A public health nurse is participating in the investigation of a foodborne illness outbreak.
Which of the following information should the nurse use to calculate the proportion of clients who ate a food item and developed illness?

Rationale for correct answers

Kawasaki disease is an acute vasculitis of unknown etiology, most likely triggered by an autoimmune inflammatory process. It primarily affects children under 5 but can occur in school-aged children. Clinical features include prolonged fever (>5 days), mucocutaneous inflammation (strawberry tongue, cracked lips), conjunctivitis, rash, and cervical lymphadenopathy. Tachycardia (HR >100/min) and tachypnea (RR >20/min) may reflect systemic inflammation. Risk of coronary artery aneurysm necessitates early diagnosis and IVIG treatment. Lab findings often include:

• Elevated ESR/CRP
• Thrombocytosis (>450,000/mm³ in subacute phase)
• Sterile pyuria
• Mild transaminitis

Rationale for incorrect Response 1 options

A. Acute rheumatic fever follows untreated Group A Streptococcus pharyngitis and presents with migratory arthritis, carditis, and chorea—not mucocutaneous signs or persistent fever without sore throat.

B. Toxic epidermal necrolysis is a severe drug reaction with widespread epidermal detachment, not associated with systemic vasculitis or cardiovascular risk.

C. Hemolytic uremic syndrome presents with bloody diarrhea, anemia, and renal failure—none of which are noted here.

Rationale for incorrect Response 2 options

A. Group A beta-hemolytic streptococcus infection causes rheumatic fever and glomerulonephritis, not Kawasaki disease.

B. Adverse drug reaction may cause TEN or Stevens-Johnson syndrome, but not Kawasaki’s vasculitis.

C. Shiga toxin-producing E. coli causes HUS, not systemic vasculitis or mucocutaneous inflammation.

Take-home points

• Kawasaki disease is a pediatric vasculitis with risk of coronary artery aneurysm.
• Diagnosis is clinical; fever >5 days plus ≥4 mucocutaneous criteria.
• Differentiate from HUS, rheumatic fever, and drug reactions based on systemic and mucocutaneous findings.
• Early IVIG and aspirin reduce cardiac complications.

Choice A rationale

A case manager is a healthcare professional who coordinates and facilitates the care of a client by managing resources, services, and support systems. By arranging for an occupational therapist, the nurse is acting as a liaison, connecting the client with a specialized resource to meet their needs, which is a key function of the case management role.

Choice B rationale

An administrator is typically responsible for the management and operations of a healthcare facility or department, including budgeting, staffing, and policy development. This role does not involve direct client care coordination like arranging for specific therapeutic services for an individual client.

Choice C rationale

A nurse consultant provides expert advice and guidance on nursing practice, education, or management to individuals, groups, or organizations. While they may provide recommendations, their primary role is not to directly arrange for services for an individual client.

Choice D rationale

A clinician is a healthcare professional, such as a nurse, who provides direct care to clients. While a nurse is a clinician, arranging for an occupational therapist is a specific coordination function that falls more under the expanded role of a case manager rather than the general duties of a clinician providing direct bedside care.