Therapeutic management

 High Dose IVIG along with salicyate therapy – to reduce the duration of fever and the incidence
of coronary artery abnormalities when given within the first 10 days of illness.
o A single large infusion of 2g/kg over 10-12 hours is recommended
 Aspirin –to control fever and symptoms of inflammation
o given initially in an antinflammatory dosage (80 to 100mg/kg/day in divided doses every
6 hours
o Once child is afebrile for 48-72 hours dosage will be decreased to an antiplatelet dosage
(3-5 mg/kg/day)
o Low dose aspirin continued until the platelet count has returned to normal
o Low dose (antiplatelet) salicylate therapy – continued indefinitely if the child develops
coronary abnormalities.
 Additional anticoagulatory therapy (warfarin) – may be indicated in children with giant
aneurysms (larger than 8mm); greater risk for morbidity and mortality
 Acetaminophen – may be given in addition to high dose aspirin in situations in which the
temperature is very high
 Antiarthritic agents when arthritis be severe enough once they are no longer on high-dose
aspirin

Nursing problems

 Hypercoagulability and venous fragility often make it difficult to maintain IV access

 Most challenging problem is patient irritability

Nursing Care Management

In patient care focuses on symptomatic relief, emotional support, diagnostic assistance, medication
administration and education of the child and family:

Initial Phase

 Nurse must monitor the child’s cardiac status carefully

 Intake and output and daily weight measurements are recorded
 Fluids need to be administered with care because of the usual finding of myocarditis
 Assessed frequently for signs of CHF; including decreased urinary output, gallop rhythm,
tachycardia and respiratory distress
 Cardiac monitoring in ff cases:
o before the initial ECG and echocardiogram are recorded and shown to be normal
o during the infusion of IV -globulin ( because of large fluid load)
o in children younger than 1 year of age
 o in any child with cardiac symptoms
 Sedation is required before echocardiography younger than 2.5 – 3 years of age, because the
child must remain still for up to 1 hour

Symptomatic Relief

 Application of cool cloths and unscented lotions and use of soft, loose clothing to minimize skin
discomfort

During Acute Phase

 Application of lubricating ointment to the lips for mouth care and is important for the mucosal
inflammation
 Clear liquids and soft foods can be offered
 Temperature must be carefully monitored
 Frequent monitoring of vital signs especially cardiac status, because of the large fluid volume
being administered to patients who have subclinical myocarditis or diminished LV
 Patency of the IV line is checked because extravasation can result in tissue damage
 Children need to be placedin a quiet environment that promotes adequate rest
 Parents are need to be supported in their efforts to comfort an often inconsolable child and they
need to understand that irritability is a hallmark of KD and that they need not feel guilty or
embarassed about their child’s behavior

Discharge Teaching

 Instruct the importance of follow-up monitoring and the circumstances under which they should
contact their practitioner:
o Irritability is likely to persist for up to 2 months after the onset of symptoms
o Peeling of the hands and feet is painless and occurs primarily in the second and third
weeks
o Arthritis, especially of the larger weight-bearing joints may persist for several weeks
o Children are most stiff in the mornings, during the cold weather, and after naps
o Recurrent fever and symptoms
 Parents should be educated about recrudescent fever 48 hours after discharge
 Parents should be instructed to take the child’s temperature daily after discharge and to contact
their physician or practitioner if there is any increase in temperature
 Parents need to be instructed about the administration of salicylates and made aware of signs of
aspirin toxicity (High doses: ringing in the ears, headache, dizziness and confusion; Low doses:
easy bruising)
 Aspirin should be stopped if it is expsed to chickenpox or influenza ( might asociate with Reye
syndrome)
 Parents should understand the unlikely but real possibility of myocardial infarction and cardiac
ischemia
 Parents of children with known severe coronary artery sequelae should be taught
cardiopulmonary resuscitation
 Contact sports must be avoided and administration of vaccine is indicated
o Yearly administer of influenza vaccine
o Measles-mumps-rubella vaccine and varicella vaccine be delayed for 11 months after the
administration of IVIG, because the body might not produce the appropriate number of
anti bodies

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