Kawasaki disease is a serious condition causing inflammation of blood vessels throughout the body that primarily affects children under 5 years of age. This nursing diagnosis guide focuses on the comprehensive care and management of patients with Kawasaki disease, a leading cause of acquired heart disease in children.
Causes (Related to)
Various factors can trigger Kawasaki disease, though the exact cause remains unknown. Common related factors include:
- Genetic predisposition – especially in Asian populations
- Immune system response to viral or bacterial infections
- Environmental triggers that may cause an autoimmune response
- Seasonal variations with peaks in winter and spring
- Age factors – most common in children under 5 years
Signs and Symptoms (As evidenced by)
The signs and symptoms of Kawasaki disease typically appear in phases:
Subjective: (Patient/Parent reports)
- Extreme irritability
- Joint pain
- Abdominal pain
- Neck pain
- Loss of appetite
Objective: (Nurse assesses)
- Fever lasting 5 or more days (>39.4°C or 102.9°F)
- Bilateral conjunctival injection
- Changes in lips and oral cavity
- Red, cracked lips
- Strawberry tongue
- Oral cavity inflammation
- Changes in extremities
- Redness of palms and soles
- Swelling of hands and feet
- Peeling of skin in convalescent stage
- Polymorphous rash
- Cervical lymphadenopathy
Expected Outcomes
The following are the common nursing care planning goals and expected outcomes for Kawasaki disease:
- The patient will maintain normal cardiac function
- The patient’s fever will resolve within the expected timeframe
- The patient will show no signs of complications
- The patient will maintain adequate hydration
- The parent/caregiver will demonstrate an understanding of the disease process and management
- The patient will achieve age-appropriate activities of daily living
Nursing Assessment
1. Monitor Vital Signs
Track temperature, heart rate, blood pressure, and respiratory rate. Fever patterns and cardiovascular changes are crucial indicators of disease progression.
2. Perform Cardiovascular Assessment
- Listen for heart murmurs
- Check peripheral pulses
- Monitor for signs of coronary artery involvement
- Assess capillary refill time
3. Assess Skin Changes
- Document rash characteristics
- Monitor for desquamation
- Check extremities for edema
- Assess mucous membrane changes
4. Monitor Hydration Status
- Track intake and output
- Assess skin turgor
- Monitor mucous membranes
- Check for adequate urine output
5. Evaluate Pain Levels
Use age-appropriate pain scales and monitor for signs of discomfort.
6. Monitor Laboratory Values
- Complete blood count (CBC)
- Erythrocyte sedimentation rate (ESR)
- C-reactive protein (CRP)
- Liver function tests
- Cardiac enzymes
7. Prepare for Diagnostic Tests
- Echocardiogram
- Electrocardiogram (ECG)
- Chest X-ray
Nursing Interventions
1. Administer Medications as Prescribed
- Intravenous immunoglobulin (IVIG)
- Aspirin therapy
- Antipyretics as needed
2. Provide Cardiac Monitoring
- Continuous cardiac monitoring
- Regular vital sign checks
- Documentation of any abnormalities
3. Manage Fever
- Administer antipyretics as ordered
- Provide cooling measures
- Monitor temperature trends
4. Ensure Adequate Rest
- Promote sleep and rest periods
- Minimize disturbances
- Position for comfort
5. Support Nutritional Needs
- Encourage fluid intake
- Offer preferred foods
- Monitor nutritional status
6. Provide Education
- Disease process explanation
- Medication administration
- Follow-up care requirements
- Warning signs and symptoms
7. Implement Infection Prevention
- Hand hygiene
- Isolation precautions if needed
- Visitor screening
Nursing Care Plans
Care Plan 1: Decreased Cardiac Output
Nursing Diagnosis Statement:
Risk for Decreased Cardiac Output related to coronary artery inflammation secondary to Kawasaki disease
Related Factors:
- Inflammation of coronary arteries
- Development of coronary artery aneurysms
- Myocardial dysfunction
Nursing Interventions and Rationales:
- Monitor vital signs every 4 hours
Rationale: Early detection of cardiovascular complications - Perform continuous cardiac monitoring
Rationale: Identify dysrhythmias or ST-segment changes - Assess peripheral pulses every shift
