A nurse is caring for an 18-month-old toddler in the emergency department who has Kawasaki disease. The nurse reviews the toddler's medical record and assessment findings. Which of the following provider prescriptions should the nurse anticipate?

Choice A reason: This test will confirm if your child had a recent streptococcal infection, as it measures the level of antibodies that the body produces against the streptolysin O enzyme, which is produced by some strains of streptococcal bacteria. A high ASO titer indicates a recent or current streptococcal infection, which can trigger rheumatic fever in some children.

Choice B reason: This test will not indicate if your child has rheumatic fever, as it does not measure the inflammation or damage to the heart, joints, or other organs that rheumatic fever can cause. Rheumatic fever is diagnosed based on the presence of two major or one major and two minor criteria, as well as evidence of a preceding streptococcal infection.

Choice C reason: This test will not indicate if your child has a therapeutic blood level of an aminoglycoside, as it does not measure the concentration of this type of antibiotic in the blood. Aminoglycosides are used to treat serious infections caused by gram-negative bacteria, and their blood levels need to be monitored to prevent toxicity and ensure efficacy.

Choice D reason: This test will not confirm if your child has immunity to streptococcal bacteria, as it does not measure the level of protective antibodies that can prevent future infections. ASO antibodies are not protective, but rather indicate a past or present exposure to streptococcal bacteria.

Choice A reason: Administering antibiotic therapy is an anticipated prescription for the client, as it can treat the possible bacterial infection that is causing the fever, anorexia, and shortness of breath. The client may have developed infective endocarditis, a serious condition that affects the heart valves and can lead to heart failure or stroke. Antibiotic therapy can help prevent further complications and reduce the risk of mortality.

Choice B reason: Obtaining an echocardiogram is an anticipated prescription for the client, as it can help diagnose the presence and severity of infective endocarditis. An echocardiogram is a noninvasive test that uses sound waves to create images of the heart and its structures. It can show if there is any damage to the heart valves, vegetation (clumps of bacteria and cells) on the valves, or signs of heart failure.

Choice C reason: Obtaining blood cultures x3 is an anticipated prescription for the client, as it can help identify the causative organism of the infection and guide the appropriate antibiotic therapy. Blood cultures are samples of blood that are taken from different sites and times and tested for the presence of bacteria or other microorganisms. They can confirm the diagnosis of infective endocarditis and determine the sensitivity and resistance of the bacteria to different antibiotics.

Choice D reason: Restricting dental hygiene is a contraindicated prescription for the client, as it can worsen the oral health and increase the risk of infection. Dental hygiene is important for preventing plaque and tartar buildup, which can harbor bacteria and cause dental caries, gingivitis, or periodontitis. These conditions can increase the risk of bacteremia (bacteria in the blood) and infective endocarditis. The nurse should teach the client to maintain good oral hygiene and use a soft-bristled toothbrush and gentle flossing.

Choice E reason: Performing a strenuous exercise regimen twice a day is a contraindicated prescription for the client, as it can increase the cardiac workload and exacerbate the symptoms of infective endocarditis. Strenuous exercise can cause tachycardia (fast heart rate), dyspnea (difficulty breathing), chest pain, and fatigue, which can worsen the condition of the heart and the valves. The nurse should advise the client to avoid strenuous exercise and limit physical activity to a level that does not cause symptoms.