SILLIMAN UNIVERSITY

COLLEGE OF NURSING
Dumaguete City

Resource Unit on KAWASAKI DISEASE

Submitted by:

LEO VAL C. ADALLA

E4

Submitted to:
Ms. Charmaine Joy V. Quilnet, RN
 COLLEGE OF NURSING
SILLIMAN UNIVERSITY
DUMAGUETE CITY

Vision:
A leading Christian Institution committed to total human development for the well-being of society and environment.

Mission:
1. Infuse into the academic learning the Christian faith anchored on the gospel of Jesus Christ; provide an environment where
Christian fellowship and relationship can be nurtured and promoted.
2. Provide opportunities for growth and excellence in every dimension of the University life in order to strengthen character,
competence, and faith.
3. Instill in all members of the University community an enlightened social consciousness and a deep sense of justice and
compassion.
4. Promote unity among peoples and contribute to national development.
Placement: Pediatrics rotation second semester
Topic: Kawasaki Disease
Time Allotment: 1 hour
Topic Description: This topic focuses on Kawasaki disease. It includes a discussion on the disease condition’s etiology, epidemiology, possible
complications, clinical manifestations, diagnostic tests, the medical management as well as the nursing management given to pediatric
patients with the disease condition.
Central Objective: At the end of the of the 1-hour discussion, the learners shall acquire basic skills, gain in depth knowledge, and manifest positive
attitude and values towards the care of pediatric patients with Kawasaki disease.
T-L
OBJECTIVES CONTENT T.A. ACTIVITIE EVALUATION
S
After the 1-hour
discussion, the I. Introduction
learner shall be A. History of Kawasaki Disease Socialized  Oral
able to: Kawasaki Disease was first noticed in Japan after World War II. Two decades later while working at the Tokyo Red discussion evaluation
 Learn the Cross Medical Centre in Japan, Dr. Tomisaku Kawasaki, noticed in about 50 children from 1961-1967 who presented 7.5 with
with a distinctive clinical features of fever and rashes, which was then thought to be a benign childhood illness. There
history and min powerpoint
were sudden deaths reported in children less than 2 years of age, who had recovered or were in the process of recovery.
the disease Post-mortem reports found that death was caused due to complications involving the heart, causing large thrombosis
slides
condition; and Myocardial Infarction. Kawasaki disease is now recognized worldwide. While it is more common among the
identify the Japanese ethnicity, we now know that it occurs in all racial groups, primarily in children fewer than 5 years of age.
systems
affected B. Kawasaki disease
Kawasaki disease alternatively known as mucocutaneous lymph node syndrome or infantile polyarteritis nodosa, is an
acute febrile vasculitis (inflammation of blood vessels). It is self-limited and is the common cause of acquired heart 2.5
disease in children in Japan and US. mins
Socialized
C. Anatomy and Physiology of the affected systems discussion
[ a video presentation courtesy of YouTube videos will be provided ] using visual
aids
 Identify the 2.5
II. Etiology mins
etiologic
The etiology is unknown, but the main cause is theorized to be infectious in genetically predisposed children that may lead
factors of the to the occurrence of immune-mediated diseases. Another possible cause of its occurrence in infants younger than 4 months
condition. is may be due to passive maternal antibody that passed during infancy. Kawaski disease does not spread by person-to-
Lecture
person contact. discussion

 Describe the III. Epidemiology

occurrence of Kawasaki disease is commonly found in Asian children seen in all race however children of Asian ancestry experience the 5
 Kawasaki highest incidence. The disorder occurs primarily in children under 5 years old. In United States, Kawasaki disease is the mins.
disease. common cause of acquired heart disease in children. It occurs predominantly in young children and occasionally in Lecture-
 Familiarize teenagers and adults. The greatest number of cases occurs in the winter and spring. discussion
with the 7.5mi
pathophysiol IV. Pathophysiology n
[ concept map during presentation ]
ogy
 Identify the 4 mins
V. Complications
complications Lecture-
The disease is self-limited however if left untreated may develop into cardiac sequelae and other heart disorders. Due
of the disease to the inflammation of blood vessels the following conditions occur: discussion
 Coronary aneurysm is a localized dilatation of the coronary blood vessel wall. using visual
aids
 CHF
 Massive myocardial infarction this is the most serious complication which results from thrombotic occlusion of a
coronary aneurysm.
 Myocarditis is the inflammation of the myocardium
 Pericarditis is the inflammation of the pericardium associated with myocardial infarction. The heart sounds become
muffled, weak and distant on auscultation and a bulge is visible on the chest over the precordial area.
 Pericardial effusion
 Mitral valve insufficiency
 Coronary vessel stenosis

