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Kawasaki Disease

Judy, a 3-year old, was illustrious to own a very red, almost strawberry-like speech. It was ignored by her parents, thus-far, the direct day she went ill delay a spiking fever. The ardor feeble follascribable a few days. By then Judy was already touch well-behaved. A month behindcited, her dowager noticed occult grooves ostensible acrave her fingernails, which prompted them to import Judy to the hospital. There, they knascribable that Judy has Kawasaki distemper.

Description


Some cardiovascular rule quackerys supervene as a fruit of a natural spirit quackery or a distemper such as Kawasaki distemper.
  • Kawasaki distemper or mucocutaneous lymph node syndrome is an clever, febrile distemper that is most repeatedly seen in boys younger than 5 years.
  • Kawasaki distemper (KD) is an clever febrile vasculitic syndrome of bestow sliphood that, although it has a cheerful prognosis delay composition, can control to fall from coronary artery aneurysm (CAA) in a very mean percentage of resigneds.
  • The quackery has so been designated mucocutaneous lymph node syndrome and puerile periarteritis nodosa.

Pathophysiology


Despite the personality mucocutaneous clinical findings that designate the malady, Kawasaki distemper is best bestow as a unconcealedized vasculitis that involves mean- to medium-sized arteries.
  • After an infection, an permutation in the immune rule supervenes; most cases supervene in the recent refuse or bestow start.
  • In the main measures of the distemper, the endothelial cells and the vascular media behove edematous, but the inside buoyant flake dregs uninjured.
  • Then, almost 7-9 days follascribable the onslaught of ardor, an importation of neutrophils supervenes, which is at-once ensueed by a proliferation of CD8+ (cytotoxic) lymphocytes and immunoglobulin A–producing plasma cells.
  • The aggravating cells conceal multitudinous cytokines (ie, tumor necrosis constituent, vascular endothelial crop constituent, monocyte chemotactic and activating constituent), interleukins, and matrix metalloproteinases that target the endothelial cells and fruit in a cascade of uniformts that uniformtuates in fragmentation of the inside buoyant flake and vascular mischief.
  • Over the direct few weeks to months, the locomotive aggravating cells are replaced by fibroblasts and monocytes, and firm connective structure begins to contrive delayin the vessel mound.
  • The intima proliferates and thickens; the vessel mound notwithstanding behoves narrowed or occluded ascribable to stenosis or a thrombus.
  • Most of the pathology of the distemper is promotive by a medium vessel arterial vasculitis.
  • Initially, neutrophils are bestow in immense gum, but the satuadmonish expeditiously switches to mononuclear cells, T lymphocytes, and immunoglobulin A (IgA)–producing plasma cells. Inflammation involves all 3 layers of vessels.
  • The limit during of the immenseest vascular mischief is when a accompanying transitional growth in the serum platelet estimate supervenes, and this is the subject-matter of the malady when the facilitate of fall is most indicative.

Statistics and Incidences


Epidemics of Kawasaki distemper chiefly supervene in the recent refuse and start, at 2- to 3-year intermissions.
  • Approximately 3,000 manifestation delay Kawasaki distemper are hospitalized annually in the United States.
  • The border annual race-local stroke per 100,000 manifestation younger than 5 years is 32.5 cases for Americans of Asian and Pacific Island depression, 16.9 cases for non-Hispanic African Americans, 11.1 cases for Hispanics, and 9.1 cases for clears.
  • Outside the United States, the distemper is most regularly observed in Japan, Taiwan, and Korea.
  • The power of Kawasaki distemper growthd from 1967 to the mid-1980s and has equalizeed out at 5000-6000 cases per year.
  • The earliest stroke of Kawasaki distemper has been reputed in Japan, where the quantity of the distemper is 10 to 20 spells remarkable than in Western estimateries.
  • Approximately 5000-6000 cases are reputed each year in Japan; the stroke in 2000 was 134.2 cases per 100,000 manifestation younger than 5 years.
  • The annual stroke reputed in clear populations succeeding a whileout the United States is congruous to that reputed in the US population, delay 11.3-14.7 cases per 100,000 manifestation younger than 5 years in Canada and 3.6 cases per 100,000 manifestation younger than 5 years in Australia.
  • From 1999-2000, the stroke in the United Kingdom was 8.1 cases per 100,000 manifestation.
  • Ontario has the earliest admonish of Kawasaki distemper succeeding a whileout of Asia, delay a ybestow stroke of 26.2 cases per 100,000 population younger than 5 years.
  • Although Kawasaki distemper has been reputed in manifestation of all ethnic origins, it supervenes most invariably in Asian manifestation, distinctly those of Japanese depression.
  • Kawasaki distemper is segregateially aggravate despicable in males than in females; the male-to-female association ranges from 1.3-1.83:1 depending on the estimatery from which the statistics are reputed.
  • Approximately 85-90% of Kawasaki distemper cases supervene in manifestation younger than 5 years; 90-95% of cases supervene in manifestation younger than 10 years.

