KAWASAKI

DISEASE
 TABLE OF CONTENTS
01. DEFINITION 06. PATIENT’S PROFILE

02. ETIOLOGY 07. ANATOMY & PHYSIOLOGY

03. INCIDENCE 08. PATHOPHYSIOLOGY

04. GENERAL SIGNS & SYMPTOMS 09. DIAGNOSTIC PROCEDURES

05. CAUSATIVE AGENT 10. MEDICAL MANAGEMENT

11. NURSING CARE PLAN

 WHAT IS
KAWASAKI DISEASE?
01.
Kawasaki disease is an illness that
primarily affects children under the
age of 5. It involves inflammation of
the blood vessels throughout the body
and can lead to symptoms such as
fever, rash, swollen lymph nodes, red
eyes, and swelling of the hands and
feet. If left untreated, it can lead to
serious complications such as
coronary artery aneurysms.
 ETIOLOGY
Where the Kawasaki Disease came from

02.
 The exact cause of Kawasaki disease is unknown, but it's
believed to involve a combination of genetic predisposition
and environmental factors. Some researchers suspect that
it may be triggered by an infection, possibly a virus,
although no specific pathogen has been consistently
identified.
Additionally, there are theories suggesting an
abnormal immune response may play a role in the
development of the disease. However, more research
is needed to fully understand the etiology of
Kawasaki disease.

Kawasaki disease is believed to have a multifactorial etiology, involving both genetic

predisposition and environmental factors. Here's why both are thought to be
involved:
GENETIC PREDISPOSITION
Studies have shown that
individuals with a family history
of the disease are at higher risk
of developing it themselves.
Additionally, certain genetic
variations have been
associated with an increased
susceptibility to Kawasaki
disease. However, genetics
alone cannot explain the
occurrence of the disease, as
not all individuals with genetic
predispositions develop it.
ENVIRONMENTAL FACTORS
One theory is that an infectious
agent, such as a virus or
bacteria, may trigger an
abnormal immune response in
genetically susceptible
individuals. However, despite
extensive research, no specific
infectious agent has been
consistently linked to Kawasaki
disease. Other environmental
factors, such as exposure to
toxins or pollutants, have also
been proposed as potential
triggers.
 RISK FACTORS

Age- primarily affects young

children under the age of 5.

Gender- boys are most likely

to develop Kawasaki disease.

Ethnicity- more prevalent in

individuals of Asian decent.

Family history-Having a family

history of Kawasaki Disease
may increase the risk of
developing the condition.
 INCIDENCE

03.
AS OF LAST UPDATE, THE INCIDENCE RATE OF
KAWASAKI DISEASE VARIES BY REGION, WITH RATES
TYPICALLY HIGHER IN EAST ASIAN COUNTRIES LIKE
JAPAN AND SOUTH KOREA.

US & JAPAN
EUROPE Reported annual
incidence rate is
Incidence rate is lower, around 240 cases
estimated to be around per 100,000
20-25 cases per children under the
100,000 children under age of 5.
5 years old.

PHILIPPINES
The majority of KD cases (68.52%) occurred in children less than five years old,
with incidence rates ranging from 15 to 23 cases per 100,000 population, and a
male-to-female ratio of 1.43:1.
04.

GENERAL
SIGNS & SYMPTOMS
 PHASE 1 (ACUTE PHASE, LASTS FOR 1-2 WEEKS):

Fever Rash Swollen lymph nodes Red eyes

Strawberry Cracked Swollen Hands

tongue lips and Feet
 PHASE 2 (SUBACUTE PHASE, LASTS FOR MORE
THAN 4 WEEKS):

Diarrhea Vomiting Peeling skin

Abdominal Low energy Joint pain

pain
 CAUSATIVE
AGENTS
05.
Staphylococci Streptococci Mycoplasma Chlamydia

VIRUSES SUCH AS;

Adenovirus Parvovirus Epstein-Barr Virus

06.

PATIENT’S
PROFILE
Name: Patient X Age: 7 years old Gender: Male

Address: Purok Kaagapay Bago, General Tinio (Papaya) Nueva Ecija

Religion: Roman Catholic Occupation: None Ethnicity: Filipino

Date of Admission: April 4, 2024 Chief Complaint: Rashes

Final Diagnosis: Pediatric Community-Acquired Pneumonia; Viral Exanthem vs.

