Kawasaki Disease

Acknowledgement This case study would not be doable without the guidance and the help of several individuals who are in one way or another contributed and extended their valuable assistance in the preparation and completion of this study. My outmost gratitude to Ms. Maria Donna Duron, the school directress of St. Augustine School of treat Espana for her genuine sincerity and encouragement. To my adviser Ms. Cecilia J. Sarte for her patient ofly supervising and assisting us with their knowledge, as we gradu entirelyy go through the process of doing the case study itself, sincerest thanks. To my clinical teacher Mr.Joey M. Cadano for all the help and valuable insight he had shared To my instructor Mr. Paolo M. Zabat and all the faculty staff for their moral support and untiring effort in encouraging us to finish our study. To my classmates and friends who gave their moral support and help all the way despite the busy schedules in preparing their own case study. To my family for supp orting me all the way, providing me with everything I need financially and emotionally. Last but not the least, to our Almighty Father for his unceasing guidance and bless(prenominal)ings, for constantly giving me hope, courage and patience.Truly none of this is possible without you. ii Table of Contents TitlePage Number I. Acknowledgementii II. Objectiveiv III. submission a. Definition1 b. Incidence1 c. Etiology2 d. Manifestations and Complications2 IV. Anatomy and Physiology3 V. Pathophysiology6 VI. Patients compose a. Biographical selective information7 b. Chief Complaint7 c. register of Present Illness7 d. Medical History8 e. Family History8 VII. laboratory Findings9 VIII. Physical Assessment11 IX. Nursing Care Plan15 X. Drug Study20 XI. Discharge Plan23 iii II. Objectives GeneralThe objective of my case study is to develop and acquire understanding, skills, and knowledge about the unhealthiness, and health promotion to prevent further complication on the specify of the p atient. Specific Nurse Centered ? Assess the patients overall health emplacement ? Impart necessary health teachings to the patient ? Perform appropriate nursing care in conjunction with the condition of the patient ? Widen and enhance the student nurses knowledge and skills through additional research about the nature of the disease, its signs and symptoms, its pathophysiology, its diagnosis and treatment.Patient Centered ? Know when to seek help from the health care providers whenever the signs and symptoms whitethorn seem ? Understand the occurrence of Kawasaki Disease ? Know what other complications may arise, if left untreated ? Gather information about the therapeutic regimen iv III. Introduction Definition Kawasaki Disease (mucocutaneous lymph node syndrome) is a form of vasculitis identified by an acute febrile illness with multiple systems affected. The cause is unknown, but autoimmunity, transmitting, and genetic predisposition are believed to be involved.It affects m ostly children between ages 3 months and 8 years 80% are younger than age 5. It occurs more commonly in Japanese children or those of Japanese decent. It has seasonal epidemics, usually in late winter and early spring. It was first described in 1967 by Dr. Tomisaku Kawasaki in Japan. Kawasaki Disease mainly affects the livestock vessels, including coronary arteries. Blood vessels throughout the personate get inflamed, and the most serious that could happen is on the heart. If left untreated after 10 long time, children may make a higher risk to develop heart problems.Kawasaki Disease manifests in three phases acute, subacute, and convalescent. The acute phase begins with the abrupt onset of high fever that is unresponsive to antibiotics and antipyretics. The child then develops the remaining diagnostic symptoms. During this dot the child is typically very irritable. The subacute phase begins with the resolution of the fever and lasts until all clinical signs of KD have disapp eared. During this phase the child is at greatest risk for the development of coronary artery aneurysms. Echocardiograms are used to monitor myocardial and coronary artery status.In the convalescent phase, all the clinical signs of KD have resolved, but