CHONG HUA HOSPITAL

Cebu City
PROGRAM FOR ENHANCING NURSING SKILLS, INVOLVEMENT, AND VALUES
EDUCATION

A CASE STUDY OF A PATIENT WITH KAWASAKI DISEASE

Submitted by
Group IV
Abaquita, Mary Joe S.
Cabarce, Mark Jayson P.
Cinco, Junrey B.
Ponla, Jaypee A.

October 2018
TABLE OF CONTENTS
 ABSTRACT
A newly diagnosed 1-year-old baby boy with Kawasaki disease (KD) came to the ER
accompanied by his parents. Chief complaints, which suit to qualifications of KD, include
intermittent fever unrelieved by analgesic, strawberry tongue, rashes on the palms of the
hands, soles of the feet and trunks. Human Immunoglobulin was then administered to prevent
cardiac complications and Paracetamol suspension for fever. Appropriate laboratories and
diagnostic work ups were done to understand and update patient’s status. By October 19,
echocardiographic result shows mild mitral regurgitation. Patient was discharged the next three
days and was given Aspirin as a home medication and have scheduled a follow up for
monitoring the condition. This case study aims to provide an in depth understanding of
Kawasaki disease in relation to patient’s condition and management.
 INTRODUCTION
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 it is an
autoimmune disease. Factors such as infection, and genetic predisposition are believed to be a
risk factor to this disease. Kawasaki Disease affects mostly 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 descent and is a seasonal epidemic, usually in late winter and early spring. This
disease was first described in 1967 by Dr. Tomisaku Kawasaki in Japan. In Asia, Kawasaki disease
is felt throughout the world but the incidence in Asia specifically in Japan in the year 2000 is
reported as being 13 cases per 100,000 children under the age of 5 years which is the highest
concentrated number of cases in a single country worldwide.

The main system affected by the disease process is the cardiovascular system. Coronary artery
vasculitis, aneurysm development, thrombosis, and myocardial thrombosis progressing over
days to weeks can be observed in clients affected by this disease. Approximately 15% to 25% of
patients develop cardiac complications (coronary thrombosis or rupture, myocardial infarction,
heart failure, vasculitis of the aorta or peripheral arteries); but the good thing is mortality is
low.

The team is interested in studying the case due to its unknown etiology. The mystery of the
diagnosis of the disease through its signs and symptoms and lab results is a very exciting topic
to discuss. By presenting this case study, we would also like to use this chance to assist nurses
and nurse educators in promoting active learning about the disease process, its management,
and how to avoid its complication.

Source:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412404/figure/ijms-18-00820-f001/
https://emedicine.medscape.com/article/965367-overview#a3
https://www.frontiersin.org/articles/10.3389/fped.2018.00198/full
https://europepmc.org/abstract/med/29461753
https://emedicine.medscape.com/article/965367-treatment
 BIOGRAPHIC DATA

Name: Patient E.P.

Birthdate: May 14, 2017
Age: 1 year old and 5 months
Gender: Male
Birthplace: Cebu City
Religion: Roman Catholic
Nationality: Filipino
Name of Father: EP
Age: 34 years old
Occupation: Seafarer
Name of Mother: AP
Age: 29 years old
Occupation: Housewife
Name of Sibling: PP
Age: 4 years old

Date admitted: October 18, 2018

Time admitted:

Date discharged: October 22, 2018

Time discharged:

Chief complaint: Intermittent fever for 6 days (38-39 °C)

Mouth sores
 HEALTH HISTORY
HISTORY OF PRESENT ILLNESSwhen
Patients signs and symptoms progress from fever to systemic manifestations which sought the
mother to seek medical advice. Mother states that the first symptom that has occurred is fever,
which is very sudden and was managed by biogesic but fever recurs hours later. She continued
medicating until 6 days from onset of fever, mother noticed red eyes without discharges, sored
tongue and rashes on the extremities started to develop. Mother went to clinic and was
advised to be admitted. In the emergency department, the child was given paracetamol 250/5
ml suspension and clinical impression depicts Kawasaki disease.

