Reye’s syndrome

Reye’s Syndrome Nursing Care Plans Diagnosis and Interventions

Reye’s syndrome NCLEX Review Care Plans

Nursing Study Guide on Reye’s Syndrome

Reye’s syndrome is an extremely rare condition that causes serious damage to the liver and the brain. It commonly affects children and young adults below 18 years of age.

Most cases are recorded in children between 4 to 12 years old. The exact cause of Reye’s syndrome is unknown; however, its occurrence is highly associated with aspirin use and viral illnesses such as seasonal flu and chickenpox.

Due to the association of Reye’s syndrome to aspirin use, it has been recommended that other over-the-counter medications should be used to treat fever and pain in children and young adults.

Reye’s syndrome can cause serious complications, including death. Immediate intervention is necessary to prevent the condition from worsening.

Signs and Symptoms of Reye’s Syndrome

  • Persistent, uncontrolled vomiting
  • Neurological symptoms
    • Changes in the level of consciousness
    • Irritability
    • Restlessness
    • Disorientation
    • Lethargy
    • Memory impairment
    • Stupor or lack of consciousness of one’s surroundings
    • Coma
    • Mydriasis or dilation of the pupils of the eyes
    • Tachypnea
    • Tachycardia
    • Loss of reflexes
    • Abnormal posturing including decerebration and decortication rigidity
    • Severe anxiety associated with hallucinations
  • Hepatic symptoms
    • Hepatomegaly – enlarged liver
    • High levels of liver enzymes
  • Low blood sugar levels
  • Increased blood ammonia levels
  • Increased blood acidity

The signs and symptoms of Reye’s syndrome may vary. A grading system has been developed by clinicians to signify the severity of the disease.

  • Grades I, II, and III are considered mild to moderate cases
  • Grades IV and V signify severe Reye’s syndrome

The signs and symptoms of Reye’s syndrome begin with a defect in mitochondrial functioning which reduces liver activities.

Reye’s syndrome also causes an abnormal accumulation of fluid in the brain tissues also known as cerebral edema. Other conditions produce the same symptoms as Reye’s syndrome and they are referred to as “Reye-like diseases.” These metabolic disorders include urea cycle disorders (UCD) and organic acidurias.

Causes of Reye’s Syndrome

The exact cause of Reye’s syndrome is unknown; however, this condition is highly associated with:

  1. Aspirin use following a viral illness or infection in young people
  2.  Fatty acid oxidation disorders – metabolic conditions characterized by the body’s inability to break down fatty acids due to a defective or missing liver enzyme. Screening tests are available to identify the presence of these hereditary disorders.

Complications of Reye’s Syndrome

Complications are rare in Reye’s syndrome. However, serious problems can arise when the brain swelling progresses rapidly and is not controlled.

Long-term difficulties associated with serious cases of Reye’s syndrome are as follows:

  • Poor attention span and memory
  • Loss of vision or loss of hearing
  • Problems with speech and language
  • Difficulties with movement and posture
  • Dysphagia or difficulty swallowing
  • Problems in the performance of activities of daily living

Diagnosis of Reye’s Syndrome

Reye’s syndrome is a very rare disorder. Its diagnosis is not dependent on a single procedure, rather, it is identified through the results of several tests, investigations, and exclusion of other possible causes. Tests will include procedures to rule out associated conditions such as meningitis, encephalitis, and inherited metabolic disorders.

  • Laboratory tests
    • Liver function test – this blood test may yield an elevated level of transaminase. An elevated bilirubin level may also be noted but it is not common.
    • Prothrombin time – a slightly prolonged prothrombin time is common in Reye’s syndrome
    • Ammonia levels – an increase of up to 1.5 times the normal level may be noted.
    • Blood glucose levels – hypoglycemia or low serum blood glucose level is a feature of severe cases of Reye’s syndrome
    • Urea and electrolyte levels
    • Salicylate levels
    • Lactate dehydrogenase
  • Urinalysis – specific gravity may be raised in Reye’s syndrome; ketonuria, or the presence of ketones in the urine, is seen in 80% of cases.
  • CT or MRI of the brain – imaging of the brain may display the presence or extent of cerebral edema. It can also help rule out other possible conditions.
  • Lumbar tap – a lumbar puncture test may be performed to rule out other medical conditions such as meningitis.
  • Liver biopsy
  • Electroencephalogram (EEG) – results showing slow waves are common in the early stages of Reye’s syndrome, while flattened waves are seen later on in the disease.

Treatment for Reye’s Syndrome

The treatment for Reye’s syndrome is aimed at the prevention and correction of metabolic abnormalities and intracranial pressure.

Early recognition and medical management improve the outcome of treatment and prevent serious deficits. There is no specific treatment for Reye’s syndrome; however, the following interventions help manage the disease:

  1. Alterations in the environment to reduce stimulations and prevent an unnecessary increase in intracranial pressure
  2. Maintenance of airway, breathing, and circulation to maintain perfusion of brain cells
  3. Monitoring of glucose levels to ensure that the patient’s blood glucose levels are normal and hypoglycemia is prevented
  4. Monitoring of blood pressure levels
  5. Monitoring of blood chemistry and providing treatment as necessary
  6. Antiemetics may be helpful to control vomiting
  7. Anticonvulsants may be used to treat seizures

Nursing Care Plans for Reye’s Syndrome

Nursing Care Plan 1

Nursing Diagnosis: Ineffective Tissue Perfusion (Cerebral) related to diminished blood flow to the brain secondary to Reye’s syndrome as evidenced by drowsiness, changes in levels of consciousness/ mentation, irritability, and memory problems

          Desired Outcome: The patient will have an improved cerebral tissue perfusion as evidenced by increased level of consciousness (i.e. awake and alert) and will have an oriented with persons, places, and things.

