Encephalopathy (Hypoxic-ischemic, Metabolic, Infectious, Hepatic) for Progressive Care Certified Nurse (PCCN)
Included In This Lesson
Outline
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
- Notice:
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.
Transcript
References
- Cleveland Clinic. (2022). Hepatic encephalopathy. https://my.clevelandclinic.org/health/diseases/21220-hepatic-encephalopathy.
- National Institute of Health [NIH]. (2022). Encephalopathy. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/health-information/disorders/encephalopathy#:~:text=Encephalopathy%20may%20be%20caused%20by,metals)%2C%20chronic%20progressive%20trauma%2C.
NCLEX
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