HISTORY OF PAST ILLNESS immunizations, previous surgery, hospitalizations, meds,

Patient is generally in good condition with no other hospital admissions other than the time of
his birth as he was admitted to the Neonatal Intensive Care Unit (NICU) due to meconium
staining. The patient did not suffer any physical injuries from the time of birth until now as
reported by his mother. The patient is not taking any maintenance drugs other than
multivitamins
 GENOGRAM

Mothers side Fathers side

Grandfather 50 y o Grandmother 47 y o Grandfather 58 y o
Grandmother 56 y o

Mother 29 y o Father 34 y o
Uncle 1 Auntie 1
Uncle 2 Uncle 1
Uncle 3 Uncle 2
Uncle 4 Auntie 2
Auntie 1
Auntie 2
Uncle 5

Brother Patient E.P

Legend: = Hypertension
= Diabetes Mellitus
= Rheumatic Heart Disease
= Deceased
 PSYCHO SOCIAL DATA
ERIK ERIKSON’S PSYCHOSOCIAL (TRUST VS MISTRUST)
The mother is the primary caregiver and baby is breastfed for 8 months exclusively. These
activities build rapport.

PIAGET’S COGNITIVE THEORY (SENSOMOTOR)

Explores his environment by eating things he touches. He cries whenever his mother/father
leaves and frowns when touched by other people. These are normal findings under 2 years old
babies. Mother knows about separation anxiety.

FREUD’S PSYCHOSEXUAL STAGES (ORAL)

The child stopped thumb sucking at the age of 1. Baby is always wearing diaper and parents are
still to initiate toilet training.

PLAY (SOLITARY)
Patient is contented when playing on his own. Parents mentioned that their child is okay with
watching videos alone and most of the time baby spends his hour watching and listening
alphabetical song.
 LIFESTYLE AND ACTIVITIES OF DAILY LIVING portrait next to physical assessment

ADL BEFORE HOSPITALIZATION ACTUAL HOSPITALIZATION INTERPRETATION AND ANALYSIS

NUTRITION  Starts to eat solid food at 5  Patient does not like the food Has decreased appetite since
months and now can eat being served onset of fever
variety of foods
 Is bottle fed (consumes
 First introduced solid food is almost 4 bottles of a 250-
cerelac bottle of milk)
 Prior to admission, patient
can consume 1/2 to 3/4 bowl
of prepared meal and since
onset of fever, fever has
lessen its intake
 Is bottle fed and can
consume up to 70 to 150 ml
of milk and (3x/day) and
since day 1 of fever milk
intake decreased
 Eats 3x a day
 With vitamins taken daily
(tiki-tiki star)
 No known allergies to food
and medications
 No dental carries and teeth
 are whitish in color
 Doens’t toothbrush yet
 Height is 81 cm
 Weight is 9.8 kg
 BMI is 14

ELIMINATION  Patient has no problem in  Daily output of urine ranges Patient has not change its usual
urinating and defecating from 650- 1000 cc number of diaper used thus
patient has normal bowel
 Uses diaper always, even  Defecates browny and mostly
elimination
when sleeping solid stool (uses 5-6x of
diaper/day)
 Usually urinates 5-6x with
yellowish in color and no foul
odor
 Usually defecates browny
solid stool with no difficulty

ACTIVITY  Usually every morning after  Has limited physical activity Patient activity and space is
waking up, patient walks with limited thus this degrades his
 He spends most of his time in
his father as their exercise chance to perform active motion
doodling and watching videos
(30 mins/day)
specifically alphabetical
songs

SLEEP AND REST  Patient usually sleeps from 8  Sleeps late most of the time Patients sleeping pattern is
to 10pm and wakes up at 8 to (9-12pm) due to noisy disrupted.
9 in the morning environment
 Always takes an afternoon  Wakes up usually 8-9 in the
 nap morning
 Still takes afternoon
naps/rest

ROLE RELATIONSHIP  Patient is living in an  As observed, his parents are Patient has good communication
extended family (parents in loving. They cuddle and they and relationship to his family
addition with his uncle, carry the child during the
auntie and grandmother) interview
 Has older brother which is 4  His mother and father are
years old now present in the room, as
watchers

