A 3-year-old child has been hospitalized for 6 days with Kawasaki disease. The child has received high-dose aspirin and intravenous immunoglobulin (IVIG). Which assessment finding would be the nurse's highest priority to report immediately to the healthcare provider?
1Temperature of 101.2°F (38.4°C) with irritability
2Bilateral conjunctival injection without purulent discharge
3Peeling skin on the fingertips and toes
4New onset of chest pain with shortness of breath✓ 정답
해설
Chest pain with shortness of breath in Kawasaki disease indicates potential cardiac complications like coronary artery aneurysms or myocardial infarction, which are life-threatening and require immediate intervention. Other findings (fever, conjunctival injection, peeling skin) are expected in acute phase and managed with standard care.
Clinical Judgment
This question evaluates prioritization in clinical judgment. The core concern of Kawasaki disease is cardiovascular complications. The child has received acute-phase treatment (IVIG, high-dose aspirin). The most dangerous aspects of Kawasaki disease are cardiac problems such as coronary arteritis, coronary artery aneurysms, myocarditis, and pericarditis. Therefore, while the other options are typical or expected symptoms of the disease, 'chest pain and dyspnea' are emergency signs strongly suggesting cardiac complications (e.g., myocardial ischemia, pericarditis), requiring immediate reporting and intervention.
Memory Tip
Remember the key complications of Kawasaki disease as Cardiac Complications. In all assessments, prioritize Chest pain or Cardiac signs above all else. "Chest pain means Call the provider Critically!"
KR vs US
While managing cardiac complications of Kawasaki disease is also the top priority in Korea, the criteria for 'Immediate Reporting' are very clear in NGN/US exams. Signs with life-threatening potential (chest pain, dyspnea, altered mental status) take precedence over all other routine management. In Korean practice, you might be accustomed to regular tests like coronary artery ultrasound, but in the exam, recognizing these signs of acute deterioration is key.
Clinical Practice Guide
When caring for a child with Kawasaki disease, monitoring for cardiac complications is the top priority. Frequently assess vital signs, especially heart rate/rhythm and respiratory status. Chest pain, difficulty breathing, pallor, sweating, and excessive fatigue are danger signs that must be reported immediately. If fever persists or recurs after IVIG administration, IVIG non-responsiveness should be considered.
Caution
Beware of traps in SATA (Select All That Apply) questions. For questions asking to select all "typical symptoms of Kawasaki disease," conjunctival injection, rash, lip/oral changes, extremity changes, and cervical lymphadenopathy are included. However, for questions asking to select "signs requiring immediate reporting," only cardiac-related symptoms and IVIG non-responsiveness (persistent high fever) are the correct answers. Do not confuse the stages of symptoms (acute, subacute, convalescent). Peeling of the skin on the hands and feet is an expected finding in the subacute stage and is not a reason for emergency reporting.
Kawasaki Disease (가와사키병) — Primarily occurring in children under 5 years of age, this is an acute systemic vasculitis of unknown cause. It causes inflammation in medium-sized arteries, including the coronary arteries, posing a risk of cardiac complications such as coronary artery aneurysms.
Coronary Artery Aneurysm (관상동맥류) — The most serious complication of Kawasaki disease. A condition where the coronary artery wall weakens and partially dilates. It increases the risk of thrombus formation, stenosis, and myocardial infarction.
Intravenous Immunoglobulin (IVIG) (정맥내 면역글로불린) — Primary standard treatment for Kawasaki disease. When administered at a high dose within 10 days of onset, it significantly reduces the incidence of coronary artery complications.
IVIG Non-responsiveness (IVIG 비반응성) — If fever does not subside or recurs within 36 hours after initial high-dose IVIG administration. This is a risk factor for coronary artery complications, and secondary treatment (steroids, other immunosuppressants, etc.) may be necessary.