Nursing Management İn Kawasaki Disease: Case Report

Abstract

 Kawasaki Disease (KD) predominantly affects children under 5, unknown cause, acute, febrile, self-limiting childhood systemic vasculitis. The disease described worldwide is the most common cause of acquired heart disease in children in developed countries. It is known that about 25% of untreated patients develop coronary artery aneurysm. Kawasaki disease, a rare but high risk of morbidity in children, is an important acquired heart disease and because of the importance of rapid treatment in preventing complications, it is very important to increase awareness, to make differential diagnosis and to establish the diagnosis in patients who do not respond to antibiotic treatment, have a long-lasting fever, restlessness, rash and other diagnostic criteria. With this case report, it is aimed to raise the awareness of pediatric nurses who care for children with kawasaki disease. Case Description: The patient who went to the family physician with high fever at the age of 2 years and 10 months, after 3 days of antibiotic treatment, fire that does not fall around 39-40 °C, widespread rash with uncertain borders that disappear with compression all over the body, redness of the eyes, cracked lips, white flaking in the tongue, pain in the right knee and restriction of movement was acceptedto the Faculty of Medicine with a preliminary diagnosis of KD with complaints. On the 8th day of the complaints, the patient was started with hourly fever monitoring, ampicillin-sulbactam, aspirin and IVIG. However, IVIG was discontinued to the patient who developed an allergy against IVIG and steroid (methylprednisolone) treatment was applied. Echocardiography (ECO) was performed by requesting a child cardiology consultation, the patient with normal ECO is planned to come to the control one month later. Gentamycin was started in the patient who developing pseudomonas aeuruginosa in throat culture. Evaluation as normal flora, of control blood and culture taken as a result of treatment after her complaints subsided and her fever was under control, the patient was discharged with recommendations. Oral methylprednisolone, aspirin and ibuprofen are prescribed. When the disease recurred after 15 days, IVIG and methylprednisolone were administered first after the antihistamines were administered at the request of the physician. In addition to left coronary aneurysm, right coronary ectasia was seen in the ECO and the patient was evaluated as recurrent kawasaki resistant to treatment and received infliximab treatment. Aspirin and deltacortil were prescribed and sent to the Cardiovascular and Thoracic Surgery Training and Research Hospital for further examination. Patient who underwent first coronary angiography one month later LMCA was discharged to be followed with aneurysmatic dilatation and CX proximal stenosis. Coronary angiography was performed on a male patient who is currently 4 years and 10 months old and the patient who did not have any problems after the procedure was discharged with prescribed drugs to come for control (oxapar will be discontinued after 2x15 mg-15 days, drisentin 3x25 mg, ecopirin 1x100 mg, coumadin dose is adjusted according to the coagulation level by the physician). Conclusion: The importance of the primary caregiver nurse is indispensable for early diagnosis in patients requiring special care, such as KD, for the symptoms to regress or disappear in a short time and to increase the quality of life.