Kawasaki Disease

Question 1

Pathophysiology of Kawasaki Disease

Answer 1

1. An auto-immuned response mediated by cytokine-induced endothelial cell surface antigens that leads to vasculitis in the medium sized arteries, including the coronary arteries
   > Neutrophils, mononuclear cells, T-lymphocytes and immunoglobulin A-producing plasma cells, infiltrate the vessels.
   > Elastin and collagen fiber fragments and the structural integrity of the vessel wall are impaired

Question 2

Signs and Symptoms

Answer 2

1. Fever (5 day duration and no response to antibiotics)
2. Chills
3. Headache
4. Malaise
5. Extreme irritability
6. Vomiting
7. Diarrhea
8. Abdominal pain
9. Joint pain
10. Bilateral conjunctivitis without exudate
11. Strawberry tongue (cracked and reddened)
12. Fissured lips
13. Pharyngeal and oral mucosa erythema
14. Hyperdynamic pericordium
15. Evaluate skin for:
    > Diffuse, erythematous, polymorphous rash
    > Edema of the hands and feet
    > Erythema and painful induration of the palms and soles
    > Peeling of the perineal region, fingers and toes, extending to the palms and soles
    > Possible Jaundice

Question 3

Risk Factors

Answer 3

1. Occurring in children 6 months to 5 years of age
2. Occurs more often in the winter and summer
3. Occurs more frequently in those of Asian or Pacific descent

Question 4

Complications

Answer 4

1. Coronary artery aneurysm
2. Cardiomyopathy
3. Heart Failure
4. Myocardial ischemia

Question 5

Nursing Assessment: Physical Examination

Answer 5

1. Palpate neck for cervical lymphadenopathy (unilateral) and joints for tenderness
2. Palpate the abdomen for liver enlargement
3. Auscultate heart noting tachycardia, gallop or murmur

Question 6

Nursing Assessment: Laboratory and Diagnostics

Answer 6

1. Elevated WBC
2. Mild to Moderate anemia
3. Elevated platelet count
4. ESR and CRP are elevated

Diagnostics
1. Echocardiograms
2. Possible cardiac catheterization

Question 7

Nursing Interventions: Drug Therapy

Answer 7

1. High-dose aspirin in four divided doses daily
2. Single infusion of IVIG

Question 8

Nursing Intervention: Monitoring Cardiac Status

Answer 8

1. Administer IV and oral fluids
2. Measure I&Os
3. Prepare child for echocardiogram
4. Assess for signs of HF:
   > tachycardia
   > gallop
   > decreased urine output
   > respiratory distress
5. Assess strength of pulses
6. Cardiac monitoring reporting arrhythmias

Question 9

Nursing Interventions: Promoting Comfort

Answer 9

1. Provide acetaminophen for fever management and apply cool cloths
2. Keep environment quiet and cluster nursing activities to decrease stimulation and hence irritability
3. Apply lip balm to prevent dry lips
4. Encourage older children to suck on ice chips and younger children to suck on popsicles
5. Provide comfortable positioning

Question 10

Nursing Intervention: Providing Child and Family Education

Answer 10

1. Monitor child’s temp after discharge until the child has been afebrile for several days
2. Irritability can last for up to 2 months
3. Report toxic effect of aspirin therapy
   > headache
   > confusion
   > dizziness
   > tinnitus
4. AVOID NSAIDs
5. ROM can help with decrease stiffness
6. Avoid measles and varicella vaccination for 11 months after high-dose of IVIG
7. Comply with cardiology follow-up appointments
8. Teach cardiopulmonary resuscitation in severe cardiac involvement upon discharge