Kawasaki Disease Flashcards
- Sam is a 4-year-old boy who presents with a 1-week history of intermittent fever, rash, and “watery, red eyes.” Clinical presentation is of an alert child who is cooperative with examination but irritable, with a temperature of 38°C (100.4°F), pulse rate of 132 bpm, and respiratory rate of 38 breaths/min. Physical examination findings include nasal crusting; dry, erythematous, cracked lips; red, enlarged tonsils without exudate; and elevated tongue papillae. The diagnosis of Kawasaki disease is being considered. Additional findings are likely to include:
A. vesicular-form rash.
B. purulent conjunctivitis.
C. peeling hands.
D. occipital lymphadenopathy. (Fitzgerald 490)
Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.
Peeling hands
- Laboratory findings in Kawasaki disease include all of the following except:
A. sterile pyuria.
B. elevated liver enzyme levels.
C. blood cultures positive for offending bacterial pathogen.
D. elevated erythrocyte sedimentation rate. (Fitzgerald 490)
Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.
C. blood cultures positive for offending bacterial pathogen.
- Long-term consequences of Kawasaki disease include:
A. renal insufficiency.
B. coronary artery obstruction.
C. hepatic failure.
D. hypothyroidism. (Fitzgerald 490)
Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.
B. coronary artery obstruction.
279. The cause of Kawasaki disease is: A. fungal. B. viral. C. bacterial. D. unknown. (Fitzgerald 490) Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.
D. Unknown
- An important part of the treatment of Kawasaki disease includes the use of:
A. antibiotics.
B. antivirals.
C. immune globulin.
D. antifungals. (Fitzgerald 490)
Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.
C. Immune globulin
Diagnostic Criteria for Kawasaki Disease
• Fever ≥5 days in duration, usually abrupt in onset, symptoms with no response to antibiotic therapy; if given, usually with irritability out of proportion to degree of fever or other signs
• In addition to fever lasting at least 5 days, ≥4 of the following should be present:
• Changes in extremities (erythema, edema, desquamation), usually with discomfort so that child often refuses to bear weight
• Bilateral, nonexudative conjunctivitis
• Polymorphous rash
• Cervical lymphadenopathy
• Changes in lips and oral cavity (pharyngeal edema, dry/fissured or swollen lips, strawberry tongue) (Fitzgerald 490)
Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.
.
Occurring primarily in the late winter and spring at 3-year intervals
Kawasaki disease is more frequent among children of Asian ancestry
twice as common in boys than in girls
surpasses rheumatic fever as the leading cause of acquired heart disease in the United States among children younger than 5 years.
The development of coronary artery aneurysms can lead to coronary artery obstruction, myocarditis, heart failure, pericarditis, mitral or aortic insufficiency, and dysrhythmias.
Risk of aneurysm is increased in patients who have fever for more than 16 days, have recurrence of fever after an afebrile period of at least 48 hours, are male, are younger than 1 year, and have cardiomegaly at the time of diagnosis.
Some patients who do not fulfill the criteria for Kawasaki disease have been diagnosed as having “incomplete” or “atypical” Kawasaki disease, a diagnosis that often is based on echocardiographic findings of coronary artery abnormalities.
no specific laboratory test for Kawasaki disease exists,
the presence of certain laboratory findings can support the diagnosis when coupled with clinical presentation.
Blood test often detects mild anemia, elevated white blood cell count, elevated sedimentation rate, and sharp increase in the number of platelets.
Urine test often reveals the presence of albumin and white blood cells.
In the acute stage (days 1 to 11), leukocytosis with a left shift and elevated erythrocyte sedimentation rate are found; both are neither sensitive nor specific for the condition.
In the subacute stage (days 11 to 21), the platelet count is often markedly elevated, with a measurement of more than 1 million/mm3 being common.
These values begin to normalize during the convalescent stage (days 21 to 60) but may not reach baseline values for 8 weeks.
During the acute stage of Kawasaki disease, or if the diagnosis is in question, an echocardiogram should be obtained.
If tests reveal an aneurysm or other heart or blood vessel abnormality, repeated echocardiograms or other tests are usually necessary for several years.
In children who return to completely normal activity after the acute phase of the illness, the study should be repeated in the second or third week of disease and repeated 1 month after laboratory tests have resolved.
Fitzgerald, Margaret A. Nurse Practitioner Certification Examination and Practice Preparation, 5th Edition. F.A. Davis Company, 20170314. VitalBook file.
Treatment of Kawasaki disease includes
consultation with experts in managing this condition
the use of intravenous immune globulin and aspirin.
(Fitzgerald 490-491)
Confirmation of the diagnosis and treatment are likely to involve
consultation with a specialist in this disease.
Long-term prognosis is generally related to the degree of permanent cardiac involvement.
