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Nursing QUESTION #9255
Question 1
A 2-year-old child is brought to the OPD with fever for 3 days, strawberry tongue, cracked lips, bilateral conjunctivitis, maculopapular rash on trunk, and cervical lymphadenopathy (2.5 cm). The MOST likely diagnosis and priority nursing concern is:
  • Scarlet fever; risk of rheumatic fever
  • Kawasaki disease; risk of coronary artery aneurysm✔️
  • Measles; risk of encephalitis
  • Stevens-Johnson syndrome; skin integrity
Correct Answer Explanation

Kawasaki Disease (KD) — an acute systemic vasculitis of childhood (most common in children under 5 years).

Diagnostic Criteria — Fever ≥5 days PLUS ≥4 of 5 features:

  1. Bilateral non-purulent conjunctivitis
  2. Oral changes: strawberry tongue, cracked/erythematous lips, oropharyngeal erythema
  3. Cervical lymphadenopathy (\(\geq 1.5\,\text{cm}\))
  4. Polymorphous rash (maculopapular, truncal)
  5. Changes in extremities: erythema/edema (acute); desquamation (convalescent)

Most serious complication: Coronary artery aneurysm (CAA) — occurs in 15–25% untreated cases, reduced to <5% with treatment.

Treatment:

  • IVIG: \(2\,\text{g/kg}\) IV single dose over 10–12 hours (reduces CAA risk)
  • Aspirin: High dose \(80{-}100\,\text{mg/kg/day}\) in 4 divided doses (anti-inflammatory phase), then low dose \(3{-}5\,\text{mg/kg/day}\) (antiplatelet phase)

Priority nursing concern: Monitor for coronary aneurysm via echocardiogram at diagnosis, 2 weeks, and 6–8 weeks.