InterventionsRationales
Assess the patient’s vital signs and neurological status at least every 4 hours, or more frequently if there is a change in them.To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment for Reye’s syndrome.
Observe the patient for any signs and symptoms of increased intracranial pressure (ICP), such as sudden headache, vomiting, and decreased alertness.To facilitate early detection and management of increased ICP.
Increased ICP can be life-threatening as it may lead to brain damage, stroke, or coma.
Stop aspirin use and provide safe alternatives for pain or fever management as prescribed by the physician.Aspirin use following a viral illness or infection in young people is found in many cases of Reye’s syndrome.
Administer osmotic diuretics (e.g. Mannitol) as prescribed.To promote blood flow to the brain and to reduce cerebral edema.
Elevate the head of the bed at 30 degrees.To promote venous drainage from the patient’s head to the rest of the body in order to decrease ICP and reduce cerebral edema.
Screen the patient for fatty acid oxidation disorders.  These metabolic conditions are characterized by the body’s inability to break down fatty acids due to a defective or missing liver enzyme. They are associated as possible causes of Reye’s syndrome.
Administer medications for symptomatic relief as prescribed.Antiemetics may be helpful to control vomiting. Anticonvulsants may be used to treat seizures.  
Reduce any stimuli that may increase ICP, such as too much noise or light.To reduce stimulations and prevent an unnecessary increase in intracranial pressure

Nursing Care Plan 2

Nursing Diagnosis: Risk for Injury related to loss of sensory coordination and cognitive deficits resulting to seizures

Desired Outcome: The patient will be able to prevent trauma or injury by means of maintaining his/her treatment regimen to control or eliminate seizure activity.

InterventionsRationales
Explore the usual seizure pattern of the patient and enable to patient and caregiver to identify the warning signs of an impending seizure.To empower the patient and his/her caregiver to recognize a seizure activity and help protect the patient from any injury or trauma. To reduce the feeling of helplessness on both the patient and the caregiver.  
Place the bed in the lowest position. Put pads on the bed rails and the floor.To prevent or minimize injury in a patient during a seizure.
Advise the caregiver to stay with the patient during and after the seizure.To promote safety measures and support to the patient. To ensure that the patient is safe if the seizure recurs.
Administer prescribed medications such as benzodiazepines, anticonvulsants, anti-epileptics, and other anti-seizure drugs.To prevent or control the occurrence of seizures.
During seizure, turn the patient’s head to the side, and suction the airway if needed.   Use a plastic bite block only when the jaw is relaxed.To maintain a patent airway. Avoid inserting the plastic bite block when the teeth are clenched to prevent any dental damage. Do not use wooden tongue depressors as they can break or splinter, causing oral damage.

Nursing Care Plan 3

Nursing Diagnosis: Anxiety related to neurological manifestations of Reye’s syndrome, as evidenced by irritability, restlessness, shortness of breath, disorganized thought process, and hallucinations

Desired Outcome: The patient will be able to reduce his/her anxiety level.

InterventionsRationales
Assess the anxiety level of the patient, anxiety triggers and symptoms by asking open-ended questions.To establish a baseline observation of the anxiety level of the patient. Open-ended questions can help explore the thoughts and feelings of the patient.
Ensure to speak in a calm and non-threatening manner to the patient. Maintain eye contact when communicating with him/her. Provide a comfortable environment by providing sufficient lighting, good ventilation, and reduced noise levels. Respect the personal space of the client but sit not too far from him/her.A calm voice and a comfortable environment can help the patient feel secured and comfortable to speak about his/her worries and fears. The client may become more relaxed and open for discussion if he/she sees the nurse as calm and appears to be in control.
Do not leave the patient when the anxiety levels are high, especially during a panic attack. Re-assure that the healthcare team are here to help him/her.To ensure the patient’s safety against self-harm. Leaving the patient alone during heightened levels of anxiety is dangerous.  
Discuss with the patient and significant other/s the available treatments for anxiety.Anxiety is treatable. Psychotherapy involves speaking with a licensed therapist and going through how to gradually cope with the symptoms. Psychotherapy is an effective and proven treatment for anxiety disorders. Medications such as anxiolytics and antidepressants can help the patient cope with anxiety.
Administer medications as prescribed. Educate the patient about each drug’s benefits, side effects, and proper administration details.Anxiolytics and certain antidepressants are often prescribed for anxiety disorders. Sedatives such as benzodiazepines may be prescribed for short-term anxiety relief.
Provide a supportive approach by giving simple and short directions.The patient has a limited attention span and is irritable or restless, thus simple and short directions are important in helping the patient cope with the situation.
Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation.To promote relaxation and reduce stress levels.

Other possible nursing diagnoses:

  • Risk for Fall
  • Risk for Ineffective Breathing Pattern
  • Deficient Fluid Volume

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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