A 7-year-old male patient with Kawasaki disease is showing signs of increased cardiovascular stress, including a heart rate of 160 bpm, respiratory rate of 32 breaths per minute, and development of a small coronary artery aneurysm. Given these findings, which nursing intervention is most critical to prioritize?

A) Administering supplemental oxygen to reduce cardiac workload.

B) Encouraging oral fluid intake to maintain hydration status.

C) Increasing the frequency of vital signs monitoring to every 4 hours.

D) Educating the family on the importance of medication adherence.

A 7-year-old male patient with Kawasaki disease is being monitored after initial treatment with IVIG and aspirin. On the eighth day, he develops increased heart rate, respiratory rate, and a coronary artery aneurysm. Which nursing intervention is most appropriate to address the patient's current condition?

A) Administer supplemental oxygen to relieve respiratory distress.

B) Encourage oral fluid intake to prevent dehydration.

C) Prepare for administration of a second dose of IVIG.

D) Monitor platelet count and assess for signs of thrombosis.

A child diagnosed with Kawasaki disease is developing new complications, including a high-grade fever, maculopapular rash, hypotension, and decreased oxygen saturation. Which nursing intervention should be prioritized in response to these new symptoms?

B) Provide supplemental oxygen and monitor oxygen saturation levels closely.

A) Administer high-dose corticosteroids as prescribed and monitor for side effects.

B) Provide supplemental oxygen and monitor oxygen saturation levels closely.

C) Increase fluid intake to manage hypotension and maintain hydration.

D) Administer antipyretics to reduce fever and improve comfort.

A 7-year-old child diagnosed with Kawasaki disease has developed new complications, including a high-grade fever, maculopapular rash, hypotension, and decreased oxygen saturation. Laboratory results show elevated troponin and ALT levels. Which nursing intervention is most critical to prioritize in managing these changes?

B) Initiate supplemental oxygen therapy to improve oxygen saturation.

A) Administer high-dose corticosteroids to reduce inflammation.

B) Initiate supplemental oxygen therapy to improve oxygen saturation.

C) Monitor liver function tests closely for signs of hepatic failure.

D) Increase oral fluid intake to address hypotension.

A child has been receiving high-dose corticosteroids and low molecular weight heparin for an inflammatory condition. Despite treatment, the rash has intensified with desquamation, and there is mild left ventricular dysfunction with coronary artery aneurysms. Which nursing intervention is a priority to address the current clinical status?

C) Initiate milrinone infusion to enhance myocardial contractility

A) Administer supplemental oxygen to maintain oxygen saturation above 95%

B) Monitor for signs of cardiac tamponade due to coronary artery aneurysms

C) Initiate milrinone infusion to enhance myocardial contractility

D) Assess neurological status every 4 hours for signs of central nervous system complications

A pediatric patient receiving high-dose corticosteroids and low molecular weight heparin has developed mild left ventricular dysfunction and coronary artery aneurysms. Which nursing intervention is the priority to address the patient's current cardiac status?

C) Administer milrinone as prescribed to improve myocardial contractility.

A) Monitor for signs of gastrointestinal bleeding.

B) Prepare the patient for immediate surgical intervention.

C) Administer milrinone as prescribed to improve myocardial contractility.

D) Increase supplemental oxygen to maintain saturation above 98%.

A pediatric patient with Kawasaki disease presents with respiratory distress and bilateral pulmonary infiltrates indicative of acute pulmonary edema. Which nursing priority should be addressed first to stabilize the patient?

C) Provide supplemental oxygen to improve oxygen saturation

A) Administer bronchodilators to relieve respiratory symptoms

B) Initiate diuretic therapy to manage fluid overload

C) Provide supplemental oxygen to improve oxygen saturation

D) Elevate the head of the bed to reduce respiratory effort

A pediatric patient with Kawasaki disease is experiencing acute pulmonary edema and worsening cardiac function. Which nursing intervention is most appropriate to prioritize in the immediate management of this child's condition?

A) Administer a diuretic to reduce fluid overload.

B) Increase oxygen flow rate to improve oxygen saturation.

C) Start intravenous corticosteroids to reduce inflammation.

D) Prepare the patient for an emergency cardiac catheterization.

A pediatric patient with Kawasaki disease is receiving treatment with furosemide and milrinone. Following treatment, the nurse notes increased urine output but persistent respiratory distress and low oxygen saturation. The patient's potassium level is also low. What is the priority nursing intervention at this time?

C) Assess for signs of worsening cardiac output and notify the healthcare provider.

A) Increase the oxygen flow rate to improve saturation levels.

B) Administer potassium supplementation to address electrolyte imbalance.

C) Assess for signs of worsening cardiac output and notify the healthcare provider.

D) Reposition the child to improve respiratory effort and comfort.

