Nursing Care Plan (NCP) for Reye’s Syndrome

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Outline

Pathophysiology

Reye’s syndrome is a rare condition that causes swelling of the liver and brain and most often occurs in children following a viral illness such as flu or chickenpox in combination with taking aspirin. Reye’s syndrome is a serious condition with no known cure that can be life threatening.  Treatment involves symptomatic care and support.

Etiology

Certain toxins, usually salicylates (aspirin), attack the liver cells causing them not to filter and regulate blood sugar and ammonia levels.  As the blood sugar level drops from vomiting, the ammonia and acidity levels rise causing the liver and brain to swell and may result in seizures or coma. Studies show that children who take aspirin or aspirin-containing products during or following a viral illness, specifically influenza and chickenpox, are at greater risk.

Desired Outcome

Patient will maintain adequate respiratory status and optimal neurologic functioning; patient will maintain adequate fluid balance

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 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.

Writing a Nursing Care Plan (NCP) for Reye’s Syndrome

A Nursing Care Plan (NCP) for Reye’s Syndrome starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


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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