COPING/ STRESS TOLERANCE  As reported by the mother,  When stress or angry, he Patient can express his feelings
when the baby is somewhat cries appropriately. When he’s angry,
stress or combative, he cries he’s frowning and when he’s
most of the time and throws happy, he smiles
out things everywhere
VALUES/BELIEF PATTERN  Patient is roman catholic  Did not notice any rosaries or Patient has good morality
other religious activities
 Mother mentioned that they
go to church occasionally but
they believe in God
 And when they go out to
church they always carry
their sons with them
 Follows catholic beliefs
 PHYSICAL ASSESSMENT please portrait

Admission assessment (10/18/18)

General survey Concious, Febrile (39°C) but not in respiratory distress

Skin Polymorphous rash, edematous hands, warm to touch, Pale
Head Normal scalp and skull
Eyes nonpurulent bilateral conjunctivitis, anecteric sclera, no discharges
Ears both pinna are normal, no discharges, odorless
Nose in midline, no lesions
Neck palpable lymp nodes
Oral cavity 8 teeth, whitish in color, fissured lips
Chest no lesions, with some rashes
Lungs no adventitious sounds
Heart normal as auscultated
Extremities warm to touch, rashes on soles of feet and palms of hands
Abdomen macular rashes
Genetalia with some rashes
Anus no hemorrhoids
Neuro CNII intact
CNIII, CNIV, CNV intact
CNVII symmetric
CNIX, CNX gag reflex present
CNXI uses accessory muscles, can shrug shoulders
CNXII negative protrusion reflex

Discharge assessment (10/22/18)

General survey Concious, afebrile (36.5°C)

Skin few scattered rash
Head Normal scalp and skull
Eyes Pupil Equally Round and reactive to light accommodation
Ears both pinna are normal, no discharges, odorless
Nose in midline
Neck lymp nodes non-palpable
Oral cavity 8 teeth, whitish in color, fissured lips
Chest no lesions, with some rashes
Lungs no adventitious sounds
Heart normal as auscultated
Abdomen has some scarring
Genetalia no rashes, normal growth
Anus no hemorrhoids

Neuro CNII intact

CNIII, CNIV, CNV intact
CNVII symmetric
CNIX, CNX gag reflex present
CNXI uses accessory muscles, can shrug shoulders
CNXII negative protrusion reflex

Vital signs upon admission (10/18/18)

Temperature 38.1°C
Heart rate 131 BPM
Respiratory rate 30 CPM
Blood pressure not taken
 Oxygen saturation 96%
Pain score 0
Fall risk High
Height 81 cm
Weight 9.80 kg
BMI
Allergies no known allergies
Nutritional patterns decrease appetite since onset of fever
Elimination patterns essentially in normal range of output
Hygiene patterns has soiled nails
Rest/sleep patterns sleep 8-14 hours per day, always takes an afternoon nap

FOCUSED ASSESSMENT: INTEGUMENTARY SYSTEM/ MUCOSAL MEMBRANE

Polymorphous rash noted, most concentrated in palms of hands and soles of feet
Hot, flushed skin with temperature of 39°C
Red palpebral conjunctiva
Strawberry tongue

Vital signs on assessment day (10/19/18)

Temperature 37.9°C
Heart rate 130 BPM
Respiratory rate 32 CPM
Blood pressure not taken
Oxygen saturation 97%

reflexes
head to toe
 ANATOMY AND PHYSIOLOGY
IMMUNE SYSTEM FUNCTION

Immune system

Specific Cell mediated Non-specific

Monocytes
Cell mediated Humoral
Macrophages

Neutrophils
Cell mediated Complement B lymphocyte

Phagocytosis
T lymphocyte Death of antigen Antibodies
Skin and mucous
membrane
T helper Chemical barrier
T suppresor Inflammatory response
T cytotoxic Interferon
Lymphokines

Viral, fungal,
protozoan, and some
bacterial protection

Graft rejection

Skin hypersensitivity

Immune surveillance
IgA IgD IgE IgG IgM

Viral Signals B Allergy and Secondary Primary

protection lymphocyte parasitic antibody antibody
cells infestation protection protection
 Your immune system is capable of identifying every single cell in your body and
recognizing those that are friendly and belonging to your "self. Once it has identified an
invader, your immune system then quickly develops a customized series of defensive weapons
that specifically target the invader's weak link. It then begins building cellular factories that
produce these weapons en masse, in quantities sufficient to totally overwhelm and crush the
invader. Then, once the invader has been defeated, the immune system has the awareness to
"shut itself down" until needed at a later date.

