Kawasaki Disease

Acknowledgement This incase study would not be possible without the guidance and the dish up of several individuals who argon in virtuoso way or an different contributed and extended their valu competent 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 breast feeding Espana for her genuine sincerity and encouragement. To my adviser Ms. Cecilia J. Sarte for her diligent ofly supervising and assisting us with their knowledge, as we gradually go d unrivaled the service of doing the case study itself, sincerest thanks. To my clinical instructor Mr.Joey M. Cadano for all the help and valu fit insight he had shargond out To my instructor Mr. Paolo M. Zabat and all the faculty staff for their moral harbor and unflagging effort in encouraging us to finish our study. To my classmates and friends who gave their moral contribute and help all the way despite the busy schedules in preparing their receive case study. To my family for supporting me all the way, providing me with everything I need financially and emotionally. outlive but not the least(prenominal), to our Almighty Father for his unceasing guidance and blessings, for endlessly giving me hope, courage and patience.Truly none of this is possible without you. ii Table of confine TitlePage Number I. Acknowledgementii II. Objectiveiv III. Introduction a. Definition1 b. Incidence1 c. Etiology2 d. Manifestations and Complications2 IV. Anatomy and Physiology3 V. Pathophysiology6 VI. Patients Profile a. biographical Data7 b. Chief Complaint7 c. History of Present Illness7 d. Medical History8 e. Family History8 VII. Laboratory Findings9 VIII. Physical Assessment11 IX. treat C atomic number 18 Plan15 X. Drug understand20 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 for warding to prevent further complication on the find out of the patient. Specific comfort Centered ? Assess the patients overall health billet ? Impart necessary health teachings to the patient ? Perform appropriate treat make do in conjunction with the condition of the patient ? Widen and enhance the student nurses knowledge and skills through additional research about the temper 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 may appear ? Understand the occurrence of Kawasaki ailment ? Know what other complications may arise, if remaining untreated ? Gather information about the therapeutical regimen iv III. Introduction Definition Kawasaki infirmity (mucocutaneous lymph node syndrome) is a form of vasculitis identified by an acute febrile illness with five-fold organizations affected. The cause is unknown, but autoimmunity, infection, and genetic predisposition are believed to be involved.It affects in the main infantren between ages 3 months and 8 age 80% are young than age 5. It occurs more commonly in Nipponese children or those of Japanese decent. It has seasonal epidemics, unwashedly in late winter and early spring. It was for the first time described in 1967 by Dr. Tomisaku Kawasaki in Japan. Kawasaki distemper mainly affects the lineage vessels, including coronary arteries. Blood vessels throughout the luggage compartment get inflamed, and the most just that could happen is on the heart. If left untreated after 10 daylights, children may consider a advanceder 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 febricityishness that is un antiphonal to antibiotics and antipyretics. The child then develops the remaining diagnostic symptoms. During this re-create the child is typically very peckish. The subacute phase begins with the resolution of the fever and lasts until all clinical signs of KD have disappeared. During this phase the child is at superior 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 returned to formula (6 to 8 weeks after onset). At the end of this stage the child has regained his or her usual temperament, get-up-and-go and appetite. The cause of Kawasaki Disease is unknown, but it is thought to be immunological ab conventionalityities that include change magnituded activation of helper T-cells and increased level of immune mediators and anti-bodies that destroy endothelial cells have been detected during the acute phase of the disease.It has been hypothesized that whatever unknown antigen, possibly a common infectious agent, triggers the immune repartee 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 relative incidence per 100,000 children younger than 5 years is 32. 5 cases for Ameri arseholes 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 heathenish origins, it occurs most commonly in Asian children, especially those of Japanese descent. evaluate are intermediate among blacks, Polynesians, and Filipinos and are lowest among whites. Manifestations and Complications Manifestations ? Fever for at least 5 days ? Polymorphous blossoming ? Strawberry dialect ? cervical lymphadenopathy Complications ? Changes in the extremities ? C onjunctival infection ? Vasculitis IV. Anatomy and Physiology picCardiovascular System Knowing the functions of the cardiovascular governance and the parts of the organic structure that are part of it is critical in understanding 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, business vessels, and store help to transport vital nutrients throughout the body as well as remove metabolic waste. They likewise help to protect the body and regulate body temperature. The cardiovascular system consists of the heart, rake vessels, and blood.This system has three main functions ? Transportof nutrients, oxygen, and hormones to cells throughout the body and remotion 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 strange micr obes and toxins. Clotting mechanisms are also express that protect the body from blood loss after injuries. ? Regulationof body temperature, unruffled pH, and water national of cells. pic Lymphatic SystemAn important supplement to the cardiovascular system in constituent to remove toxins from the body, the lymphatic system is also a crucial support of the immune system. Unlike blood, lymph only moves one way through your body, propelled by the action of nearby skeletal vims. 