Causes


The etiology is obscure, but the distemper appears to be caused by an transmitted constituency.
  • Genetic constituents. Siblings of fictitious manifestation own a 10-20 spells remarkable verisimilitude of enunciateing Kawasaki distemper than the unconcealed population, and manifestation in Japan whose parents had Kawasaki distemper appear to own a aggravate stern contrive of the distemper and to be aggravate sensitive to alighting.
  • Infection. Features of Kawasaki distemper that are agreeing delay an transmitted etiology grasp the supervenerence of epidemics chiefly in recent refuse and start delay 3-year intermissions and the speedlike geographic distribute of those epidemics; the self-poor species of the distemper; and the personality ardor, adenopathy, and eye types.

Clinical Manifestations


The clinical bestowation of Kawasaki distemper varies aggravate spell, delay the clinical line conventionally disjoined into three measures: clever, subacute, and convalescent. Acute Febrile Stage The clever meaunfailing begins delay an unexpected onslaught of ardor and lasts almost 7-14 days; the ardor is typically haughty-spiking and periodic, delay peak climes ranging from 102-104°F (39-40°C) or remarkable; in importation to ardor, types and symptoms of this exhibition may grasp the behindcited:
  • Irritability
  • Nonexudative bilateral conjunctivitis (90%)
  • Anterior uveitis (70%)
  • Perianal erythema (70%)
  • Erythema and edema on the hands and feet; the fall impedes ambulation
  • Strawberry speech and lip fissures
  • Hepatic, renal, and GI dysfunction
  • Myocarditis and pericarditis
  • Lymphadenopathy (75%), unconcealedly a unique, noble-minded, nonsuppurative cervical node measuring almost 1.5 cm
Subclever Stage The subclever meaunfailing begins when the ardors own feeble, and it continues until week 4-6; the hallmarks of this meaunfailing are desquamation of the digits, thrombocytosis (the platelet estimate may exceed 1 pet/μL), and the crop of coronary aneurysms; the facilitate for quick fall is earliest at this measure. Convalescent Stage The convalescent exhibition is noticeable by exhaustive analysis of clinical types of the malady, usually delayin 3 months of bestowation; this meaunfailing begins delay the revert to baseline of the clever exhibition reactants (eg, erythrocyte sedimentation admonish, C-relocomotive protein) and other laboratory abnormalities; during this measure, most of the clinical findings resolve; thus-far, occult rectangular grooves athwart the nails (Beau lines) may behove presumable 1-2 months follascribable the onslaught of ardor.

Physical Examination

Because no local Nursing essay can be manufactured for Kawasaki distemper and no clinical characteristic is pathognomonic, the personality of Kawasaki distemper is naturalized on the intercourse of a galaxy of clinical findings.
  • Changes in the peripheral extremities. Initial reddening or edema of the palms and soles, ensueed by membranous desquamation of the finger and toe tips or rectangular grooves athwart the fingernails and toenails (Beau lines).
  • Polymorphous venturesome (not vesicular). Usually unconcealedized but may be poor to the groin or inferior extremities.
  • Oropharyngeal changes. Erythema, fissuring, and crusting of the lips; strawberry speech; copious mucosal introduction of the oropharynx.
  • Conjunctivitis. Bilateral, nonexudative, afflictionless bulbar conjunctival introduction.
  • Lymphadenopathy. Clever nonpurulent cervical lymphadenopathy delay lymph node transversion immenseer than 1.5 cm, usually unilateral.

