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Our human body is a very complex system. One functions for the benefit and or expense
of another. Our subsystem is as vital as the other thus they are interrelated. Considering this
facet, we have looked into reality that in this diverse physiological wonders, lies the infinite
possibility of not only functioning but of disparities and deviations as well.

In life, one continues to exist in oblivion. There are always uncertainties in every events
and occurrences whirl through our lives. We do not know when is the exact point in time where
our bodily homeostasis will be disturbed and when change will cease to happen. Some of the
surprising changes can be considered blessings but most of the time they are we fervently hope
this would not occur especially those that concern our health.

In this particular case study, we wish to present the case of our patient, Jeia Denisz
Jimenez and 7 years of age. She was admitted at PAFGH for the reason of intermittent fever
and localized rashes o the hands and chest and with the admitting diagnosis of ATP t/c
Kawasaki Disease.

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, infection, and geneticpredisposition are believed to be involved. It affects mostly
children ages between 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 later winter and early spring. It was first described in 1967 by Dr.Tomisaku Kawasaki
in Japan.

Although Kawasaki is a multisystem disease, the cardiovascular system appears to be

the primary site with coronary artery vasculitis, aneurysm development, thrombosis and
myocardial thrombosis progressing over days to weeks. Approximately 15-25 % of patient
develop cardiac complications (coronary thrombosis or rupture, MI, heart failure, vasculitis of
aorta or peripheral arteries); however mortality is low.

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By far, the highest incidence of Kawasaki disease occurs in Japan (175 per 100,000), though its
incidence in the United States is increasing. Kawasaki disease is predominantly a disease of
young children, with 80% of patients younger than 5 years of age.

The disease affects boys more than girls. Approximately 2000-4000 cases are identified in the
United States each year.

 

The causative agent of Kawasaki disease is still unknown, but current theories center primarily
on immunological causes for the disease. Evidence increasingly points to an infectious etiology,
but debate continues on whether the cause is a conventional antigenic substance or a
superantigen. Per a Children¶s Hospital Boston / Harvard Medical school information page on
the disease, ³Some studies have found associations between the occurrence of Kawasaki
disease and recent exposure to carpet cleaning or residence near a body of stagnant water;
however, cause and effect have not been established.´

An association has been identified with an SNP in the ITPKC gene, which codes an enzyme
that negatively regulates T-cell activation. An additional factor that suggests genetic
susceptibility is the fact that regardless of where they are living, Japanese children are more
likely than other children to contract the disease. The HLA-B51 serotype has been found to be
associated with endemic instances of the disease.


 

Stage I ± Acute Febrile Phase (First 10 days)

u The child appears severely ill and irritable.

u Major diagnostic criteria established by the Centers for Disease Control and Prevention
(CDC) are as follows:

a. High, spiking fever for 5 days or more.

b. Bilateral conjunctival injection.

c. Oropharyngeal erythema, ³Strawberry ³ tongue, or red dry lips.

d. Erythema and edema of hands and feet, periungal desquamation.

e. Erythematous generalized rash.

f. Cervical lymphadenopathy greather than 0.6 inch (1.5cm)

u Pericarditis, myocarditis, cardiomegaly, heart failure, and pleural effusion.

u Other associated findings include meningitis, arthritis, sterile pyuria, vomiting, and
diarrhea.

Stage II ± Subacute Phase (Days 11 to 25)

u Acute symptoms of stage I subside as temperature returns normal. The child remains
irritable and anorectic.
u Dry, cracked lips with fissures.
u Desquamation of toes and fingers.
u Coronary thrombus, aneurysm, myocardial infarction, and heart failure.
u Thrombocytosis peaks at 2 weeks.

Stage III ± Convalescent Phase (Until sedimentation rate and platelet count normalize)

u The child appears well.

u Transverse grooves of fingers and toenails (Beau¶s lines).
u Coronary thrombosis, aneurysms may occur.


