If the fetal monitor demonstrates a specific pattern, which action would the nurse perform first?

Choice A rationale

Coronary thrombosis is a life-threatening complication where a blood clot forms in a coronary artery, leading to a myocardial infarction. Kawasaki disease causes inflammation of the blood vessels (vasculitis), which can damage the endothelium of the coronary arteries. This damage creates a site for clot formation, which can occlude blood flow and cause severe myocardial ischemia or death.

Choice B rationale

Coronary stenosis is a narrowing of the coronary arteries. While it can be a long-term complication of Kawasaki disease, leading to restricted blood flow, it is generally considered a less immediate and life-threatening complication than an acute thrombosis or aneurysm. The stenosis itself is not the most serious acute event, although it does increase the risk of later cardiac events.

Choice C rationale

A decreased sedimentation rate, or ESR, would not be a complication. In fact, an elevated ESR is a hallmark of the acute inflammatory process in Kawasaki disease. The ESR measures the rate at which red blood cells settle, which is increased during inflammation due to the presence of acute-phase proteins. A decreased ESR would indicate a reduction in inflammation, not a complication.

Choice D rationale

Coronary artery aneurysm is a primary serious complication of Kawasaki disease. The vasculitis can weaken the arterial walls, leading to the formation of aneurysms. These aneurysms can rupture, causing a hemorrhage, or they can be the site of a thrombosis. Aneurysms are a significant source of long-term morbidity and mortality in children with the disease.

Choice E rationale

Hypocoagulability, or a reduced ability to form blood clots, is not a complication of Kawasaki disease. In the acute phase, patients are more likely to be in a hypercoagulable state due to the systemic inflammatory response. This increased risk of clotting is what makes coronary thrombosis a significant concern, not hypocoagulability

Choice A rationale

Rapid breathing games would worsen the child's condition. Rapid breathing, or hyperventilation, can lead to respiratory alkalosis, which is an imbalance in the body's acid-base balance. It can also cause dehydration and further irritate the respiratory tract, increasing the child's discomfort and potentially exacerbating the symptoms of the upper respiratory infection.

Choice B rationale

Enforcing strict bed rest is generally not necessary and can sometimes be detrimental. While rest is important, complete immobility can increase the risk of complications such as pneumonia due to a lack of lung expansion. Moderate activity is often encouraged to prevent pooling of secretions and to maintain normal respiratory function.

Choice C rationale

Limiting fluid intake is contraindicated. Adequate hydration is crucial for a child with an upper respiratory infection. Fluids help to thin respiratory secretions, making them easier to clear from the airways, and prevent dehydration, which can be a significant risk, especially if the child has a fever.

Choice D rationale

Increasing room humidity is a beneficial measure. Humidified air helps to soothe inflamed respiratory passages and moisten secretions, making them less viscous and easier for the child to cough up. This can significantly reduce nasal congestion, cough, and throat irritation, improving the child's ability to breathe comfortably.