. injection
of Benzathine penicillin.; Early (within 1 week) treatment of
streptococcal pharyngitis to prevent an initial attack of acute
rheumatic fever.
SECONDARY-Prevent recurrences so as to reduce the damage to
heart valves and the risk of chronic rheumatic heart disease.
Indicated for children who have had acute rheumatic fever or have
rheumatic heart disease.
Monthly single i.m. benzathine penicillinor daily oral penicillin
4/2/2023 28
30. Prognosis
♣ Untreated, ARF lasts on average 12 weeks.
♣ With treatment, patients are usually discharged from hospital within
1–2 weeks
♣ Markers should be monitored every 1–2 weeks until they have
normalized (usually within 4–6 weeks), and an echocardiogram
should be performed after 1 month to determine if there has been
progression of carditis.
4/2/2023 30
31. Category of Patient Duration of Prophylaxis
Patient without proven carditis For 5 years after the last attack or 18 years
of age (whichever is longer)
Patient with carditis (mild mitral
regurgitation or healed carditis)
For 10 years after the last attack, or 25
years of age (whichever is longer)
More severe valvular disease Lifelong
Valvular surgery Lifelong
4/2/2023 31
32. Reference
1. Nelson Behrman, Kliegman, Text Book of pediatrics; 2000.
2. Jordan, Scott. Heart disease in pediatrics.1989.
3. Levy, Sheldon, Sulyman. Diagnosis and Management of the
hospitalized child. 1984 aver
32