# A 5-year-old child with Kawasaki disease in the acute phase has developed coronary artery aneurysms confirmed by echocardiography. The child's temperature is 102.8°F (39.3°C), heart rate 130 bpm, and appears irritable with persistent fever. The parents ask about fever management. What is the most appropriate nursing intervention?

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## 문제

A 5-year-old child with Kawasaki disease in the acute phase has developed coronary artery aneurysms confirmed by echocardiography. The child's temperature is 102.8°F (39.3°C), heart rate 130 bpm, and appears irritable with persistent fever. The parents ask about fever management. What is the most appropriate nursing intervention?

A 4-year-old child diagnosed with Kawasaki disease is currently in the acute phase of the illness. The child has been hospitalized for 5 days and has developed coronary artery aneurysms as confirmed by echocardiography. Current vital signs show temperature 102.8°F (39.3°C), heart rate 130 bpm, respiratory rate 28/min, and blood pressure 95/60 mmHg. The child appears irritable and has persistent fever despite ongoing treatment. The parents are concerned about the high fever and are asking the nurse about giving acetaminophen or ibuprofen to help reduce their child's temperature and discomfort.

## 보기

1. Administer ibuprofen as ordered to reduce fever and inflammation
2. Apply cooling blankets and tepid sponge baths to reduce body temperature
3. Administer acetaminophen as ordered and avoid aspirin and ibuprofen **✔ 정답**
4. Encourage increased fluid intake and monitor for signs of dehydration

**정답: 3**

## 해설

Acetaminophen is preferred for fever management in Kawasaki disease with coronary aneurysms to avoid bleeding risks from NSAIDs like ibuprofen, as these children often receive anticoagulant therapy. Other options are less appropriate due to potential harm or insufficient focus on medication safety.

## 심화 해설

Clinical Context and Pathophysiology

This child is in the acute phase of Kawasaki disease (KD), an acute systemic vasculitis that predominantly affects medium-sized arteries, particularly the coronary arteries. The presence of coronary artery aneurysms (CAAs) confirmed on echocardiography indicates significant vascular inflammation and endothelial damage. In untreated cases, CAAs may develop in up to 25% of patients, making KD the leading cause of acquired heart disease in children [4]. The persistent fever at 102.8°F (39.3°C) reflects ongoing systemic inflammation, which further increases the risk of thrombotic complications within the damaged coronary vessels.

Rationale for Medication Selection

The core therapeutic goal during the acute phase of KD is to reduce inflammation with high-dose aspirin and intravenous immunoglobulin (IVIG). Once CAAs have developed, antiplatelet therapy becomes critical to prevent thrombosis within the aneurysmal segments. Acetaminophen is the preferred antipyretic and analgesic agent in this scenario because it effectively reduces fever and discomfort without interfering with platelet function. In contrast, ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase and impair platelet aggregation, which can increase the risk of bleeding and counteract the intended antiplatelet effect of aspirin. Administering acetaminophen as ordered while strictly avoiding aspirin and ibuprofen is therefore the safest and most appropriate nursing action.

Why Other Options Are Incorrect

Administering ibuprofen (Option 1) would compromise the antiplatelet regimen essential for preventing coronary thrombosis. Applying cooling blankets and tepid sponge baths (Option 2) may cause shivering and vasoconstriction, which can paradoxically raise core body temperature and increase metabolic demand; external cooling does not address the underlying inflammatory process and is not recommended in KD. While encouraging fluid intake and monitoring for dehydration (Option 4) is an important supportive measure, it does not directly address the parents' specific concern about fever management. The priority intervention is pharmacologic fever reduction with a safe agent that does not antagonize necessary antiplatelet therapy.

Clinical Correlation with Platelet Activity

Children with KD, especially those who develop CAAs, often exhibit significant alterations in platelet parameters, including extreme thrombocytosis during the subacute phase . Elevated platelet counts and increased platelet activation contribute to a hypercoagulable state within the aneurysmal coronary arteries. This pathophysiologic mechanism underscores why meticulous attention to medication selection is critical. Any agent that further disrupts hemostasis, such as ibuprofen, can tip the balance toward either thrombotic or hemorrhagic complications. The nurse must recognize that fever management in this context is not simply about temperature reduction; it is about selecting an intervention that preserves the therapeutic antiplatelet environment necessary to protect the child's coronary circulation.References (research sources)

- [4]Advance in the Kawasaki disease related coronary artery aneurysms: knowledge mapping, trends, and research frontiers.Research articleChen Y, Zheng J, Wang H, Wu Z. (2026) · DOI: 10.1186/s13019-026-04166-x

## 임상 시나리오

Clinical Practice Guide: Fever Management in Kawasaki Disease with Coronary Aneurysms

In the acute phase of Kawasaki disease complicated by coronary artery aneurysms, the primary therapeutic goals are inflammation control and thrombosis prevention. High-dose aspirin is initially used for its anti-inflammatory effect, followed by low-dose aspirin for antiplatelet therapy once fever resolves. When fever persists, acetaminophen is the antipyretic of choice because it does not inhibit cyclooxygenase or impair platelet aggregation, preserving the protective antiplatelet effect of aspirin.

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen should be avoided. They reversibly inhibit platelet function and can increase the risk of thrombotic events in the damaged coronary arteries. External cooling measures, such as cooling blankets, are not recommended as they can induce shivering and discomfort, which elevates metabolic rate and oxygen consumption without treating the underlying inflammatory process.

Nursing priorities include strict adherence to the prescribed medication regimen, continuous cardiac and hemodynamic monitoring, accurate intake and output assessment, and family education regarding the rationale for avoiding NSAIDs and the importance of long-term follow-up with a pediatric cardiologist.

## 핵심 개념

- **Kawasaki Disease** — An acute systemic vasculitis primarily affecting medium-sized arteries, especially coronary arteries, and the leading cause of acquired heart disease in children.
- **Coronary Artery Aneurysm** — A pathological dilation of a coronary artery segment, a serious complication of Kawasaki disease that increases the risk of thrombosis and myocardial infarction.
- **Antiplatelet Therapy** — Medication such as low-dose aspirin used to inhibit platelet aggregation and prevent clot formation within damaged vessels like aneurysms.
- **Acetaminophen** — An analgesic and antipyretic that reduces fever and pain without affecting platelet function, making it safe to use with aspirin therapy.

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