  


u The diagnostic of Kawasaki disease is based on clinical manifestations. The CDC

requires that fever and four of the six other criteria listed above in stage I be
demonstrated.
u Electrocardiogram, echocardiogram, cardiac catheterization, and angiocarddiography
may be required to diagnose cardiac abnormalities.
u Although there are no specific laboratory tests, the following may help support diagnosis
or rule out other disease.

1. CBC ± leukocytosis during acute stage.

2. Erythrocytes and hemoglobin ± slight decrease.

3. Platelet count ± increased during second to fourth week of illness.

4. IgM, IgA, IgG, and IgF ± transiently elevated.

5. Urine ± protein and leukocytes present.

6. Acute phase reactants (ESR, C-reactive protein, alpha I antitrypsin) are elevated
during the acute phase.

7. Myocardial enzyme levels (serum CK-MB) suggest MI if elevated.

8. Liver enzymes (AST, ALT) ± moderately elevated.

9. Lipid profile ± low high density lipoprotein and high triglyceride level.

  




u Immune globulin (gamma globulin) I.V. therapy ± IVGG (2g/kg/day) is initiated during
stage I in one 8 to 10 hour infusion to reduce the incidence of coronary artery
abnormalities.
u Aspirin therapy
u Thrombolytic therapy may be required during stages I, II, or III.


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sonitoring

1. Monitor pain level and child¶s response to analgesics.

2. Institute continual cardiac monitoring and assessment for complications; report
arrhythmias.
Ô Take vital signs as directed by condition; report abnormalities.
Ô Assess for signs of myocarditis (tachycardia, gallop rhythm, chest pain).
Ô Monitor for heart failure (dyspnea, nasal flaring, grunting, retractions, cyanosis,
orthopnea, crackles, moist respirations, distended jugular veins, edema).
Closely monitor intake and output, and administer oral and I.V fluids as ordered.
 Monitor hydration staus by checking skin turgor, weight, urinary output, specific gravity,
and presence of tears.
Observe mouth and skin frequently for signs of infection.

Supportive care

1. Allow the child periods of uninterrupted rest. Offer pain medication routinely rather than
as needed during stage I. Avoid NSAIDS if the child is in aspirin therapy.
2. Perform comfort measures related to the eyes.
Ô Conjunctivities can cause photosensitivity, so darken the room, offer sunglasses.
Ô Apply cool compress.
Ô Discourage rubbing the eyes.
Ô Instill artificial tears to soothe conjunctiva.
3. Monitor temperature every 4 hours. Provide sponge bath if temperature above normal.
4. Perform passive range of motion exercises every 4 hours while the child is awake
because movement may be restricted.
5. Provide quiet and peaceful environment with diversional activities.
6. Provide care measures for oral mucous membrane.
Ô Offer cool liquids like ice chips and ice pops.
Ô Use soft toothbrush only.
Ô Apply petroleum jelly to dried, cracked lips.
7. Provide skin measures to improve skin integrity.
Ô Avoid use of soap because it tends to dry skin and make it more likely to
breakdown.
Ô Elevate edematous extremities.
Ô Use smooth sheets.
Ô Apply emollients to skin as ordered.
Ô Protect peeling of skin, observe for signs of infection.
8. Offer clear liquids every hour when the child is awake.
9. Encourage the child to eat meals and snack with adequate protein.
10. Infuse I.V fluids through a volume control device if dehydration is present, and check the
site and amount hourly.
11. Explain all procedures to the child and family.
12. Encourage the parents and child to verbalize their concerns, fears, and questions.
13. Practice relaxation techniques with child, such as relaxation breathing, guided imagery,
and distraction.
14. Prepare the child for cardiac surgery or thrombolytic therapy if complications develop.
15. Keep the family informed about progress and reinforce stages and prognosis.

Nurses play a significant role in the management and care of patient with conditions such as
this. We play an essential part in symptom management associated with the disease and
therapy. We likewise form part in the patient¶s support system, which is considerably a factor
that has an immense effect on the cure and recovery of this type of disease. In the patient¶s
health care management as a whole, we nurses are like a soothing balm to their needs.

