Nursing Care Plan for Reye’s Syndrome

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 of developing Reye’s syndrome.

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:

  • Fatigue
  • Excessive drowsiness
  • Irritability
  • Changes in personality
  • Headaches

Objective Data:

  • Vomiting
  • Diarrhea
  • Confusion and disorientation
  • Weakness of extremities
  • Seizures
  • Loss of consciousness

Nursing Interventions and Rationales

  1. Assess and monitor vital signs

  2. 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.

  3. Perform complete assessment of systems including neurological status

  4. Help determine staging of disorder and treatment required. Seizures,  loss of reflexes, posturing and lack of pupil reaction indicate more advanced neurologic involvement.

  5. Monitor blood glucose levels

  6. Drops in blood glucose can indicate elevated ammonia levels.  Hyper- and hypoglycemia can result in further complications of the condition.

  7. Initiate IV and monitor fluid balance

  8. Maintain hydration with presence of vomiting or diarrhea. Watch for signs of fluid overload.

  9. Initiate seizure safety precautions  per facility protocol

  10. Place infant or toddler in crib with padding, raise bed rails for older children in case of seizures. Keep oxygen and suction readily available

  11. Assess for signs of increased intracranial pressure

  12. Monitoring may be done with intraventricular catheter. Prevent swelling of the brain if possible to reduce risk of brain damage.

  13. Administer medications and blood products as required per facility protocol

  14. 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.

  15. Monitor diagnostic tests and labs

  16. Watch for jaundice and elevation of liver enzymes and ammonia levels.

  17. Provide postoperative and wound care as necessary

  18. Patient may be required to undergo craniotomy to relieve intracranial pressure. Prevent infection at the incision site, which could lead to meningitis.

  19. 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.


References

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