Assessment and Symptom Findings


No local laboratory Nursing essay is used to diagnose Kawasaki distemper; thus-far, undoubtful abnormalities acquiesce delay multitudinous measures.
  • Urine proteins. Aggravate of-late, 2 urine proteins hinder pledge as biomarkers of Kawasaki distemper: meprin A or filamin C; these 2 biomarkers were symptomally better to ESR or CRP; investigators attested aggravate than 190 proteins that were bestow solely in manifestation delay Kawasaki distemper, including the proteins associated delay endothelial and myocardial cell damnification (filamin C) and immune regulators (meprin A).
  • CBC. On exhaustive blood estimates (CBCs), mild-to-modeadmonish normochromic anemia is observed in the clever measure; the clear race cell estimate (WBC) is modeadmonish to haughty (50% of resigneds own a WBC immenseer than 15,000/µL), delay a left displace, which is a superior type of uneminent and grown granulocytes.
  • Platelet estimate. During the subclever measure, thrombocytosis is the unappropriated marker; the platelet estimate begins to mount in the coopereprove week and continues to mount during the third week; platelet estimates mean 700,000/μL, but equalizes as haughty as 2 pet own been observed.
  • Cholesterol. Serum cholesterol, haughty-density lipoprotein, and apolipoprotein A equalizes are reduced; these values serve to adhere past clinical analysis of the distemper.
  • Echocardiography. Echocardiography is the con-over of select to evaluate for coronary artery aneurysms (CAAs), in twain greatly manifested and reputed inexhaustive cases of Kawasaki distemper.
  • Imaging studies. Magnetic clang imaging (MRI), magnetic clang angiography (MRA), and ultrafast computed tomography (CT) scanning are other noninvasive Nursing essays that can be used to evaluate coronary artery abnormalities.
  • Electrocardiography. On electrocardiography (ECG), tachycardia, prolonged PR intermission, ST-T speed changes, and reduced voltage of R speeds may declare myocarditis; Q speeds or ST-T speed changes may declare myocardial infarction.
  • Cardiac enzymes. Cardiac enzyme equalizes (eg, creatine kinase [CK], creatine kinase myocardial ligament [CK-MB], cardiac troponin, lactate dehydrogenase [LD-1 >LD-2]) are wealthy during a myocardial infarction.

Medical Management


The main design of composition for Kawasaki distemper is to hinder coronary artery distemper and to succor symptoms.

Pharmacologic Therapy

Full doses of intravenous immunoglobulin (IVIG) are the mainstay of composition, acrave delay other refuses.
  • Intravenous immunoglobulin. IVIG succors clever inflammation and has been shown to refer the admonish of coronary aneurysms from immenseer than 25% in untreated resigneds to 1-5% in entertained resigneds; maximal benefits are seen when IVIG is consecrated delayin the earliest 10 days of the malady.
  • Aspirin. Aspirin has a synergistic property delay IVIG and has crave been a plummet segregate of therapy for Kawasaki distemper; resigneds on prolonged aspirin therapy must be instructed that accompanying use of ibuprofen antagonizes the irreversible property of platelet discountenance by aspirin and should be avoided during therapy; importationally, the facilitates of enunciateing Reye syndrome during an locomotive contamination delay influenza or varicella should be addressed.
  • Other secondary constituencys. In importation to their use in composition of IVIG-resistant Kawasaki distemper, corticosteroids own been inthorough as segregate of first therapy; the roles of other secondary therapies, including pentoxifylline and abciximab, own not yet been definitively determined; pentoxifylline acts as an anti-aggravating constituency by inhibiting protuberance necrosis constituent-alpha and may refer the stroke of aneurysms; abciximab is a platelet glycoprotein IIb/IIIa receptor inhibitor and has been used in attention delay plummet therapies in resigneds delay Kawasaki distemper and hercules aneurysms.
  • Anticoagulant therapy. Anticoagulants such as warfarin and low molecular influence heparin are used in resigneds delay great aneurysms in whom the facilitate of thrombosis is haughty. The design is to practise an interpolitical recognizedized association (INR) of 2-2.5.

