A nurse is caring for an adolescent in an emergency department who was brought to the emergency department by their parent. The adolescent reports intermittent low-grade fever and anorexia. Manifestations presented a few days after having dental work performed. Now they are worse. The adolescent noticed shortness of breath with exertion today. The nurse reports the 2400 assessment findings to the provider. Which of the following should the nurse anticipate the provider will prescribe? For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the client.

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.

Choice A reason: Gastrointestinal system is not the primary system affected by Kawasaki disease, although some children may have symptoms such as diarrhea, vomiting, or abdominal pain. These are not specific to Kawasaki disease and may be caused by other conditions.

Choice B reason: Cardiovascular system is the most important system to monitor in children with Kawasaki disease, as it can cause inflammation of the blood vessels, especially the coronary arteries that supply the heart. This can lead to serious complications such as coronary artery aneurysms, myocarditis, pericarditis, valvular dysfunction, and arrhythmias. Children with Kawasaki disease need regular echocardiograms to assess the cardiac function and structure.

Choice C reason: Respiratory system is not the primary system affected by Kawasaki disease, although some children may have symptoms such as cough, rhinorrhea, or wheezing. These are not specific to Kawasaki disease and may be caused by other conditions.

Choice D reason: Integumentary system is not the primary system affected by Kawasaki disease, although some children may have symptoms such as rash, peeling of the skin, red eyes, red lips, and red tongue. These are not specific to Kawasaki disease and may be caused by other conditions.