I.

INTRODUCTION
II.PATIENT’S PROFILE
A. Demographic Profile
B. History of past illness/s
C. History of Present illness/s
III. BIOGRAPHICAL DATA
A. Genogram
IV. ASSESSMENT
A. Physical Assessment (Head-to-Toe Assessment)
B. Gordon’s Functional Pattern of Assessment
V. ANATOMY AND PHYSIOLOGY
VI. PATHOPHYSIOLOGY
VII. LABORATORY AND DIAGNOSTIC EXAMINATION/S
VIII. NURSING CARE PLAN (ADPIE)
IX. DRUG STUDY
X. DISCHARGE PLAN
Introduction

Patient 0 was admitted at Pagamutan ng Dasmariñas last September 25 2020

at eleven thirty in the evening with chief complaint of High Fever, redness of
both eyes, rash in the abdomen area, red and swollen tounge, extreme
irritability, crying and minimal sleep. Few hours prior to confinement Mrs. 0,
mother of Patient 0 stated that he has high fever for 5 days and did not seek
medical advice earlier because when the patient was taking Tempra the fever
decrease. The patient was brought in PD by his mother. He was examined by
Dra. Calma and ordered to undergo some laboratory examinations such as
CRP, WBC, RBC, HGB, HCT, Maralia Test Direct Smear), Echocardiogram,
Nuetrophils/lympocytes and Platelets. After some examinations he was
admitted to Medicine Ward and treatment was continued.

Kawasaki is a rare childhood illness and its etiology is unknown. According to

research the idea of an infectious etiology; however, no one particular virus or
bacteria has been implicated. There are circumstantial data supporting the
role of some bacterial toxins (eg, staphylococcal toxic shock toxin,
streptococcal erythrogenic toxin) and viruses (Epstein-Barr virus, parvovirus,
HIV-2); however, these data have not been substantiated.

Kawasaki disease is a multi-system disorder involving vasculitis of the inner

lining of the blood vessels that eventually can harm the coronary arteries.
Kawasaki disease is the leading cause of acquired heart disease in children in
the United States and Japan.

According to the American Heart Association, Kawasaki disease is a major

cause of heart disease in children, with about 4,000 children diagnosed in the
United States each year. Filipino children had the highest recurrence rates, 12
of 788 patients and it is common to first- or second-degree relative with a
history of Kawasaki disease.

Kawasaki disease can closely mimic other syndromes and infections. It is

commonly misdiagnosed as a viral exanthem. Symptoms that point to a
diagnosis other than Kawasaki disease include exudative conjunctivitis,
exudative pharyngitis, generalized (rather than cervical) lymphadenopathy,
discrete intraoral lesions, and a bullous or vesicular rash. Toxin-mediated
illnesses, such as group A streptococcus infections (eg, toxic shock syndrome
and scarlet fever) can also present with fever, rash, mucous membrane
changes, and abnormal extremity findings.4,6 Desquamation in Kawasaki
disease tends to affect the hands and feet, as it does in toxic shock
syndrome; however, in Kawasaki disease, it usually begins in the periungual
region. In scarlet fever, the desquamation tends to be diffuse and flaking,
whereas in Kawasaki disease it tends to be sheetlike.6 Toxin-mediated
illnesses generally lack the articular involvement. Measles, echovirus,
adenovirus, and Epstein-Barr viral infections can also mimic Kawasaki
disease; however, these conditions usually lack the signs of systemic
inflammation as well as the extremity changes seen in Kawasaki disease.4
Another condition that can be mistaken for Kawasaki syndrome is acrodynia
(mercury hypersensitivity reaction). This also presents with fever, rash,
swelling of the hands and feet, desquamation, and photophobia. However,
this is relatively rare and is a much less likely diagnosis unless there is a
convincing history of mercury exposure.

