UNIVERSITY OF SOUTHERN PHILIPPINES FOUNDATION

COLLEGE OF HEALTH SCIENCE

NURSING DEPARTMENT
A.Y 2020-2021
2nd SEMESTER

CARE OF THE MOTHER, CHILD, ADOLESCENT

(ACUTE AND CHRONIC)

NgCM109 LEC

RESEARCH TOPIC: KAWASAKI SYNDROME

Submitted by:

_Marie Ashley Casia__

Clinical Instructor:

Mrs. Erlinda M. Guzman ,RN, MAN

 RESEARCH TOPIC

Definition:

Kawasaki disease (mucocutaneous lymph node syndrome) is a form of vasculitis identified by an acute

febrile illness with multiple systems affected. The cause is unknown, but autoimmunity, infection, and
genetic predisposition are believed to be involved. It affects mostly children between ages 3 months and 8
years; 80% are younger than age 5. It occurs more commonly in Japanese children or those of Japanese
decent. It has seasonal epidemics, usually in late winter and early spring. It was first described in 1967 by Dr.
Tomisaku Kawasaki in Japan.

Although Kawasaki disease is a multisystem disease, the cardiovascular system appears to be the primary
site with coronary artery vasculitis, aneurysm development, thrombosis, and myocardial thrombosis
progressing over days to weeks. Approximately 15% to 25% of patients develop cardiac complications
(coronary thrombosis or rupture, myocardial infarction, heart failure, vasculitis of the aorta or peripheral
arteries); however mortality is low.

Incidence and Risk Factors:

By far, the highest incidence of Kawasaki disease occurs in Japan (175 per 100,000), though its incidence in
the United States is increasing. Kawasaki disease is predominantly a disease of young children, with 80% of
patients younger than 5 years of age.
The disease affects boys more than girls. Approximately 2000-4000 cases are identified in the United States
each year.

Causes:

The causative agent of Kawasaki disease is still unknown, but current theories center primarily on
immunological causes for the disease. Evidence increasingly points to an infectious etiology, but debate
continues on whether the cause is a conventional antigenic substance or a superantigen. Per a Children’s
Hospital Boston / Harvard Medical school information page on the disease, “Some studies have found
associations between the occurrence of Kawasaki disease and recent exposure to carpet cleaning or
residence near a body of stagnant water; however, cause and effect have not been established.”
An association has been identified with an SNP in the ITPKC gene, which codes an enzyme that negatively
regulates T-cell activation. An additional factor that suggests genetic susceptibility is the fact that regardless
of where they are living, Japanese children are more likely than other children to contract the disease. The
HLA-B51 serotype has been found to be associated with endemic instances of the disease.
Signs and symptoms:

Stage I – Acute Febrile Phase (First 10 days)

 The child appears severely ill and irritable.

 Major diagnostic criteria established by

the Centers for Disease Control and
Prevention (CDC) are as follows:

a. High, spiking fever for 5 days or more.

b. Bilateral conjunctival injection.

c. Oropharyngeal erythema, “Strawberry “ tongue,

or red dry lips.

d. Erythema and edema of hands and feet,

periungal desquamation.

e. Erythematous generalized rash.

f. Cervical lymphadenopathy greather than 0.6

inch (1.5cm)

 Pericarditis, myocarditis, cardiomegaly, heart failure, and pleural effusion.

 Other associated findings include meningitis, arthritis, sterile pyuria, vomiting, and diarrhea.

Stage II – Subacute Phase (Days 11 to 25)

 Acute symptoms of stage I subside as temperature returns normal. The child remains irritable and
anorectic.

 Dry, cracked lips with fissures.

 Desquamation of toes and fingers.

 Coronary thrombus, aneurysm, myocardial infarction, and heart failure.

 Thrombocytosis peaks at 2 weeks.

Stage III – Convalescent Phase (Until sedimentation rate and platelet count normalize)

 The child appears well.

 Transverse grooves of fingers and toenails (Beau’s lines).

 Coronary thrombosis, aneurysms may occur.

Diagnostic evaluation:

 The diagnostic of Kawasaki disease is based on clinical manifestations. The CDC requires that fever
and four of the six other criteria listed above in stage I be demonstrated.

 Electrocardiogram, echocardiogram, cardiac catheterization, and angiocarddiography may be

required to diagnose cardiac abnormalities.

 Although there are no specific laboratory tests, the following may help support diagnosis or rule out
other disease.

