Kawasaki Disease: Symptoms, Causes and Treatment

Kawasaki Disease Symptoms, Ca workouts and TreatmentBackgroundKawasaki dis order (KD) is a general vasculitis syndrome which whitethorn involve m either organs, such as myocardium and the conduction system, and whitethorn cause firing off in other organs such as pericarditis, endocarditis, cholecystitis etc.EtiologyThere is only little information of the etiology of KD. It is suspected as an infectious disease with an un whopn pathogen (KatoSuda, 2012) or autoimmune disease (Starkebaum, 2013) that has an precipitous systemic vasculitis syndrome.PrevalenceKD is a prevalent cardiac disease in Asia, North America, South America, Europe and Australia. Nakamura and Yanagawa (2004) stated that Asians were nearwhat 5-10 times more susceptible than white persons. (cited in KatoSuda, 2012)II. Clinical disposition of Kawasakis DiseaseMedical diagnostic criteriaThe principal diagnostic criteria of KD be presence of at least five of the major features persistent febrility for at least 5 days, conjunctival injection, changes in the mucosa of the oropharynx(such as strawberry mark tongue), changes in the peripheral extremities, erythematous rash over extremities or/and trunk, and cervical lymphadenopathy. If leaf nodes do not fulfill the classic criteria, they be considered as having incomplete KD. (Kato Suda, 2012)Difference amongst Roseola disease and Kawasaki disease both(prenominal) Roseola and Kawasaki disease begin with sudden high fever, but their discourses atomic number 18 very different. The fever of KD is not very responsive to acetaminophen or ibuprofen which post be used to treat the fever of Roseola. by and by the fever, KD and Roseola graphemes both catch rash but their onsets of rash ar not the same. Roseola case develops rash at the time of fever resolution, while KD case develops rash within twain to three weeks aft(prenominal) the onset of fever which may not be go downd.(Wang et al., 2009) Also, KD presents with about verbal manifestations, like erythema, edema, fissuring of lips and a strawberry tongue which cannot be found in Roseola cases. (Ely Seabury, 2010)II. Clinical understanding of Kawasakis DiseasePotential ComplicationsChildren with Kawasakis disease can develop vasculitis that causes weakening of the blood vessels and leads to aneurysms. Without treatment in time, 1 in 5 children with Kawasaki disease give develop coronary aneurysms. (Suzuki et. al., 1986) any formation of blood clot in a coronary arterial blood vessel aneurysm or rupture of a large coronary arterial blood vessel aneurysm would lead to myocardial infarction which may cause death. similarly the coronary arteries, the myocardium, valves, and pericardium can become inflammatory. Arrhythmias or freakish functioning of some heart valves, myocardial infarction and heart failure may also occur.Standard Treatments in Hong KongGuided by the Hospital Authority in Hong Kong, intravenous gamma-globulin (IVGG) and aspirin be the treatment protocols for all KD guests admitted to hospital. (Yung et. al., 2002)For evaluating the coronary arteria lesions, echocardiography are d bingle for all patients and coronary angiography and heart catheterization are performed for discriminating guests.III. Case acquire and its nursing judgement tool, a 1-yerar old baby, has been diagnosed as having Kawasaki Disease after(prenominal) admission. ray is now suspected at the acute phase (Stage I) of the disease since he shows irritability, persistent fever for 4 days and erythematous rash over his extremities.For subjective data, he has high fever and looseness of the bowels for few days fever was debase after treating with antipyretics and diarrhoea was subsided and rashes developed over his entire hands, arms, feet and legs, stated by his begin.For objective data, he is irritable, has a glary red tongue his palms and soles had erythematous rash.In approximately of the cases, leaf nodes also micturate conjunctiv itis, conceited cervical lymph nodes, inflammation of the pharynx and the oral mucosa develops with red and cracked lips and swollen joints. Beside of developing erythematous rash, shinny on the extremities may be edema and peeling. Mostly, clients suffer from cardiac problems, such as myocarditis and tachycardia. (Starkebaum, 2013) These should be assessed after admission.IV. Plan for carebreast feeding diagnosis for the case studyHyperthemia related to