Pediatric Nursing Q 171
A child with Kawasaki disease is admitted to the pediatric ward. Which of the following medications will you expect to be a part of the treatment? Select all that apply.
A. Gamma Globulin
B. Warfarin.
C. Acetaminophen
D. Aspirin
E. Atenolol
Correct Answer: A, B, & D
The principal goal of treatment for Kawasaki disease is to prevent coronary artery disease and to relieve symptoms such as fever and joint pain so an antipyretic, antiplatelet, and gamma globulin is used. Treatment aims with Kawasaki disease point to minimize the risk of coronary artery aneurysm (CAA) formation, which peaks two to four weeks after illness onset, by decreasing the inflammation of the coronary arteries. Supportive care is also essential.
Option A: Patients should receive high dose IVIG at 2 g/kg over 10-12 hours as well as high dose aspirin (ASA) (80 mg/kg/day to 100 mg/kg/day divided every six hours) until the patient has been afebrile for over 48 hours. Ideally, IVIG should be started within 7-10 days of the onset of fever to prevent potential cardiac complications and can decrease CAA formation from 25% to 3-5%.
Option B: Low-molecular-weight-heparin or warfarin (with a goal of INR 2 to 2.5) is recommended in patients who have large CAAs, as well as an antiplatelet agent (clopidogrel or dipyridamole) to prevent thrombus formation due to decreased flow and the damaged epithelium.
Option C: This is antipyretic but is not responsive to this disease. Acetaminophen (APAP) is a non-opioid analgesic and antipyretic agent used to treat pain and fever. It is used as a single agent for mild to moderate pain and in combination with an opioid analgesic for severe pain.
Option D: ASA is believed to modulate platelet activity by downregulating inflammation and preventing thrombosis; however, there is no evidence to support that ASA actually prevents the development of CAA. It is also of note that children are at higher risk of developing Reye syndrome if they develop influenza or varicella infections while taking ASA, and children should receive the influenza vaccine and abstain from the varicella vaccine while taking ASA.
Option E: This is a beta-blocker. Atenolol is a second-generation beta-1-selective adrenergic antagonist indicated in the treatment of hypertension, angina pectoris, and acute myocardial infarction.