Functions of the Immune system

It provides protection against invasion by microorganisms from outside the body and protects
the body from internal threats and maintains the internal environment by removing dead or
damaged cells.
Remove space
Immune response.
Lymphocytes are produced in the bone marrow and migrate to the lymphoid tissue, where they
remain dormant until they need to form sensitized lymphocytes for cellular immunity or
antibodies for humoral immunity.
B lymphocytes, some of them, lie dormant until a specific antigen enters the body, at which
they greatly increase in number and are available for defense.
T and B lymphocytes are necessary for a normal immune response.

Humoral response
Humoral response is immediate. This type of response provides protection against acute,
rapidly developing bacterial and viral infections.

Cellular response
Cellular response is delayed. This is also called delayed hypersensitivity.
This type of response is active against slowly developing bacterial infections and is involved in
autoimmune responses, some allergic reactions, and rejection of foreign cells.

Immunity
Innate immunity is also called native or natural immunity. It is present at birth and includes
biochemical, physical, and mechanical barriers of defense, as well as the inflammatory
response.
Acquired immunity also known as adaptive immunity is received passively from the mother’s
antibodies, animal serum, or antibodies produced in response to a disease. Immunization
produces active acquired immunity.
Endothelial cells and function

The endothelial cells form a one-cell thick walled layer called endothelium that lines all of our
blood vessels such as arteries, arterioles, venules, veins and capillaries. Smooth muscle cells
layer beneath the endothelial cells. The exception to this is the capillaries where endothelium
makes up the entire blood vessel wall.

Functions of the Endothelial cells

Barrier Function.The endothelium acts as a barrier between the blood and the rest of the body
tissue while being selectively permeable for certain chemicals and white blood cells to move
across from blood to tissue or for waste and carbon-dioxide to move from tissue to blood. This
property of endothelial cells is especially investigated in the blood-brain-barrier system. In
certain neuro-degenerative diseases, it is difficult to develop drugs that can cross the
endothelial barrier efficiently. Research is focused on better mimicking and understanding the
functions of blood brain barrier systems to increase the efficacy of drug development.

Regulating blood flow. Endothelial cells generate an anti-thrombotic surface that facilitates
transit of plasma and cellular constituents throughout the vasculature. The endothelium is also
responsible for maintaining homeostasis and formation of new blood vessels (process referred
to as angiogenesis). Angiogenesis has key applications in cancer research. Tumor growth is
supported by formation of new blood vessels that provide nutrients for these cells to expand.
Current research and drug discovery areas are focused on understanding how inhibiting
angiogenesis can have implications on tumor expansion.

Endothelial cells consist of "cobblestone" morphology, stain positive for Factors VIII (an
essential blood-clotting protein synthesized by endothelial cells) and take up acetylated low-
density lipoprotein (Lonza Group Ltd , 2018)

Inflammatory response. Endothelial cells are also active participants in and regulators of the
inflammatory processes.
 PATHOPHYSIOLOGY

Modifiable Risk Factors Non- Modifiable Risk Factors

-Polluted and cramped - Age (6 months – 10 years old)
- Ethnicity (Japanese descent)

Infection of unknown pathogen

Inflammatory Response of T-cells, mononuclear cells, and IgA

producing plasma cells against medium sized arteries

Upregulation of hepcidin Increased inflammatory

expression Cytokines

hepcidin interacts with

Inflammatory infiltrates Fever (39 degrees
ferroportin
replaced by fibroblast which Celsius)
thicken and narrows the Adenopathy
Intima
intracellular iron sequestration
and decreased iron absorption
from duodenum
Conjunctivitis
hepcidin-induced transient Hand and feet swelling
Treatment:
General rashes
anemia Aspirin to serve as
Hemoglobin 9.6 g/dL Anti pyretic and
Hematocrit 26.3 % blood thinner to
avoid Aneurism

