kawasaki disease (MUCOCUTANEOUS LYMPH NODE SYNDROME)

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kawasaki disease (MUCOCUTANEOUS LYMPH NODE
SYNDROME)

• Prepared by Avigaile B. Cantor, R.N.

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1.Demographic data

• Case no 165
• Name Baby Girl A
• Age 2 years old
• Sex Female
• Diagnosis KAWASAKI
• DISEASE

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2.PHYSICAL ASSESSMENT

• ? GENERAL ASSESSMENT
• Patient looks weak, pale and febrile.
• She is conscious and oriented.
• VITAL SIGNS
• RR 26/ min
• PR 130bpm
• T39C
• SPo2 98

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• 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)

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• GASTROINTESTINAL TRACT
• No palpable masses
• MUSCULOSKELETAL
• Moderately active, moving freely ambulatory

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Past medical history

• The patient has family history of asthma.
• PREVIOUS SURGERY
• No history of surgery.

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Present medical history

• 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.

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Developmental milestones

• Unobtainable History.
• IMMUNIZATION SCHEDULE
• Unobtainable History.

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TOPIC PRESENTATION

• 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.

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• 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.

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Anatomy and physiology
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• 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.

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• 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.

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• 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.

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ETIOLOGY

• -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.

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Predisposing factors Age-1 year old
Sex-Male Race-Asian  

• Precipitating Factors
• Unknown yet linked with unknown etiologic agent
  and environmental factors

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.
Autoimmune response

• If treated
• Discharge the
• patient

Good prognosis
If not treated Complications developed Pericardit
is,Myocarditis, Cardiomegaly,Coronary artery
aneurysm
DEATH
Myocardial infarction
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Signs and symptoms
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Signs and symptoms

• 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

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Phases of disease

• 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)

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LABORATORY INVESTIGATIONS
CODE Patient Results Normal Range
WBC 8.54 3.98-10.04
RBC 3.9 (106/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
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Diagnostic procedures

• 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.

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Diagnostic procedure

• 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.

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treatment

• 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.

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• Immunoglobulin (IVIG) medicine. This is given
  through a vein (intravenous, or IV) to reduce
  inflammation of the blood vessels.
• COMPLICATIONS OF IVIG
• Renal failure
• Renal insufficiency
• DM

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Drug study
DRUG ROUTE/DOSE/FREQUENCY 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.
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Medical management

• 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.

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Nursing management

•  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.

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complications
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Prioritization of nursing problems

• 1.Acute pain related to sore throat and joint
  pain.
• 2. Fever altered body temperature m/b T
  101.8F-103.2F.
• 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.

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Nursing care plan
ASSESSMENT PLANNING INTERVENTION EVALUATION
CUES/ EVIDENCE 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 39C RR 26bpm PR130bpm NURSING DIAGNOSIS Altered body temperature related to infection/ inflammation GOALS AND DESIRED OUT COME After 6-8 hours of nursing intervention the patient will be able to maintain core temperature within normal range. NURSING INTERVENTIONS monitor vital signs Monitor core temperature Provide tepid sponge bath as necessary Dependent Administered paracetamol as ordered Dose 5ml Route P.O Frequency every 4-6 hours RATIONALE to know the baseline data to evaluate effects degree of hyperthermia To reduce body temperature To reduce inflammation and pain. After 6-8 hours of nursing interventions the goals were met as evidenced by demonstrate temperature within normal range from 39C -36.9C. good skin turgor VS stable BP 90/60 T 36.9C RR23bpm PR120bpm
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ASSESSMENT PLANNING INTERVENTION EVALUATION
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-39C RR-26 bpm Nursing Diagnosis Impaired Skin integrity Related to inflammatory process as evidenced by disruption of skin surfaces, macular rash and skin desquamation After 3 days of nursing interventions, the client will be able to Display timely healing of rash and skin desquamation Maintain optimal nutrition. Nursing Intervention Independent Periodically re measure/  photograph wound and observe for complications. Keep the area clean/dry, carefully Collaborative Application of anti-itch ointment. Administer hydroxyzine as ordered Rationale to monitor progress of wound healing to assist bodys natural process of repair to prevent irritation and relieve skin itchiness. to decreaseinflammation After 3 days of nursing interventionsGoal 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.
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Nursing health teaching

• 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.

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conclusion

• 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.

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Bibliography

• Nelson textbook of Pediatrics
• www.webmd.com/heart-disease/tc/kawasaki-disease-
• en.wikipedia.org/wiki/Kawasaki_disease?
• rnspeak.com Maternal Child Nursing

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THANKYOU!!!

• END OF PRESENTATION