Kawasaki Disease
 ANATOMY
&
PHYSIOLOGY
07.
 HEART
The pump that circulates
blood throughout your
body is the heart, a fist-
sized organ. It is the
primary organ of your
circulatory system.
 AORTA
The principal and biggest artery
in the human body.

LEFT CORONARY ARTERY

Supplies blood to the left side of
the heart muscle and emerges CORONARY SINUS
from the aorta above the left
cusp of the aortic valve. The right atrium receives
more than half of the
RIGHT CORONARY deoxygenated blood that
ANTERIOR INTERVENTRICULAR BRANCH
ARTERY leaves the heart muscle
A branch of the left coronary artery. through this sizable vein.
Provides blood to the right
atrium, right ventricle, and
the atrioventricular and
sinoatrial nodes, which GREAT CARDIAC VEIN
control the heart rhythm. Supplies the left anterior
descending artery in the
RIGHT CORONARY same area of the heart.
VEIN
Return deoxygenated blood
from the heart muscle to the
heart POSTERIOR ARTERY
Supplies blood to the
posterior, or bottom, part

THE HUMAN
of the heart and is a branch
of the right coronary artery
that runs lengthwise along
the back of the organ.

HEART
POSTERIOR VEIN GREAT CARDIAC VEIN
Removes fluid from the left
ventricle's inferior wall. Contributes to the
venous drainage of the
external layer of the
myocardium of the
posterior right atrium
and right ventricle.
 SKIN
It is the largest organ in
the body. It completely
envelops the body and
act as a barrier against
injury, infection, heat,
and light.
3 LAYERS OF
SKIN
STRATUM CORNEUM
The outermost layer that is
HAIR FOLLICLE constantly shed.

EPIDERMIS
The skin's thin outer layer is
called the epidermis
MELANOCYTE
Produces melanin.
DERMIS
The skin's middle BASAL CELLS
layer
Located at the base of
the epidermis, directly
beneath squamous cells.
SUBCUTANEOUS FAT
Deepest layer of the skin
that helps conserve body SWEAT GLAND
heat and act as a shock
absorber that protects
the body from injury. SEBACEOUS GLAND
NERVE

BLOOD VESSELS
PATHOPHYSIOLOGY

08.
DIAGNOSTIC
PROCEDURES

09.
 URINALYSIS
PHYSICAL CHEMICAL MICROSCOPIC

Color: Yellow Glucose: Negative Red Blood Cells: 0-1/

HPF
Clarity: Slightly turbid Protein: Trace (=/-)
Pus Cells: 2-3/ HPF
Specific gravity: 1.020 Ketone: Negative
Epithelial Cells: Rare
pH: 7.0 Nitrite: Negative
Mucus Threads:
Urobilinogen: High (2 Moderate
mg/dL)
Bacteria: Few
Bilirubin: Negative
Amorphous
Urates/PO4: Few
 HEMATOLOGY
COMPONENT RESULT REFERENCE VALUE

RBC Count 4.28 x 1012/L (Male: 4.5-6.0 x 1012/L)

(Female: 4.0- 5.5 x 1012/L)
Hematocrit 0.34 g/L (Male: 0.40-0.54)
(Female: 0.37- 0.47)
Hemoglobin 120 g/L (Male: 120-170 g/L)
(Female: 110- 150 g/L)
MCV 79.2 fL
(80- 100 fL)
MCH 28.0 pg (27- 31 pg)
MCHC 354 g/L 310-370 g/L
RDW-CV 13.3% (11.6- 14.6%)

RDW-SD 40.5 fL (39-46 fL)

Platelet Count 367 x 109/L (150- 450 x 109/ L)

MPV (mean platelet volume) 8.5 fL (7.6-13.2 fL)
PDW (platelet distribution width)
15.7 fL (14.8- 17.2%)
 HEMATOLOGY
COMPONENT RESULT REFERENCE VALUE

WBC Count 14.9 x 109/L (adults: 5-10 x 109/L)

(children: 6.2-17.0 x 109/L)
Segments 0.67% (0.50- 0.70)

Lymphocytes 0.21% (0.20-0.40)

Monocytes 0.08% (0-0.10)

Eosinophils 0.04% (0-0.05)

Basophils ______ (0-0.1)

Bands ______ (0-0.11)

Immature Cells ______

Reticulocyte ______ (adult: 0.5-1.5%)