We’ve handle this patient last September 25 2020. Our clinical instructor gave
us the opportunity to study the case. Hence, this case study aims to help
understand the disease process of Kawasaki Disease, and to orient one of the
appropriate nursing interventions that could be offered to patients.
II.PATIENT’S PROFILE

A. DEMOGRAPHICAL DATA

Patient’s Name: Patient 0.P

Age: 5 years old
Gender: Male
Nationality: Filipino
Religion: Roman Catholic
Civil Status: Single
Occupation: Student
Date and Time of Admission: September 25 2020
Attending Physician: Dra. Marlisa Calma, M.D.
Chief complaint: Intermittent High Fever for 6days (39°C-40°C), redness of
both eyes and rashes on the palms of the hands, soles of the feet and trunk,
lips cracking, swollen lymph glands in the neck
Admitting Diagnosis: Kawasaki Disease
Final diagnosis: Kawasaki Disease

B. History of past illness/s

Patient 0 has no prior hospitalization. According to the mother of the

patient his EPI was completed. He had fever during the eruption of his teeth.
Simple cough and cold during change in weather stated by the mother.

C. History of Present illness/s

Patient was brought to ER with the chief complaint of High Fever, redness
of both eyes, rash in the abdomen area, red and swollen tongue and extreme
irritability. According to the patient’s mother he has high fever for 5 days
before bringing him to the ER. He took Tempra to ease the fever at home.
According to the patient’s father, his sister was diagnosed with Kawasaki
Disease during childhood.

III. BIOGRAPHICAL DATA

Genogram
IV. ASSESSMENT (Draft: Baby)

Admission Assessment:

NAME: Patient O.P AGE: 5 years old SEX: M Ht.: 3’11” Wt.: 27kg

VITAL SIGNS (09/25/2020, 10:00 a.m.)

38.9° C [/] axillary [ ] oral [ ] rectal [ ]

TEMPERATURE
tympanic
140 BPM [ ] regular [ /] irregular [ ]
PULSE RATE
strong [ ] bounding [ ] thready
30 CPM [ ] regular [ /] irregular [ ] deep
RESPIRATORY RATE [ ] shallow
95%
SPO2

PAIN SCALE 7/10 (+) Facial Grimace

Subsequent to assessing the diff manifestations of Patient P.O, Indeed He

has a positive Kawasaki disease based on the Major Diagnostic criteria
established by the Centers for Disease Control and Prevention (CDC) for
Kawasaki disease.
A. Physical Assessment (Head-to-Toe Assessment)

Assessment Normal Findings Analysis

General appearance Neat appearance with General appearance According to Dr. Feily
patient assessment
light complexion and may contribute to an
commences with
short curly hair individual’s base on the assessing the general
of the patient which
Wearing T - shirt and ability to interact ,looks
includes level of
diaper. and body odor. interaction, looks well
or unwell.
@snynaps .ecu.edu
Vital signs Temperature 38.9°c Vital signs are normal According to Gurevich
Panigrahi the nurse
Pulse Rate 140bpm base on the following ;
should monitor vital
Respiratory Rate Temperature : signs closely during the
acute phase of
30cpm (35.5 to 37.5)
Kawasaki Disease,
SPO2 95% Pulse Rate (80-120) recording all the vital
signs before
Pain Scale 7/10 Respiratory Rate (20-
administering
(+) facial grimace. 28) medications especially
the temperature before
SPO2 95%
taking aspirin and
(-) facial grimace. manage pain with age -
appropriate techniques
and analgesics, other
than ibuprofen which
has been shown to
block aspirin’s
antiplatelet effect.
Skin Polymorphous skin Skin is without lesions, According to the study
of
rash, edematous no stretchmark, and
racg.org.polymorphous
hands, warm to to any scars, normally skin rash usually begins
in the nappy area.
touch , pale. warm temperature,
Where there may be
good turgor and desquamation early in
the disease and
elasticity, texture varies
spreads to involve the
from smooth to coarse. trunk, extremities and
face and edematous it
Nails should be clean
also affect the entire
and short, nail plate body swollen neck
glands, hands and feet
should be firmly
and also eyes and lips.
attached to nail bed,
scalp is clean and dry.
Hair is smooth and firm.
Kozier & Erb’s
Fundamentals of
Nursing, 8th Edition
Health Assessment in
Nursing, 4th Edition
 Assessment Normal Findings Analysis
Head Normal upon The head is Examination of the
assessment symmetrical, size head and neck is a
fundamental part of
varries with age and
the standard physical
body stature . examination. It is
Kozier & Erb’s typically one of the
Fundamentals of first parts of
the physical
Nursing, 8th Edition
examination and is
Health Assessment in performed with the
Nursing, 4th Edition patient in a seated
position. Because the
complete head
and neck
examination is lengthy,
it is usually tailored to
the patient's history
and presenting
complaint
Eyes Non- purulent Symmetrical, no In a study by Ohio et
bilateral discharge, no al, the incidence of
conjunctivitis, discoloration, no edema superficial punctate
or tenderness, pupil
anecteric sclera , red keratitis, vitreous
constricts
eyes, no discharges opacities,
Kozier & Erb’s
Fundamentals of Nursing, papilledema, and sub
th
8 Edition conjunctival
Health Assessment in
hemorrhage was,
Nursing, 4th Edition
respectively.