1. CBC – leukocytosis during acute stage.

2. Erythrocytes and hemoglobin – slight decrease.
3. Platelet count – increased during second to fourth week of illness.
4. IgM, IgA, IgG, and IgF – transiently elevated.
5. Urine – protein and leukocytes present.
6. Acute phase reactants (ESR, C-reactive protein, alpha I antitrypsin) are elevated during the acute phase.
7. Myocardial enzyme levels (serum CK-MB) suggest MI if elevated.
8. Liver enzymes (AST, ALT) – moderately elevated.
9. Lipid profile – low high density lipoprotein and high triglyceride level.

Pharmacologic interventions:
 Immune globulin (gamma globulin) I.V. therapy – IVGG (2g/kg/day) is initiated during stage I in one 8
to 10 hour infusion to reduce the incidence of coronary artery abnormalities.
 Aspirin therapy
 Thrombolytic therapy may be required during stages I, II, or III.

Nursing Diagnosis: Hyperthermia related to inflammatory disease process as evidenced by a consistent increased temperature of 38.5 C on its 6 th day.
DEFINING CHARACTERISTICS
Subjective Data:
“unom na ka adlaw gihilantan
gihapun ang akong anak ” as
verbalized by the patient’s
mother.
Objective Data:
Received patient lying in bed
without an IVF hooked:
 Hot, flushed skin noted
 Dry and cracked lips
noted
 Profuse sweating noted
 Oropharyngeal
reddening or strawberry
tongue” noted
 Desquamation of the
palms and soles noted
 Peripheral erythema
noted
 Peripheral edema noted
 Irritability noted
SCIENTIFIC BASIS
Hyperthermia means the body
temperature elevate above
normal range. Kawasaki disease
causes swelling (inflammation)
in children in the walls of small
to medium-sized blood vessels
that carry blood throughout the
body. Kawasaki disease
commonly leads to inflammation
of the coronary arteries, which
supply oxygen-rich blood to the
heart Kawasaki Disease begins
with a fever that lasts for at least
5 days. Along with the fever the
child may display irritability,
intermittent fatigue, and
occasional colicky abdominal
aching.
KAWASAKI SYNDROME
EXPECTED OUTCOME
Short Term Goal:
After 4 hours of Nurse-Patient
Interaction, the patient’s
temperature will drop to 38 C .
Long Term Goal:
After 24 hours of Nurse-Patient
Interaction, the patient will
maintain temperature within
normal range and demonstrate
behaviors to monitor and
promote normal body
temperature.
NURSING INTERVENTIONS RATIONALE
 Assess the patient’s vital
signs at least every four
hours.
 Closely monitor intake
and output, and
administer oral and I.V
fluids as ordered.
 Monitor hydration
status by checking skin
turgor, weight, urinary
 To assist in creating an
accurate diagnosis and
monitor effectiveness of
medical treatment,
particularly the
antibiotics and fever-
reducing drugs (e.g.
Paracetamol)
administered.
 To assist in creating an
accurate diagnosis and
monitor effectiveness of
medical treatment,
particularly the
antibiotics and fever-
reducing drugs (e.g.
Paracetamol)
administered.
 To assist in creating an
accurate diagnosis and
monitor effectiveness of
  Restlessness noted output, specific gravity,
and presence of tears.
Vital Signs taken as of the ff:
T- 38.5 C
PR- 101 bpm
RR- 21 cpm
BP- 122/80 mmHg
O2 Sat- 95 %
 Observe mouth and skin
frequently for signs of
infection.
 Remove excess clothing,
blankets and linens.
Adjust the room
temperature.
 Administer the
prescribed anti-pyretic
medications.
 Offer a tepid sponge
bath.
medical treatment,
particularly the
antibiotics and fever-
reducing drugs (e.g.
Paracetamol)
administered.
 For early detection of
infection
 To regulate the
temperature of the
environment and make
it more comfortable for
the patient.
 Use the fever-reducing
medication to stimulate
the hypothalamus and
normalize the body
temperature. Aspirin
helps alleviate fever and
reduces joint pain due
to its inflammatory
property.
 To facilitate the body in
cooling down and to
provide comfort.
 Elevate the head of the
bed.
 Head elevation helps
improve the expansion
of lungs, enabling the
patient to breathe more
effectively.

 Perform passive range  Movement may be

of motion exercises restricted
every 4 hours while the
child is awake

 Provide quiet and  To provide relaxation to

peaceful environment the patient.
with diversional
activities.