(newborn: 2.5-6.5%
Blood Type “A” Rh-D Positive
REMARKS: Blood Typing c/o: Bianca Marie M. Cabusas
 PHYSICAL ASSESSMENT CXR C-REACTIVE PROTEIN:
- General Appearance: awake and alert - Haziness in both - 86.19mg/dL – Positive
perihilar areas and
- BP: N/A
posterior basal
- PR: 128 segments of left
lower lobe
- RR: 29

- T: 37.4°c - Heart within

normal size
- WT: 23kg

- HT: N/A - Both

hemidiaphragms,
- Skin: Dry sealing rashes in chest area
sulci, and
- HEENT: (+)CLAD, Balbar conjunctivitis, (+) visualized bones
strawberry tongue. are intact.
- ABD: Soft nontender

-Extremities: (+) swelling both feet

BRADEN SCALE:
10.

MEDICAL
MANAGEMENT
Name of the drug
a. Generic name: CEFUROXIME b. Brand Name: Ceftin c. Dose/ dosage / route: 750mg every eight hours intravenously
Mechanism of action
A broad-spectrum cephalosporin antibiotic, cefuroxime prevents the formation of bacterial cell walls. By attaching itself to one
or more penicillin-binding proteins (PBPs), it prevents bacteria's cell walls from undergoing the last stage of peptidoglycan
synthesis, known as transpeptidation. By stopping cell wall assembly, this process kills bacteria cells.

Classification: antibiotic
cephalosporin
Indication Contraindication Side Effect
Acute bacterial otitis media Hypersensitivity to cefuroxime or Gastrointestinal disturbances
Upper respiratory tract infections other cephalosporins. (nausea, vomiting, diarrhea)
Skin infections History of severe allergic reactions Skin rash
Urinary tract infections to Penicillins or other beta-lactam Headache
Gonorrhea Dizziness
Early Lyme disease antibiotics.
Impetigo
Nursing Responsibility
Before:
Obtain a specimen for culture and sensitivity test before giving the first dose. Ensure the patient is not allergic to penicillin
or cephalosporins.

During:
Verify the patient’s identity. Administer the right drug with the right dose at the right time. Check the patency of the IV
site and IV line. If hypersensitivity occurs, stop the administration immediately.

Post:
Regulate the IVF with the line prescribed flow rate. Monitor liver function tests, renal function tests, and blood counts. Do
not stop the therapy without notifying the physician. Document and record to the chart.
Name of the drug
a. Generic name: ARIKAYCE, AMIKIN b. Brand Name: Amikacin c. Dose/ dosage / route: 170mg every 12 hours intravenously

Mechanism of action
Amikacin is an aminoglycoside antibiotic derived from kanamycin A. It inhibits bacterial protein synthesis by binding to the 16S ribosomal RNA
subunit. Amikacin is bactericidal and exerts activity against more resistant strains of gram-negative bacteria (including Acinetobacter baumanii and
Pseudomonas aeruginosa) and some gram-positive bacteria.
Classification: Therapeutic Class: Antibiotic Pharmacologic Class: Aminoglycoside
Indication Contraindication Side Effect
Treatment for severe bacterial infections in the short term that Hypersensitivity nausea and vomiting,
are brought on by susceptible strains of: Gram-negative to amikacin or loss of appetite and increased thirst,
bacteria, such as Escherichia coli and Pseudomonas species, other rash, or injection site reactions
Proteus species that are indole-positive and indole-negative, aminoglycosides Ototoxicity: Risk of hearing loss due to
Providencia species, species of Klebsiella, Enterobacter, and . aminoglycoside-induced damage to the
Serratia, Acinetobacter species (Mima-Herellea) Pre-existing inner ear.
Also used for patients who do not respond to conventional hearing Nephrotoxicity: Potential kidney damage.
treatment for lung disease brought on by the Mycobacterium impairment. Neuromuscular blockade: Can interfere with
avium complex (MAC) bacteria. neuromuscular transmission.
Nursing Responsibility
Before:
Perform baseline tests: Before the initial dose, culture and sensitivity (C&S), renal function, and vestibulocochlear nerve function should be
assessed. Monitor for history of hypersensitivity or toxic reaction with an aminoglycoside antibiotic.
Be cautious with patients having impaired renal function, eighth cranial (auditory) nerve impairment, preexisting vertigo or dizziness, tinnitus,
dehydration, fever, older adults, premature infants, neonates and infants, myasthenia gravis, parkinsonism, hypocalcemia.