Assessment Normal Analysis

 Findings
Ears Both pinna are Symmetrical, no According to
normal, no discharge, color kawasakihearing@echo
discharges same as facial skin, The results indicate
normal voice tones that children with
audible.
Kawasaki disease
Kozier & Erb’s
might occur during
Fundamentals of
treatment of the acute
Nursing, 8th Edition
Health Assessment phase usually involves

in Nursing, 4th mild bilateral hearing

Edition loss and recovers
naturally. However, this
study suggests that
determination of the
causes and clinical
implications of hearing
loss in Kawasaki
disease requires long-
term follow-up studies
with more cases.

Assessment Normal Findings Analysis

Nose In midline , no Nasal septum is According to
lesions intact, no swelling, no medline.com
 discharges or any Kawasaki disease is
irregularities. sometimes called
Kozier & Erb’s mucocutaneous
Fundamentals of lymph node
th
Nursing, 8 Edition syndrome because it
Health Assessment also affects glands
th
in Nursing, 4 Edition that swell during an
infection (lymph
nodes), skin, and the
mucous membranes
inside the mouth,
nose and throat.
Neck Swollen lymph nodes Neck should have no According to Xiang
et, al.(2016)
masses, positioned
Kawasaki disease is
at mid-line. No a condition that
mainly affects
stiffness, no
children under the
tenderness and age of 5. It's also
known as
nodules palpated.
mucocutaneous
Kozier & Erb’s lymph node
syndrome.
Fundamentals of
The characteristic
Nursing, 8th Edition symptoms are a high
temperature that
Health Assessment
lasts for 5 days or
in Nursing, 4th Edition more, with:
a rash
swollen glands in the
neck

Assessment Normal Findings Analysis

Oral Cavity Strawberry like Uniform pink color, According to Dr.
Lorain the diagnosis
tongue noted , noted soft, moist, 20 teeth
is based on clinical
 no lesions or any in 5 year old, tounge features including
fever for more than
bleeding, teeth are is centrally
five days
whitish in color, positioned, no accompanied by
bilateral
fissured lips. swelling and lesions.
conjunctivitis,
Kozier & Erb’s oropharyngeal
changes, cervical
Fundamentals of
lymphadenopathy,
Nursing, 8th Edition polymorphous rash,
and peripheral
Health Assessment
extremity changes.
in Nursing, 4th Edition Conjunctivitis,
oropharyngeal
changes, and rash
are the most
common clinical
features of the
disease. Changes of
the lips and oral
cavity include
erythema, dryness,
fissuring, peeling,
vertical cracking and
bleeding of the lips; a
strawberry tongue
with erythema and
prominent fungiform
papillae; and diffuse
erythema of the
oropharyngeal
mucosa. In nearly all
of the cases, these
findings of the lip and
oral mucosa heal
without any sequela.
In this study, present
a case of KD with
extensive and severe
lip and oral mucosa
involvement
complicated with
microstomia that
needed surgical
correction.

