Nursing Care Plan (NCP) for Reye’s Syndrome
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Lesson Objective for Reye’s Syndrome
- Understanding Reye’s Syndrome:
- Develop a comprehensive understanding of Reye’s Syndrome, including its pathophysiology, clinical manifestations, and the populations most at risk.
- Recognition of Early Signs and Symptoms:
- Identify the early signs and symptoms of Reye’s Syndrome, emphasizing the importance of prompt recognition for timely intervention and improved outcomes.
- Knowledge of Risk Factors:
- Gain insight into the risk factors associated with Reye’s Syndrome, particularly the connection to aspirin use in children during viral infections, enabling proactive education and preventive measures.
- Effective Nursing Interventions:
- Acquire knowledge about evidence-based nursing interventions and care strategies for patients with Reye’s Syndrome, focusing on supportive care, monitoring, and collaboration with the healthcare team.
- Patient and Family Education:
- Develop effective communication skills to educate patients and their families about Reye’s Syndrome, its prevention, and the importance of avoiding aspirin in children with viral illnesses.
Pathophysiology of Reye’s Syndrome
- Mitochondrial Dysfunction:
- Reye’s Syndrome involves a disruption in mitochondrial function, particularly in the liver cells. This impairment leads to a decrease in the production of adenosine triphosphate (ATP), the primary energy source for cells.
- Fatty Acid Accumulation:
- As a consequence of mitochondrial dysfunction, there is an abnormal accumulation of fatty acids in the liver. This accumulation can result in hepatic steatosis (fatty liver), leading to liver dysfunction.
- Hyperammonemia:
- The impaired liver function in Reye’s Syndrome hinders the normal breakdown of ammonia, leading to elevated levels of ammonia in the bloodstream. Hyperammonemia contributes to neurological symptoms and complications.
- Cerebral Edema and Encephalopathy:
- The elevated ammonia levels and metabolic disturbances can lead to cerebral edema, causing an increase in intracranial pressure. This results in encephalopathy, presenting as altered mental status, seizures, and potentially life-threatening neurological complications.
- Association with Viral Infections and Aspirin Use:
- Reye’s Syndrome is often associated with preceding viral infections, particularly influenza and varicella (chickenpox). Additionally, the use of aspirin during or after these viral infections, especially in children and adolescents, has been identified as a significant risk factor for the development of Reye’s Syndrome.
Etiology of Reye’s Syndrome
- Viral Infections:
- Reye’s Syndrome is often preceded by viral infections, with influenza and varicella (chickenpox) being commonly associated. The viral infection sets the stage for the subsequent development of Reye’s Syndrome.
- Aspirin Use in Children:
- A significant risk factor for Reye’s Syndrome is the use of aspirin (acetylsalicylic acid) in children and adolescents during or after viral infections. Aspirin has been specifically linked to the development of Reye’s Syndrome, especially when used to manage symptoms of viral illnesses.
- Age Group Susceptibility:
- Reye’s Syndrome primarily affects children and teenagers, with the majority of cases occurring in individuals under the age of 18. There is a lower incidence in adults.
- Seasonal Variation:
- Cases of Reye’s Syndrome often exhibit a seasonal variation, coinciding with the peak occurrence of viral infections, particularly influenza and varicella, which are more prevalent during specific times of the year.
- Genetic Predisposition:
- While the exact genetic factors contributing to Reye’s Syndrome are not fully understood, there may be a genetic predisposition that influences an individual’s susceptibility to the syndrome, especially when combined with viral infections and aspirin use.
Desired Outcome for Reye’s Syndrome
- Stabilization of Metabolic Function:
- Achieve and maintain metabolic stability by addressing mitochondrial dysfunction, reducing hyperammonemia, and restoring normal cellular energy production.
- Resolution of Neurological Symptoms:
- Attain a resolution of neurological symptoms, including encephalopathy, seizures, and altered mental status, through appropriate interventions and supportive care.
- Recovery of Liver Function:
- Promote the recovery of liver function by addressing hepatic steatosis and mitigating damage, facilitating the normalization of liver enzymes and overall hepatic performance.
- Prevention of Complications:
- Prevent or minimize complications associated with Reye’s Syndrome, such as cerebral edema, organ failure, and secondary infections, to improve overall prognosis and reduce long-term sequelae.
- Full Restoration of Health:
- Aim for the complete restoration of health, ensuring that the patient can resume normal activities and functions without persistent neurological deficits or compromised organ function.
Reye’s Syndrome Nursing Care Plan
Subjective Data:
- Headaches
- Fatigue
- Excessive drowsiness/lethargy
- Changes in personality
- Irritability
Objective Data:
- Vomiting
- Diarrhea
- Confusion/disoriented/hallucinations
- Weakness of extremities
- Seizures
- Loss of consciousness
Nursing Assessment for Reye’s Syndrome
- Medical History:
- Obtain a detailed medical history, with a specific focus on recent viral infections, including symptoms, duration, and any associated treatments. Inquire about the use of medications, especially aspirin, and assess the timeline of symptom onset.
