KAWA

SAKI
DISEA
SE
 PATIENT’S
PROFILE
NAME: MAPUTE, Jaime Mary DATE ADMITTED: September 22, 2022
AGE: 10 WARD: Pediatric Ward
SEX: Female BED NO.: 6
CIVIL STATUS: Single CHIEF COMPLAINT: Fever, Rashes, and
EDUCATIONAL ATTAINMENT: Red Eyes
Elementary School MEDICAL DIAGNOSIS: Kawasaki
OCCUPATION: Student Disease
MOTHER’S NAME: Mapute, Mary
FATHER’S NAME: Mapute, Alex
ADDRESS: Purok 7, Tabung, Guindulman,
Bohol
PREVIOUS ILLNESSES: None
PREVIOUS HOSPITALIZATIONS:
 DEFINITION OF
THE DISEASE
• 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 was previously called mucocutaneous lymph node

syndrome because it also causes swelling in glands (lymph nodes) and
mucous membranes inside the mouth, nose, eyes and throat. The
disease was first described in Japan by Tomisaku Kawasaki in 1967.
 PATHOPHYSIOL
• OGY
The normal coronary artery is composed of three general layers: the tunica
intima, tunica media and tunica adventitia. The intima is mainly composed of
endothelial cells, the media of smooth muscle cells and the adventitia of
loose connective tissue. In Kawasaki disease, necrotizing arteritis develops
in the first 2 weeks of the disease and is associated with neutrophilic
infiltration
• This gradually destroys the intima, media and some portions of the adventitia
of the coronary artery. (CD8+ T cells, IgA+ plasma cells, monocytes and
macrophages compose the inflammatory infiltrate during subacute chronic
arteritis.)
• These cells release pro-inflammatory cytokines such as IL-1β and TNF,
which contribute to luminal myofibroblast proliferation, in which
myofibroblasts, mainly derived from smooth muscle cells, and their matrix
products progressively obstruct the coronary lumen.
 SIGNS AND
• SYMPTOMS
To receive a diagnosis of Kawasaki disease, a child usually will have a fever
greater than 102.2 F (39 C) for five or more days and at least four of the
following signs and symptoms.
• A rash on the main part of the body or in the genital area
• An enlarged lymph node in the neck
• Extremely red eyes without a thick discharge
• Red, dry, cracked lips and an extremely red, swollen tongue
• Swollen, red skin on the palms of the hands and the soles of the feet, with
later peeling of skin on fingers and toes
• The symptoms might not occur at the same time, so it's important to let your
child's health care provider know about a sign or symptom that has gone
away.
 SIGNS AND
• SYMPTOMS
Other signs and symptoms that might develop include:
• Abdominal pain
• Diarrhea
• Irritability
• Joint pain
• Vomiting
• Children with a high fever for five or more days who have fewer than four of
the above signs and symptoms might have what's known as incomplete
Kawasaki disease. Children with incomplete Kawasaki disease are still at
risk of coronary artery injury and still require treatment within 10 days of the
onset of symptoms.
 DIAGNOSTIC
•
PROCEDURES
2-D ECHOCHARDIOGRAM
• Patients who have Kawasaki Disease should have an echocardiogram every 1-2 years
to screen for heart problems. Echcardiography may reveal signs of myocarditis,
pericarditis, arthritis, aseptic meningitis, and inflammation of the coronary arteries.

• CBC (COMPLETE BLOOD COUNT)

• The results may refelct problems with fluid volume or loss of blood.

• ESR (ERYTHROCYTE SEDIMENTATION RATE)

• It measures how much inflammation is in the body.

• URINALYSIS
• May be done as part of a routine medical exam to screen for early signs of the
disease.
 MEDICAL
MANAGEMENT
•
S
The doctor might prescribe medication to make the patient feel better,
such as aspirin and drugs that prevent blood clots.