Assessment Normal Findings Analysis

Chest No lessions,with No chest pain, no
widespread rash. lesion on chest, no
rashes.
Kozier & Erb’s
 Fundamentals of
Nursing, 8th Edition
Health Assessment
in Nursing, 4th
Edition
Lungs No adventitious No difficulty in KD patients can have
concurrent infections,
sounds breathing, no
especially pulmonary
wheezing, no symptoms. The cause
of KD is likely to be
shortness of
associated with M.
breathing pneumoniae infection.
Thus, immediate
.Kozier & Erb’s
treatment of M.
Fundamentals of pneumoniae infection
in KD patients is very
Nursing, 8th Edition
important.
Health Assessment
in Nursing, 4th
Edition
Heart Normal as Normal heart should According to heart institute
Kawasaki disease
auscultated. look along the lines
Kawasaki disease is if not
of the external chest untreated, it can lead to
in appearance serious complications such
without lifts , as inflammation of the
blood vessels. This can be
heaves , or
particularly
thrills.Palpated in the dangerous because it can
th
5 intercostal space affect the coronary
at the med clavicular arteries--the blood vessels
that supply blood to the
line. Heart should
heart muscle--causing
rate normal rhythm. coronary artery aneurysms
Kozier & Erb’s to develop. An aneurysm is
Fundamentals of a ballooning out of a
th damaged and weakened
Nursing, 8 Edition
blood vessel wall. 
Health Assessment
in Nursing, 4th
Edition

Assessment Normal Findings Analysis

Extremities Warm to touch, Both extremities are According to Japan
equal in size.
rashes on soles of Have the same contour academy changes in
feet and palms of with prominences of peripheral extremities.
joints.
hands, peeling of No involuntary The findings on the
movements.
 skin around No edema hands and feet in KD
Color is even.
fingernails and Temperature is warm are distinctive. Within
toenails. and even. 5 days of onset,
Has equal contraction
and even. diffuse erythema of
(Kozier & Erb’s
the palms and soles
Fundamentals of
and/or in durative
Nursing, 8th Edition)
(Health Assessment in edema of the hands
Nursing, 4th Edition) and feet occur.
Sometimes the
degree of
swelling is great and
the skin is shiny and
looks as though
it is about to burst.
Abdomen Macular rashes. Unblemished skin, Kawasaki disease
should be considered
Normal growling uniform in color,
in all children with
sounds of 12.Upon symmetric contour, fever, abdominal pain,
and radiologic
percussion. no distention.
signs of pseudo-
Abdomen is Kozier & Erb’s obstruction, even in
the absence of typical
tympanic in sound. Fundamentals of
symptoms and signs.
Nursing, 8th Edition A more
comprehensive
Health Assessment
analysis
in Nursing, 4th including all clinical
forms of Kawasaki
Edition
disease would be
useful to correlate
intestinal involvement
with worse out-
comes for cardiac
complications, as well
as to clues to more
rapid diagnosis and
avoidance of
unnecessary invasive
procedures.