During:
Monitor the patient for signs of decreased renal function such as declining urine output and increasing blood urea nitrogen (BUN), creatinine, and
declining glomerular filtration rate (GFR). Monitor for adverse effects such as neurotoxicity, ototoxicity, dizziness, nausea, vomiting, hepatotoxicity,
hypokalemia, hypomagnesemia, skin rash, urticaria, pruritus, redness, oliguria, urinary frequency, hematuria, tubular necrosis, azotemia.

Post:
Continue to monitor renal function and vestibulocochlear nerve function at regular intervals during therapy. Monitor for any adverse effects and
report to the healthcare provider if any are observed.
Name of the drug
a. Generic name: SALBUTAMOL b. Brand Name: Ventolin c. Dose/ dosage / route: 1 nebule every 8 hours
Mechanism of action
Salbutamol works by stimulating the beta-2 adrenoceptors in your bronchial muscles, which are the smooth muscles lining the
two large tubes (bronchi) that carry air from your windpipe (trachea) to your lungs. This causes your bronchi to relax and dilate,
widening your airway for a short period of about 4 to 6 hours and making it easier for you to breathe.
Classification: Short-acting beta-2 adrenergic agonist.
Indication Contraindication
Side Effect
Salbutamol is used to relieve the Salbutamol is not
symptoms of asthma or recommended for feeling shaky
bronchospasm. It is used to relieve breastfeeding mothers. It is headache
symptoms such as chest tightness, not to be taken during the muscle cramps
wheezing, shortness of breath, and first six months of pregnancy. fast heart rate
coughing in some other chest Not to administer to a anxiety
diseases too, such as COPD woman at risk of miscarriage dizziness

Nursing Responsibility
Before:
Ask your patient if she is not pregnant or lactating. Record a baseline vital signs for comparison after drug administration.
Monitor respiratory and pulse rate. Assess the volume of the pulse, in the case of tachycardia.

During:
Monitor respiratory rate, oxygen saturation, and lungs sounds before and after administration. If more than one inhalation is
ordered, wait at least 2 minutes between inhalations. Use a spacer device to improve drug delivery, if appropriate.

Post:
Continue to monitor respiratory and pulse rate. Health educate your patient on the effect of the drug. Complete a respiratory
assessment (respirations, pulse oximetry, and lung auscultation) before and after the medications have been administered
and compare the results.
Name of the drug
a. Generic name: PARACETAMOL HYDROCLORIDE b. Brand Name: Metin c. Dose/ dosage / route: 5mcg per mL syrup; 5mL two
times a day per orem
Mechanism of action
Procaterol is a long-acting beta-2-adrenergic receptor agonist. It is a potent bronchodilator that may be administered orally or
by aerosol inhalation. It belongs to the class of adrenergics for systemic use, selective beta-2-adrenoreceptor agonists.

Indication
for the relief of dyspnea and other
symptoms caused by respiratory
obstructive disturbance in bronchial
asthma, chronic bronchitis, and
pulmonary emphysema
Nursing Responsibility
Contraindication
Side Effect
Special precautions should be
taken for patients with Shock or anaphylactoid reaction
hyperthyroidism, hypertension, significant decrease in serum K levels,
heart disease, and diabetes palpitations
mellitus. It is not a substitute for tachycardia and tremor,
inhaled corticosteroids or other headache
anti-inflammatory agents nausea and vomiting
skin rash.

Before:
Perform baseline tests: Before the initial dose, assess the patient’s respiratory status and vital signs.
Be cautious with patients having heart disease, hypertension, hyperthyroidism, diabetes mellitus.

During:
Monitor the patient for signs of decreased respiratory function such as declining oxygen saturation and increasing
respiratory rate. Monitor for adverse effects such as nausea, vomiting, dry mouth, gastric discomfort, headache or dull
headache, tremors, dizziness, numbness of limbs, drowsiness.