the laboratory values have not dieed to normal (6 to 8 weeks after onset). At the end of this stage the child has regained his or her usual temperament, energy and appetite. The cause of Kawasaki Disease is unknown, but it is thought to be immunologic abnormalities that include change magnitude activation of helper T-cells and increased level of repellent mediators and anti-bodies that destroy endothelial cells have been detected during the acute phase of the disease.It has been hypothesized that some unknown antigen, possibly a common infectious agent, triggers the immune response in a genetically predisposed child. Incidence Epidemics of Kawasaki disease primarily occur in the late winter and spring, at 2- to 3-year intervals. Approximately 3000 children with Kawasaki disease are hospitalized annually in the United States. The approximate annual race-specific incidence per 100,000 children younger than 5 years is 32. 5 cases for Americans of Asian and Pacific Island descent, 16. 9 cases for non-Hispanic African Americans, 11. cases for Hispanics, and 9. 1 cases for whites. Although Kawasaki disease has been reported in children of all ethnic origins, it occurs most commonly in Asian children, especially those of Japanese descent. Rates are negotiate among blacks, Polynesians, and Filipinos and are lowest among whites. Manifestations and Complications Manifestations ? Fever for at least 5 days ? Polymorphous rash ? Strawberry tongue ? Cervical lymphadenopathy Complications ? Changes in the extremities ? Conjunctival infection ? Vasculitis IV. Anatomy and Physiology picCardiovascular System Knowing the functions of the cardiovascular system and the parts of the body that are part of it is critical in under standing the physiology of the human body. With its complex pathways of veins, arteries, and capillaries, the cardiovascular system keeps life pumping through you. The heart, blood vessels, and blood help to transport vital nutrients throughout the body as well as remove metabolic waste. They also help to harbor the body and regulate body temperature. The cardiovascular system consists of the heart, blood vessels, and blood.This system has three main functions ? Transportof nutrients, oxygen, and hormones to cells throughout the body and removal of metabolic wastes (carbon dioxide, nitrogenous wastes). ? Protectionof the body by white blood cells, antibodies, and complement proteins that circulate in the blood and defend the body against orthogonal microbes and toxins. Clotting mechanisms are also present that protect the body from blood loss after injuries. ? Regulationof body temperature, eloquent pH, and water content of cells. pic lymphatic SystemAn important supplement to t he cardiovascular system in helping to remove toxins from the body, the lymphatic system is also a crucial support of the immune system. opposed blood, lymph only moves one way through your body, propelled by the action of nearby skeletal heftinesss. The lymph is pushed into the bloodstream for elimination. Appreciating the importance of the lymphatic system in filtering, recycling, and producing blood as well as filtering lymph, collecting excess fluids, and absorbing fat-soluble materials is necessary to the understanding of human physiology.The lymphatic system consists of lymphatic vessels, a fluid calledlymph,lymph nodes, the thymus, and the spleen. This system supplements and extends the cardiovascular system in the following ways ? The lymphatic system collects excess fluids and plasma proteins from surrounding tissues (interstitial fluids) and returns them to the blood circulation. Because lymphatic capillaries are more porous than blood capillaries, they are able to colle ct fluids, plasma proteins, and blood cells that have escaped from the blood.Within lymphatic vessels, this collected material forms a usually colorless fluid called lymph, which is transported to the right hand and left subclavian veins of the circulatory system. ? The lymphatic system absorbs lipids and fat-soluble materials from the digestive tract. ? The lymphatic system filters the lymph by destroying pathogens, inactivating toxins, and removing particulate matter. Lymph nodes, small bodies interspersed along lymphatic vessels, act as cleaning filters and as immune response centers that defend against infection. V.Pathophysiology VI. Patients Profile Biographical Data Name S. T. Age 3 years aging GenderMale AddressQuezon City Birth date January 14, 2010 Religion Catholic NationalityFilipino Informant Mother Date of AdmissionFebruary 17, 2013 Admission Data Chief Complaint High Fever Initial Diagnosis Urinary Tract Infection Final Diagnosis Kawasaki Disease Attending Physician Dr. K. D. History of Present illness Patients present condition started 5 days prior to admission when patient have fever at 38. 