5월 27일 강의.freee

1.진단 = Kawasaki disease

Age: Children under the age of 5 are at the highest risk.

Sex: It slightly more frequently affects boys than girls.

Ethnicity: Children of Asian or Pacific Islander descent have the highest rates, with Japanese children seeing the highest incidence.

Mayo Clinic +4

Potential Environmental & Infectious Triggers

Although Kawasaki disease is not contagious, seasonal outbreaks in the late winter and spring strongly suggest that unidentified viral or bacterial infections may trigger the disease in genetically predisposed childre

2.IVIG 먼저 주기

.Kawasaki질환 치료법 맞는거은?

최근에는 높은 농도의 immunoglobulin으로 치료한다

salicylic therapy한다

The principal goal of treatment for Kawasaki disease is to prevent coronary artery disease and to relieve symptoms. Full doses of intravenous immunoglobulin (IVIG) are the mainstay of treatment.

Admit all patients to the hospital for administration of IVIG and for observation until fever is controlled. Closely monitor cardiovascular function. Once the fever resolves, clinically significant heart failure or myocardial dysfunction is unlikely.

Aspirin has traditionally been part of the standard treatment of this disorder. Although some authors have suggested that aspirin is no longer needed, most experts use high-dose aspirin for a variable period, followed by lower-dose aspirin for its antiplatelet effects. Aspirin is used in patients with small coronary artery aneurysms (CAAs). Dipyridamole is indicated in patients with larger CAAs.

The appropriate treatment of patients who fail to respond to IVIG remains unclear. Severe Kawasaki disease that is resistant to IVIG may benefit from intravenous pulse corticosteroid therapy or infliximab infusion.

Transfer patients with suspected Kawasaki disease to a facility that has clinicians experienced in the care of these patients and a pediatric or adult cardiologist to evaluate the echocardiogram. Some authorities recommend transferring patients who have documented coronary artery aneurysms to a tertiary pediatric facility

3.예상되는 진단 SATA

conjunctivitis

arthritis

가와사키

Gastrointestinal: Abdominal pain, vomiting, diarrhea, or liver inflammation (hepatitis).

Neurological: Extreme irritability, lethargy, or rarely, aseptic meningitis, facial palsy, and seizures.

Joints: Swelling and pain in both small and large joints, which can persist after other symptoms fade.

Other organs: Inflammation can sometimes affect the lungs, pancreas, or kidneys.

4.약물 중재 SATA

aspirin

clopidogrel (혈소판 60만 )

The primary treatment for Kawasaki disease combines Intravenous Immunoglobulin (IVIG) and Aspirin. Administered promptly, this combination drastically lowers the risk of developing heart complications like coronary artery aneurysms

Corticosteroids: Used either as an adjunctive primary therapy (e.g., prednisolone) or a rescue therapy to manage severe inflammation.

Infliximab (Remicade): A monoclonal antibody used as rescue therapy for patients who remain resistant to IVIG and corticosteroids.

Other Immunomodulators: Other options like cyclosporine may be utilized in severe, refractory cases.

5. 20대 여성 맹장염ngn

(NGN)배 통증 6/10이고 겉으로는 문제 없는데 호흡이랑 맥박이 빠른, 불안장애 히스토리가 있는 여자 가장 먼저 address해야 하는 내용?

. NGN) 윗배에서 통증 시작, 아랫배로 옮김. 오른쪽이 아프다고 하고 침대에서 못움직인다. 26세 여성환자로 마지막 생리 3주전이고 보통 27일마다 생리한다고함. 구토증상없고 속울렁, 소변검사 못하겠다고 하는 상태. -예상진단 및 처지, 파라미터?

진단명

맹장염

cholecystitis

pancreatitis

diverticulitis

peritonitis

## Appendicitis

6.위험요인

Appendicitis is primarily caused by a blockage in the appendix, which leads to inflammation and infection. Key risk factors include age (most common between 10 and 30), male sex, family history, and a low-fiber diet that causes constipation

7.간호중재

- 전체적으로 쉬운 편

Involves initial hospital admission for broad-spectrum intravenous antibiotics, usually followed by a course of oral antibiotics.

While highly effective, there is a risk of symptom recurrence, which may eventually require an appendectom

Appendicitis management is time-sensitive and tailored to the severity of the inflammation. The standard, most definitive treatment is a surgical appendectomy, although uncomplicated cases can sometimes be successfully managed with intravenous antibiotics

8.UAP 환자 밥 안 받았다고 한다(밥은 다 배부됨)

신경계 사정,

삼킴 assessment

우측 팔 weakness

9. ischemic cva 퇴원 간호

30도 머리 올린다

2시간 마다 체위 변경

음료수 주고 30분 sitting position

해야할 일을 cluster 해서 오전에 몰아서 한다

어두운 환경을 제공해준다

10.NGN . CABG 한 아저씨 상처관리 발열있었고 VAC 걸었다

Lactic level

혈소판 수치

PT.INR모니터 여부.

razor로 VAC 주변 털 민다

Lactic acidosis following Coronary Artery Bypass Grafting (CABG) is often caused by tissue hypoperfusion (low oxygen delivery) or stress-induced metabolic changes during cardiopulmonary bypass. Elevated blood lactate levels are common in the ICU after heart surgery and act as a critical marker for patient recovery and potential complications.

NGN CABG 수술했는데 wound 안좋아서 하루 두번 드레싱 하다가 VAC 단 아저씨.

The major complications include bleeding that may require a return to the operating room, heart attack, heart failure, arrhythmia, stroke, changes in cognitive function, pulmonary problems, wound infection, renal failure, and death.

Vacuum-Assisted Closure (or Vacuum-Assisted Dressing)

type of negative pressure wound therapy (NPWT) that uses suction to promote healing, manage exudate, and reduce edema in complex or chronic wounds. It is also known as a "wound VAC

Method: Single-use electric clippers are used to trim hair, not shave it, which is safer and more effective.

Timing: Clipping should occur on the day of surgery, ideally just before the procedure to minimize the chance of skin irritation.

Areas: Hair is typically removed from the chest, groin, and often the legs and forearms (if a vein is harvested for the bypass).

Avoid Razors: Razor shaving increases infection risk and is not recommended.

Vacuum-Assisted Clipping: A vacuum-assisted hair removal device (e.g., ClipVac) can be attached to the clipper to immediately collect hair, preventing it from contaminating the operating room