• The doctor will probably also give them immune globulin into a vein
(intravenous, or IV). This has proteins called antibodies to help fight
infection. It’s more effective when a child takes it with aspirin than
aspirin is alone. It will lower a child’s risk of heart issues when they get
it early on in treatment.
 DRUG
STUDY
DRUG NAME: Paracetamol
DOSAGE: 250mg/5mL
ROUTE & FREQUENCY: Suspension, 6mL q4H
MECHANISM OF ACTION:
Paracetamol has a central analgesic effect that is mediated through
activation of descending serotonergic pathways. Debate exists about its
primary site of action, which may be inhibition of prostaglandin (PG)
synthesis or through an active metabolite influencing cannabinoid
receptors.
 DRUG
STUDY
INDICATIONS: CONTRAINDICATIONS:
• painful and febrile • caloric undernutrition.
conditions • acute liver failure.
• headache/migraine, • liver problems.
• toothache, • a condition where the body
• neuralgia, is unable to maintain
• colds and influenza, adequate blood flow called
• sore throat, shock.
• backache, • acetaminophen overdose.
• rheumatic pain • acute inflammation of the
• dysmenorrhoea. liver due to hepatitis C
virus.
 DRUG
STUDY
NURSING RESPONSIBILITIES:
• Check that the patient is not taking any other medication
containing paracetamol.
• Monitor patient’s vital signs.
• Inform patient to not use this drug without any medical direction.
• Instruct parent to not give children more than 5 doses in 24 hours
unless prescribed by the physician.
 DRUG
STUDY
DRUG NAME: Penicilin G
DOSAGE: 1.4 million units
ROUTE & FREQUENCY: IVTT, q4H ANST
MECHANISM OF ACTION:
Penicillin G exerts a bactericidal action against penicillin-susceptible
microorganisms during the stage of active multiplication. It acts through
the inhibition of biosynthesis of cell-wall peptidoglycan, rendering the cell
wall osmotically unstable.
 DRUG
STUDY
INDICATIONS: CONTRAINDICATIONS:
• the treatment of septicemia, • History of severe allergic
• meningitis, reactions or penicillin and
• pericarditis, its derivatives.
• endocarditis • Patients who have had
• severe pneumonia. Stevens-Johnson syndrome
after administering
penicillin or a penicillin
derivative.
 DRUG
STUDY
NURSING RESPONSIBILITIES:
• Monitor signs of allergic reactions and anaphylaxis, including
pulmonary symptoms (tightness in the throat and chest, wheezing,
cough dyspnea) or skin reactions (rash, prurits, urticaria). Notify
physician or nursing staff immediately if these reactions occur.
• observe patient closesly 30 mins after administration of parenteral
penicillin. A red flare or wheal around the site may indicate
hypersensitivity.
 DRUG
STUDY
DRUG NAME: Prednisone
DOSAGE: 20mg/tab
ROUTE & FREQUENCY: 1 tab P.O, T.I.D
MECHANISM OF ACTION:
Prednisone decreases inflammation via suppression of the migration of
polymorphonuclear leukocytes and reversing increased capillary
permeability. It also suppresses the immune system by reducing the
activity and the volume of the immune system.
 DRUG
STUDY
INDICATIONS:
• anti-inflammatory or
immunosuppressive drug
for allergic, dermatologic,
gastrointestinal,
hematologic,
ophthalmologic, nervous
system, renal, respiratory,
rheumatologic, infectious,
endocrine, or neoplastic
conditions as well as in
organ transplant.
CONTRAINDICATIONS:
• documented
hypersensitivity to the drug
or components of the
formulation.
• Contraindications to the
administration of
prednisone include the
presence of systemic
fungal infections.
 DRUG
STUDY
NURSING RESPONSIBILITIES:
• Administer once-a-day doses before 9AM to mimic normal peak
corticosteroid blood levels.
• Be alert for signs of hypocalcemia.
• Monitor for withdrawal syndrome.
• Inform patient or parent that a slight weight gain with improved
appetite is expected.
• Instruct patient to report signs and symptoms of GI distress.
• Instruct patient to report persistent backache or chest pain that
may occur with long-term therapy.
 NURSING
MANAGEMENT
NURSING DIAGNOSIS: Hyperthermia related to an Inflammatory disease
process possibly evidenced by Fever as high as 104°F that lasts for more
than 5 days and dry, cracked lips.
OBJECTIVE DATA: Rashes on abdominal area, Temperature of 38.9 C
SUBJECTIVE DATA: "Amo siya gidala sa hospital kay init man kaayu
siya, niya nagpula iya mata, Gibajuok pod siya" as verbalized by the
mother.
RATIONALE:
Kawasaki disease commonly leads to inflammation of the coronary
arteries, which supply oxygen-rich blood to the heart. Inflammation in any
part of the body over a prolonged period of time may trigger the immune
system to react it as a threat, thus, stimulating the patient’s hypothalamus
to increase the patient’s temperature.
 NURSING
MANAGEMENT
NURSING INTERVENTIONS:
INDEPENDENT
1. Monitor vital signs especially temperature every 2 hours if elevated.
Kawasaki disease initially begins with a high fever (102° to 104°F) for 5 or more days in
duration.

2. Provide adequate rest periods.

Bed rest decreases metabolic demands and oxygen consumption.

3. Assess skin for texture, turgor, color, moisture, and integrity.

Classical skin features of Kawasaki disease involves erythema, swelling, and desquamation
affecting the skin of the extremities and a polymorphous rash.

4. Encourage fluid intake as indicated

If the child is dehydrated or diaphoretic, fluid loss contributes to fever.
 NURSING
MANAGEMENT
NURSING INTERVENTIONS:
DEPENDENT
4. Administer due medications as prescribed by the physician.

COLLABORATIVE
5. Collaborate with the other members of medical team.
Collaboration between physicians, nurses, and other health care professionals
increases team members' awareness of each others' type of knowledge and skills, leading
to continued improvement in decisionmaking.
 PROGNOSIS

IF TREATED
• Treating it within 110 days of when it began may greatly reduce the chances of lasting
damage to the coronary arteries supplying the heart muscles.

IF LEFT UNTREATED
• If Kawasaki Disease is left untreated, it can lead to serious complications such as
inflammation of the blood vessels. This can be particularly dangerous because it can
affect the coronary arteries, causing coronary aneurysms to develop.
THAN
K
YOU!