A pediatric patient with Kawasaki disease and moderate left ventricular dysfunction is being treated with milrinone and furosemide. The patient has shown increased urine output and stable blood pressure but persistent respiratory distress and low oxygen saturation. Upon review, the serum potassium level is 3.2 mEq/L. What is the most appropriate nursing action to address the patient's current condition?

C) Initiate potassium supplementation to address hypokalemia.

A) Increase the infusion rate of furosemide to enhance diuresis.

B) Administer supplemental oxygen to improve oxygen saturation.

C) Initiate potassium supplementation to address hypokalemia.

D) Prepare for intubation due to respiratory distress.

kawasaki - Nursing Case Study

Pathophysiology

• Primary mechanism: Kawasaki disease involves an aberrant immune response, likely triggered by an infectious agent, which leads to widespread inflammation in medium-sized arteries, particularly the coronary arteries. This immune activation results in endothelial damage and progressive vasculitis.

• Secondary mechanism: The inflammatory response causes the release of cytokines and immune cells, exacerbating vascular injury and contributing to the formation of aneurysms in the coronary arteries. This process disrupts normal blood flow and increases the risk of thrombosis.

• Key complication: Coronary artery aneurysms may develop, potentially leading to myocardial infarction or ischemia in severe cases, significantly impacting cardiac function and requiring close monitoring and management.

Patient Profile

Demographics:

7-year-old male, elementary school student

History:

• Key past medical history: Previously healthy with no significant medical history

• Current medications: None

• Allergies: None known

Current Presentation:

• Chief complaint: Persistent fever and rash for the past 6 days

• Key symptoms: High fever, irritability, red eyes, strawberry tongue, swollen hands and feet, peeling skin on fingertips, and enlarged cervical lymph nodes

• Vital signs: Temperature 39.5°C, Heart rate 140 bpm, Respiratory rate 28 breaths per minute, Blood pressure 100/60 mmHg

Section 1

As the healthcare team continued to monitor the 7-year-old male patient diagnosed with Kawasaki disease, they noted a significant change in his clinical status. Despite initial treatment with high-dose intravenous immunoglobulin (IVIG) and aspirin, the patient developed worsening symptoms. On the eighth day of illness, the child began to exhibit signs of increased cardiovascular stress. His heart rate increased to 160 bpm, and he became more fatigued and less responsive to stimuli. His respiratory rate also increased to 32 breaths per minute, indicative of increased cardiac workload or respiratory distress.

A follow-up echocardiogram revealed concerning findings: the development of a small coronary artery aneurysm in the left anterior descending artery. Laboratory tests showed elevated inflammatory markers, including C-reactive protein (CRP) at 8 mg/L (normal <3 mg/L) and an elevated erythrocyte sedimentation rate (ESR) of 50 mm/hr (normal <20 mm/hr), indicating ongoing systemic inflammation. Additionally, a mild thrombocytosis was noted, with platelet counts rising to 550,000/µL, which could increase the risk of thrombosis within the aneurysm.

These changes prompted the healthcare team to reassess the treatment plan urgently. The team considered the potential need for additional anti-inflammatory therapy, such as corticosteroids, and evaluated the necessity of anticoagulation to prevent thrombosis in the aneurysm. This development in the case required careful monitoring of cardiac function and frequent reassessment of vital signs and laboratory markers to prevent further complications and guide timely interventions. The evolving scenario underscores the importance of vigilant observation and the ability to adapt management strategies in response to the dynamic nature of Kawasaki disease and its complications.

Section 2

New Complications

Despite the healthcare team's proactive measures, the patient's condition continued to evolve, presenting new challenges. On the tenth day of illness, the child developed a high-grade fever of 39.5°C (103.1°F), accompanied by a diffuse maculopapular rash across his torso and extremities. His blood pressure readings began to fluctuate, with a noticeable drop to 85/50 mmHg, raising concerns about potential shock. The patient's oxygen saturation decreased to 92% on room air, necessitating supplemental oxygen to maintain adequate levels. These clinical changes suggested the possibility of systemic involvement beyond the cardiovascular system, potentially indicating the onset of Kawasaki shock syndrome.

New laboratory results provided further insights into the child's deteriorating condition. Troponin levels were mildly elevated at 0.08 ng/mL (normal <0.05 ng/mL), suggesting myocardial involvement or stress. Additionally, liver function tests showed an increase in alanine aminotransferase (ALT) to 95 U/L (normal <40 U/L), indicating possible hepatic inflammation or stress. The combination of these findings, along with the persistent thrombocytosis and elevated inflammatory markers, pointed to a more severe inflammatory response that required urgent attention.

In light of these developments, the healthcare team decided to escalate the treatment regimen. High-dose corticosteroids were initiated to dampen the intense inflammatory response, and low molecular weight heparin was started as a precautionary measure to address the risk of thrombosis within the developing coronary aneurysm. These interventions necessitated close monitoring of the child's hemodynamic status and laboratory parameters to evaluate their effectiveness and ensure the prevention of further complications. The situation highlighted the critical need for adaptability in the management of Kawasaki disease, as well as the importance of anticipating potential complications and responding swiftly to changes in the patient's clinical status.