Assessment Normal Analysis

Findings
Genitalia With some rashes No discharges, no According to Karim
mass, no rashes. 2016 genital part has
Kozier & Erb’s erythematous
 Fundamentals of polymorphous rash over
th
Nursing, 8 Edition trunk and genitalia.
Health Assessment An acute or chronic itchy
th
in Nursing, 4  and dermatitis can
Edition be primary, or secondary
to scratching.
Anus No hemorrhoids According to
pediatric.ph using a
rectal thermometer with
care. It may
accidentally poke a
hole in the rectum. It
may pass on germs
from the stool. Follow
the product maker's
directions for correct
use.
B. Gordon’s Functional Pattern of Assessment
Areas Functional Before During Analysis
Pattern Hospitalized Hospitalization
Health Before During It’s very important
Perception–Health Hospitalization the Hospitalization: that the mother is
Management Mother’s Patient The mother’s aware what to do if
Pattern Verbalized Patient verbalized the child has fever
“Nagpabalik balik ''Ito nabigyan siya for 3 days or more,
po ang kanyang ng paunang lunas mother should
lagnat sa loob ng sa kanyang lagnat know when to take
anim na araw at at medyo bumaba her child to visit
umabot ito sa 39- na ang kanyang the Dr. right away
40°C at tuloy ang lagnat pati narin after 3 days of
kanyang lagnat sa ang pamumula sa nonstop fever to
luob ng limang kanyang mata pero check those sign
araw. Sa luob ng medyo iritable siya and symptoms that
apat na araw ngayon dahil sa shows to the child.
napansin ko ang mga IV na She shouldn’t wait
mga rashes sa nakalagay sa 6 days fever
bandang tiyan niya kanya. Sana po before taking her
at pamumula sa gumaling na siya child to the
kanyang mata agad sa gamot na Physician because
ganun din ang binigay sa kanya. that signs of fever
pamamaga sa might showing
kanyang kamay at infections to the
paa , hanggang sa child that triggers
meron din akong more to get worse
napansin sa and should be
kanyang leeg na treated early of the
may parang may signs before it gets
namamagang ugat that worse. It’s
sa kanyang important to the
bandang leeg na mother to be
nagiging dahilan aware with the
na irritable na ang health of their child
aking anak, Simula and any symptoms
ng ipinanganak ko shows should
siya hindi ko pa taking to the Dr. to
siya nadadala sa be check and
hospital maliban make sure that the
nalang sa kanyang child is healthy.
vaccine. Because the Dr.
will help the child
to prevent more
acute diseases
that will lead to
heart disease
acquired from
Kawasaki disease.

Healthy Children by American

Academy of Pediatrics
 Areas Before During Analysis
Functional Hospitalized Hospitalization
Pattern
Nutritional Before The Mother’s The mother of the patient
Metabolic Hospitalization Patients should always watch the
: The Mother’s Verbalized nutrition that the child may
Patient “Hindi na siya eat, specially eating junk
verbalized masyado food should be avoided
“Kumakain palakain and always seek medical
naman siya 3 ngayon dahil health advice or the
times a day at narin siguro sa nutritionist, what will be the
umiinom din gamot na proper diet that should be
ng tubig. binigay sa given to a child who has a
Mahilig din sa kanya medyo Kawasaki disease because
kahit anong hindi daw some food might trigger
pagkain lalo na maganda ang those signs and symptoms
sa biskits , kanyang that will cause into major
Ayaw lang po panlasa. Pero problem. Scientists haven't
ng sqweet at malakas parin found an exact cause for
crunchy, siya uminom ng Kawasaki disease. It might
kakain siya ng tubig. be linked to genes, viruses,
snacks kahit bacteria, and other things
anong oras in the world around a child,
niya gusto such as chemicals and
irritants. The disease
probably isn't contagious,
but it sometimes happens
in clusters in a community.
BMC Pediatrics
Tai et al. BMC Pediatrics
Areas Functional Before During Analysis
Pattern Hospitalized Hospitalization
Elimination Before During Due to
Hospitalization Hospitalization hospitalization the
the Mother’s the Mother’s patient elimination
Patient Patient pattern is also
Verbalized verbalized “Dahil altered and
“Madalas naman siguro sa continued
siya dumumi sa kanyang monitoring by the
isang araw. nararamdaman physician to
Maayos naman hindi siya evaluate if there
po ung pagdumi masayado are any changes
niya nakakadumi ng in the bowel of
normal. Siguro the patient.
dahil naka KAWASAKI
diapher lang siya DISEASE UK
kaya hindi siya
comportable sa
pagdumi.