5C associated with rash from face to neck.The patient was brought to Capitol Medical Center and diagnosed with UTI due to bacteria present in his piss. He was given paracetamol and antibiotics for the treatment. They allowed to go home. 4 days PTA, still with fever documented at 39. 5C and rash. Swelling of face and lips are cracked. The mother noticed short, quick breathing. The patient was brought again to the hospital, strawberry tongue is famed upon physical examination. The patient was referred to Infectious Disease (ID) Specialist and confirmed having Kawasaki Disease upon conformatory and other laboratory finding.Past Health History Patients mother verbalized that all involve immunizations since birth has been done to the patient. The patient has only experience stomach pain and minor health problems such as occasional cough, cold, and mild fev er. Family History Mother Father Hypertension - + PTB - Cancer - - Allergies - - VII. Laboratory Findings Urinalysis Report approach pattern Actual Interpretations Implication Color clarification or Pale yellow Light Yellow Normal indicates good hydration and urine concen tration Character Clear Slightly Turbid Abnormal increase fluid using up Glucose (-) (-) Normal well hydrated Reaction 4. 6-8ph 6. ph Normal there is normal hydrogen ion concentration and extracellular fluid Specific gloom 1. 010-1. 025 1. 010 Normal the concentrating ability of the kidney is normal PUS cell 0 5-8 Abnormal indicates possible urinary tract infection Administer antibiotic as request Squamous (-) Few Abnormal increase fluid intake Bacteria (-) Few Abnormal increase fluid intake increase intake of Vitamin C hematology Report Laboratory/ Diagnostic Results Normal Values Interpretation Implication Procedures Hemoglobin 106 g/L 130-180 decrease Decresed hemoglobin leads to symptoms of anemia Hematocrit 0. 32 % 0. 40-0. 54 decrease Decreased hematocrit leads to symptoms of anemia WBC Count 20. 07 5. 0-10. increase Increased WBC was due to forepart of infection Coagulation Profile Platelet Count 605 150-450 increase Increased PLT points to abnormal conditions of excess clotting Differential Count Neutrophil 65 % 50-70 % normal Within normal condition Lymphocytes 45 % 25-35 % increase Will lead to signs of viral infection Eosinophil 1 % 1-5 % normal Within normal condition VIII. Physical Assessment firmament/ REGION METHOD USED NORMAL FINDINGS ACTUAL INTERPRETATION/ ANALYSIS FINDINGS General Appearance Temp 36. 5-37. 2C Temp 39. 5C non normal.All this symptoms are present due to hyperthermia with Resp. Rate 20-30 cpm manifestations of increased respiratory Inspection Resp. Rate 35cpm rate and cardiac rate. Fundamentals of impulse Rate 80-130 cpm Nursing, Kozier & Erbs 8th Edition, Pulse Rate pp. 529. Auscultation No Pallor 140bpm Without signs of fatigue Pallor Inspection No edema Fatigue Accumulation of fluid in the extremities because of prolong staying Bipedal non- indention edema in bed, and unwarranted accumulation of Palpation fluid in the third spaces, edema developed. Fundamentals of Nursing, Kozier & Erbs 8th Edition, pp. 579. non normal due to excessive accumulation of fluid in the third spaces, edema developed.Fundamentals No edema of Nursing, Kozier & Erbs 8th Edition, pp. 579. With non- pitting edema Skin Palpation Not normal.Temperature exceeds the normal temperature because of the presence of infection that causes the skin to be warm. Not normal.A skin lesion is an Skin is mil dly warm to alteration in a clients normal skin touch Warm to touch appearance. Fundamentals of Nursing, Kozier & Erbs 8th Edition, pp. 576. Not