inflammatory disease process, increase metabolic rate and dehydration as expressd by trunk temperature greater than normal range stake for decreased cardiac interweave perfusion related to vasculitisImpaired oral mucous membrane related to inflammatory process, dehydration, and mouth breathing as evidenced by presence of bright red tongueImpaired skin uprightness related to inflammatory process, altered circulation as evidenced by having erythematous rash over palms and soles and his mummys verbalization of presence of rash o ver extremitiesRisk for imbalanced nutrition less than body requirements related to inflammation and swollen of oral mucous membrane and tongueIneffective family therapeutic victuals management related to knowledge deficit to Kawasaki disease as evidence by wrongly distinguishing Roseola and Kawasaki DiseaseNursing fretfulnesss prudence for hyperthermiaTo treat hyperthermia, cooling should be promoted by wearing lightweight and boggy clothing. This can encourage heat loss by radiation and conduction. codswallop bags can be put on the forehead or slightly neck of client. Adequate water intake is also encouraged. In order to prevent complications and promote pouffe, out front administering aspirin, nurses should monitor temperature every 4 hours until client becomes afebrile for a day. Administer antipyretic medication if confirming.Peter, in the case study, was treated with antipyretics before so his fever was lower. Continuous temperature monitoring is required. Also, incre ase his fluid intake promotes recovery and prevents dehydration. Peter will be afebrile, canvas with thermometer, and free of complications due to high-grade fever within 3 days.Management for Risk of complications and infectionAt the acute phase of KD, nurses should monitor clients cardiac condition closely by assessing clients cardiac status fixityly, i.e. once a day, including measuring the apical rate, along with assessing any symptoms of shortness of breath and SaO2 level of client. Continuous monitoring is restrained suggested even though no S/S has shown up. The goal is that Peter will not develop any complications before discharge. Assessing any deterioration condition is for evaluating nursing interventions in preventing complications.Once cardiac complications start to develop keep strict I/O and monitor SaO2 Q4H. Administer secondary oxygen as prescribed. If client continues irritable and shows cyanosis, administer sedation as prescribed to deoxidise oxygen consumpt ion and cardiac workload. Long depot FU is required.In addition, note the presence of compromised vision of patient. Bilateral conjunctival inflammation was reported to be the most common symptom of Kawasaki disease after fever. (Yun et al., 2011) Note for any redness and assess the visual ability at regular time intervals.If Peter is suspected having compromised vision, assessed by providing vision stimuli to stick out any respond, consult ophthalmologist if possible.Management for Impaired skin integrity and oral mucous membraneMost of the KD clients will have erythematous rash over body, altered mucous membrane condition and strawberry tongue, as mentioned. leaf nodes skin condition is assessed at regular time intervals. Also, nurse can apply emollients to light uponed area as ordered, and educate parents and help client to wear soft and loose clothing. Promoting nutritionary status and encourage fluid intake are important in healing of rash. For the mucosal conditions, we sh ould fork up client mouth care, lubricate his lips and provide adequate clear liquid if not contraindicated.In Peters case, the aims are preventing lesion and promoting healing of the rash of his extremities and inflammated tongue within ii weeks. Also, maintaining built-in and moist oral mucous membrane that are free of inflammation, ulceration and infection before discharge. The oral condition will not affect his appetite, so as the nutritional status, evaluated by assessing his body weight daily.Management for Altered comfortClient suffered from KD often shows irritability due to painful sensation and fever. (To deal with fever, please refer to Management for hyperthermia) Administer analgesia as prescribed to reduce the pain.A quiet environment may calm client, nurses can talk softly and avoid bright light if possible. James et al.