Areas Functional Before During Analysis

Pattern Hospitalized Hospitalization
Activity-Exercise As verbalized by During Patient is only 5
the mother of hospitalization years old. He is in his
the patient “ as verbalized by early childhood
Masiglain the mother stage. Characterized
by rapid physical
naman siya at “Napansin ko na
growth; increase in
madalas medyo independence and
naglalaro siya matamlay siya decrease in
ng kanyang mga ngayon at helplessness. Also,
laruan at mahilig walang gana sa maximum learning
siya mga laruan pero can be attained by
makipaglaro sa sana mabalik na children at this stage;
ibang bata. po ang kanyang minds are like
sigla. sponges which soak
up knowledge.
Appearance pf
“teachable moments”
and control of
environment is
manifested.
Activity intolerance
related to
inflammation and
degeneration of
myocardial muscle
cells.

Marianne Belleza,
R.N.
NurseLabs
 Areas Before During Analysis
Functional Hospitalized Hospitalization
Pattern
Sleep-Rest As verbalized During Due to his conditions
by the Mother Hospitalization that his signs and
of the Patient verbalized by the symptoms showed in
“Wala naman Mother of the this body caused him to
po problema Patient “Ngayon be restlessness and the
sa kanyang dahil siguro sa physician will continue
pagtulog, nararamdaman monitoring his condition
madalas niya iritable siya at to prevent those signs of
natutulog din hindi nakakatulog Kawasaki disease. The
siya ng hapon ng maayos. Dr. will treat the disease
at sa gabi with the right
naman medication.
natutulog siya The medication used to
ng mga 8 to 9 treat Kawasaki disease
hours. in the hospital is called
intravenous gamma
globulin (IVIG). IVIG is
given through a vein
over 8 to 12 hours.
Children stay in the
hospital for at least 24
hours after completing
the IVIG dose to make
sure the fever does not
return and other
symptoms are
improving. Aspirin
should only be given to
young children under
doctors' supervision, as
it can cause a serious
liver condition called
Reye Syndrome.
Healthy Children by
American Academy of
Pediatrics
Section on Cardiology ＆
Cardiac Surgery
 Areas Before During Analysis
Functional Hospitalized Hospitalization
Pattern
Cognitive Before During the Due to the
Perceptual hospitalization Hospitalization Kawasaki disease
the Mother “The patient is the child was
verbalized moderate level of affected his
“Maayos naman visual, auditory, cognitive perceptual
ang kanyang olfactory and still due to those signs
paningin at can’t speak or showed in her body.
pandinig ganun pronounce words Piaget noted that
din ang kanyang clearly. Mental children in this
panlasa. process such as stage do not yet
perceiving, understand
remembering, concrete logic,
reasoning, cannot mentally
deciding and manipulate
problem solving information, and are
is still in unable to take the
progress. point of view of
other people, which
he termed.

Pediatric Cardiology
and Adult Congenital
Heart Disease
Liang-Jen Wang/ Ho-
Chang Kuo
 Areas Before During Analysis
Functional Hospitalized Hospitalization
Pattern
Self- As verbalized During The patient is on early
Perception by his Mother hospitalization the childhood, he learns to
/Self- “Sa edad patient was not exercise will, to make
Concept niyang 5 able to choices and explore
years old, communicate their world
marunong na much due to his independently. If not, he
siya mamili condition. becomes uncertain
kung ano about the world and
gusto niya themselves and doubt
lalo na sa that they can do
pagkain at sa anything by themselves.
kung ano ang Self-will exercise choice
kanyang and self-restraint, no
susuotin. self-control, and low
self-esteem. During
early childhood, children
start to develop a "self-
concept," the attributes,
abilities, attitudes and
values that they believe
define them. Because
early self-concepts are
based on easily defined
and observed variables,
and because many
young children are given
lots of encouragement,
Preoperational children
often have relatively
high self-esteem (a
judgment about one's
worth)
EARLY CHILDHOOD
EMOTIONAL AND SOCIAL
DEVELOPMENT:
AGGRESSION
 Areas Before During Analysis
Functional Hospitalized Hospitalization
Pattern
Sexuality- Verbalized by the During The parents are
Reproductive mother of the Hospitalization: responsible to
patient “Hindi The patient is 5 teach your child to
naman siya years old, and explain the
ganun ka curious has not curiosity about the
sa sarili niya. experienced any early age
Wala naman ako problem with childhood to
napapansin na regards to his understand the
kakaibang action reproductive sexuality and
sa sexuality organs and touching and
behavior niya. sexual response. looking and talking
The demands for about the bodies is
toilet training a mostly typical
may conflict with and healthy part of
the child’s the child’s
instinctual development at
pleasure in this age.
having bowel
movements at Jones&Bartlett
will. Learning