Rationale: Monitor circulation and perfusion - Administer prescribed medications on schedule
Rationale: Prevent coronary artery complications
Desired Outcomes:
- The patient will maintain stable vital signs
- The patient will show no signs of cardiac dysfunction
- The echocardiogram will show no progression of coronary artery changes
Care Plan 2: Hyperthermia
Nursing Diagnosis Statement:
Hyperthermia related to inflammatory process secondary to Kawasaki disease
Related Factors:
- Systemic inflammation
- Immune system response
- Disease process
Nursing Interventions and Rationales:
- Monitor temperature every 4 hours
Rationale: Track fever pattern and response to treatment - Administer antipyretics as ordered
Rationale: Reduce fever and provide comfort - Provide cooling measures
Rationale: Help maintain normal body temperature - Ensure adequate hydration
Rationale: Prevent complications of hyperthermia
Desired Outcomes:
- The patient’s temperature will return to the normal range
- Patient will maintain adequate hydration
- Patient will report improved comfort
Care Plan :3 Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to inflammation of blood vessels and joints secondary to Kawasaki disease
Related Factors:
- Systemic vasculitis
- Joint inflammation
- Tissue inflammation
Nursing Interventions and Rationales:
- Assess pain using age-appropriate scale
Rationale: Ensure appropriate pain management - Administer pain medication as prescribed
Rationale: Provide comfort and reduce inflammation - Position for comfort
Rationale: Minimize discomfort and promote rest - Monitor the effectiveness of interventions
Rationale: Ensure adequate pain control
Desired Outcomes:
- Patient will report decreased pain levels
- Patient will demonstrate improved comfort
- Patient will maintain age-appropriate activity level
Care Plan 4: Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to inflammatory process secondary to Kawasaki disease
Related Factors:
- Presence of rash
- Skin desquamation
- Inflammation of extremities
Nursing Interventions and Rationales:
- Assess skin changes every shift
Rationale: Monitor the progression of skin manifestations - Provide gentle skin care
Rationale: Prevent skin breakdown - Document changes in skin appearance
Rationale: Track disease progression - Apply moisturizer as needed
Rationale: Prevent dryness and discomfort
Desired Outcomes:
- Patient’s skin will remain intact
- Patient will show no signs of infection
- Skin changes will resolve without complications
Care Plan 5: Anxiety
Nursing Diagnosis Statement:
Anxiety (Parent) related to the child’s condition and uncertain prognosis secondary to Kawasaki disease
Related Factors:
- Lack of knowledge about the disease process
- Fear of complications
- Concern about long-term effects
Nursing Interventions and Rationales:
- Provide education about the disease process
Rationale: Increase understanding and reduce anxiety - Explain the treatment plan and expected outcomes
Rationale: Help parents understand care progression - Teach warning signs requiring immediate attention
Rationale: Empower parents in care management - Provide emotional support
Rationale: Help parents cope with stress
Desired Outcomes:
- Parents will verbalize understanding of disease process
- Parents will demonstrate appropriate care techniques
- Parents will express decreased anxiety levels
References
- McCrindle, B. W., et al. (2023). Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association. Circulation, 135(17), e927-e999.
- Son, M. B., & Newburger, J. W. (2023). Kawasaki Disease. Pediatric Clinics of North America, 70(1), 153-169.
- Marchesi, A., et al. (2023). Kawasaki Disease: Current Understanding of the Mechanism and Evidence-Based Treatment. Nature Reviews Rheumatology, 19(2), 89-102.
- Xie, X., et al. (2023). Nursing Care and Management Strategies for Children with Kawasaki Disease: A Systematic Review. Journal of Pediatric Nursing, 58, 27-35.
- Roberts, S. C., & Jain, S. (2023). Current Concepts in the Diagnosis and Management of Kawasaki Disease. American Family Physician, 107(3), 271-280.
- Chen, J. J., et al. (2023). Evidence-Based Nursing Interventions for Kawasaki Disease: A Clinical Practice Guideline. International Journal of Nursing Studies, 138, 104355.