(2013) suggested that outline the bed with soft blanket from home can promote clients sleeping quality. Encourage parents to bring clients popu lar toys and nipple may also help in comforting client. go down on should manage the procedure systematically, in order to minimize disrupting clients rest period. These actions can apply in Peters case. Peter will have adequate rest and show clam at present after having these nursing actions.Family Education close to parents may not know what Kawasaki disease is. Nurses should provide information to clients family and answer the inquiries. Clients parents are often anxious of clients condition. Assessing the parents anxiety level and explaining procedure clearly are necessary. Nurse should also comfort parents by assuring them the fever, pain and irritability of the child will resolve eventually.Focusing on the case scenario, nurse should help his mother to notice the differences between KD and Roseola, including the etiology and S/S, after Peters admission. To reduce the chances of developing complications, nurse can t distributively his mother to monitor and assess early signs of complications of heart at the routine time, such as abnormal heart rate, arrhythmia, cyanosis and lower extremities edema. Provide pamphlet about KD for his mother to read. postulation for any inquiry and let her to verbalize at least two significant signs of having complications can evaluate her understanding.To prevent further infection, clients carer should be educated to provide proper hand hygiene before touching client. It is also encouraged if we can invite her in proviso the treatment regimen, which can reduce her anxiety and promote her compliance to clients treatment regimen.Besides, since Peter is 1-year old, before Peter discharges, we should educate the mother that after IVGG treatment, vaccinations with live vaccine (e.g. MMR) should be delayed for 6 months. It is because antibodies may interfere with the immune responses to the vaccines (Salisbury Begg, 1996, as cited in Cheng, Wong So, 2003). We should make sure his mum remembers the specific dates of FU in o rder to detect abnormalities showing signs of potential complications.V. deathKawasaki Disease is a common paediatric disease, and it is different from Roseola. With early diagnosis, treatment and continuous follow-ups, it is a manageable and curative disease.Mimicry in Butterflies sampleMimicry in Butterflies ExperimentIntroductionThe experiment will be canvassing parody in butterflies. Mimicry is the similarity between two organisms that evolved to protect a species from its piranas. The similarity can be appearance, behaviour, sound or scent. Mimicry can be mutually beneficial for both organisms, or it can be damaging to one of the organisms involved. Batesian mimicry is when a virtuous species imitates the warning signals of a harmful species, it is an antipredator adaptation. The wings of the Monarch butterfly are made up of a inexorable, orange and white pattern. They are aposematic in both caterpillar and butterfly form, warning off predators with their bright sinis ter wings as a warning of their unsuitable taste. Cardenolide aglycones is responsible for the undesirable taste of the Monarch butterflies, which the caterpillars ingest while feeding on milkweed. The vicereine butterfly is distinguishable from the Monarch butterfly from its post median black line on the vein of its hindwing and it is smaller in size. Its defence against predators is mimicry of the Monarch butterfly.Hypothesis and PredictionsThe hypothesis is that mimicry in the butterflies does not have an effect on preference from the birds. Our predictions are that the birds will not acquire the model butterfly because of the bright food coloring of the model butterfly. This means that the birds will more likely choose the mimic butterfly because it is less bright coloured.AimsTo see which butterfly the birds chooses first and to test mimicry in the vicereine butterfly and to see what effect mimicry has on preference from the birds. pilot burner studyA pilot study was unde rtook at Treborth Botanical gardens. The study was designed to emulate the mimicry of the monarch butterfly by the viceroy butterfly. This was done using different colour suet pellets. Yellow suet pellets and red suet pellets were used. They both had the same flavour. This was designed so that the birds would be choosing primarily on the colour and not the taste. Five sites of study were chosen. One pile of red suet pellets and one pile of