A 3-year-old child is admitted to the pediatric unit with a 5-day history of high fever. The nurse is conducting an assessment for suspected Kawasaki disease. Which assessment finding would be MOST indicative of this condition?
The nurse is evaluating a toddler with prolonged fever for signs of Kawasaki disease to prevent serious cardiac complications.
1Bilateral conjunctival injection without exudate, strawberry tongue, and polymorphous rash on the trunk and extremities✓ 정답
2Petechial rash on the extremities, joint swelling, and abdominal pain with vomiting
3Koplik spots in the mouth, coryza, and photophobia with conjunctivitis
4Vesicular rash in various stages, intense pruritus, and fever with malaise
해설
Kawasaki disease is diagnosed by fever plus at least 4 of 5 criteria. Option 1 includes three key criteria: bilateral conjunctival injection without exudate, strawberry tongue, and polymorphous rash, making it most indicative. Other options suggest different conditions: petechial rash with joint swelling (meningococcemia), Koplik spots (measles), or vesicular rash (chickenpox).
Clinical Judgment
This question assesses the ability to identify the core clinical signs of Kawasaki disease. The key is to remember the specific 5 diagnostic criteria along with persistent fever for 5 days or more. Option 1 accurately describes three of these criteria (bilateral conjunctival injection without exudate, strawberry tongue, and polymorphous rash). This is the most typical symptom cluster that raises suspicion for Kawasaki disease. The other options present signs of different conditions (e.g., varicella, measles, meningococcemia), making Differential Diagnosis crucial.
Memory Tip:
A mnemonic to remember the 5 principal criteria of Kawasaki disease: Conjunctivitis, Oral changes, Rash, Extremity changes, Adenopathy. The initials spell COREA. It sounds just like "Korea," making it easy to remember.
KR vs US:
While the diagnostic criteria and treatment principles are the same, in Korea, the use of additional immunosuppressants (such as infliximab) may be considered more actively if fever persists or coronary artery abnormalities develop after intravenous immunoglobulin (IVIG) administration. Also, research on the rate of incomplete Kawasaki disease (cases not meeting all diagnostic criteria) in Korean children is active.
Clinical Practice Guide
When evaluating a patient suspected of having Kawasaki disease, the nurse should do the following:
1. Notify HCP! Report immediately if an unexplained fever lasting 5 days or more is observed along with any one of the COREA symptoms.
2. Monitor for cardiac complications: auscultate heart sounds (murmurs), check vital signs, and review ECG and echocardiogram results.
3. Treatment management: Monitor for hypersensitivity reactions during IVIG administration, and observe for signs of gastrointestinal bleeding during high-dose aspirin administration.
4. Family education: Educate on the importance of long-term follow-up (echocardiogram) and the risk of Reye's syndrome while taking aspirin (in case of chickenpox/influenza infection).
Caution:
It is important to note that Kawasaki disease involves conjunctival injection "without exudate". If purulent discharge is present, bacterial conjunctivitis should be suspected. Also, the rash can appear in various 'polymorphous' forms, so do not focus only on a specific pattern but assess the overall clinical picture.
Kawasaki Disease — Kawasaki disease. An acute systemic vasculitis of unknown cause, primarily occurring in children under 5 years of age, which can lead to cardiac complications such as coronary artery aneurysms.
Mucocutaneous Lymph Node Syndrome — Other names for Kawasaki disease. Reflects the characteristic of being a syndrome that involves mucous membranes (oral, conjunctival), skin (rash), and lymph nodes.
Coronary Artery Aneurysm — Coronary artery aneurysm. The most serious complication of Kawasaki disease, a condition where the blood vessel wall weakens and dilates. It can cause myocardial infarction.
Intravenous Immunoglobulin — Intravenous immunoglobulin. Used as a first-line treatment for Kawasaki disease, it suppresses inflammation and reduces the risk of coronary artery complications.
Strawberry Tongue — Strawberry tongue. A tongue that appears red and bumpy with protruding papillae. One of the oral mucosal changes seen in conditions such as Kawasaki disease and scarlet fever.