Metabolic encephalopathy is a temporary or permanent impairment of brain function resulting from various systemic metabolic disturbances. This nursing diagnosis focuses on identifying and managing symptoms, preventing complications, and promoting optimal patient outcomes through comprehensive care planning.
Causes (Related to)
Metabolic encephalopathy can develop due to various underlying conditions and factors:
Primary Metabolic Disturbances:
- Hepatic dysfunction
- Renal failure
- Diabetic ketoacidosis
- Hypoxia
- Electrolyte imbalances
- Thyroid disorders
- Severe infections
Contributing Factors:
- Advanced age
- Malnutrition
- Medication side effects
- Dehydration
- Substance abuse
- Critical illness
- Multiple organ dysfunction
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Confusion
- Memory problems
- Sleep disturbances
- Mood changes
- Difficulty concentrating
- Headaches
- Visual disturbances
- Fatigue
Objective: (Nurse assesses)
- Altered level of consciousness
- Disorientation
- Asterixis (flapping tremor)
- Abnormal vital signs
- Changes in pupillary response
- Altered reflexes
- Speech changes
- Abnormal laboratory values
Expected Outcomes
Successful management of metabolic encephalopathy is indicated by:
- Improved mental status and orientation
- Stabilized vital signs
- Normalized laboratory values
- Enhanced safety awareness
- Improved nutritional status
- Prevention of complications
- Better communication ability
- Increased participation in daily activities
Nursing Assessment
1. Mental Status Evaluation
- Monitor consciousness level
- Assess orientation
- Evaluate cognitive function
- Document behavioral changes
- Track sleep patterns
2. Physical Assessment
- Monitor vital signs
- Check neurological status
- Assess skin condition
- Evaluate muscle strength
- Monitor intake and output
3. Laboratory Monitoring
- Track electrolyte levels
- Monitor blood glucose
- Assess liver function tests
- Check kidney function
- Monitor arterial blood gases
4. Safety Assessment
- Evaluate fall risk
- Check environmental hazards
- Assess self-care ability
- Monitor for seizure activity
- Document safety precautions
5. Nutritional Status
- Monitor weight changes
- Assess appetite
- Track caloric intake
- Check for swallowing difficulties
- Monitor for malnutrition signs
Nursing Care Plans
Nursing Care Plan 1: Acute Confusion
Nursing Diagnosis Statement:
Acute Confusion related to metabolic disturbances as evidenced by disorientation, altered consciousness, and impaired cognitive function.
Related Factors:
- Electrolyte imbalances
- Organ dysfunction
- Medication effects
- Toxin accumulation
Nursing Interventions and Rationales:
- Monitor mental status regularly
Rationale: Enables early detection of changes and progression - Maintain consistent caregivers
Rationale: Reduces confusion and promotes familiarity - Implement reality orientation
Rationale: Helps maintain cognitive function and orientation
Desired Outcomes:
- The patient will demonstrate improved orientation
- The patient will show enhanced cognitive function
- The patient will maintain safety
Nursing Care Plan 2: Risk for Injury
Nursing Diagnosis Statement:
Risk for Injury related to altered mental status and impaired physical mobility as evidenced by confusion and unsteady gait.
Related Factors:
- Altered consciousness
- Poor coordination
- Sensory deficits
- Environmental hazards
Nursing Interventions and Rationales:
- Implement fall precautions
Rationale: Prevents accidents and injuries - Provide adequate lighting
Rationale: Enhances visibility and orientation - Monitor medication effects
Rationale: Prevents adverse reactions
Desired Outcomes:
- The patient will remain free from injury
- The patient will demonstrate safe behavior
- The patient will maintain physical safety
Nursing Care Plan 3: Impaired Gas Exchange
Nursing Diagnosis Statement:
Impaired Gas Exchange related to metabolic alterations as evidenced by abnormal blood gases and altered mental status.
Related Factors:
- Metabolic acidosis/alkalosis
- Respiratory compromise
- Altered oxygen delivery
- Neurological impairment
Nursing Interventions and Rationales:
- Monitor respiratory status
Rationale: Ensures adequate oxygenation - Position for optimal breathing
Rationale: Improves ventilation - Administer oxygen as ordered
Rationale: Maintains adequate oxygenation
Desired Outcomes:
- The patient will maintain normal blood gases
- The patient will demonstrate improved mental status
- The patient will maintain adequate oxygenation
Nursing Care Plan 4: Imbalanced Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than Body Requirements related to metabolic disturbances as evidenced by weight loss and poor intake.
Related Factors:
- Altered metabolism
- Poor appetite
- Impaired consciousness
- Digestive disorders
Nursing Interventions and Rationales:
- Monitor nutritional intake
Rationale: Ensures adequate nutrition - Assist with feeding
Rationale: Promotes safe food consumption - Monitor lab values
Rationale: Tracks metabolic status
Desired Outcomes:
- The patient will maintain adequate nutrition
- The patient will demonstrate weight stability
- The patient will show improved metabolic status
Nursing Care Plan 5: Disturbed Sleep Pattern
Nursing Diagnosis Statement:
Disturbed Sleep Pattern related to metabolic encephalopathy as evidenced by difficulty sleeping and altered circadian rhythm.
Related Factors:
- Metabolic changes
- Environmental factors
- Anxiety
- Pain
Nursing Interventions and Rationales:
- Maintain sleep-wake cycle
Rationale: Promotes normal circadian rhythm - Control environmental stimuli
Rationale: Enhances sleep quality - Monitor medication effects
Rationale: Prevents sleep disruption
Desired Outcomes:
- The patient will maintain a regular sleep pattern
- The patient will report improved rest
- The patient will demonstrate a normal day-night cycle
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Butterworth RF. Metabolic Encephalopathies. In: Siegel GJ, Agranoff BW, Albers RW, et al., editors. Basic Neurochemistry: Molecular, Cellular and Medical Aspects. 6th edition. Philadelphia: Lippincott-Raven; 1999. Chapter 38. Available from: https://www.ncbi.nlm.nih.gov/books/NBK20383/
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Reddy P, Culpepper K. Inpatient Management of Encephalopathy. Cureus. 2022 Feb 10;14(2):e22102. doi: 10.7759/cureus.22102. PMID: 35291547; PMCID: PMC8917954.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Slooter AJC, Otte WM, Devlin JW, Arora RC, Bleck TP, Claassen J, Duprey MS, Ely EW, Kaplan PW, Latronico N, Morandi A, Neufeld KJ, Sharshar T, MacLullich AMJ, Stevens RD. Updated nomenclature of delirium and acute encephalopathy: statement of ten Societies. Intensive Care Med. 2020 May;46(5):1020-1022. doi: 10.1007/s00134-019-05907-4. Epub 2020 Feb 13. PMID: 32055887; PMCID: PMC7210231.