Post:
Continue to monitor respiratory function and vital signs at regular intervals during therapy.
Monitor for any adverse effects and report to the healthcare provider if any are observed.
Name of the drug
a. Generic name: LEVOCCETIRIZINE DIHYDROCHLORIDE b. Brand Name: Allerzet c. Dose/ dosage / route: 2.5mg per 5mL syrup; 5mL
two times a day per orem
Mechanism of action
Levocetirizine, the active R-enantiomer of cetirizine, is a 2nd generation antihistamine. It is a potent and selective antagonist of
histamine H1-receptors on effector cells in the blood vessels, gastrointestinal and respiratory tracts.
Indication Contraindication
Side Effect
to relieve runny nose; sneezing; and redness, Levocetirizine should not be used if
itching, and tearing of the eyes caused by you are allergic to levocetirizine or constipation, vomiting, diarrhea, fever,
hay fever, seasonal allergies, and allergies to cetirizine (Zyrtec). You should not cough, sinus pain, ear infection, and
other substances such as dust mites, animal take levocetirizine if you have end- drowsiness. Increased symptoms of
dander, and mold. It is also used to treat stage kidney disease or if you are allergies or urticaria, painful or difficult
symptoms of hives, including itching and on dialysis. Any child younger than urination, little to no urination, dizziness
rash 12 years old with kidney disease or fainting sensation, fever, and
should not take levocetirizine indications of an ear infection
Nursing Responsibility
Before:
Assess the patient’s history for allergy to any antihistamines, hydroxyzine. Be cautious with patients having narrow-angle
glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction,
pyloroduodenal obstruction. Perform a physical examination including skin color, lesions, texture; orientation, reflexes, affect;
vision examination; R, adventitious sounds; prostate palpation; renal function tests.

During:
Administer drug on an empty stomach, 1 hour before or 2 hours after meals, to increase the absorption. Monitor the patient for
signs of adverse effects such as somnolence, sedation, palpitation, edema, nausea, diarrhea, abdominal pain, constipation,
bronchospasm, pharyngitis, fever, photosensitivity, rash, myalgia, arthralgia, angioedema.

Post:
Continue to monitor the patient’s respiratory status and vital signs at regular intervals during therapy. Monitor for any adverse
effects and report to the healthcare provider if any are observed.
 NURSING
CARE PLAN
11.
 ASSESSMENT
Subjective Data:

The parent reported scratching of upper extremities & lower extremities.

Objective Data:

Maculopapular rash
Swelling of the feet
Erythema of the skin
Dry sealing rash in chest area

Vital signs:
T - 37.4
PR - 128
RR - 29
O2sat - 99%
 NURSING
DIAGNOSIS
Impaired Skin integrity related to inflammatory
process as evidenced by disruption of skin surfaces,
macular rash, and skin desquamation.
 PLANNING

After the nursing intervention, the patient will;

Short Term:

Experience relief from itching and discomfort associated with the rash.

The patient and parent will have a comprehensive understanding of the

inflammatory process and its impact on skin integrity.

Report decrease or no more signs of edema of the feet.

 PLANNING

After the nursing intervention, the patient will;

Long Term:

The patient's skin integrity will be restored, with no further disruption

or signs of inflammation.

The patient and parent will demonstrate proficiency in managing the

child's skin condition at home, including proper hygiene and
maintenance.
 INTERVENTIONS
Independent:

·Use age-appropriate language and teaching materials to educate both the

child and parents on proper skin care techniques, emphasizing gentle
cleansing and moisturizing to prevent further skin irritation.

Encourage the child to wear loose-fitting, comfortable clothing made from

soft fabrics to minimize friction and irritation in affected areas.

Create a soothing environment for the child, such as providing cool baths or
using mild, fragrance-free moisturizers, to alleviate itching and discomfort.

Regularly assess the child's skin condition and provide gentle skincare as
needed, such as applying moisturizers to promote healing and prevent
complications.
 INTERVENTIONS

Dependent:

·Administer prescribed 2.5mg per 5ml of Levoccetirizine

Dihydrochloride syrup, as ordered by the healthcare
provider.

Administer prescribed IV fluids as ordered.

 INTERVENTIONS

Collaborative:

Collaborate with the child's pediatrician to implement strategies for

managing the skin condition in educational or social settings,
ensuring continuity of care and support for the child's needs.

Consult with a pediatric dermatologist or specialist for expert

assessment and recommendations regarding advanced treatment
options or specialized care techniques tailored to children.
 EVALUATION
After nursing intervention, the patient;

Short Term:

Goal met. The patient experienced relief from itching and discomfort
associated with the rash.

Goal met. The patient and parent have a comprehensive understanding of

the inflammatory process and its impact on skin integrity.

Goal met. The patient reported no more signs of edema of the feet.
 EVALUATION
After nursing intervention, the patient;

Long term:

Goal met. The patient's skin integrity was restored, with no further
disruption or signs of inflammation.

Goal met. Patient and parent demonstrated proficiency in managing

the child's skin condition at home, including proper hygiene and
maintenance
THANK YOU!!