Kawasaki Disease

Raiza Nikkita V. Pascual

Definition
 Mucocutaneous Lymph Node Syndrome or known as
Kawasaki Disease, is an acute, febrile, multi system
disorder that occurs almost exclusively in children
before the age of puberty.

 It is the leading cause of acquired Heart Disease in

children 2yrs of age and younger.

 It was first described in 1965 by Dr. Tomisaku

Kawasaki in Japan.
Cause / Etiology

 The cause of Kawasaki Disease remains unknown.

However, recent evidence suggests it is an Immune

Mediated Vasculitis ( inflammation of blood vessels )
triggered by an acute infection or by a bacterial toxin.
Risk Factors
 Unknown, but it apparently develops in genetically
predisposed individuals after exposure to an as-yet-
unidentified infectious agent
 Seen most frequently in children younger than
five years old
 Peak incidence is in boys under four years of age
 Signs & Symptoms
 High fever (39-40˚C) that does not respond to
antipyretic
 Conjunctival infection(redness of conjunctiva)

 Oral changes (strawberry tongue & red cracked lips)

 Skin desquamates on the palms & sole of the feet

 Joints may swell & reddened (arthritic)

 Variety of rashes occur (often confined to diaper area)

Diagnostic Test
1. Electrocardiography ( ECG )
 Graphically records the electrical current &
generated by the Heart & measured by electrodes
connected to an amplifier & strip chart recorder.

Purpose:

- to identify conduction abnormalities, cardiac

arrythmias, myocardial ischemia or infarction.

- to document pacemaker performance.

Nsg. Responsibilities:

- assist the patient in supine or semi fowler’s position.

- expose the chest, ankles & wrists.

- place lead properly.

- disconnect the equipment, remove the electrodes &

remove the gel w/ a moist cloth towel.
2. Echocardiography ( ECHO )
 Noninvasive test examines the size, shape and motion
or cardiac structures.

Purpose:
- to diagnose & evaluate valvular abnormalities.
- to measure & evaluate the size of the heart’s
chambers & valves.

Nsg. Responsibilities:
- assists the child to remain still.
- remove the conductive gel from the patient’s skin
after the test.
Management
MEDICATION
1. Aspirin ( Acetylsalicylic Acid )
C = Analgesic & Antipyretic
A = Thought to produce analgesia by blocking pain impulses, by
inhibiting synthesis of prostaglandin in the CNS or of other
substances that sensitize pain receptors to stimulation. May
relieve fever by central action in the hypothalamic heat
regulating center & exert its anti-inflammatory effect by
synthesis of inhibiting prostaglandin & that of other mediators
of the inflammatory response as well. In low doses, it also
appears to impede clotting by preventing formation of a
platelet aggregating substances.
I = Poly-arthritic or inflammatory conditions.
Mild pain or fever
Kawasaki Disease
2. Intravenous Immune Globulin ( IVIG )
C = Immune Serum
A = provides passive immunity by increasing anti body
titer. The primary component is IgG
(immunoglobulin G)
I = to prevent coronary artery aneurysm in patients
with kawasaki disease.

SURGICAL PROCEDURE
 If the child is left w/ Coronary Artery Disease from stenosis

( abnormal narrowing in a blood vessel ) of the Coronary Arteries,

Coronary bypass surgery may be necessary in the future.
NURSING DIAGNOSIS

1. Risk for Ineffective Peripheral Tissue Perfusion

R/T inflammation of blood vessels
Goal:
 the child will maintain adequate tissue perfusion
during the course of illness.
Nsg. Intervention:
 observe for signs of heart failure & edema.
 inspect extremities for color & palpate for warmth
& capillary filling in toes & fingers.
 if the child is developing myocarditis, be alert for
chest pain, arrythmias & ECG changes.
2. Acute Pain R/T fever, skin manifestations and joint
inflammation.

Goal:
The child will rest comfortably & will express
decreased pain.

Nsg. Intervention:
 provide comfort measures such as use of heat/cold
packs, touch, repositioning.
 encouraged adequate rest periods.
 administer analgesics as indicated.
3. Impaired Oral Mucus Membrane

Goal:
 Identify specific intervention to promote healthy
oral mucosa.

Nsg. Intervention:
 encourage adequate fluids.
 lubricate lips w/ lip balm & other oral lubricant
solution.
 encourage the child to continue brushing his teeth.
Prognosis
With early treatment, rapid recovery from the
acute symptoms can be expected and the risk of
coronary artery aneurysms greatly reduced.
Untreated, the acute symptoms of Kawasaki disease
are self-limited ( the patient will recover eventually),
but the risk of coronary artery involvement is much
greater.
Research
January 2009
For the new study, the international consortium
combined their patients to perform a genome-wide
association study in 119 Caucasian KD cases and 135
matched controls from Australia, Holland, USA and the
UK. They looked at 250000 genetic variants in each
patient and uncovered the most significant genes that
appeared to be involved in Kawasaki disease. They then
replicated this in an independent cohort of a total of
893 KD cases plus population and family controls.
The researchers are now planning to analyse an Asian
cohort of people with Kawasaki disease, to see if their
results can be replicated in this population.
THANK YOU!