Kawasaki Disease on the NCLEX
CRASH and burn findings, IVIG plus aspirin treatment, and why coronary aneurysms drive everything.
Kawasaki is an acute vasculitis of young children and the leading cause of acquired heart disease in kids in developed countries. The stakes are the coronary arteries.
CRASH and burn
Mostly children under 5. Diagnosis is clinical: fever plus the mucocutaneous findings. Conjunctivitis: bilateral, non-purulent. Rash: polymorphous, trunk. Adenopathy: cervical, usually unilateral, at least 1.5 cm. Strawberry tongue, red cracked lips, oral mucosal changes. Hands and feet: swelling and redness, then peeling of fingers and toes in the subacute phase. And burn: fever of 5 or more days, high and unresponsive to antibiotics. Extreme irritability is typical.
Treatment: IVIG plus aspirin
IVIG 2 g/kg as a single infusion, ideally within 10 days of fever onset, cuts the coronary aneurysm rate sharply. Monitor during infusion like any blood product: vitals, reaction watch. High-dose aspirin during the acute phase, then low-dose antiplatelet aspirin for weeks after. This is the famous exception: aspirin is normally avoided in children because of Reye syndrome, but in Kawasaki the benefit wins. Teach parents to report influenza or varicella exposure while on aspirin. Delay live vaccines (MMR, varicella) about 11 months after IVIG - the antibodies blunt the vaccine response.
The coronary artery risk
Coronary artery aneurysms are the major complication. Baseline echocardiogram at diagnosis with repeat echos in follow-up. Monitor for signs of myocarditis and heart failure: tachycardia out of proportion, gallop, poor feeding. Nursing comfort care matters: oral care for cracked lips, cool cloths, quiet environment for the irritable child, clear parent teaching about the peeling skin (painless, expected).
Frequently asked
Why give aspirin to a child here?
The anti-inflammatory and antiplatelet effect protects the coronary arteries. Kawasaki and rheumatic conditions are the recognized exceptions to the no-aspirin rule.
Fever persists after IVIG?
Report it. About 10-15% of children need a second IVIG dose. Persistent fever raises aneurysm risk.
MMR due 2 months after IVIG?
Defer it. Live vaccines wait about 11 months after IVIG because passive antibodies block the response.
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