 Encourage the parents  To address concerns

and child to verbalize immediately and
their concerns, fears, effectively.
and questions.
Nursing Diagnosis: Acute Pain related to inflammatory process as evidenced by a pain scale level of 9/10 and cries when being touched or moved.

DEFINING CHARACTERISTICS: SCIENTIFIC BASIS EXPECTED OUTCOME NURSING INTERVENTION RATIONALE

SUBJECTIVE DATA:
“ mohilak ako anak basta
mahikapan iya lawas labi na sa
iya kamot ug tiil” as verbalized
by the patient’s mother.
OBJECTIVE DATA:
Received patient lying on bed
without an IV hooked:
 Facial grimacing noted
 Guarded behavior noted
 Extreme irritability
noted
 Crying noted
 Oropharyngeal
reddening or strawberry
tongue” noted
 Desquamation of the
Unpleasant sensory and
emotional experience arising
from actual or potential tissue
damage or described in terms of
such damage. Kawasaki disease
is an illness that
causes inflammation (swelling
and redness) in blood vessels
throughout the body. Kawasaki
Disease begins suddenly. It can
cause blood vessels to become
inflamed or swollen throughout
the body. If untreated, the
swelling can lead to damage of
the blood vessel walls, especially
those that go to the heart
(coronary arteries).
Short term goal:
After 4 hours of nurse-patient
interaction, the patient will
report that pain is relieved with
a scale of 4/10.
Long term goal:
After 1 day of nurse-patient
interaction, the patient will
follow prescribed
pharmacological regimen and
demonstrate use of relaxation
skills and diversional activities.
 Assess pain level
through observation
(verbal expressions of
pain, facial grimace),
utilizing pain
scale assessment, and
by obtaining relevant
pain information from
parents about child’s
expression of
pain.
 Maintain the child’s
room distraction-free
and keep it dim.
 Explain to parents
reason for child’s
discomfort/irritability.
 Explain to parents that
irritability may persist
for up to 2 months; that
peeling skin on hands
and feet is normal and
not painful.
 Provides information
upon which valid
pain assessments and
treatment
effectiveness can be
based.
 Darkness
reduces eye discomfort
caused by conjunctivitis.
 Promotes understanding
and cooperation.
 Promotes understanding
and allows parents to
anticipate needs.
 palms and soles noted
 Peripheral erythema
noted  Explain to parents that  Prolonged joint pain is
 Peripheral edema noted joint pain may continue not uncommon; ROM
for several weeks; Teach with heat helps increase
Vital Signs taken as of the ff: parents on passive ROM flexibility.
T- 38.5 C exercises in a warm
PR- 101 bpm bath.
RR- 21 cpm  Apply cool cloths to the  Alleviate skin itching,
BP- 122/80 mmHg skin, lotion, and soft, therefore, promotes
O2 Sat- 95 % loose clothing on the comfort.
Pain Score of 9/10. child.
 Handle child gently and  Movement causes
avoid unnecessary discomfort
movements.
 Apply lubricating lip  Moistens dry oral
ointments and mucosa to lessen
glycerin swabs to the discomfort and promote
oral mucosa; oral intake.
offer cool liquids and
soft foods.
 Administer IV  Decreases inflammatory
immunoglobulin and process and helps
high dose ASA therapy decrease fever.
as indicated
 Provide quiet and  To provide relaxation to
peaceful environment the patient.
with diversional
activities.

 Encourage the parents  To address concerns

and child to verbalize immediately and
their concerns, fears, effectively.
and questions.
REFERENCE:

Kawasaki Disease. (n.d.). Physiopedia. Retrieved June 7, 2022, from https://www.physio-pedia.com/Kawasaki_Disease

Martin, P. (2022, March 18). 6 Kawasaki Disease Nursing Care Plans. Nurseslabs. Retrieved June 7, 2022, from https://nurseslabs.com/6-kawasaki-disease-
nursing-care-plans/
Kawasaki disease - Symptoms and causes. (2021, November 18). Mayo Clinic. Retrieved June 7, 2022, from
https://www.mayoclinic.org/diseases-conditions/kawasaki-disease/symptoms-causes/syc-20354598
Kawasaki Disease: Symptoms, Diagnosis and Treatment. (n.d.). Nationwide Children's Hospital. Retrieved June 7, 2022, from
https://www.nationwidechildrens.org/conditions/kawasaki-disease