Kawsaki Ru
Kawsaki Ru
Kawsaki Ru
NSG 124
Pediatric Concept
“Kawasaki Disease”
Submitted to:
Prof. Paida P. Abdulmalik
Faculty of the College of Health Sciences
Mindanao State University-Main Campus
Marawi City
Submitted by:
Mohammad Ali A. Baruang
Camellah B. Abdullah
KAWASAKI DISEASE
Definition: Kawasaki disease, also known as mucocutaneous lymph node syndrome, is an
acute febrile illness primarily affecting young children. It is characterized by systemic
inflammation of blood vessels, which can lead to vasculitis and potential complications,
particularly involving the coronary arteries.
Causes: The exact cause of Kawasaki disease is unknown, but it is believed to involve a
combination of genetic predisposition and environmental factors triggering an abnormal
immune response. Potential triggers may include viral or bacterial infections, toxins, or other
environmental factors, although no specific infectious agent has been consistently identified.
Signs and Symptoms:
The signs and symptoms of Kawasaki disease can vary but often include:
- Prolonged fever lasting five or more days (mandatory criterion)
-Changes in the lips and oral cavity (e.g., strawberry tongue, redness, and cracking of lips)
- Cervical lymphadenopathy (enlarged lymph nodes)
- Rash over the body
- Bilateral non-purulent conjunctivitis
- Redness and swelling of the hands and feet (erythema and edema)
Other symptoms may include irritability, abdominal pain, joint pain, and diarrhea.
Clinical Criteria
The primary diagnostic approach for Kawasaki disease is based on clinical criteria, which
include:
1. Fever: Persistent fever for five or more days.
2. At least four of the following five criteria:
• Rash: Polymorphous, non-vesicular rash.
• Conjunctivitis: Bilateral non-purulent conjunctivitis.
• Changes in the extremities: Erythema and edema of the hands and feet,
later followed by desquamation (peeling of the skin).
• Oral changes: Redness, fissuring, or cracking of the lips; strawberry tongue;
diffuse erythema of the oropharyngeal mucosa.
• Cervical lymphadenopathy: Typically unilateral, with at least one lymph
node >1.5 cm in diameter.
Laboratory Tests
Laboratory tests are used to support the diagnosis and assess the severity of inflammation
and potential complications:
1. Complete Blood Count (CBC):
• Elevated white blood cell count (leukocytosis).
• Elevated platelet count (thrombocytosis), particularly in the subacute phase.
• Anemia (normocytic, normochromic).
2. Inflammatory Markers:
• Elevated C-reactive protein (CRP).
• Elevated erythrocyte sedimentation rate (ESR).
3. Liver Function Tests:
• Elevated liver enzymes (alanine aminotransferase [ALT], aspartate
aminotransferase [AST]).
4. Urinalysis:
• Presence of sterile pyuria (white blood cells in urine without bacterial
infection).
• Proteinuria (protein in urine).
5. Albumin Levels:
• Hypoalbuminemia (low albumin levels).
Imaging Studies
Imaging studies are crucial for assessing cardiac involvement and other potential
complications:
1. Echocardiography:
• Used to evaluate coronary artery involvement (aneurysms, dilation, stenosis).
• Performed at diagnosis, 2 weeks, and 6-8 weeks after onset of the disease.
• Assesses heart function, valvular involvement, and pericardial effusion.
2. Chest X-ray:
• May be used to assess for pulmonary involvement, such as infiltrates or
effusions.
• Generally not a primary diagnostic tool for Kawasaki disease but helps rule out
other conditions.
3. Electrocardiogram (ECG):
• Used to detect arrhythmias or ischemic changes.
• Part of routine cardiac assessment in Kawasaki disease.
Additional Tests
In some cases, additional tests may be performed to rule out other conditions or
complications:
1. Blood Cultures:
• To rule out bacterial infections, particularly in febrile children.
2. Lumbar Puncture:
• May be performed if meningitis is suspected.
3. Angiography:
• Considered if there is a high suspicion of significant coronary artery
involvement that requires detailed imaging.
• More invasive and typically reserved for complex cases.
Differential Diagnosis
To confirm Kawasaki disease, it is essential to differentiate it from other diseases with similar
presentations, such as:
• Scarlet fever.
• Toxic shock syndrome.
• Measles.
• Systemic juvenile idiopathic arthritis.
• Viral infections (e.g., adenovirus, Epstein-Barr virus).
Summary
Diagnosis of Kawasaki disease involves a multifaceted approach that combines:
• Clinical criteria.
• Laboratory tests to assess inflammation and organ involvement.
• Imaging studies, particularly echocardiography, to monitor coronary artery health.
This comprehensive diagnostic approach helps ensure accurate diagnosis and timely
management of Kawasaki disease to prevent complications and improve outcomes.
Nursing Diagnosis: Nursing diagnoses for a child with Kawasaki disease may include:
• Hyperthermia related to systemic inflammation
• Altered tissue perfusion related to vasculitis and potential coronary artery
involvement
• Risk for fluid volume deficit related to fever, decreased oral intake, and potential
gastrointestinal symptoms
• Acute pain related to inflammation and joint involvement
• Anxiety related to hospitalization, unfamiliar procedures, and uncertainty about the
child's condition
Nursing Management: Nursing management for Kawasaki disease involves:
• Monitoring vital signs, cardiac status, and symptoms
• Administering medications as prescribed (e.g., IVIG, aspirin)
• Providing comfort measures (e.g., cool compresses, hydration)
• Educating the child and family about the disease, treatment plan, and signs of
complications
• Offering emotional support and reassurance
• Facilitating communication and collaboration among healthcare team members
• Planning for follow-up care and monitoring after discharge
Medical Management: Medical management of Kawasaki disease includes:
• Intravenous immunoglobulin (IVIG) to reduce inflammation and modulate the
immune response
• Aspirin to alleviate fever and prevent blood clot formation
• Corticosteroids or other immunomodulatory therapies in refractory cases
• Antiplatelet agents (e.g., clopidogrel) to reduce the risk of thrombosis in patients with
coronary artery abnormalities
Surgical Management: Surgical interventions for Kawasaki disease may be necessary in
cases of severe coronary artery complications, such as:
• Coronary artery bypass grafting (CABG) to bypass obstructed coronary arteries
• Percutaneous coronary intervention (angioplasty) to open narrowed or blocked
coronary arteries These procedures aim to restore blood flow to the heart and reduce
the risk of myocardial infarction and other cardiovascular complications.
Overall, the management of Kawasaki disease requires a multidisciplinary approach involving
pediatricians, cardiologists, nurses, and other healthcare professionals to ensure timely
diagnosis, appropriate treatment, and monitoring for complications. Early recognition and
intervention are crucial for optimizing outcomes and preventing long-term sequelae
associated with Kawasaki disease.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9650356/
https://www.ncbi.nlm.nih.gov/books/NBK537163/
https://sites.medschool.ucsd.edu/som/pediatrics/research/centers/kawasaki-
disease/research/Pages/default.aspx