5. Kawasaki Disease

what is kawasaki disease?

inflammation of medium-sized blood vessels throughout the body (cute systemic vasculitis)

• can involve coronary arteries

what age group is most commonly affected by kawasaki disease?

children 6 months to 5 years old

why is kawasaki disease a major cardiac concern in children? *

it’s the leading cause of acquired heart disease in children

• coronary artery dilation or aneurysms are major complications

what assessment findings suggest kawasaki disease?

• prolonged high fever and irritability

• red eyes without drainage

• bright red, chapped lips

• strawberry tongue

• red, inflamed oral mucosa and pharynx

• swollen hands and feet, red or peeling palms and soles

• nonblistering rash

• enlarged lymph nodes

• bilateral joint pain

• peeling skin in the perineum

• enlarged liver; tachycardia, gallop, or murmur

what fever pattern suggests kawasaki disease? *

high fever lasting 5 days to 2 weeks, unresponsive to antipyretics or antibiotics

what can tachycardia, a gallop, or a murmur indicate in kawasaki disease?

• tachycardia may result from fever

• gallop or murmur may indicate cardiac involvement

what laboratory findings are expected in kawasaki disease?

• anemia

• 🔺 WBC count in active phase

• thrombocytosis, (increased platelets) in the later phase

• elevated erythrocyte sedimentation rate (ESR)

• elevated C-reactive protein (CRP)

what cardiac tests are used in kawasaki disease?

• echocardiogram at diagnosis

  • establishes a baseline and assesses coronary involvement

• repeat echocardiograms to monitor changes

• cardiac catheterization if more information is needed

what are the treatment goals for kawasaki disease?

1. reduce coronary artery inflammation

2. prevent coronary thrombosis (clot)

what medications treat acute kawasaki disease?

• high-dose aspirin in 4 divided doses daily

• high-dose intravenous immunoglobulin (IVIG) infusion

why is aspirin used to treat kawasaki disease?

• reduces inflammation, fever, and pain

• inhibits platelet aggregation (clots)

what serious risk is associated with aspirin and viral illness in children? *

Reye syndrome

how does aspirin therapy change as kawasaki disease improves?

• high dose until the child is afebrile

• lower dose afterward until the platelet count normalizes, often 6–8 weeks

when should intravenous immunoglobulin (IVIG) be started for kawasaki disease? *

within the first 10 days of illness for the best treatment response

when should kawasaki symptoms improve after intravenous immunoglobulin (IVIG)?

within 36 hours, a second dose may be needed if symptoms do not improve

what monitoring is needed during intravenous immunoglobulin treatment for kawasaki disease?

follow hospital monitoring policy during and after the infusion

• watching for allergic reactions because it is a donor product

how long should live vaccines be delayed after intravenous immunoglobulin (IVIG) for kawasaki disease? *

11 months

what if a child received a live vaccine less than 14 days before intravenous immunoglobulin? *

repeat the vaccine after the 11-month waiting period

what comfort measures help children with kawasaki disease?

• acetaminophen for pain and fever (don’t add more nsaids)

• quiet environment and clustered care

• cool cloths on painful joints

• vaseline on dry, cracked lips

• soft diet and soothing cool foods or fluids

why is acetaminophen preferred over ibuprofen during aspirin treatment for kawasaki disease? *

avoid adding another NSAID while the child is receiving aspirin

what diet and oral comfort measures help children with kawasaki disease?

• soft diet for inflamed oral tissues

• ice pops or developmentally safe ice chips

• cool, moist washcloth for an infant to suck on

what follow-up teaching is essential for families of children with kawasaki disease? *

• follow the medication regimen

• keep healthcare provider and cardiology appointments

• obtain repeat labs to monitor platelets and guide aspirin discontinuation

• continue diet and comfort measures

• mouth and joint pain can last up to 8 weeks