Kawasaki Disease

Kawasaki Disease Nursing Care Plans Diagnosis and Interventions

Kawasaki Disease NCLEX Review Care Plans

Nursing Study Guide on Kawasaki Disease

Kawasaki disease is a condition characterised by systemic inflammation of blood vessels mostly affecting children below five years of age.

The etiology of this disease is still unknown, however it is believed that a “trigger” causes the inflammatory response in the body.

This trigger causes inflammation mostly in the coronary arteries leading to acquired heart conditions in children.

The inflammatory response can also affect lymph nodes hence the disease is also known as mucocutaneous lymph node syndrome.

Kawasaki disease is believed to have a genetic origin. The severity of signs and symptoms and complications depends on the development of heart conditions.

Signs and Symptoms of Kawasaki Disease

The clinical manifestations of Kawasaki disease are divided in three phases.

  1. First Phase or Acute Phase. This phase may last for 1-2 weeks and is evidenced by:
  • High fever of unknown cause which may last for 1-2 weeks
  • Redness of the eyes without discharge
  • A rash on the main part of the body and in the genital area
  • Red, dry, cracked lips and extremely red, swollen tongue
  • Swollen, red skin on the palms of hands and soles of feet
  • Swollen lymph nodes
  • Irritability

2. Second Phase or Subacute Phase. This phase may last for 2-4 weeks and is evidenced by:

  • Fever, but it may subside by this time
  • Desquamation of the skin may occur – this occurs when the skin starts to peel off mostly on the tips of the fingers and toes
  • Joint pain
  • Diarrhea and vomiting
  • Abdominal pain

3. Third Phase or Convalescent Phase. This phase usually occurs after 6-8 weeks following the onset of the disease:

  • Signs and symptoms in the acute and subacute phase subside
  • Blood count will return to normal

Causes of Kawasaki Disease

The etiology of Kawasaki disease is still unknown up to this day. Theories to its causes point toward genetic origin.

It is believed that a genetic mutation makes the body respond differently to a trigger.

The following are the risk factors of Kawasaki disease:

  • Age. Children below the age of five years are at higher risk of acquiring the disease.
  • Sex. The incidence of Kawasaki disease is higher in boys than girls.
  • Ethnicity. Kawasaki disease has a higher incidence rate in people of Asian or Pacific Island descent.

Complications of Kawasaki Disease

Kawasaki disease is the leading cause of acquired heart problems in children. The heart complications may include the following:

  • Inflammation of the coronary arteries which can lead to aneurysm
  • Inflammation of heart muscles or myocarditis
  • Heart valve problems

Diagnosis of Kawasaki Disease

There is no definitive diagnostic procedure to diagnose Kawasaki disease. The diagnosis depends on the presence of signs and symptoms and by ruling out other diseases with the same manifestations.

  • History taking
  • Physical assessment. A thorough physical assessment will need to be completed by the physician. Lymph nodes swelling will need to be checked especially of the cervical nodes. The presence of rash and the traditional strawberry tongue will be noted as well.
  • Blood tests. Blood tests will not definitively diagnose Kawasaki disease; however, they may be requested to rule out the presence of other diseases. Blood tests suggesting Kawasaki disease may show the following:
    • Elevated CRP or C-reactive protein and erythrocyte sedimentation rate (ESR)
    • Elevated liver enzymes
    • Hypoalbuminemia
    • Platelets of >450 per mm3 in the first week
    • White blood cell count of >15,000/uL
    • Cerebrospinal fluid (CSF) pleocytosis
    • Sterile pyuria
  • Electrocardiogram (ECG). An ECG test may be performed to measure the electrical impulses of the patient’s heartbeat. Kawasaki disease often affect the heart hence this will need to be checked. ECG may show mild abnormalities suggesting myocarditis.
  • Echocardiogram. An imaging test to view the heart will help identify heart problems. It may show pericardial effusion, LV dilation, mitral insufficiency and decreased systolic function.

Treatment of Kawasaki Disease

Once a diagnosis of Kawasaki disease has been made, treatment will need to be started immediately to prevent serious complications.

The treatment of Kawasaki disease will focus on reducing the fever and managing the inflammation.