normal. Poor capillary refill results in poor oxygenation. Without peeling, must be soft and flavourless Peeling (desquamation) palms Not normal because there is increase and soles inflammation of the blood vessels causing it to be red in color. Inspection Capillary refill is less than 3 seconds With a capillary refill of 5 seconds Normal No infection, swelling and Palpation moist lips Red mucous membranes in the mouth Normal Mouth Dry lips Inspection Cracked lips Not normal due to infection. Fundamentals of Nursing, Kozier & Erbs Strawberry tongue noted 8th Edition, pp. 607 Reactive/ responsive to noises Reacts to brasslike noises Not normal.Use of accessory muscle (abdominal muscle, trap ezius muscle, Symmetrical and patent and sternocleidomastoid muscle) and Symmetrical and patent increased RR signifies fatigue and hyperthermia. Ears Not glaring Fundamentals of Nursing, Kozier & Erbs Enlarged, palpable 8th Edition, pp. 548. Nose Inspection Breath sounds are resonantBreath sounds are resonant Thorax is rounded Lymph Nodes thorax is rounded Inspection Palpation normal RR 20-30cpm, RR 35cpm Not normal due to inflammation of the skin lesions normal PR 80-130bpm Chest, Thorax and Lungs HR 140bpm Percussion no use of accessory muscles in breathing. Use of accessory muscle Inspection (abdominal muscle, trapezius muscle, and sternocleidomastoid Not normal due to process of the Unblemished skin muscle) disease and infection.Weakness is due Palpation to lack of energy needed to do normal No tenderness relaxed Presence of rash activities. abdomen with smooth, consistent tension Not normal. Pain was caused by the Tenderness and presence of bacteria in the urine. No restriction in hypersensitivity Inspection activities, no weakness and Auscultation alert Inability to tolerate Abdomen There should no pain mat up activities, weak in appearance, when voiding irritable and lethargic Inspection Protein is not evident in the urine Palpation With difficulty in urination. Color of the urine is yellow Normal urine output is Not normal.This is also caused by 500-1000cc/day or equivalent accumulation of excessive fluid in the musculoskeletal and to 20-25cc hr body neurolo- gical status Inspection There should no edema, tenderness, or swelling present . Genitourinary Inspection Non-pitting edema on both feet noted Lower Extremities Inspection Palpation IX. Nursing Care Plan X. Drug Study XI. Discharge Plan Medication Patient is given discharge care drug for 2 weeks of 120 mg of aspirin every day or 30 mg QID. Exercise/ Activity The patient can tote up his usual activities as soon his condition become normal. There is no restriction with regard to physical activities as long as it is tolerable to the patients health status. Treatment Allow the child to rest for faster recovery. Since the patient is taking anti-platelet medications, precautionary measures are discussed to avoid bleeding tendency.The patient is instructed to return to his attending physician within one week after date discharge for a follow up consultation. He is also required to have CBC, platelet count and ESR during that visit. Health Teaching Good hygiene is encouraged. prosperous toothbrush are recommended. Petroleum jelly can be apply to dry cracked lips. Use mild soap in cleaning the skin and a mild lotion can be applied to pr otect skin from drying and peeling. Instill artificial tears to sooth conjunctiva as instructed. Outpatient Orders Remind the family on their follow-up check-up with their physician. Maintain good and safe environment to evaluate the progress of the treatment.Diet Soft or pureed diet is advised when the childs oral mucosa is still inflamed. Cool liquids like ice chips and ice pops can also be offered. Diet will return to usual when the child is able to tolerate it. Provide high protein diet to promote faster recover. Increase fluid intake to prevent dehydration. A Case Presentation of Kawasaki Disease In Partial Fulfilment of the requirement in Maternal and Child Nursing II A Compilation Presented to St. Augustine School of Nursing Espana, Manila Presented By Julie Anne G. Lumbera PN-4A Ms. Cecilia J. Sarte MCN II Instructor and Adviser Mr. Joey M. Cadano Clinical Instructor KAWASAKI DISEASE pic