Areas Before During Analysis

Functional Hospitalized Hospitalization
Pattern
Coping-Stress Verbalized by his Upon Involve the parents
Tolerance mother “Hindi hospitalization to the child’s coping
naman siya iyakin the patient tends stress because most
at madalas to cry or play of that early
masayahing bata things/toys to childhood depends
naman siya sa cope his stress there coping from
bahay. their parents and
family for fast
recovery.

Nurse Nanda
By: Mas Sugeng
 Areas Functional Before During Analysis
Pattern Hospitalized Hospitalization
Role-Relationship Verbalized by the The patient was Support from
mother comfortable family is
“Pangatolo siya around her important for
sa mga anak ko, mother and the child’s fast
kambal sila. siblings during recovery from
Marunong siya hospitalization. the disease.
mag initiate ng Wasn’t initiate any
aktibidad at activities during Nurse Nanda
masaya sa mga his hospitalization Mas Sugeng
accomplishment
niya sa kanyang
laro.

Areas Before During Analysis

Functional Hospitalized Hospitalization
Pattern
Value-Belief Verbalized by During Parents might have a
the mother hospitalization big impact to the child’s
“Katoliko verbalized by belief and those values
kami the mother should always come
parehong “Hindi naman from the parents and
magulang ako against sa relatives. Will help his
niya at palagi kahit anong beliefs to help him know
naming siya paraan ng pag that the presence of
sinasama sa gamot at what they believe will
simbahan. naniniwala ako help his coping to get
sa fast recovery.
pamamagitan
ng dasal at pag Edelman, C., & Mandle, C.,
gamot sa anak (2010).
ko ay gagaling
siya.
 ANATOMY/PHYSIOLOGY

The immune system is a complex network of cells and proteins that defends the
body against infection. The immune system keeps a record of every germ (microbe)
it has ever defeated so it can recognize and destroy the microbe quickly if it enters
the body again.
Function of Immune system:

Immune system:

A complex system that is responsible for distinguishing us from everything

foreign to us, and for protecting us against infections and foreign substances.
The immune system works to seek and kill invaders. It provides protection
against invasion by microorganism from outside the body and protects the body from
internal threats and maintain the internal environments by removing dead or
damaged cells.

The main parts of the immune system are: white blood cells, antibodies, the
complement system, the lymphatic system, the spleen, the thymus, and the bone
marrow. These are the parts of your immune system that actively fight infection.

Type of Immunity

Innate Immunity (Non-specific immunes system) also called native or natural

immunity. It is present at birth and includes biochemical, physical, and mechanical
barriers of defense, as well as the inflammatory response.

First line of defense

The body's most important nonspecific defense is the skin, which acts as a
physical barrier to keep pathogens out. Even openings in the skin (such as the mouth
and eyes) are protected by saliva, mucus, and tears, which contain an enzyme that
breaks down bacterial cell walls.
Second line of defense
Inflammatory system. A basic way in which the body reacts to infection, irritation
or other injury, the key feature being redness, warmth swelling and pain.
Inflammation is now recognized as a type of nonspecific immune response.

Phagocytosis is a process by which certain living cells called phagocytes ingest

or engulf other cells or particle. the most-effective phagocytic cells are two kinds of
white blood cells; the macrophages (large phagocytic cells) and the neutrophils (a
type of granulocyte). The macrophages occur especially in the lungs, liver, spleen,
and lymph nodes, where their function is to free the airways, blood, and lymph of
bacteria and other particles.

Acquired Immunity (Antigen Specific Immune system) also known as adaptive

immunity is received passively from mother’s antibodies, animal serum, or antibodies
produced in response to a disease. Immunization produces active acquired immunity.