  1. Gamma Globulin. Gamma globulin, an immune protein, is administered intravenously. The administration of gamma globulin lowers the risk of coronary artery problems from occurring. The mechanism of gamma globulin lowering the risk of heart problems is unknown.
  2. Aspirin. This drug helps alleviate fever and reduces joint pain due to its anti-inflammatory property. Caution is recommended in the use of aspirin as it is known to cause Reye’s syndrome. Reye’s syndrome is a serious condition that can cause liver and brain swelling. It is related to aspirin intake after a viral infection. The administration of aspirin should be made under medical supervision.
  3. Monitoring heart problems. Follow up care is needed to monitor possible development of heart conditions.

Nursing Care Plans for Kawasaki Disease

Nursing Care Plan 1

Nursing Diagnosis: Hyperthermia related to the inflammatory process of Kawasaki disease as evidenced by temperature of 38.5 degrees Celsius, rapid and shallow breathing, flushed skin, profuse sweating, and weak pulse.

 Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.

InterventionsRationales
Assess the patient’s vital signs at least every 4 hours.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antibiotics and fever-reducing drugs (e.g. Paracetamol) administered.
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed anti-pyretic medications.Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature. Aspirin helps alleviate fever and reduces joint pain due to its anti-inflammatory property. Caution is recommended in the use of aspirin as it is known to cause Reye’s syndrome.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.

Nursing Care Plan 2

Nursing Diagnosis: Alteration in comfort related to hyperthermia as evidenced by irritability and restlessness of the child

Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range and will verbalize feeling more comfortable.

InterventionsRationales
Remove excessive clothing, blankets and linens. Adjust the room temperature.To regulate the temperature of the environment and make it more comfortable for the patient.
Administer the prescribed anti-pyretic medications.Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.
Offer a tepid sponge bath.To facilitate the body in cooling down and to provide comfort.
Elevate the head of the bed.Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.
Provide a cooling blanket to the patient.To facilitate the body in cooling down and to provide comfort.

Nursing Care Plan 3

Nursing Diagnosis: Fluid Volume Deficit related to dehydration due to fever as evidenced by temperature of 39.0 degrees Celsius, skin turgidity, dark yellow urine output, profuse sweating, and blood pressure of 89/58.

Desired Outcome: Within 24 hours of nursing interventions, the patient will be able to achieve a normal fluid balance with absence of fever.

InterventionsRationales
Commence a fluid balance chart, monitoring the input and output of the patient.To monitor patient’s fluid volume accurately and effectiveness of actions to reverse dehydration.
Start intravenous therapy as prescribed. Encourage oral fluid intake as tolerated.To replenish the fluids lost from profuse sweating, and to promote better blood circulation around the body.
Educate the patient (or guardian) on how to fill out a fluid balance chart at bedside.To help the patient or the guardian take ownership of the patient’s care, encouraging them to drink more fluids as needed, or report any changes to the nursing team. 
Monitor patient’s serum electrolytes and recommend electrolyte replacement therapy (oral or IV) to the physician as needed.Sodium is one of the important electrolytes that are lost when a person is sweating. Hyponatremia or low serum sodium level may cause brain swelling.

Nursing Care Plan 4

Nursing Diagnosis: Acute Pain related to the inflammatory process of Kawasaki disease as evidenced by pain score of 10 out of 10, verbalization of joint pain, guarding sign on the painful areas, irritability, and restlessness

Desired Outcome: The patient will demonstrate relief of pain as evidenced by a pain score of 0 out of 10, stable vital signs, and absence of restlessness.

InterventionsRationale
Administer prescribed medications that alleviate the symptoms of joint pain.Aspirin helps alleviate fever and reduces joint pain due to its anti-inflammatory property. Caution is recommended in the use of aspirin as it is known to cause Reye’s syndrome.
Assess the patient’s vital signs and characteristics of pain at least 30 minutes after administration of medication.  To monitor effectiveness of medical treatment for the relief of pain. The time of monitoring of vital signs may depend on the peak time of the drug administered.  
Elevate the head of the bed if the patient is short of breath. Administer supplemental oxygen, as prescribed. Discontinue if SpO2 level is above the target range, or as ordered by the physician.To increase the oxygen level and achieve an SpO2 value within the target range.
Place the patient in complete bed rest. Educate patient on deep breathing exercises, and relaxation techniques.To promote healing and recovery.

Other possible nursing diagnoses:

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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