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 bare 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 future(a) ways ? The lymphatic system collects scanty 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 collect fluids, plasma proteins, and blood cells that have escaped from the blood. indoors lymphatic vessels, this equanimous material forms a usually colorless fluid called lymph, which is transported to the right and left subclavian veins of the circulatory system. ? The lymphatic system absorbs lipids and fat-soluble materials from the digestive piece of land. ? 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 old GenderMale AddressQuezon City Birth fancy Janu ary 14, 2010 Religion Catholic NationalityFilipino Informant Mother Date of portalFebruary 17, 2013 Admission Data Chief Complaint High Fever sign Diagnosis Urinary Tract Infection Final Diagnosis Kawasaki Disease Attending Physician Dr. K. D. History of Present illness Patients posit condition started 5 days prior to admission when patient have fever at 38. 5C associated with rash from impertinence to neck.The patient was brought to Capitol Medical Center and diagnosed with UTI collectable to bacteria present in his peeing. 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 goofy. The mother noticed short, quick breathing. The patient was brought again to the hospital, strawberry tongue is noted upon physical examination. The patient was referred to Infectious Disease (ID) Specialist and support having Kawasaki Disease upon conformatory and other labor atory finding.Past Health History Patients mother verbalized that all needed 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 fever. Family History Mother Father high blood pressure - + PTB - Cancer - - Allergies - - VII. Laboratory Findings Urinalysis base design Actual Interpretations subtraction Color Light or Pale yellow Light discolour Normal indicates good hydration and urine concen tration Character Clear Slightly hidden brachydactylic increase fluid intake Glucose (-) (-) Normal well render Reaction 4. 6-8ph 6. ph Normal there is normal hydrogen ion stringency and extracellular fluid Specific Gravity 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 ordered 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 haemoglobin 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 compute 20. 07 5. 0-10. increase summationd WBC was collectable to presence of infection clotting 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 AREA/ REGION METHOD USED chemical formula F INDINGS ACTUAL INTERPRETATION/ ANALYSIS FINDINGS General Appearance >Temp 36. 5-37. 2C > Temp 39. 5C not normal.All this symptoms are present due to hyperthermia with >Resp. put 20-30 cpm manifestations of increased respiratory brushup > Resp. Rate 35cpm rate and cardiac rate. Fundamentals of >impulsion Rate 80-130 cpm Nursing, Kozier &038 Erbs 8th Edition, > Pulse Rate pp. 529. Auscultation > No Pallor 140bpm > Without signs of fatigue > Pallor Inspection > No dropsy > Fatigue Accumulation of fluid in the extremities because of prolong staying > bipedal non- pitting edema in bed, and excessive accumulation of palpation fluid in the third spaces, edema developed. Fundamentals of Nursing, Kozier &038 Erbs 8th Edition, pp. 579. not normal due to excessive accumulation of fluid in the third spaces, edema developed.Fundamentals > No edema of Nursin g, Kozier &038 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 trim to be warm. Not normal.A skin lesion is an > Skin is mildly warm to alteration in a clients normal skin attain > Warm to touch appearance. Fundamentals of Nursing, Kozier &038 Erbs 8th Edition, pp. 576. Not normal. Poor capillary refill results in poor oxygenation. > Without peeling, must be soft and smooth > 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, intumescency and Palpation moist lips > Red mucous membranes in th e mouth Normal Mouth > Dry lips Inspection > Cracked lips Not normal due to infection. Fundamentals of Nursing, Kozier &038 Erbs > Strawberry tongue noted 8th Edition, pp. 607 > Reactive/ responsive to noises > Reacts to loud noises Not normal.Use of accessory muscle (abdominal muscle, trapezius muscle, > Symmetrical and obvious and sternocleidomastoid muscle) and > Symmetrical and patent increased RR signifies fatigue and hyperthermia. Ears > Not distinct Fundamentals of Nursing, Kozier &038 Erbs > Enlarged, palpable 8th Edition, pp. 548. Nose Inspection > Breath sounds are resonant>Breath sounds are resonant > Thorax is rounded Lymph Nodes > chest of drawers 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 140 bpm 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 > pith and presence of bacteria in the urine. > No restriction in hypersensitivity Inspection activities, no weakness and Auscultation alert > Inability to tolerate Abdomen > on that point should no pain felt 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 No t normal.This is also caused by 500-1000cc/day or similar 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 write down Extremities Inspection Palpation IX. Nursing Care Plan X. Drug Study XI. Discharge Plan Medication Patient is given discharge keep drug for 2 weeks of 120 mg of aspirin every day or 30 mg QID. Exercise/ Activity The patient can resume 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 a re discussed to lift 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 erythrocyte sedimentation rate during that visit. Health Teaching Good hygiene is encouraged. low-key toothbrush are recommended. Petroleum jelly can be applied to dry cracked lips. Use mild soap in cleaning the skin and a mild lotion can be applied to protect skin from drying and peeling. Instill artificial tears to sooth conjunctiva as instructed. Outpatient Orders Remind the family on their fulfil 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 mucous membrane 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 faste r recover. Increase fluid intake to prevent dehydration. A Case Presentation of Kawasaki Disease In Partial Fulfilment of the requirement in Maternal and baby Nursing II A Compilation Presented to St. Augustine School of Nursing Espana, manilla Presented By Julie Anne G. Lumbera PN-4A Ms. Cecilia J. Sarte MCN II Instructor and Adviser Mr. Joey M. Cadano Clinical Instructor KAWASAKI affection pic