This case study is meaningfully designed to provide awareness and thorough explanation to
one of the rarest diseases that occur in our country. Our presentation aims to recognize the
need of people to understand the course of the disease. We have assent the implication of this
research that it may encourage keenness and be a source of information to a number of people,
who remains naïve to this bodily infirmity. May this new means of learning be valuable fount of
vital information to those people who wish to study the same disease.

People shouldn¶t take Kawasaki disease more so to those who are concerned because
management is the key. In life, hurdles and humps are sprayed to test us. It takes recognition
and acceptance that even our anatomical and physiological features; God¶s chisel is shaping us
to be significant individual molded by pain and strength. This study does not only provide our
readers of medical information but of a challenge and course of holistic spectacle as well.
c c


A. Biographical Data

Patients name: Jeia Denisz Jimenez,

Age: 7y.o

Date of birth: October 09,2002

Date of admission: August 11, 2010

Sex: female

B. Chief complaints

The mother of the patient verbalized that she had an intermittent fever and
rashes.

C. History of present illness

Patient was admitted last august 11, 2010 at Air Force Gen.Hhospital with the chief
complaints of intermittent fever and localized rashes o the hands and chest. Two days
before the onset of fever, patient consulted on a dermatologist. Five days after the onset of
fever, the presence of sorethroat and strawberry color of the tongue appeared. Patient¶s
signs and symptoms are diagnosed of Kawasaki disease.

D. Past history

The patient has no medical and surgical history. Paractamol is given everytime patient
has fever. The ptient has allergy to chiken, resulting to itch rashes on both hands. Patient
had no experience of injuries and accidents. During her childhood, only fever, cough and
colds are the primary complaints about ther health. Already completed her immunizations
during her childhood years.

E. Family medical history

the patient is 7yrs. Old and was iagnosed o Kawasaki disase last august 11, 2010. She
has 2 siblings namely Robert and Suri who are currently having rashes all over their body.
Her parents namely jasper and hazel has family health illnesses.

Paternal: colon cancer

Maternal: diabetes
 F. Social history

Since the patient is only 7yrs.old, ishe is normally found reading books and playing with
siblings after it. She is now in grade 2 at St. Therese Academy. Their religion is catholic and
attends mass every Sunday and prays everyday. She is the eldest daughter among the 3
children of Mr. and Mrs. Jimenez. According to the mother, sheis a sweet and kind girl.

G. GORDON¶S FUNCTIONAL PATTERN

   
 
! 
 

 
! 
 " 

    Health is the state of Health also deals with The patient is referring
being healthy. Takes or without having to her condition
medication when sick. illnesses. Taking because she never
medication is a part of a been to a hospital/only
healthy action. home care.


 # $
 She eats 3 times a day; She eats 3 times a day, The patient should eat
drinks 6-8 glassess of drinks 5-7 glasses of and drink more during
water a day, and water everyday. And hospitalization to
currently taking ceelin she did not take her recover early and it¶s a
vitamins. must also take the
vitamins
%

 
 Urinates 5 times a day, Urinates 4 times a day It depends on the intake
drinks 6-8 glasses of and defecates 2 times
water a day. She is
taking her vitamins
(ceelin)
" 

&%'
 Walking outside their No proper exercise, just She cant go out of bed
house every morning lying in bed because of her physical
Sleeps at 9pm-6am appearance.
& Sleeps at 8pm-5am Sleeps at 9pm-6am No alteration; the range
is still normal


 She can perfectly She can still recognize No alteration on the
recognize anything, can anything and a bit cognitive side
explain some things cooperative
   She can recognize well She¶s not in school, but She¶s a little bit shy to
and has capability to do it seems she is willing to express her feelings
things well explain anything I asked
& 

 She is the first child She¶s still sweet but She might be conscious
She is ³super moody of her rashes
malambing´

 She cries when her She misses her naughty She is sensitive and
sibling become naughty sides of her siblings loving sister

   She is weak She just sleep to relieve She prefer to sleep than
the pain oe discomfort crying
( &
  Believes in ghost Always pray at night She is religious little girl

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