Strawberry Tongue
Mouth Sores
 Treatment:
IVIG

hepcidin levels decrease

Decrease inflammation
significantly

KAWASAKI DISEASE TREATED

-minimal rashes
-Lymph nodes normal in size
- Sclera white in color and the palpebral conjunctiva appears pink
- Patient is afebrile (36. 5 degree Celsius)
Complication:
Mild Mitral Valve Regurgitation
Legends:

Signs and symptoms

Treatment
 COURSE IN THE WARD
Day of admission
Patient was admitted at the pediatric ward on October 18,2018 around 2:50 PM. Upon
admission, patient’s mother complained high, intermittent fever unrelieved by paracetamol,
mouth sores, bilateral conjunctivitis and rashes on hands, feet and trunks. Patient was
stabilized at the emergency department by administering Paracetamol 250/5ml suspension,
6ml every 4 hours as needed for fever >38°C. of complete blood count and referral were made.
Clinical impression is related to Kawasaki disease.
Around 10 in the evening, patient has started human immunoglobulin 5000 mg/ 100 ml vial.
6ml/hour for the first hour and 12ml/hr for the second hour and then remaining was given for
over 10 hours via infusion pump. Patient was monitored closely.
Day 2 of admission (10/19/2018)
Patient starts to normalize. His temperature turns 37.4 from 38.1 and his rashes start to
resolve. At exactly 5:00 PM ECG result was out and revealed Mitral regurgitation, mild.
Day 3 of admission (10/20/18)
Patient has stable vitals signs. Doctor ordered to consume the ranitidine stocks then
discontinue. He was also ordered with aspirin 80 mg 1 tab orally 4x a day which wil be
continued even after discharge.
Day 4 of admission (10/21/18)
No new orders were given. Patient is ready for discharged. Has normal vital signs and no other
abnormal signs and symptoms
Day of discharge (10/22/18)
Patient’s Mother was instructed about the take home medications about when to take,
precautions and other considerations. Parents were also asked to come to the doctors clinic for
follow up on October 25, 2018.
 LABORATORY AND DIAGNOSTIC EXAMINATION RESULTS
Hematology Report/Complete Blood Count
Date & time: 10/17/2018; 4:44 pm
Result Normal Values Significance
10/17/2018; 4:44
pm
WBC 17.06 6-27 Increased. May indicate
infection mostly bacteria
and some viruses,
inflammation or
inflammatory conditions

RBC 4.04 3.7-4.5 Decreased. May indicate

sudden or chronic bleeding
may also indicate kidney
disease that may lead to
decrease erythropoietin/

Hemoglobin 9.6 10.5-12.0 Decreased. May be caused

by excessive loss of blood
from. For example, severe
trauma or bleeding from
sites or patient’s that
undergo surgery.

Hematocrit 28.3 33-36 Decreased. May be caused

by excessive blood loss or
caused by decreased
production of haemoglobin.

Platelet 543 150-350 Increased possibly due to

damage of endothelial cells,
which has coagulant effect.
Blood Indices
MCV 70.1 70-78 Within normal range

MCH 23.9 23-27 Within normal range

MCHC 33.9 30.0-33.0 Slightly increased possibly

due to inflammatory disease
process
RDW 13.9 Within normal range.
 PDW 36.3 Within normal range.

MPW 6.7 Within normal range.

Absolute Differential Count

Neutrophil # 10.44 1.5-8.5 Increased neutrophil #
indicates infection which is
most likely bacterial, injury,
surgery.
Lymphocytes # 3.34 4-10.53 Decreased. Indicates under
nutrition and may have
symptoms of an infection
Monocytes # 0.7 0.6 Within normal range.

Eosinophils # 2.03 0.3 Within normal range.

Basophils # 0.08 Within normal range.

