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. Show
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)
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)
Stage II – Subacute Phase (Days 11 to 25)
Stage III – Convalescent Phase (Until sedimentation rate and platelet count normalize)
Diagnostic evaluation:
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:
Nursing Interventions: Monitoring
Supportive care
Image by courtesy of: http://www.chw.edu.au/ What Do You Think?What is the priority nursing intervention for a 12 year old client newly diagnosed with bacterial meningitis?Acute bacterial meningitis must be treated immediately with intravenous antibiotics and sometimes corticosteroids. This helps to ensure recovery and reduce the risk of complications, such as brain swelling and seizures.
Which symptoms would the nurse anticipate in a child with Kawasaki disease Select all that apply?In addition to several days of fever, children with Kawasaki disease may develop symptoms such as rash, swollen neck glands, swollen hands and feet, and red eyes, lips and tongue. Early on, Kawasaki disease can affect the function of the heart muscle or the heart valves.
What is the major health concern of children in the United States?Childhood obesity
For the third year in a row, childhood obesity tops the list of the biggest health concerns for kids. Despite recent declines in the prevalence among preschool-aged children, obesity is still a big problem in the United States.
Which choice includes the components of a complete pediatric history?The basic components of a pediatric history are as follows: history of presenting illness, past history including prenatal, birth, and postnatal history, past medical history, surgical history, growth and developmental, medications, allergies, immunizations, family history, social history and review of systems.
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