yellow suet pellets were left at each test location. The scads of suet were placed on tree branches and in bird feeders were possible, but some had to be left on the ground. This possibly could corrupt results as ground-based rodents could take away suet pellets and these are not the subject of the experiment. Of the five sites of study four lashings of red pellets were fully consumed, compared to only two sites in which the yellow suets were completely consumed. We took this as indication that the birds on site had a preference between the tw o colours of suet. However, the results may have been corrupted by fruit-eating(prenominal) birds and small mammals which may have consumed the suet pellets instead of the target bird species.Methodseggs would be collected from the area to be surveyed to ensure successful polymorphs are obtained from both species, and breeding age adult butterflies are not removed from the environment. The eggs would then be reared to adulthood (as only adult viceroys use mimicry). The butterflies would then be freeze-dried to preserve their colour and any unpalatable compounds in their tissues. This would also lower water activity and thus lower the chance of introducing bacteria and other pathogens to bird populations. The area to be surveyed would be divided into quadrats with equal and random treatments across varying habitats (as literature suggests predator density and diversity affects the success of mimicry). Per treatment a Viceroy and a Monarch butterfly would be pinned in close proximit y to each other on a tree. First preference of prey would be recorded in the case of a butterfly being eaten by a predator. Predator species could also be recorded to discover if any species (such as different Passeriform species) show a preference for either butterfly.StatisticsA chi-squared test is used as data to be generated is frequency calculate data on which butterfly was chosen first which certifies that the data matches the requirements for a one-way chi-squared test.DiscussionAfter analysing the weaknesses from the pilot study, the method was modified in the hope that it would make the plan stronger. With the issue of other predators, the ability to sack them attacking the butterfly was overcome by monitoring all test species. What was shown in our pilot study that in fact all the bright colour suet pellet was gone contradicts what we believe should occur but the stigma in the pilot study design may account for that. The pass judgment outcome for this experiment would be that batesian mimicry is shown.ReferencesChai, P. (1986). Field observations and feeding experiments on the responses of rufous-tailed jacamars (Galbula ruficauda) to free-flying butterflies in a tropical rainforest. Biological Journal of the Linnean Society, 29(3), pp.161-189.DellAglio, D., Stevens, M. and Jiggins, C. (2016). evasion of an aposematically coloured butterfly by wild birds in a tropical forest. bionomic Entomology, 41(5), pp.627-632.Flickr, (2011). Viceroy Caterpillar. image Available at https//c1.staticflickr.com/7/6185/6068401472_e8d8be1611_b.jpg Accessed 28 Feb. 2017.Guenther, L. (n.d.). characterization of a monarch caterpillar. image Available at http//www.kidzone.ws/animals/monarc1.jpg Accessed 28 Feb. 2017.King, R., Stansfield, W. and Mulligan, P. (2007). A dictionary of Genetics. 7th ed. Oxford Oxford University Press, p.278.Lindstedt, C., Eager, H., Ihalainen, E., Kahilainen, A., Stevens, M. and Mappes, J. (2011). Direction and strength of selection by predators for the color of the aposematic timber tiger moth. Behavioral Ecology, 22(3), pp.580-587.Parsons, J. (1965). A digitalis-like toxin in the monarch butterfly,Danaus plexippusL. The Journal of Physiology, 178(2), pp.290-304.Pfennig, D., Harcombe, W. and Pfennig, K. (2001). Frequency-dependent Batesian mimicry. Nature, 410(6826), pp.323-323.Ritland, D. (1998). Mimicry-related ravage on Two Viceroy Butterfly (Limenitis archippus) Phenotypes. The American Midland Naturalist, 140(1), pp.1-20.Sutherland, W. (2006). Ecological census techniques. 2nd ed. Cambridge Cambridge University Press, pp.1-446.van Zandt Brower, J. (1958). Experimental Studies of Mimicry in Some North American Butterflies Part I. The Monarch, Danaus plexippus, and Viceroy, Limenitis archippus archippus. organic evolution, 12(1), pp.32-47.Wickler, W. (1965). Mimicry and the Evolution of Animal Communication. Nature, 208(5010), pp.519-521.