LUC# 0.47 0.0-0.4 Increased due to infection

Urinalysis Report
Date & time: 10/17/2018; 5:16 pm
Physical Result Normal Values Significance
characteristics 10/17/2018; 5:16
pm
Color Yellow Urine naturally has some
yellow pigments called
urobilin or urochrome. The
darker urine is the more
concentrated, it tends to be
due to dehydration.
Transparency Clear If urine is clear probably it is
caused by drinking too much
water which can throw off
electrloyte balance in
potentially harmful ways.
ph 7 4.6-8.0 Within normal range
Specific gravity 1.01 1.003-1.035
Within normal range
Chemical Characteristics
Protein Negative Negative Within normal range
Glucose Negative Negative Within normal range

Ketone Negative Negative Within normal range.

Urobilinogen Negative Up to 2 Within normal range.

Leukocytes Negative Negative Within normal range.

Blood/hb Negative Negative Within normal range.

Bilirubin Negative Negative Within normal range.

Nitrite Negative Negative Within normal range.

Microscopic Findings
Red blood cells 8 0-11 Within normal range.
White blood cells 8 0-11 Within normal range.
Bacteria 5 0-111 Within normal range.

Squamous 20 0-11 Within normal range.

epithelial cells
Cast 0 0-11 Within normal range.

Echocardiographic Report

Summary of Interpretation

Result:
• Situs solitus
• Levocardia
• Intact/interatrial and ventricular septum
• Atrioventricular and ventriculoarterial concordance
• Normal chamber sizes
• Mitral regurgitation, mild
• Good left ventricular systolic function
• Normal size coronary arteries
• LCA
Proximal 0.23cm ( Z-score +1 SD)
distal 0.22CM
• RCA
proximal 0.21
 distal 0.19
• No pericardial effusion

IMPRESSION:

• Mitral Regurgitation, mild

 DRUG STUDY

DRUG NAME ROUTE/ INDICATION MECHANISM OF ACTION CONTRAINDICATION SIDE NURSING

DOSAGE/ EFFECTS RESPONSIBILITIES/
FREQUENCY PATIENT TEACHING

Generic name: 20 grams

Immune serum via
globulin infusion
pump
Brand name:
Vizcarra
over 12
Pharmacologic hours as
class: follows
first hours:
Therapeutic 12ml give
class: remaining
382ml over
10 hours at
38.2 ml/hr
via infusion
pump
 DRUG NAME ROUTE/ INDICATION MECHANISM OF ACTION CONTRAINDICATION SIDE NURSING
DOSAGE/ EFFECTS RESPONSIBILITIES/
FREQUENCY PATIENT TEACHING

Generic name: 20 grams

Immune serum via
globulin infusion
pump
Brand name:
Vizcarra
over 12
Pharmacologic hours as
class: follows
first hours:
Therapeutic 12ml give
class: remaining
382ml over
10 hours at
38.2 ml/hr
via infusion
pump
 DRUG NAME ROUTE/ INDICATION MECHANISM OF ACTION CONTRAINDICATION SIDE NURSING
DOSAGE/ EFFECTS RESPONSIBILITIES/
FREQUENCY PATIENT TEACHING

Generic name: 20 grams

Immune serum via
globulin infusion
pump
Brand name:
Vizcarra
over 12
Pharmacologic hours as
class: follows
first hours:
Therapeutic 12ml give
class: remaining
382ml over
10 hours at
38.2 ml/hr
via infusion
pump
 NURSING CARE PLAN
1. ACTUAL
FORMAT

Assessment Diagnosis Expected outcome Nursing Interventions Rationale Evaluation

Objective data: Hyperthermia related After 8 hours of After 8 hours of

to inflammatory nursing interventions, nursing interventions,
Temperature 39°C
disease process as the patient will be
HR 142 BPM evidenced by able to:
elevated Goal number 1 fully
RR 40 CPM - decrease his Independent:
temperature(39°C) met as evidenced by
temperature from
and hot, flushed skin - provide tepid - promotes heat loss decreased of
39°C to 36.6- 37.5 °C
sponge bath. through conduction temperature to
Flushed skin, warm to
and evaporation 37.4°C
touch
The patient’s parents
will be able to:
Goal number 2 fully
- discuss adequate of
- demonstrate met as evidenced by
fluid intake and other - promote wellness
behaviors to monitor patient was changed
methods like
and promote and good ventilation to lose clothing from
loosening clothing
normothermia tight clothing
and providing cool
- identify underlying environment.
cause/ contributing
Goal number was
factors and
fully met 3 as
importance of Dependent:
evidenced by
treatment -Administer PCM verbalization of the
120/5ml suspension mother the the
causes could be
- produces antipyretic bacterial, virus and
effect other pathogens.