Section 3

Change in Patient Status

Within 48 hours of initiating high-dose corticosteroids and low molecular weight heparin, the healthcare team observed notable changes in the child's clinical status. The fever persisted, albeit slightly reduced, stabilizing at 38.7°C (101.7°F). However, the rash intensified, now presenting with areas of desquamation, particularly on the hands and feet. This raised concerns about the ongoing inflammatory process, despite the aggressive treatment measures. Blood pressure readings showed slight improvement, averaging 95/60 mmHg, yet remained a critical focus due to the potential risk of shock. Oxygen saturation improved modestly to 94% with the continued use of supplemental oxygen, indicating a partial response to interventions.

A repeat echocardiogram was conducted to assess cardiac function and the extent of coronary involvement. The results revealed mild left ventricular dysfunction, with an ejection fraction of 45% (normal >55%), and the presence of small coronary artery aneurysms. This cardiac involvement heightened the need for vigilant observation and optimization of cardiac support. In addition, the child showed signs of irritability and lethargy, which necessitated a neurological assessment to rule out central nervous system complications.

The evolving clinical picture required the healthcare team to reassess their management strategy, balancing the need for aggressive treatment of the inflammatory response with the potential side effects of corticosteroids. The integration of cardiac support with medications like milrinone was considered to enhance myocardial contractility and improve hemodynamics. This phase of the child's journey emphasized the importance of ongoing evaluation and adjustment of treatment plans based on dynamic clinical findings, urging the team to remain proactive in preventing further complications while supporting organ function.

Section 4

As the healthcare team continued to monitor the child's progress, a new complication emerged. Despite initial improvements in oxygen saturation and blood pressure, the child's respiratory status began to deteriorate. Oxygen saturation levels dropped back to 90% on supplemental oxygen, and the child developed increased work of breathing, characterized by nasal flaring and intercostal retractions. This prompted an urgent reassessment of the respiratory system, and a chest X-ray was ordered. The imaging revealed bilateral pulmonary infiltrates suggestive of acute pulmonary edema, likely secondary to the evolving cardiac dysfunction.

Laboratory tests further indicated an elevation in brain natriuretic peptide (BNP) levels, rising to 700 pg/mL (normal <100 pg/mL), which corroborated the suspicion of heart failure exacerbation. Additionally, inflammatory markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) remained elevated, reflecting the persistent inflammatory response despite corticosteroid therapy. The child's white blood cell count showed a slight increase to 18,000/mm³, with a left shift, suggesting ongoing systemic inflammation.

In light of these developments, the multidisciplinary team convened to adjust the treatment plan. It was decided to initiate diuresis with furosemide to manage the pulmonary edema and reduce cardiac workload. Milrinone infusion was started to improve cardiac contractility and peripheral perfusion. The team also considered the need for closer monitoring in a pediatric intensive care setting to provide enhanced supportive care. This adjustment in management highlighted the complexity of Kawasaki disease with cardiac involvement, underscoring the necessity for thorough clinical reasoning and prompt intervention to stabilize the child's condition and prevent further complications.

Section 5

As the pediatric intensive care unit team continued to manage the child's condition, a change in patient status was observed. Two hours after the initiation of furosemide and milrinone, the child's urine output increased, indicating a positive diuretic response. However, the child's respiratory status did not show significant improvement. Oxygen saturation remained at 91% on high-flow nasal cannula, and the child's work of breathing persisted, with continued nasal flaring and intercostal retractions. Heart rate remained elevated at 130 beats per minute, and blood pressure was stable, albeit slightly low for age at 85/50 mmHg. These findings suggested that while diuresis might have alleviated some fluid overload, the cardiac function had not improved sufficiently to enhance respiratory status.

In response to these findings, the team decided to titrate the milrinone infusion to optimize cardiac output further, closely monitoring for any signs of hypotension. Additionally, a transthoracic echocardiogram was performed to assess cardiac function. The echocardiogram revealed moderate left ventricular dysfunction with an ejection fraction of 35%, supporting the need for ongoing inotropic support. The team also reassessed fluid balance and electrolyte levels, noting that serum potassium was low at 3.2 mEq/L, likely secondary to diuretic therapy. Potassium supplementation was initiated to prevent arrhythmias and support cardiac function.

These developments highlighted the complexity of managing Kawasaki disease with cardiac involvement, as the child's condition required careful balancing of diuresis and inotropic support. The healthcare team remained vigilant for potential new complications, such as arrhythmias or worsening cardiac output, while continuing to tailor interventions based on the evolving clinical picture. This dynamic situation underscored the importance of ongoing reassessment and adjustment of the treatment plan to stabilize the child and prevent further deterioration.