5
mins.
VI. Diagnostic Tests
 Give the Currently there is no specific diagnostic test available for Kawasaki disease. The diagnosis is therefore established
importance of based on the clinical findings and associated laboratory results.
the common
examinations Principal Diagnostic Criteria for Kawasaki disease
in diagnosing CDC states that presence of four of the following 6 criteria which includes fever:
patients for 1. Fever for 5 or more days (often diagnosed with shorter duration of fever if other symptoms are present)
Kawasaki 2. Bilateral conjunctival infection (inflammation) without exudation
disease. 3. Changes in the oral mucous membranes, such as erythema, dryness, and fissuring of the lips; oropharyngeal
reddening; or “strawberry tongue” (large papillae are exposed)
4. Changes in the extremities, such as peripheral edema, Erythema of the palms and soles, periungual desquamation
(peeling) of the hands and feet
5. Polymorphous rash
6. Cervical lymphadenopathy (one lymph node >1.5cm) 3.5
mins
Several associated laboratory findings when combined with clinical data, can be helpful in making the diagnosis. Such as
the:
 A. Complete Blood Count with differential-. A typical child with Kawasaki disease is anemic and has leukocytosis
with a “shift to the left” (increased immature white blood cells) during acute phase.
B. Erythrocyte Sedimentation Rate (ESR)- This is the rate at which the RBCs settle out in a tube of unclotted blood.
Increase in ESR reflects on going inflammation and generally persist for 6 to 8 weeks.
Normal values: (M) 0- 14 mm/hr (F) 0- 20 mm/hr
C. Platelet count- Thrombocytosis with hypercoagulability becomes evident in the subacute phase and peaks 3 to 4
weeks after the onset of fever. Lecture-
Normal values: 150-400T/cumm discussion
D. Urinalysis- Done in a clean-catch method, microscopic urinalysis reveals a sterile pyuria with mononuclear cells. using visual
E. Echocardiography- Ultrasonic waves directed through the heart are reflected backward, or echoed, when they pass aids
from one type of tissue to another. This are used to monitor myocardial and coronary artery status. Decreased LV
contractility
 Describe the F. Electrocardiography (ECG/EKG) – There is tachycardia-gallop rhythm; decreased R-wave; ST depression; t wave 7.5
common flattening or inversion; Prolong PR and OT interval mins
Pharmacologi
c VII. Therapeutic Management
interventions The goals for treatment of Kawasaki disease include:
in managing 1. Promoting a rapid anti-inflammatory response
patients with 2. Preventing coronary thrombosis by inhibiting platelet aggregation Lecture-
Kawasaki 3. Minimizing long-term coronary factors by exercise, diet and healthy lifestyle choices discussion
diseasse using visual
Available treatment for the disease condition includes: aids
A. Intravenous immune globulin (IVIG)- A single large infusion of 2 g/kg over 10 to 12 doses (recommended)
reduces the duration of the fever and incidence of coronary artery abnormalities when given within the first 10 days
of the illness. The administering of this follows the same guidelines as for any blood product, with frequent
monitoring of vital signs. Also, watch for allergic reactions and cardiac status for large administration in patients
with Myocarditis. Patency of IV line is checked because extravasation can cause tissue damage.
B. Medications:
1. Aspirin- Given as an anti-inflammatory dose (80 to 100 mg/ kg/ day in divided doses every 6 hours) also to
relieve fever and symptoms of inflammation. Once the fever subsides, aspirin is continued at an antiplatelet
dose (3 to 5 mg/ kg/ day) for patients without ECG evidence of coronary artery changes until ESR and platelet
have returned to normal (6 to 8 weeks). Drug should be carefully monitored.
2. dipyridamole or Warfarin therapy- If coronary artery abnormalities develop, aspirin or dipyridamole therapy is
used indefinitely otherwise it can be stopped. Additional anticoagulant therapy, such Warfarin (Coumadin) is Lecture-
sometimes added in patients with evidence of turbulent flow through the affected vessels sections or with giant discussion
aneurysm (> 8 mm). using visual
3. Thrombolytic therapy aids
Most children with KD recover fully after treatment. However when cardiovascular complications occur, serious
condition may result. Death occurs rarely and almost always results from ischemia due to coronary thrombosis or
 Apply the stenosis. However children who had KD must evade from other risk factors for coronary disease as possible. Studies
nursing have shown that their coronary and peripheral arteries are stiffer than normal.
process in the
care of
patients with VIII. Nursing Management Socialized
Kawasaki A. Assessment discussion
disease.  Acute phase (listeners
 The acute phase usually lasts 1-2 weeks. It begins with an abrupt onset of high spiking, remittent fever that is are free to
unresponsive to antibiotics and antipyretics and other signs of illness such as: share
 Abrupt onset of high fever (>39°C) which lasts for days- This occurs as the body’s pyrogens act on the insights)
entrance of foreign invaders with the increase thermostat of the hypothalamus.
 Irritability occurs since the child experiences discomforts brought about by other symptoms.
 Bilateral nonpurulent conjunctival inflammation – The bulbar mucous membranes of the conjunctival is
inflamed. Open forum
 Erythema of the oropharynx, dryness and fissuring of the lips
 “Strawberry tongue” The normal coating of the tongue sloughs off, leaving the large papillae exposed,
resembling to strawberry.
 Cervical lymphwadenopathy wherein at least a single node is 1.5 cm or larger.
 Polymorphous rash- This rash occurs on different forms in each child but is never vesicular. It is most often
accumulated close to the genital area
 Erythema of the urethral meatus
 Tachycardia
 Edema on extremities
 Laboratory findings:
o Elevated Erythrocyte Sedimentation Rate and platelet count- It is increased due to presence of
inflammation
o Positive C- reactive protein
o Decrease in Red Blood Cells and Hemoglobin- A child with KD is anemic
o Hypoalbuminemia

