Encephalopathy (Hypoxic-ischemic, Metabolic, Infectious, Hepatic) for Progressive Care Certified Nurse (PCCN)

Encephalopathy (Hypoxic-ischemic, Metabolic, Infectious, Hepatic)

Definition/Etiology:

• Definition: brain disease altering brain structure or function
• Causes:
  • Hypoxic-ischemic
  • Metabolic
  • Infectious
  • Hepatic

Pathophysiology:

• Depends on cause
  • • Hypoxic-ischemic: low oxygen/perfusion
    • Metabolic: metabolic dysfunction (e.g. diabetes, renal)
    • Infectious: bacteria, virus, prion
    • Hepatic: increased ammonia

Noticing: Assessment & Recognizing Cues:

• Altered mental status*
• Progressive loss of consciousness
• Memory challenges
• Cognitive difficulties
• Subtle personality changes
• Concentration challenges
• Lethargy
• Slurred speech
• Muscle twitches
• Listen to care team- (i.e, CNA, techs, etc) and family/caregivers. Many an early catch is from a sitter or family member noticing subtle changes

Interpreting: Analyzing & Planning:

• CT scan
• MRI
• EEG
• Spinal fluid analysis
• labs, ABG’s

Responding: Patient Interventions & Taking Action:

• Depends on cause
  • Hypoxic-ischemic:
  • BP meds (if perfusion issues related to increased pressure)
  • Metabolic:
    • Manage underlying condition (e.g. diabetes)
  • Infectious:
    • Antibiotic, antiviral
  • Hepatic:
    • Lactulose
• Safety is priority, too!
  • They are more likely to get OOB, remove/tamper with lines, FALL RISK

Reflecting: Evaluating Patient Outcomes:

• Symptoms improve?
  • Slow/prevent progression of encephalopathy
  • Medication Regimen
  • Dietary/lifestyle changes

Linchpins (Key Points):

• Brain is sick from lack of nutrients or increase in toxins.
  • Notice:
    • Altered mental status
    • Interpret: Brain- CT, MRI, EEG
    • Respond: Depends on cause
    • Reflect: slow/prevent progression

Cleveland Clinic. (2022). Hepatic encephalopathy. https://my.clevelandclinic.org/health/diseases/21220-hepatic-encephalopathy.Cleveland Clinic. (2022). Hepatic encephalopathy. https://my.clevelandclinic.org/health/diseases/21220-hepatic-encephalopathy.