Kawasaki Disease

KAWASAKI DISEASE

PATHOPHYSIOLOGY

Predisposing factors: Precipitating Factors:

Age-1 year old Unknown yet linked with
Sex-Male unknown etiologic agent
Race-Asian and environmental factors
Autoimmune
Response (possible if
tested of HLA-
BN22J2 antigen)
Release of Chemical
Mediators
( histamine,
bradykinin,
prostaglandin)
Vasodilation and
Cellular Permeabilty
Attraction of
Phagocytes and WBC
Entry of antigen on
lymphatic capillaries Increase pressure due
S/S: to inflammation and
Redness entry of antibodies Phagocytosis by neutrophils and
macrophages (antigens are
Swelling localized and inflammation
Heat happens
Systemic blood vessels
involvement
(inflammation of small &
medium size vessels)
If treated: If not treated:

Ampicillin Complications developed
Cetirizine
Diazepam
Ceftriaxone
Paracetamol
Pericarditis
Myocarditis
GOOD PROGNOSIS
Cardiomegaly
Myocardial infarction
Heart failure
Ruptured coronary
aneurysym
DEATH
Definition:
-is an illness that involves the skin, mouth, and lymph nodes, and most often affects kids under
age 5. The cause is unknown, but if the symptoms are recognized early, kids with Kawasaki
disease can fully recover within a few days. Untreated, it can lead to serious complications that
can affect the heart.
- mucocutaneous lymph node syndrome
MANAGEMENT
Pharmacologic interventions:
• Immune globulin (gamma globulin) I.V. therapy – IVGG (2g/kg/day) is initiated during
stage I in one 8 to 10 hour infusion to reduce the incidence of coronary artery
abnormalities.
• Aspirin therapy
• Thrombolytic therapy may be required during stages I, II, or III.
Monitoring
1. Monitor pain level and child’s response to analgesics.
2. Institute continual cardiac monitoring and assessment for complications; report
arrhythmias.
○ Take vital signs as directed by condition; report abnormalities.
○ Assess for signs of myocarditis (tachycardia, gallop rhythm, chest pain).
○ Monitor for heart failure (dyspnea, nasal flaring, grunting, retractions, cyanosis,
orthopnea, crackles, moist respirations, distended jugular veins, edema).
1. Closely monitor intake and output, and administer oral and I.V fluids as ordered.
2. Monitor hydration staus by checking skin turgor, weight, urinary output, specific
gravity, and presence of tears.
3. Observe mouth and skin frequently for signs of infection.
Supportive care
1. Allow the child periods of uninterrupted rest. Offer pain medication routinely rather than
as needed during stage I. Avoid NSAIDS if the child is in aspirin therapy.
2. Perform comfort measures related to the eyes.
○ Conjunctivities can cause photosensitivity, so darken the room, offer sunglasses.
○ Apply cool compress.
○ Discourage rubbing the eyes.
○ Instill artificial tears to soothe conjunctiva.
3. Monitor temperature every 4 hours. Provide sponge bath if temperature above normal.
4. Perform passive range of motion exercises every 4 hours while the child is awake
because movement may be restricted.
5. Provide quiet and peaceful environment with diversional activities.
6. Provide care measures for oral mucous membrane.
○ Offer cool liquids like ice chips and ice pops.
○ Use soft toothbrush only.
○ Apply petroleum jelly to dried, cracked lips.
7. Provide skin measures to improve skin integrity.
○ Avoid use of soap because it tends to dry skin and make it more likely to
breakdown.
○ Elevate edematous extremities.

