Unit 3: NR328 - Kawasaki disease/associated multisystem inflammatory syndrome (with COVID-19)
For each potential nursing intervention, click to specify whether the intervention is indicated, nonessential, or contraindicated. Mark only one response per intervention.
Indicated - Place the child on cardiac monitor. Request an order for a peripheral intravenous line. Request an order for supplemental oxygen. Nonessential - Place the child in a client gown. Contraindicated - Apply warm compresses to the skin.
When conducting a physical examination of a child with suspected Kawasaki disease, which finding would the nurse expect to assess?
Strawberry tongue
A toddler with Kawasaki disease is admitted to the pediatric unit. The caregivers inquire about why the child is receiving aspirin when it is contraindicated for other minor illnesses. The nurse's best response would be which of the following? Select all that apply.
Aspirin therapy is not contraindicated and necessary for treatment Length of aspirin therapy is related to the child's response High doses of aspirin will be given while the fever is high
A nurse is caring for a child with Kawasaki disease. Which of the following clinical manifestations should the nurse be continually assessing for? Select all that apply.
ALL
Multisystem inflammatory syndrome in children (MIS-C) is caused by which of the following? Select all that apply.
COVID-19 unknown cause
A child with multisystem inflammatory syndrome in children (MIS-C) is admitted to the pediatric unit. To promote comfort, the nurse should do which of the following? Select all that apply.
Cluster care to allow for adequate rest periods Monitor respiratory status Administer medications as ordered
The nurse is caring for a pediatric client with Kawasaki disease. Which assessment data is consistent with the clinical manifestations of Kawasaki disease?
Expected - cervical lymphadenopathy edema and erythema on the hands and feet strawberry tongue irritability exanthem conjunctivitis mucositis Unexpected - cyanosis muscle aches sweating
Select the 4 findings that require immediate attention.
Fewer wet diapers High fever for 7 days Abdominal rash Bright red tongue
The nurse is preparing a child for discharge after treatment for Kawasaki disease. The child had been receiving high doses of aspirin. The nurse instructs the parents to report any toxic effects of the aspirin therapy, which may include:
Headache, confusion, dizziness, or tinnitus
The nurse has received orders from the health care provider. Click to highlight below the 3 orders that the nurse should perform right away.
Immune globulin (gamma globulin) 2g/kg/day over 10 hours Vital signs every 2 hours or more often as needed Administer aspirin 80mg/kg/day divided every 6 hours
Review the Electronic Health Record (EHR), then answer the question in the Nurses' Notes tab. For each assessment finding, click to highlight the findings that require immediate follow-up by the nurse.
Irritable, sleepy, only responsive to painful stimuli nasal flaring, subcostal and intracoastal retractions, crackles noted bilaterally Gallop rhythm Disoriented, drowsy Skin is hot to the touch Facial flushing ALL VITALS
For each client finding below, click to specify if the finding is consistent with Kawasaki disease, multisystem inflammatory syndrome in children (MIS-C), or sickle cell anemia. Each finding may support more than one disease process. Note: Each column must have at least one response option selected.
Kawasaki Disease - Edema of the hands, feet Enlarged lymph nodes Fever MIS-C - ALL Sickle Cell Anemia - Abdominal pain Difficulty breathing Edema of the hands, feet
When caring for a child with Kawasaki disease, the nurse would identify which of the following as appropriate during treatment?
Management includes administration of aspirin and intravenous immunoglobulin (IVIG).
Which of the following should be included in the nursing management and care of a child diagnosed with Kawasaki disease?
Monitor I/O
An 18-month-old child diagnosed with Kawasaki disease is very irritable, refuses to eat, and exhibits peeling skin on the hands and feet. What should the nurse do first?
Place the toddler in a quiet environment
The nurse is explaining the Kawasaki disease process and treatment plan of care to the caregiver. For each of the statements made by the caregiver, click to specify whether the statement indicates an understanding or no understanding of the teaching provided.
Understanding - "As my child ages, they will need more tests." "I will call the doctor if my child starts acting out of character." "I will feed my child healthy snacks." "I will gently massage and move my child's legs when giving a bath." No understanding - "I can get my child vaccinated before we leave the hospital." "My child will be fully cured by discharge."