Nursing Management


The nursing administration of a slip delay Kawasaki distemper involves the follascribable ruleatic approach:

Nursing Assessment

The slip should be assessed in total exhibition of the distemper:
  • Acute febrile exhibition. The slip appears sternly ill and hypercritical; there is haughty, spiking ardor for 5 or aggravate days, bilateral conjuctival introduction, oropharyngeal erythema, strawberry speech, or red and dry lips, erythema and edema of hands and feet, periungual desquamation, erythematous unconcealedized venturesome, and cervical lymphadenopathy immenseer than 0.6 inch (1.5 cm).
  • Subclever exhibition. Clever symptoms of the clever meaunfailing subside; clime reverts to recognized. The slip dregs hypercritical and anorectic.
  • Convalescent exhibition. Check the slip’s new set of symptom fruits to organize he distemper’s foothold.

Nursing Diagnosis

Based on the toll postulates, the senior nursing diagnoses are:

Nursing Thrift Planning and Goals

Main Article: 6 Kawasaki Distemper Nursing Thrift Plans

The designs for the resigned grasp:
  • The resigned and rise get direct intellect of or demonstadmonish the behindcited: Kawasaki distemper is an malady that causes protuberance and inflammation of race vessels. This protuberance and inflammation may supervene in vessels of the spirit. This is why we mentor your slip so closely.
  • The resigned and rise get interpret the demand for CRM and maybe oximetry.
  • The resigned and rise get direct intellect of medications used to entertain inflammation.
  • The resigned and rise get direct intellect of or demand for echocardiogram and maybe EKG during access and as outresigned to ensue up cardiac foothold.
  • The resigned and rise get demonstadmonish the behindcited: Coping strategies (rise and slip), slip spirit referral and ensue of delineation uniform at residence as demanded for yielding.

Nursing Interventions

Nursing interventions for the resigned delay Kawasaki distemper are:
  • Monitor pain. Mentor affliction equalize and slip’s solution to analgesia.
  • Cardiac mentoring and toll. Take life-containing types as directed by states; assess for types of mycocarditis (tachycardia, gallop rhythm, chest affliction);  and mentor for spirit failure.
  • Monitor I&O. Closely mentor intake and output, and mentor hydration foothold by checking peel turgor, influence, urinary output, local starch, and intercourse of veneration.
  • Plan limits of tranquillity and activities. Allow the slip limits of continuous tranquillity; tolerate the slip to agitate environing voluntarily underneathneath supervision; stipulate tender toys and still state and tolerate use of hands and fingers; and stipulate still, loyal environment delay diversional activities.
  • Provide verbal thrift. Offer promising liquids (ice chips and ice pops); speed to tender, benign foods; and produce bung thrift total 1 to 4 hours delay expend bung swabs; use tender toothbrush solely follascribable beneficial has supervenered.

Evaluation

Goals are met as evidenced by:
  • Child’s symptoms are seemly and aggravateall the slip’s state has improved.
  • No ardor for at meanest 18 hours former to acquit.
  • Echocardiogram exhaustive.
  • Cardiologist has seen slip
  • Child’s physician has been contacted and acquit instructions and ensue up delineations own been finalized.
  • Child has a confirmed enactment delay physician delayin 48 hours of acquit.
  • Cardiology ensue up enactment(s) are scheduled.

Documentation Guidelines

Documentation in a slip delay Kawasaki distemper involves the behindcited:
  • Duration of the drift and local contributing constituents.
  • Perception of affliction, propertys on spiritstyle, and rely-onations of therapeutic administration.
  • Baseline and subjoined findings and singular hemodynamic patterns, spirit and exhalation sounds, ECG patterns, intercourse/strength of pulses, peel or structure foothold, renal output, and mentation.
  • Level of disposition.
  • Characteristics of lesions or state, ulcer category.
  • Condition of verbal mucous membranes, regulation verbal thrift conduct and interferences.
  • Plan of thrift.
  • Teaching delineation.
  • Responses to interventions, education, and actions manufactured.
  • Attainment or speed towards desired outcomes.
  • Modifications to delineation of thrift.

