Kawasaki Syndrome was first discovered by a Japanese physician Tomisaku Kaswasaki in the 1960s. He noticed a cluster of symptoms in Japanese schoolchildren. Kawasaki Syndrome affects children younger than the age of 5 years old, but peaks at ages 18-24 months. In 2000, there was an average of 77% of children in the United States being treated for Kawasaki disease (Gale, 2008). The disease appears to be influenced by sex and race. Males and children of Asian or Pacific Island descent have a higher incidence of the disease.
The disease is also linked to socioeconomic status and is more common in high median household income (Gale, 2008). Kawasaki syndrome affects several different organs in the body. Thus, this paper will aim to detail common clinical manifestations that will present in regards to the circulatory system, integratory system, and the treatment/care of the disease. Kawasaki disease can be a potentially fatal inflammatory disease with the cause to be unknown scientists and doctors have not been able to single out an exact cause of the disease.
However, they have suggested ideas that the disease could come from a variety of places such as exposure to a toxin, exposure to chemicals used in carpet cleaning, and exposure to an airborne pathogen (Gale, 2008). The disease attacks different areas of the body, such as complications in cardiovascular disease. Some of the complications include myocarditis (inflammation of the heart muscle); arrhythmias (disturbances in heart rhythm); aneurysms (areas of blood vessel dilation in the coronary arteries); arteritis (inflammation of an artery) in their arms and legs (Frey, 2016).
Aims of therapy for patients who develop coronary artery aneurysms is to prevent the formation of thrombosis. A Low-dose aspirin (3-5 mg/kg daily) alone or with other antiplatelet agents such as clopidogrel and ticlopidine may be beneficial for some patients (Burns, 2002). High doses of Aspirin can be given as well (80 to 100 mg/kg/day) in four divided doses (Ball, Bindler, Cowen, 2015). Mucocutaneous lymph node syndrome is also known as Kawasaki syndrome. The disease can affect the lymph nodes by increasing them in size or swelling.
There can be a rash that develops over the child’s chest and genital areas. After the initial onset of a fever of greater than 104 degree F the fever is followed by peeling of the skin that begins in the fingertips and toenails. The child’s lips could become very red with the tongue becoming red like the color of a strawberry. The palms, soles, and mucous membranes that line the eyelids and cover the exposed portion of the eyeball. The eyeball may look or become a purplish color (Gale, 2016). Erythematous (redness of the skin) and usually happens because of hyperemia (increased blood flow).
With children that spike the fever, which is the main sign the disease. There are three stages of the disease: acute, subacute, and convalescent stage (Ball, Bindler, Cowen, 2015). During the acute stage, lasting 1 to 2 weeks, the child will have irritability, high fever that persists more than 5 days, hyperemic conjunctivae, red throat, swollen hands and feet, maculopapular or erythema multiforme-like rash on the trunk and perineal are, unilateral enlargement of the cervical lymph nodes, diarrhea and hepatic dysfunction (Ball, Bindler, Cowen, 2015).
During the subacute stage, lasting 2 to 4 weeks, is when the parent may notice crackling of the lips and fissures, desquamation of the skin on the tips of the fingers and toes, joint pain, cardiac disease, and thrombocytosis (ball, Bindler, Cowen, 2015). In the convalescent stage, 6 to 8 weeks after the disease onset, the child appears normal, but lingering signs of inflammation may be present (Ball, Bindler, Cowen, 2015). The disease has been shown to be treated with a single IV infusion of immune globulin (IVIG) 2 g/kg over 8 to 12 hours. Administering IVIG within 5 to 10 days of onset reduces the risk for coronary artery aneurysm.
IV diphenhydramine before IVIG will help to reduce the risk of allergic reactions to the medication (Ball, Bindler, Cowen, 2015). Most children fully recover, but are still monitored for cardiac disease for several months. There is a special role the nurses play in the care of a child with the disease. The nurses’ main role is to focus on promoting comfort, monitoring for early signs of complications or disease progression, and supporting the family (Ball, Bindler, Cowen, 2015). The nurse assesses for pain in the child and makes sure the child’s skin is clean and dry and always makes sure the lips a lubricated.
The try the use of cool compresses to help with the fever to make the child more comfortable (Ball, Bindler, Cowen, 2015). Also the nurse will make sure the child is eating small, frequent meals of soft foods and that liquids are neither too hot nor too cold (Ball, Bindler, and Cowen. 2015). If the child shows signs of being in pain such as crying uncontrollably then the nurse will ask the physician to prescribe pain medication that will be within the child’s range of medication and then the nurse will administer the medication per the doctors’ orders.
The nurse needs to be using passive rang-of-motion exercises to facilitate joint movement with rest periods in between because the child is usually lethargic and irritable (Ball, Bindler, and Cowen, 2015). The nurse is the primary advocate for the child so the nurse needs to assess and monitor the child for any signs of complications as discussed in the above reading. Parents need to be educated about the signs and symptoms of the disease as discuss above so that they can try to catch the disease early.
The complications can be reduced if the disease is caught early enough. Give the parents information about the disease and the child’s treatment so they can provide comfort and reassurance to the child. At discharge the parents are advised to limit activities that could cause bleeding with the child on aspirin the child could bleed more than normal. If the child has no complications of cardiovascular complications the child can live an active lifestyle with no limitations.
However, if the child does experience complications with coronary aneurysms the child is placed on limitation of strenuous activity (Ball, Bindler, and Cowen 2015). In conclusion, there is much that is needed to be learned about Kawasaki Disease. Why does it only affect children of the ages 5 and younger? How come there has been no known causes for the disease or any known cures for the disease? With the reports being a little high in the United States parents really need to be educated about the disease and how it can mimic possibly other diseases.