When pathogens are able to bypass innate immune defenses, the adaptive
immune system is activated. The main cells of the immune system are lymphocytes
known as B lymphocytes (B-cells) and T lymphocytes(T-cells). B cells are produced
and mature in bone marrow, a white blood cells that produce antibodies and aid in
immunological memory such as IgG, IgM, IgA, IgD, and IgE. T cells are also
produced in bone marrow, but they mature in the thymus, a white blood cells
specialised to assist B cells (helper T) and others directly kills infected cells (killer T).
Immunoglobulin
IgG is the main form of antibodies in circulation (acquired immunity). It has the
capacity to cross the placental barrier. Production increases after immunization.
IgA is the main Antibody type in external secretions, such as saliva, tears and
mother’s milk.
IgM function as antigen receptors on lymphocytes surface prior to immunization,
it secreted during primary response.
IgE is responsible for allergic symptoms in immediate hypersensitivity reactions.
Interacts with basophils and masticates causes histamine release.
IgD Membrane immunoglobulin. Function as antigen receptors on B naive
lymphocytes surface prior to immunization, other function unknown.

Endothelial cells and function

The endothelial cells forms a one cell thick wall layer called endothelium
that lines all of the blood vessel such as arteries, arterioles, venues, veins and
capillaries. Smooth muscles cells layers beneath the endothelial cells. The
exception to this is the capillaries where endothelium makes up the entire
blood vessel wall.
Functions of Endothelial cells
Barrier Functions. The endothelium acts as a barrier between the blood
and there rest of the body tissue while being selectively permeable for certain
chemicals and white blood cells to move across from blood to tissue of for
waste and carbon dioxide to move form tissue to blood. This property of
endothelial cells is special investigated in blood brain barrier system. In
certain neuro degenerative diseases, it is difficult to develop drugs that can
cross the endothelial barrier efficiently.
Regulating the Blood flow. Endothelial cells generate an anti thrombolytic
surface that facilities transit of plasma and cellular constituents throughout the
vasculature. It is also responsible for maintaining homeostasis and formation
of new blood vessel (process referred to angiogenesis). Angiogenesis has a
key application in cancer research. Endothelial cells consist of “cobblestone”
morphology, stain positive for factor VIII(an essential blood clotting protein
synthesized by endothelial endothelial cells) and take up acetylated low
density lipoprotein.
Inflammatory response. Endothelial cells are also active in participants in
and regulators of inflammatory process.
 VI. PATHOPHYSIOLOGY

Exposure to bacteria / Virus

Auto Immune
Response
(Histamin, Bradykini) Detection of Foreign Body

Activation of Cell Immune Increase Pressure Increase

Response Inflammatory
due to Pressure due to
(Phagocytosis) _Innate Response
inflammation inflammation
DEfenses

Activation of
Inflammation of
Adaptive
blood Vessel
Defenses

T Cells in thymus
glands goes in Widespread B-cells
the lymp nodes proliferation and activations
(cell mediated activation of (Humoral
response) platelets Response)

Regulator T Spontaneous
cells in product of
Helper cell
lympnodes cytotoxic
activation
are antibodies and
stimulated immune complex

Attracts or Lymphokine prod.

B cell
stimulatio activate more B
on cell, Cytotoxic
tcell natural Attracts other
killer cells, lymphocytes and wbc
macrophages

Release of multitude of
proinflammatory
cytokines
Lymph nodes S/sx of our pt
General Circulation of
Body Mucosa Straberry Tongue

Skin Rashed
Attacts and localized on
the system of the body
Eyes Conjuctivities

Kawasaki Disease
VII. LABORATORY AND DIAGNOSTIC EXAMINATION/S
VIII. NURSING CARE PLAN (ADPIE)

Nursing Care Plan

Actual Potential
Hyperthermia Impaired physical mobility
Acute Pain Related to
Impaired Skin Integritty
Impaired oral mucuos membrane
IX. DRUG STUDY
X. DISCHARGE PLAN