Text Mode

Text Mode: All questions and answers are consecrated on a unique page for balbutiation and sympathetic at your own step. Be unfailing to pounce a pen and disquisition to transcribe down your answers.

1. A 5-year-old lass Hannah is of-late diagnosed delay Kawasaki distemper. Asegregate from the attested symptoms of the distemper, she may so likely enunciate which of the behindcited? A. Sepsis B. Meningitis C. Mitral valve distemper D. Aneurysm contriveation 1. Answer: D. Aneurysm contriveation.
  • D: Kawasaki distemper is a elevated sliphood malady that affects the race vessels. 20% to 25% of manifestation can enunciate aneurysm contriveation if not intervened.
  • A, B, C: Manifestation who proof the distemper usually demand spiritcrave ensue-up enactments to preserve an eye on spirit vigor.
2. A slip delay Kawasaki distemper is admitted to the pediatric parry. Which of the follascribable medications get you rely-on to be a segregate of the composition? Select all that apply: A. Gamma Globulin B. Warfarin C. Acetaminophen D. Aspirin E. Atenolol 2. Answer: A. Gamma Globulin, B.Warfarin ,D. Aspirin.
  • A, B, D: The main design of composition for Kawasaki distemper is to hinder coronary artery distemper and to succor symptoms such as ardor and flexure affliction so an antipyretic, antiplatelet, and gamma globulin is used.
  • C: Option C is antipyretic but is not sympathetic to this distemper.
  • E: Option D is a beta blocker.
3. The nursing thrift delineation for a toddler diagnosed delay Kawasaki Distemper (mucocutaneous lymph node syndrome) should be naturalized on the haughty facilitate for crop of which drift? A. Chronic vessel plaque contriveation B. Pulmonary embolism C. Occlusions at the vessel bifurcations D. Coronary artery aneurysms 3. Answer: D. Coronary artery aneurysms.
  • D: Kawasaki Distemper involves all the mean and medium-sized race vessels. There is transitional inflammation of the mean vessels which speedes to the medium-sized athletic arteries, theoretically baleful the mounds and controling to coronary artery aneurysms.
  • A, B, C: These options are all defective.
4. An expend nursing personality for clients who are prelude anticoagulants would be which of the behindcited? A. Risk for damnification akin to prolonged bleeding spell, discountenance of platelet union, and growthd facilitate of GI. B. Potential for damnification akin to GI toxicity and reduce in bleeding spell. C. Altered safety akin to GI bleeding and increasing platelet union. D. Facilitate for damnification akin to thrombocytosis prolonged prothrombin spell. 4. Answer: A. Facilitate for damnification akin to prolonged bleeding spell, discountenance of platelet union, and growthd facilitate of GI bleeding.
  • A: The nursing personality addresses all the interactions that embarrass a intimidation to the client prelude twain these refuses.
  • B: Select B is defective accordingly bleeding spell is prolonged not reduced when twain refuses are used.
  • C: Select C is defective accordingly platelet union is inhibited not growthd when twain refuses are used.
  • D: Select D is defective accordingly thrombocytosis does not supervene delay use of either refuse.
5. Which of the follascribable is the best order for achieveing a material Nursing essay on a toddler? A. From crown to toe B. Distally to proximally C. From abdomen to toes, the to crown D. From meanest to most obtrusive 5. Answer: D. From meanest to most obtrusive.
  • D: When examining a toddler or any mean slip, the best way to percontrive the exam is from meanest to most obtrusive.
  • A&C: Starting at the crown or abdomen is obtrusive and should be avoided.
  • B: Proceeding from distal to proximal is inexpend at any age.

See Also


Related topics to this con-over guide:

Further Reading


Recommended media and books for pediatric nursing:
  1. PedsNotes: Nurse's Clinical Pocket Guide (Nurse's Clinical Pocket Guides)
  2. Pediatric Nursing Made Incredibly Easy
  3. Wong's Essentials of Pediatric Nursing
  4. Pediatric Nursing: The Critical Components of Nursing Care

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