 Subacute phase
 This phase begin when fever and other acute signs have subsided, but irritability anorexia, and conjunctival
inflammation ay persist. Subacute phase is associated with desquamation, thrombocytosis, the development of
coronary aneurysms, and the highest risk for sudden death. This phase generally lasts until about the 4 th week.
Other clinical manifestations in this phase are:
 Desquamation of fingers and toes- It is usually found on palms and soles
 Arthralgia or arthritis- Joints may swell and redden, stimulating an arthritic process
 Transient diarrhea
 Facial palsy
 Sensorineural hearing loss
 Convalescent phase
 Convalescent phase begins when all clinical signs of illness have disappeared and continues until the erythrocyte
sedimentation rate (ESR) returns to normal, approximately 6-8 weeks after the onset of illness.

B. Nursing Diagnosis
1. Acute Phase
Altered body temperature: Hyperthermia
Impaired skin integrity
Impaired Tissue integrity
2. Sub-Acute Phase
Ineffective Tissue Perfusion related to inflammation of blood vessels
Altered comfort: pain r/t swelling of joints

C. Planning
Upon proper interventions the child is expected that he/she will
 Have temperature levels to normal range
 Minimized presence of scarring
 Minimized redness/swelling
 Absence of discharges (skin)
 maintain adequate tissue perfusion during the course of illness
 experience a tolerable level of pain during the course of illness

D. Interventions
Inpatient care focuses on supportive care, medication administration, diagnostic assistance, and education of the child
and family.
 Monitor cardiac status carefully.
 Observe the child for signs of heart failure such as tachycardia, dyspnea, crackles and edema.
 Inspect extremities for color and palpate for warmth and capillary filling in toes and fingers to evaluate peripheral
tissue perfusion.
 Carefully monitor and record child’s intake and output and daily weight.
 If the child is developing Myocarditis, be alert for chest pain, arrythmias, and ECG changes.
  Observe findings that need reported and properly document.

 The child is administered with acetylsalicyclic acid (aspirin). Ibuprofen may be given for its anti-inflammatory
action helps reduce patient’s pain and itchiness.
 Provide additional comfort measure such as rocking and holding.
 Protect edematous areas from pressure- make sure that clothing is not constricting and irritating to skin.
 Apply lip balm to protect lips from cracking and drying.
 Offer extra fluids to help maintain hydration and reduce mouth tenderness.
 Prevent overexertion of the child. These children are place in a quiet environment that promotes adequate rest.
 Encourage the child to continue brushing his teeth (use soft toothbrush or a padded tongue blade).
 Soft, nonirritating foods such as gelatin may be better tolerated than food that requires chewing and acidic fluids
such as orange juice that might sting.
 Observe for possible gastrointestinal obstruction such as vomiting.
Health teachings on:
 Passive range of motion exercise may be indicated and can be done most easily during the child’s bath if arthritis  Game
develops. (Cabbage
 Importance of follow-up monitoring Game)
 Aspirin toxicity such as ringing of ears, headache, dizziness and confusion.
 The likelihood of myocardial infarction
The nurse must also provide emotional support to parents by acknowledging their effort in comforting an inconsolable
child. They must understand that irritability is a hallmark of KD.

 Actively E. Evaluation 15
participate in mins
the open Upon evaluation the child is expected to have the following findings:
forum and  Child’s pulse, blood pressure, and respiratory rate are within age-acceptable parameters; capillary filling time is
evaluation. less than 5 seconds
 Child states that level of pain is tolerable.
 Child will be less irritable

F. Article
The article is entitled “Abnormal Liver Panel in Acute KD”.
http://journals.lww.com/pidj/Abstract/publishahead/Abnormal_Liver_Panel_in_Acute_Kawasaki_Disease.99192.a
spx

X. Open forum and Evaluation