Collaborative:
- monitor periodic lab
studies relative to
general well-being
and status of specific - assisst them with
problems correcting/
minimizing
conditiona and
optimal healing
 2. Actual NCP

Assessment Diagnosis Expected outcome Nursing interventions Rationale Evaluation

Objective data: Impaired skin After 8 hours of Independent: After 8 hours of

integrity; peripheral holistic nursing care, nursing interventions,
- Red rashes on
erythema related to the patient will be
hands, feet and ongoing fever able to:
secondary to
trunks SHORT TERM LONG
Kawasaki disease
TERM Goal number number
- Edematous hands
1 fully partially met
- manifest healing of
- cervical lymph - protect edematous - to prevent pressure as evidenced by
peripheral erythema
nodes are palpable areas from pressure sore decrese number of
as evidenced by
rashes, not
- fissured lips disappearance of
completely
rashes on the hands,
feet and trunks
Dependent
Goal number 2 fully
- administer human - aids kawasaki met as evidenced by
the parent’s will be
immunoglobulin as disease mother not using
able to :
ordered soap, instead she
used tap water to
cleanse while tapping
Collaborative: skin gently

- check for
laboratories and
 communicate with - to monitor and
other specialist like update patients
cardiac for monitorin status
g
- avoid use of soap or
- tends to dry skin
mild soap only
- demonstrate and more likely to
measures to improve cause breakdown
or protect skin
integrity
Dependent:
- apply emollient to - promote
skin as ordered moisturization to skin
 3.. Risk NCP

Assessment Diagnosis Expected outcome Nursing interventions Rationale Evaluation

Objective cues Impaired oral mucous After 8 hours in After 8 hours in

membrane related to nursing interventions, nursing interventions,
Dry mouth Independent:
inflamed oral mucosa
Strawberry tongue and dehydration
- the child’s oral
Inflamed tongue -provide soft, non - less irritation to the
mucosa will be free
irritating foods such oral mucosa Goal was partially
frrom dryness and
as gelatin met as evidenced by
irritation
fissured lips but
- increase fluid intake
- promotes hydration absence of
strawberry tongue

Dependent:
- keeps the lips
- apply soothing lubricated to avoid
ointments to the lips, sore
- 2 OTHERS as prescribed
ADD
 DISCHARGE PLANNING

TAKE HOME MEDICATIONS

Aspilets (Aspirin) 80mg tablet 500’s 1 tablet 4 times a day orally until 10/24/2018,
Wednesday
Aspilets (Aspirin) 80mg tablets 500’s 1/2 tablet once a day orally for 2 months
Teachings about medications
EXERCISE
Advised the parents to have regular physical activity like hiking early in the morning for 30
minutes

ENVIRONMENT
Advised significant others to keep surroundings clean and stress free as possible
Encouraged parents to maintain safety for baby- any object that fits in a tissue tube is
considered choking hazard

TREATMENT
Advised parents to have their child a regular check up with their pediatrician
Reminded the parents to religiously follow the discharged medicines as ordered

HEALTH TEACHINGS
Instructed the parents to take the 1 tab Aspilet every after breakfast, lunch, supper and at
bedtime
While taking the 1/2 tab of Aspilet after lunch only
Educated about bleeding precautions like the use of knee pads and soft bristle toothbrush
Encouraged the parents to regularly monitor the child’s condition and to report unusual
signs
Instructed the parents to take the medications with meals
 Discussed with the parents the adverse effects of the medication to be taken such as easy
bruising or bleeding, difficulty of hearing, and signs of kidney problems like change in
the amount of urine

OUT PATIENT CONSULTATION

10/25/2018 Follow up visit with Dr.M’s to her clinic

DIET
No restrictions and encouraged to eat variety of foods daily
Advised to limit fat intake
Educated about green leafy vegetables which could potentiate bleeding

Fluid intake

Dark colored food s