- Neurological Assessment:
- Conduct a thorough neurological assessment, including the evaluation of mental status, level of consciousness, responsiveness, and presence of neurological symptoms such as seizures, irritability, or lethargy.
- Vital Signs Monitoring:
- Continuously monitor vital signs, paying close attention to temperature variations, as Reye’s Syndrome can be associated with hyperthermia. Frequent temperature checks are crucial for detecting changes promptly.
- Gastrointestinal Assessment:
- Assess gastrointestinal symptoms such as vomiting, nausea, and signs of hepatic dysfunction, including jaundice and changes in bowel habits. Document the frequency and characteristics of vomiting.
- Fluid and Electrolyte Balance:
- Monitor fluid intake and output to assess hydration status. Reye’s Syndrome can lead to fluid and electrolyte imbalances, and prompt intervention is necessary to maintain homeostasis.
- Liver Function Tests:
- Obtain and monitor liver function tests, including serum transaminases, bilirubin, and coagulation profile. Assess for signs of hepatic dysfunction, such as hepatomegaly and jaundice.
- Blood Ammonia Levels:
- Monitor blood ammonia levels regularly, as elevated ammonia is a characteristic feature of Reye’s Syndrome and is associated with neurological symptoms. Early detection allows for timely intervention.
- Respiratory Assessment:
- Assess respiratory status, including respiratory rate, effort, and oxygen saturation. Closely monitor for signs of respiratory distress or failure, which may indicate complications such as cerebral edema.
- Skin Assessment:
- Conduct a thorough skin assessment to identify any rashes, petechiae, or signs of poor perfusion. Skin findings may provide additional clues to the overall condition and help guide interventions.
Implementation for Reye’s Syndrome
- Supportive Care:
- Provide meticulous supportive care to address the specific needs of the patient. This includes maintaining a quiet and calm environment to minimize stimuli that could exacerbate neurological symptoms.
- Fluid and Electrolyte Management:
- Administer intravenous fluids judiciously to maintain hydration and correct electrolyte imbalances. Monitor fluid balance closely, adjusting the infusion rate based on the patient’s response and ongoing assessments.
- Hepatic Support:
- Collaborate with the healthcare team to implement measures to support hepatic function. This may involve avoiding hepatotoxic medications, providing nutritional support, and closely monitoring liver function tests.
- Neurological Monitoring and Management:
- Continuously monitor neurological status, promptly intervening if signs of increased intracranial pressure or neurological deterioration occur. Administer antiepileptic medications as prescribed to manage seizures effectively.
- Prevent Complications:
- Implement strategies to prevent complications, particularly cerebral edema. This may involve the use of osmotic agents, positioning to optimize cerebral perfusion, and collaboration with the medical team for potential interventions such as hyperventilation.
- Collaborative Multidisciplinary Care:
- Engage in ongoing collaboration with a multidisciplinary team, including physicians, pharmacists, and other healthcare professionals. Regular communication and coordination are essential for optimizing patient care and addressing evolving needs.
Nursing Interventions and Rationales
| Nursing Intervention (ADPIE) | Rationale |
| Assess and monitor vital signs | Determine oxygenation and respiratory status. Get baseline data to determine effectiveness of interventions.
Changes in temperature can indicate damage to the brain and difficulty regulating temperature. |
| Perform complete assessment of systems including neurological status | Help determine staging of disorder and treatment required. Seizures, loss of reflexes, posturing and lack of pupil reaction indicate more advanced neurologic involvement. |
| Monitor blood glucose levels | Drops in blood glucose can indicate elevated ammonia levels. Hyper- and hypoglycemia can result in further complications of the condition. |
| Initiate IV and monitor fluid balance | Maintain hydration with presence of vomiting or diarrhea. Watch for signs of fluid overload. |
| Initiate seizure safety precautions per facility protocol | Place infant or toddler in crib with padding, raise bed rails for older children in case of seizures. Keep oxygen and suction readily available |
| Assess for signs of increased intracranial pressure | Monitoring may be done with intraventricular catheter. Prevent swelling of the brain if possible to reduce risk of brain damage. |
| Administer medications and blood products as required per facility protocol | Medications may be given to manage symptoms of vomiting, diarrhea, fever, hyper- or hypoglycemia, seizures, swelling and pain.
Patients with liver involvement are at risk for bleeding due to effect on clotting factors. Blood products may transfused or plasma and platelets may be given to prevent bleeding. |
| Monitor diagnostic tests and labs | Watch for jaundice and elevation of liver enzymes and ammonia levels. |
| Provide postoperative and wound care as necessary | Patient may be required to undergo craniotomy to relieve intracranial pressure. Prevent infection at the incision site, which could lead to meningitis. |
| Provide communication, support and education for parents / caregivers | Help reduce anxiety in family members with frequent updates and support.
Help increase understanding of disease and risk factors. Provide resources for home care or long-term needs. |
Evaluation for Reye’s Syndrome
- Neurological Status:
- Evaluate improvements or deterioration in neurological status, including changes in consciousness, responsiveness, and the presence of seizures. Compare current assessments with baseline data to gauge the effectiveness of interventions.
