Kawasaki Disease

WHAT YOU SHOULD KNOW:

• Kawasaki disease (KD) is a rare illness in children that causes fever and vasculitis. Vasculitis is a condition where the walls of your child's blood vessels become inflamed (swollen). KD is commonly seen in children from 6 months to 5 years of age. It may also occur in older children and in children younger than six months old. KD may damage the blood vessels in your child's heart and cause heart problems. KD is more common in male children and those of Asian descent.
  
  
• The exact cause of KD is not known. It is believed to be caused by an infection from germs called bacteria or viruses. Your child may have a fever for more than five days, a rash, and dry, red, cracked lips. He may also have swollen lymph nodes in his neck, and red eyes. His skin on the palms of his hands and bottoms of his feet may be red and scaly. Your child may need blood tests, an echocardiogram, imaging tests, and a chemical stress test. Treatments include medicines such as aspirin and immune globulin, or surgery. Having your child's condition treated during its early stage may resolve his symptoms. Treatment may also prevent severe heart problems and his risk for a heart attack in the future.

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

RISKS:

• Medicines used to treat KD may cause an allergic response. Medicines used for treatment may also cause your child to get Reye's syndrome. This is a condition that causes damage to your child's brain and liver. Your child may also bleed or bruise easily from medicines used for treatment. Your child may have an infection or bleed too much with surgery. Even with treatment, your child may have heart problems from KD later in life.
  
  
• If your child's KD is left untreated, the blood vessels in your child's heart may become damaged. The blood vessels may become weak, and they may bulge out like a balloon and burst. This may cause your child to have a heart attack, and he may die. Talk to your child's caregiver if you are worried or have more questions about your child's illness or treatment.

WHILE YOU ARE HERE:

Informed consent: You have the right to understand your child's health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your child's condition. Your child's caregiver should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives your child's caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to your child. Before giving your consent, make sure all your questions have been answered so that you understand what may happen to your child.

Blood tests: Your child may need blood taken for tests. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV. Blood tests can give caregivers more information about your child's health condition. Your child may need to have blood drawn more than once.

Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Three or five sticky pads are placed on your child's chest. Each pad has a wire leading to a TV-type screen or to a small portable box (telemetry unit). This screen or box shows a picture of your child's heartbeat. Caregivers watch this picture to make sure your child's heart is doing OK.

IV: An IV is a tiny tube placed in your child's vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

Vital signs: This includes taking your child's temperature, blood pressure, pulse (counting his heartbeat), and respirations (counting his breaths). To take your child's blood pressure, a cuff is put on his arm and tightened. The cuff is attached to a machine which gives your child's blood pressure reading. Caregivers may listen to your child's heart and lungs by using a stethoscope. Your child's vital signs are taken so caregivers can see how he is doing.

Medicines:

• Aspirin: This medicine is also an anti-platelet drug. It helps thin your child's blood so clots do not form. Aspirin may also help decrease your child's fever. If caregivers tell your child to take aspirin, do not let him take acetaminophen or ibuprofen. Aspirin may cause a very serious illness called Reye's syndrome. Reye's syndrome may cause brain and liver damage. Do not give more or less aspirin to your child than what his caregiver says. Ask your child's caregiver for more information about Reye's syndrome.
  
  
• Blood thinners: This medicine helps stop clots from forming in your child's blood. Clots can cause strokes, heart attacks, and death.
  
  
• Clot busters: This medicine helps break apart blood clots. Once the blood clots are gone, blood flow may increase to your child's heart muscle. The medicine is given in your child's IV. An IV is a tube placed in your child's vein for giving medicine or liquids. This medicine may decrease the amount of damage to your child's heart muscle, and may save his life.
  
  
• Immune globulin: This medicine may be given to help your child’s immune system fight his infection. Ask your caregiver for more information about how immune globulin medicine may help your child.
  
  
• Steroids: This medicine may be given to decrease inflammation, which is redness, pain, and swelling. There are many different reasons to take steroids. With KD, steroid medicine may help prevent problems with your child's immune system. Be sure you understand why your child needs steroids. Do not let your child stop taking this medicine unless his caregiver tells you to.

Tests:

• Chemical stress test: During this test, medicine is used to make your child's heart work like it would when he exercises. If his heart has blocked or damaged blood vessels, the medicine may make his heart work harder. Chemical stress testing may also show changes in your child's heart activity while he is active or at rest. Ask your caregiver for more information about this test.
  
  
• Imaging tests: Your child may be given dye before the pictures are taken. The dye may help your child's caregiver see the pictures better. Children who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your child's caregiver if your child is allergic to shellfish, or has other allergies.
  
  
  • Computed tomography: This is also called a CT scan. A special x-ray machine uses a computer to take pictures of your child's body. It may be used to look at your child's heart and blood vessels.
    
    
  • Echocardiogram: This test is also called an echo. Sound waves are used to show pictures of the size and shape of your child's heart. The echo can also show how well the heart is pumping and how well blood flows through it. Your child will lie down during the test. Caregivers will squirt clear gel onto your child's chest to help the echo probe move easily. The echo pictures are shown on a TV-like screen. The whooshing noise that you may hear is the sound of blood flowing through the heart. Caregivers may ask you to stay in the room with your child during this test.
    
    
  • 12 Lead EKG: This test helps caregivers see your child's heart activity. It helps caregivers look for changes or problems in different areas of the heart. Sticky pads are placed on your child's chest, arms, and legs. Each pad has a wire that is hooked to a machine or TV-like screen. This machine shows a tracing of your child's heart beat. This test takes about five to ten minutes. Your child must lie very still during the test.
    
    
  • Magnetic resonance angiography: This is also known as a MRA. This test is used to look at the blood vessels in your child's heart. The test is also done to see how his blood flows through his heart. Your child will need to lie still during his MRA. Never enter the MRA room with an oxygen tank, wrist watch, or any other metal objects. This can cause serious injury.
    
    
  • Chest x-ray: This is a picture of your child's lungs and heart. Caregivers use it to see how your child's lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection (such as pneumonia) or other problems.

Treatment options:

• Cardiac catheterization: A cardiac catheterization is a test to see how well your child's heart is working. It is also used to see how well the blood vessels connected to the heart are doing. A special tube is threaded into your child's heart through a blood vessel in his arm, leg, or neck. Dye may be given so x-ray pictures of your child's blood vessels show up better on a TV-like screen. Your child's caregiver may also measure the pressure inside your child's heart.
  
  
• Surgery:
  
  
  • Angioplasty: This is done to increase blood flow to your child's heart. A thin tube with a balloon on the end is placed into the narrowed or blocked blood vessel. The balloon is then inflated (filled with air) to widen the artery and restore blood flow. A stent (small mesh tube) may also be placed into your child's narrow blood vessel.
    
    
  • Coronary bypass surgery: This surgery is done to replace a blocked blood vessel. A healthy artery or vein from another part of your child's body may be used. This may decrease your child's risk of having a heart attack in the future.
    
    
  • Heart transplant: This is when your child's diseased heart is replaced with a healthy heart. This is done when your child's heart is badly damaged by KD. Your child will be given a heart from someone else (a donor). The heart transplant is done while your child is in the hospital. This may cure your child's illness, but it may cause other health problems.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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