Prepared by: Avigaile B. Cantor, R.N. no: 165*** Name: Baby Girl A Age: 2 years old Sex: Female Case Diagnosis: KAWASAKI DISEASE ● GENERAL ASSESSMENT Patient looks weak, pale and febrile. She is conscious and oriented. VITAL RR SIGNS = 26/ min PR= 130bpm T=39*C SPo2= 98 % SKIN Pale in appearance Warm to touch Slightly dehydrated Poor skin turgor Erythematous maculopapular rashes noted HEAD and NECK No deformities found. Left lymph node ( 1 x1 cm) •GASTROINTESTINAL TRACT No palpable masses •MUSCULOSKELETAL Moderately active, moving freely; ambulatory The patient has family history of asthma. PREVIOUS SURGERY No history of surgery. A 2 years old, female patient brought to OPD- PEDIA with mother chief complaint of fever, sore throat since 10 days. Patient receiving antibiotic 7 days with no improvement. Skin rashes since 5 days. Unobtainable History. IMMUNIZATION SCHEDULE Unobtainable History. INTRODUCTION What is KAWASKI DISEASE? ( MUCOCUTANEOUS LYMPH NODE SYNDROME) “ A Self limited vasculitis of unknown etiology that predominantly affects children younger than 5 years. It is now the most common cause of acquired heart disease in children in the United States and Japan.” Jane Burns, MD* Idiopathic multisystem disease chareacterized by vasculitis of small and medium blood vessels, including coronary arteries. Kawasaki disease is an illness that involves the skin, mouth, and lymph nodes, and most often affects kids under age 5. The cause is unknown. SKIN is a soft outer covering of an animal, in particular a vertebrate. The adjective cutaneous literally means "of the skin" (from Latin cutis, skin). In mammals, the skin is the largest organ of the integumentary system made up of multiple layers of ectodermal tissue, and guards the underlying muscles, bones, ligaments and internal organs. Because it interfaces with the environment, skin plays a key role in protecting (the body) against pathogens and excessive water loss. Its other functions are insulation, temperature regulation, sensation, and the protection of vitamin B folates.Red rash usually first seen on the palms and soles that then spreads to involve the torso within a couple days. The most common appearance is a hive-like rash; however it mayalso resemble measles (morbilliform rash), erythemai multiforme or a scarletina like rash. It is more impressive on the hands and feet than the torso and the hands and feet generally develop some swelling as well. HEART may be affected in as many as one of five children who develop Kawasaki disease. Damage sometimes occurs to the blood vessels that supply the heart muscle (the coronary arteries) and to the heart muscle itself. A weakening of a coronary artery can result in an enlargement or swelling of the blood vessel wall (an aneurysm). Infants less than 1 year old are usually the most seriously ill and are at greatest risk for heart involvement. TONGUE Characteristics of strawberry tongue are sloughing of the filiform papillae(caused by the systemic inflammatory process) and persistence of the fungiform papillae,which form the "seeds" of the strawberry. Strawberry tongue is not specific to Kawasaki disease; it may also be present in streptococcal and staphylococcal toxin-mediated disease. LYMPH NODES Edema is often seen in the hands and feet and the cervical lymph nodes are often enlarged. -Experts don't know what causes the disease. PREDISPOSING FACTORS: Young age group ( below 5 years) Considered to be an autoimmune disease. Heredity Environmental facts Exposure to previous infection Regardless of the location, Japanese children are more prone to develop this. Precipitating Factors: Unknown yet linked with unknown etiologic agent and environmental factors Predisposing factors: Age-1 year old Sex-Male Race-Asian S/S: A fever lasting at least 5 days. Red eyes. A body rash. Swollen, red, cracked lips and tongue. Swollen, red feet and hands. Swollen lymph nodes in the neck. If treated: Discharge the patient DEATH Myocardial infarction Autoimmune response Good prognosis If not treated: Complications developed Pericarditis,Myocarditis, Cardiomegaly,Coronary artery aneurysm Persistent fever between 102 °F up to 104 °F Classic sign is persistent fever that may last for 5 days Fever does not improve even with antipyretic medications Red eyes without any discharges Cracked and red lips Red buccal mucosa Strawberry tongue, white spots with bumps can be seen also Palmar and planter redness. Joint swelling Lymphadenopathy Skin rashes that is evident in the middle part of the body Irritability and inability to sleep Abdominal pain Acute ( 1-2 weeks from onset) Febrile, irritable Oral changes, rash. Erythema of feet Subacute (2-8 weeks from onset) desquamation gradual improvement even without treatment Convalescent ( Months to years later) CODE Patient Results Normal Range WBC 8.54 3.98-10.04 RBC 3.9 (10^6/UL) 3.93-5.22 HGB 10.6 (G/DL) 11.2-15.7 HCT 34.2(%) 34.1-44.9 PLT 967(10^/UL 182-369 C-Reactive Protein (CRP) POSITIVE ( 24 mg/L Negative ESR 89 mm in 1st hr 0-20 There is no known specific test for Kawasaki disease. CBC- increased platelet count. Erythrocyte sedimentation rate(ESR) C-reactive protein(CRP) Chest x-rays- revealed NORMAL ECG- No