○ Use smooth sheets.
○ Apply emollients to skin as ordered.
○ Protect peeling of skin, observe for signs of infection.
8. Offer clear liquids every hour when the child is awake.
9. Encourage the child to eat meals and snack with adequate protein.
10. Infuse I.V fluids through a volume control device if dehydration is present, and check the
site and amount hourly.
11. Explain all procedures to the child and family.
12. Encourage the parents and child to verbalize their concerns, fears, and questions.
13. Practice relaxation techniques with child, such as relaxation breathing, guided imagery,
and distraction.
14. Prepare the child for cardiac surgery or thrombolytic therapy if complications develop.
15. Keep the family informed about progress and reinforce stages and prognosis.
Symptoms
Kawasaki disease often begins with a high and persistent fever greater than 102°F, often as high
as 104°F. A persistent fever lasting at least 5 days is considered a classic sign. The fever may last
for up to 2 weeks and does not usually go away with normal doses of acetaminophen (Tylenol)
or ibuprofen.
Other symptoms often include:
• Extremely bloodshot or red eyes (without pus or drainage)
• Bright red, chapped, or cracked lips
• Red mucous membranes in the mouth
• Strawberry tongue, white coating on the tongue, or prominent red bumps on the back of
the tongue
• Red palms of the hands and the soles of the feet
• Swollen hands and feet
• Skin rashes on the middle of the body, NOT blister-like
• Peeling skin in the genital area, hands, and feet (especially around the nails, palms, and
soles)
• Swollen lymph nodes (frequently only one lymph node is swollen), particularly in the
neck area
• Joint pain and swelling, frequently one both sides of the body
Additional symptoms may include:
• Irritability
• Diarrhea, vomiting, and abdominal pain
• Cough and runny nose
Etiology
Signs and symptoms:

Stage I – Acute Febrile Phase (First 10 days)
• The child appears severely ill and irritable.
• Major diagnostic criteria established by the Centers for Disease Control and Prevention
(CDC) are as follows:
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)
• Pericarditis, myocarditis, cardiomegaly, heart failure, and pleural effusion.
• Other associated findings include meningitis, arthritis, sterile pyuria, vomiting, and
diarrhea.
Stage II – Subacute Phase (Days 11 to 25)
• Acute symptoms of stage I subside as temperature returns normal. The child remains
irritable and anorectic.
• Dry, cracked lips with fissures.
• Desquamation of toes and fingers.
• Coronary thrombus, aneurysm, myocardial infarction, and heart failure.
• Thrombocytosis peaks at 2 weeks.
Stage III – Convalescent Phase (Until sedimentation rate and platelet count normalize)
• The child appears well.
• Transverse grooves of fingers and toenails (Beau’s lines).
• Coronary thrombosis, aneurysms may occur.
Diagnostic evaluation:
• The diagnostic of Kawasaki disease is based on clinical manifestations. The CDC
requires that fever and four of the six other criteria listed above in stage I be
demonstrated.
• Electrocardiogram, echocardiogram, cardiac catheterization, and angiocarddiography
may be required to diagnose cardiac abnormalities.
• Although there are no specific laboratory tests, the following may help support diagnosis
or rule out other disease.
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.
Etiology: UNKNOWN

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KAWASAKI DISEASE

Predisposing factors: Precipitating Factors:

If treated: If not treated:

can affect the heart.

- mucocutaneous lymph node syndrome

stage I in one 8 to 10 hour infusion to reduce the incidence of coronary artery

• Thrombolytic therapy may be required during stages I, II, or III.

1. Monitor pain level and child’s response to analgesics.

2. Institute continual cardiac monitoring and assessment for complications; report

○ Take vital signs as directed by condition; report abnormalities.

○ Assess for signs of myocarditis (tachycardia, gallop rhythm, chest pain).

orthopnea, crackles, moist respirations, distended jugular veins, edema).

gravity, and presence of tears.

3. Observe mouth and skin frequently for signs of infection.

as needed during stage I. Avoid NSAIDS if the child is in aspirin therapy.

2. Perform comfort measures related to the eyes.

○ Conjunctivities can cause photosensitivity, so darken the room, offer sunglasses.

○ Apply cool compress.

○ Discourage rubbing the eyes.

○ Instill artificial tears to soothe conjunctiva.

because movement may be restricted.

5. Provide quiet and peaceful environment with diversional activities.

6. Provide care measures for oral mucous membrane.

○ Offer cool liquids like ice chips and ice pops.

○ Use soft toothbrush only.

○ Apply petroleum jelly to dried, cracked lips.

7. Provide skin measures to improve skin integrity.

○ Elevate edematous extremities.

○ Apply emollients to skin as ordered.

○ Protect peeling of skin, observe for signs of infection.

8. Offer clear liquids every hour when the child is awake.

site and amount hourly.

11. Explain all procedures to the child and family.

Signs and symptoms:

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