Clinical Intensive 1 brief overview

1. Kawasaki
Disease
BY: KRISTIE NICOLL

2. Kawasaki Disease? What is that?
▪ A pediatric inflammatory disease that has an unknown origin.
▪ Causes systemic vascular inflammation which can lead to
permanent coronary damage if not treated.
▪ Named after Tomisaku Kawasaki who discovered the disorder in
1967
▪ Seen more in Japanese children <2% US children <1% (diagnosed
cases) More prevalent in children of Asian descent in US, with
males under 5 being most common.
▪ Most common in children < 5 years of age
▪ Varying symptoms make diagnosis difficult

3. THREE PHASES OF KD
ACUTE
(signs appear)
1-10 DAYS
TREATMENT
NEEDS TO
BEGIN
SUB-ACUTE
(skin peeling)
11-21 DAYS
CONVALESCENT
Therapy/monito
ring continue
21-60 DAYS
Long term
effects
determined
Etiology
▪ Systemic vasculitis in
medium/large vessels
▪ No known cause
Thought to possibly originate
from a virus or exposure to
unknown toxin.
▪ No definitive evidence pointing to
KD being transmittable from
person-to-person
* A 4TH PHASE IS ADDED IF NEEDED FOR
CHRONIC EFFECTS (CORONARY ANEURYSM
BY SOME, IF NEEDED

4. SIGNS OF KD
• Red Irritated
Eyes-non
purulent
• Swollen red
hands and feet
(making walking
painful, difficult)
• Red raised rash
on trunk and
groin area
• “Strawberry
tongue
• Dry fissured lips
• Single swollen
cervical lymph
node
4 out of 5 symptoms
considered sufficient
for diagnosis. Further
testing required
including MANDATORY
echocardiogram to
determine heart
damage and coronary
artery function

5. Why is Kawasaki Disease so important?
▪ Kawasaki is the NUMBER 1 cause of pediatric acquired heart
disease!
▪ Coronary artery aneuyrysms develop in up to 30% of children with
KD left untreated.
▪ This can lead to ischemic heart disease and even SUDDEN DEATH!

6. Treatment
▪ IVIG 2g/kg single infusion over 12 hours
-This can shorten febrile period from 2 weeks to 2-3 days.
▪ High dose ASA 30-50mg/kg/day in 4 equal doses x 2 weeks
▪ ASA 2-5mg/kg/day once fever is completely gone for up to SIX
weeks
▪ ECG and echocardiograph initially and throughout treatment to
monitor heart function

7. Nursing Diagnoses
▪ Chronic pain related to inflammation of
the myocardium or pericardium.
▪ Risk for decreased cardiac output related to accumulation of fluid
in the pericardial sac.
▪ Activity intolerance related to inflammation and degeneration of
myocardial muscle cells.
▪ Impaired skin integrity related to inflammatory process, altered
circulation, and edema formation.
▪ Impaired oral mucous membrane related to inflammatory
process, dehydration, and mouth breathing. (Nurselabs, 2018)

8. Nursing Interventions
▪ Monitor pain level
▪ Monitor I & O closely
▪ Allow for extended rest periods in caring for child
▪ Provide good oral care
▪ Educate family members on need for follow-up cardiac monitoring

10. Thanks for watching!