Question

Pediatrics: Kawasaki Disease ( please fill all lines)

1) Alterations in health (diagnosis)

2) Pathophysiology Related to Client Problem

3) Health Promotion and Disease Prevention

4) Risk Factors

5) Expected Findings

6) Laboratory Tests

7) Diagnostic Procedures

8) Safety Considerations

9) Nursing Care

10) Therapeutic Procedures

11) Medications

12) Client Education

13) Interprofessional Care

14) Complications

ACTIVE LEARNING TEMPLATE System Disorder STUDENT NAME DISORDER/DISEASE PROCESS REVIEW MODULE CHAPTER Alterations in Health (Diagnosis) Pathophysiology Related to Client Problem Health Promotion and Disease Prevention ASSESSMENT SAFETY CONSIDERATIONS Risk Factors Expected Findings Laboratory Tests Diagnostic Procedures PATIENT-CENTERED CARE Complications Nursing Care Medications Client Education Therapeutic Procedures Interprofessional Care

Answer 1

Kawasaki disease, also known as mucocutaneous lymph node syndrome, is an acute, systemic vasculitis of small- and medium-sized arteries that predominantly affects patients younger than five years.

Assessment:

Alterations in Health (Diagnosis) :

• High fever, above 101 and minimally responsive to medications that normally bring down a temperature -usually lasting more than 5 days
• Rash and/or peeling skin, often between the chest and legs and in the genital or groin area, and later on the fingers and toes
• Swelling and redness in hands and bottoms of feet, followed by sloughing of skin of hands and feet
• Redness in the eyes
• Enlarged glands, especially in the neck
• Irritated throat, inner mouth, and lips
• Swollen, bright red “strawberry tongue”
• Joint pain
• Stomach trouble, with diarrhea and vomiting

Pathophysiology-

When a child has Kawasaki disease, the blood vessels throughout his body become inflamed. This can damage the coronary arteries, the vessels that carry blood to his heart.

But Kawasaki disease doesn’t affect just the heart. It can also cause problems with lymph nodes, skin, and lining of the mouth, nose and throat.

Health Promotion and Disease Prevention-

There is no known prevention for Kawasaki disease. Approximately one child in a hundred may develop the disease a second time.

Risk factors-

Three things are known to increase risk of developing Kawasaki disease, including:

• Age. Children under 5 years old are most at risk of Kawasaki disease.
• Sex. Boys are slightly more likely than girls are to develop Kawasaki disease.
• Ethnicity. Children of Asian or Pacific Island descent, such as Japanese or Korean, have higher rates of Kawasaki disease.

Expected Findings-

-Temperature is usually above 101 and minimally responsive to medications that normally bring down a temperature -usually lasting more than 5 days

-Blood tests are used to detect mild anemia, an elevated white blood cell count and an elevated sedimentation rate

-A sharp increase in the number of platelets, a major clotting element in blood, also may be found

-Urine tests may reveal the presence of protein (albumin) and white blood cells.

-An echocardiogram (or echo) is used to look for possible damage to the heart or to the coronary arteries that supply blood to the heart muscle.

Laboratory tests-

- Erythrocyte sedimentation rate

- C-reactive protein level

- Hyponatremia

- Complete Blood Count

- Hypoalbuminemia

- Urine analysis

Diagnostic Procedures-

- Echocardiogram

- Electrocardiogram.

Patient-Centered Care:

Nursing Care-

• Assessment-The child should be assessed in every phase of the disease i,e.a) Acute febrile phase. The child appears severely ill and irritable; there is high, spiking fever for 5 or more days, bilateral conjuctival injection, oropharyngeal erythema, strawberry tongue, or red and dry lips, erythema and edema of hands and feet, periungual desquamation, erythematous generalized rash, and cervical lymphadenopathy greater than 0.6 inch (1.5 cm). b)Subacute phase. Acute symptoms of the acute stage subside; temperature returns to normal. The child remains irritable and anorectic. c)Convalescent phase. Check the child’s new set of diagnostic results to establish he disease’s status.
• Monitor pain- Monitor pain level and child’s response to analgesia.
• Cardiac monitoring and assessment. Take vital signs as directed by conditions; assess for signs of mycocarditis (tachycardia, gallop rhythm, chest pain); and monitor for heart failure.
• Monitor I&O- Closely monitor intake and output, and monitor hydration status by checking skin turgor, weight, urinary output, specific gravity, and presence of tears.
• Plan periods of rest and activities- Allow the child periods of uninterrupted rest; encourage the child to move about freely under supervision; provide soft toys and quiet play and encourage use of hands and fingers; and provide quiet, peaceful environment with diversional activities.
• Provide oral care- Offer cool liquids (ice chips and ice pops); progress to soft, bland foods; and give mouth care every 1 to 4 hours with special mouth swabs; use soft toothbrush only after healing has occurred.

Therapeutic Procedures-

If the child develops continuing heart problems, a child with a coronary artery aneurysm may require:

• Coronary artery angioplasty: This procedure opens arteries that have narrowed to the point that they impede blood flow to the heart.
• Stent placement: This procedure involves implanting a device in the clogged artery to help prop it open and decrease the chance of another blockage. Stent placement may accompany angioplasty.
• Coronary artery bypass graft: This operation involves rerouting the blood around a diseased coronary artery by grafting a section of blood vessel from the leg, chest or arm to use as the alternate route.

Medications-

Even though the cause of Kawasaki disease is unknown, specific medications are known to be beneficial.

-The standard initial treatment is aspirin and intravenous immunoglobulin (IVIG).

-Aspirin is used to reduce fever, rash, joint inflammation, and pain, and to help prevent formation of blood clots.

-IVIG decreases the risk of developing coronary artery abnormalities when given early in the illness.

-Other medications such as steroids or infliximab may be used in children who do not respond to IVIG.

A major goal of treatment both in the hospital and at home is to make a child as comfortable as possible while the illness runs its course.

Client Education:

- Ask the parents to be cooperative with the health staff during the course of treatment.

- Explain the parents about the disease, it's sign and symptoms, risk factors etc.

- Explain about the course of treatment and the management.

- Ask the parent to clarify all there doubts regarding the disease.

- Advice the parents to give the child medications on time.

- Explain about the medications given, its action, side effect and complications.

- Clear all the queries of the parents regarding the disease.

- Advice on importance of follow up visit after discharge.

Complications:

• Abnormal heart rhythms (dysrhythmia)
• Inflamed heart muscles (myocarditis)
• Damaged heart valves (mitral regurgitation)
• Inflamed blood vessels (vasculitis)