- Fluid and Electrolyte Balance:
- Assess the patient’s fluid and electrolyte balance, monitoring for improvements in hydration status and correction of any imbalances. Evaluate urine output, serum electrolyte levels, and overall fluid responsiveness.
- Liver Function:
- Review liver function tests to assess improvements in hepatic function. Monitor serum transaminases, bilirubin levels, and coagulation profile to determine the effectiveness of interventions aimed at supporting the liver.
- Resolution of Symptoms:
- Evaluate the resolution of presenting symptoms, such as vomiting, jaundice, and gastrointestinal distress. Document improvements in overall well-being and the absence of signs and symptoms associated with Reye’s Syndrome.
- Prevention of Complications:
- Assess the success of preventive measures in avoiding complications, particularly cerebral edema. Monitor for any signs of increased intracranial pressure and evaluate the effectiveness of interventions aimed at preventing or managing complications.
References
https://www.mayoclinic.org/diseases-conditions/reyes-syndrome/symptoms-causes/syc-20377255
http://www.reyessyndrome.org/treat.html
https://my.clevelandclinic.org/health/articles/6088-reyes-syndrome
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Transcript
Hi everyone. Today, we are going to be creating a nursing care plan for Reye’s syndrome. So let’s get started. First. We’re going to go over pathophysiology. Reye’s syndrome is a rare condition that causes swelling of the liver and brain. It most often occurs in children following a viral illness, such as the flu or the chicken pox in combination with taking aspirin. Some nursing considerations: you want to assess vital signs, perform a complete system assessment, assess intracranial pressure, lab values, implement seizure precautions, administer medications or blood products, and educate the parent or the caregiver. Desired outcome: patients are going to maintain adequate respiratory status, optimal neurologic functioning, and the patient will remain in adequate fluid balance.
So we’re going to go through the care plan. Here we’re going to be writing some subjective data and some objective data. What are some things we’re going to see in a patient that has Reye’s Syndrome? One of the main things you’re going to see or that they’re going to complain about headaches. And some objective data you’re going to see is there’s going to be some confusion, disorientation, and some weakness. Some other things to keep in mind for these patients: they’ll have some fatigue, extreme drowsiness, maybe some changes in personality, or irritability. You’ll also see possible diarrhea, hallucinations, seizures, and loss of consciousness.
So what are some inter interventions that we’re going to do as nurses? One of the main things that we’re going to do is we’re going to assess and monitor their vital signs. So we’re going to determine oxygenation and respiratory status, so you want to make sure you’re getting baseline data to determine the effectiveness of the interventions that you are giving. Any sort of changes in temperature can indicate damage to the brain itself or difficulty regulating their temperature. Another intervention that we’re going to be looking for is a complete assessment of systems, such as neurological status. So you want to help determine staging of this disorder and treatment required. Seizures, loss of reflexes, posturing,lack of pupil reaction can indicate more of an advanced neurologic involvement with these patients. Another intervention we’re going to do is monitor their blood glucose levels – a drop in blood glucose can indicate elevated ammonia levels. hyper and hypoglycemia can result in further complications of this condition. Other interventions we’re going to want to initiate are seizure precautions or seizure safety. And have seizure precautions per protocol. So you want to make sure you’re placing the infant or the toddler in a crib with padding, and raise the bedrails up for older children in case of seizures. You want to make sure you’re keeping their oxygen and suction readily available by the crib or bed in case you may need it. Other interventions that we’re going to be doing: you want to make sure you’re assessing for signs of intracranial pressure. Monitoring may be done with an intraventricular catheter, which will prevent the swelling of the brain if possible, and reduce the risk of brain damage. Another intervention we’re going to be doing is we’re going to administer any sort of medications or blood products. And why do we do this? So, medications may be given to manage symptoms of vomiting, diarrhea, fever, hyper or hypoglycemia, swelling, and pain for these patients. Due to liver involvement, patients are at risk for bleeding due to the effect on clotting factors. So, blood products may be transfused or plasma and platelets may be given and able to prevent bleeding in these patients. Another thing we’re going to be doing for intervention is monitoring diagnostics and other lab values. We’re going to watch for jaundice and any sort of elevation in liver enzymes, And we’re also going to be looking for increased ammonia.
All right. So we’re going to go over some key points. So pathophysiology: it’s a rare condition that causes swelling of the liver and brain. It most often occurs in children following a viral illness, such as the flu or chickenpox. Some subjective and objective data that you’re going to see in these patients: you’re going to see headache, fatigue, excessive drowsiness, irritability, vomiting, diarrhea, confusion, disorientation, weakness of the extremities, seizures, loss of consciousness. Also, make sure you’re assessing their vital signs, doing a complete systems assessment, assessing the intracranial pressure, monitor blood glucose levels and liver enzymes since they will likely be elevated in these patients, and seizures. You want to make sure you’re placing these patients on seizure precautions, administering any sort of medications and or blood products as required. Awesome.
We love you guys. Go out and be your best self today and, as always, happy nursing.
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