Ischemia, WNL. Echocardiogram – revealed NORMAL, NORMAL coronary arteries. Echocardiogram and electrocardiogram can also check the valves and other parts of the heart that may signal an infection. It may also indicate myocarditis, pericarditis or any inflammation of the heart. •Aspirin to help to reduce pain and fever and to lower the risk of blood clots. •Aspirin has been used to reduce inflammation and to inhibit platelet aggregation in children with Kawasaki disease. Immunoglobulin (IVIG) medicine. This is given through a vein (intravenous, or IV) to reduce inflammation of the blood vessels. COMPLICATIONS Renal failure Renal insufficiency DM OF IVIG: DRUG ROUTE/DOSE/FREQ UENCY ACTION Aspirin P.O / 80-100 mg /every 6 hours Drug may relieve fever through central action in the hypothalamic heat- regulating center. IV Immune globulin I.V/ 22 g/ every 12 hours Provides passive immunity by increasing antibody titer. The primary component is IgG. Its unknown how it works for idiopathic thrombocytopenic purpura. Admission to the nearest hospital must be warranted. Intravenous fluids should be instituted in order to prevent further dehydration. The standard treatment involves a prevention of serious cardiac complications with the use of intravenous gamma globulin. Aspirin is used as a complementary dose with IV gamma globulin. Monitor the vital signs every hour. Note the persistence of fever and refer to the physician. Instruct the mother to do tepid sponge bath. Encourage increase of fluid intake if patient is not vomiting. Provide comfortable clothes for the child. Alley the fears and hopes of the family. Observe proper hand washing before and after each nursing procedure in order to prevent further infection. Administer medication as per Doctor regimen. 1.Acute pain related to sore throat and joint pain. 2. Fever altered body temperature m/b T= 101.8F103.2F. 3.Conjunctivitis L & R eye redness. ( This is the evidence). 4.Rash Impaired Skin Integrity at bilateral hands M/B red rash 5. Joint inflammation pain m/b warmth, redness and swelling. ASSESSMENT PLANNING INTERVENTION EVALUATION CUES/ EVIDENCE GOALS AND DESIRED OUT COME NURSING INTERVENTI ONS After 6-8 hours of nursing interventions the goals were met as evidenced by: SUBJECTIVE: “ Mother complaints that her child having fever since 10 days,” OBJECTIVE: Increased in body temperature above normal range flushed skin, warm to touch increased RR, T= 39*C RR= 26bpm PR=130bpm NURSING DIAGNOSI S Altered body temperatu re related to infection/ inflammat ion After 6-8 hours of nursing intervention the patient will be able to maintain core temperature within normal range. *monitor vital signs *Monitor core temperature RATIONALE *to know the baseline data *to evaluate effects degree of hyperthermia *demonstrate temperature within normal range from 39*C -36.9*C. *good skin turgor *Provide tepid sponge bath as necessary Dependent: *Administer ed paracetamol as ordered Dose: 5ml Route: P.O Frequency: every 4-6 hours *To reduce body temperature * To reduce inflammation and pain. *VS stable: BP= 90/60 T= 36.9*C RR=23bpm PR=120bpm ASSESSMENT Cues/Evidence SUBJECTIVE “ mother complaints that there is skin rash for 5 days. OBJECTIVE: •Pale in appearance •Warm to touch Slightly dehydrated •Poor skin turgor •Erythematous maculopapular rashes noted T-39*C RR-26 bpm PLANNING Nursing Diagnosis Impaired Skin integrity Related to inflammatory process as evidenced by disruption of skin surfaces, macular rash and skin desquamation INTERVENTION Nursing Interventio n After 3 days of nursing interventions, the client will be able to: 1. Display timely healing of rash and skin desquamation 2. Maintain optimal nutrition. Independe nt: *Periodical ly re measure/ photograph wound and observe for complic ations. Rationale *to monitor progress of wound healing *Keep the area clean/dry, carefully *to assist body’s natural proces s of repair Collaborat ive: *Applicatio n of antiitch ointment. *to prevent irritation and relieve skin itchiness. *Administe r hydroxyzi ne as ordered EVALUATION *to decreaseinfla mmation After 3 days of nursing interventions:Goal met: the client has able to exhibit optimum healing of rashes and skin desquamation. The client has able to eat regularly 3 times a day. 1.Encouraged the mother for the proper diet of the child. 2.Advice in regards to a heart-healthy diet. 3.Advice the mother to do physical care for her child. 4.Instructed the mother to observe signs of the disease. 5. Explained to the mother the importance of follow up care. 6.Emphasized the importance of take home medications prescribed by the physician. It may be a few weeks before your child feels completely well. But most children with Kawasaki disease get better and have no long-term problems. Early treatment is important because it shortens the illness and lowers the chances of heart problems. Follow-up tests can help you and your doctor be sure that the disease did not cause any serious problems. If your child is affected, know what to watch for and when to seek care. Nelson textbook of Pediatrics www.webmd.com/heart-disease/tc/kawasakidisease en.wikipedia.org/wiki/Kawasaki_disease rnspeak.com › Maternal & Child Nursing END OF PRESENTATION