Reye’s syndrome is a rare but serious condition that causes swelling in the liver and brain. It most often affects children and teenagers recovering from a viral infection, such as chickenpox or the flu.
Reye’s syndrome can occur when someone takes aspirin to treat a viral illness or infection, especially in children and teens. This condition progresses rapidly and can be life-threatening if not diagnosed and treated promptly.
Causes (Related to)
Reye’s syndrome can result from various factors that contribute to its development. The following are common causes of Reye’s syndrome:
- Use of aspirin or aspirin-containing medications in children and teenagers with viral infections
- Recent viral infections, particularly influenza or chickenpox
- Exposure to certain toxins or chemicals
- Genetic predisposition or metabolic disorders
- Fatty acid oxidation disorders
- Salicylate sensitivity
Signs and Symptoms (As evidenced by)
Reye’s syndrome can manifest with a variety of signs and symptoms. In a physical assessment, a patient with Reye’s syndrome may present with one or more of the following:
Subjective: (Patient reports)
- Persistent or recurrent vomiting
- Extreme fatigue or lethargy
- Confusion or disorientation
- Headache
- Vision changes
Objective: (Nurse assesses)
- Rapid breathing (hyperventilation)
- Irritability or aggressive behavior
- Seizures
- Loss of consciousness
- Abnormal posturing (decorticate or decerebrate)
- Elevated liver enzymes
- Decreased blood glucose levels
- Increased ammonia levels
- Prolonged prothrombin time
- Elevated intracranial pressure
Expected Outcomes
The following are the common nursing care planning goals and expected outcomes for Reye’s syndrome:
- The patient will maintain stable vital signs within normal limits
- The patient will demonstrate an improved level of consciousness
- The patient will maintain adequate cerebral perfusion
- The patient will exhibit normal liver function tests
- The patient will maintain stable blood glucose levels
- The patient will show no signs of increased intracranial pressure
- The patient will have no occurrence of seizures
- Patient and family will demonstrate an understanding of Reye’s syndrome and its management
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. The following section will cover subjective and objective data related to Reye’s syndrome.
- Monitor vital signs closely.
Assess for changes in blood pressure, heart rate, respiratory rate, and temperature. These can indicate the progression of the syndrome or the development of complications. - Assess neurological status frequently.
Use the Glasgow Coma Scale (GCS) to evaluate the level of consciousness, pupillary reactions, and motor responses. Changes in neurological status can indicate worsening cerebral edema. - Evaluate for signs of increased intracranial pressure.
Check for headache, vomiting, altered level of consciousness, papilledema, and abnormal posturing. These symptoms may indicate dangerously high intracranial pressure. - Monitor blood glucose levels.
Hypoglycemia is common in Reye’s syndrome and can worsen neurological symptoms. - Assess liver function.
Monitor liver enzymes, bilirubin levels, and prothrombin time. Liver dysfunction is a hallmark of Reye’s syndrome. - Evaluate respiratory status.
Assess respiratory rate, depth, and pattern. Watch for signs of respiratory distress or failure. - Monitor fluid and electrolyte balance.
Check for signs of dehydration, electrolyte imbalances, and fluid overload. - Assess for bleeding tendencies.
Watch for easy bruising, prolonged bleeding from puncture sites, or other signs of coagulopathy. - Evaluate nutritional status.
Assess for signs of malnutrition or metabolic imbalances. - Gather information about recent illnesses and medication use.
Inquire about recent viral infections and use of aspirin or salicylate-containing products.
Nursing Interventions
Nursing interventions and care are essential for the patient’s recovery from Reye’s syndrome. In the following section, you’ll learn about possible nursing interventions for a patient with Reye’s syndrome.
- Maintain a patent airway.
Ensure proper positioning and suction as needed to prevent aspiration. Be prepared for potential intubation if respiratory status deteriorates. - Monitor and manage intracranial pressure.
Elevate the head of the bed 30-45 degrees, minimize stimulation, and administer osmotic diuretics as ordered. - Provide seizure precautions.
Ensure a safe environment, pad side rails, and have seizure medication readily available. - Manage fluid and electrolyte balance.
Administer IV fluids as ordered and monitor intake and output closely. - Control blood glucose levels.
Administer glucose as ordered and monitor blood glucose levels frequently. - Protect the liver.
Avoid hepatotoxic medications and monitor liver function tests closely. - Provide nutritional support.
Collaborate with a dietitian to ensure adequate nutrition, possibly through enteral or parenteral feeding. - Manage pain and discomfort.
Administer pain medication as ordered, avoiding aspirin and NSAIDs. - Prevent complications.
Implement measures to prevent deep vein thrombosis, pressure ulcers, and hospital-acquired infections. - Provide emotional support and education.
Offer support to the patient/family and educate them about Reye’s syndrome, its management, and prevention.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for Reye’s syndrome.
Care Plan 1: Increased Intracranial Pressure
Nursing Diagnosis Statement:
Risk for Increased Intracranial Pressure related to cerebral edema secondary to Reye’s syndrome.
Related factors/causes:
- Cerebral edema associated with Reye’s syndrome
- Altered cerebral blood flow
- Metabolic disturbances
Nursing Interventions and Rationales:
- Monitor neurological status every 2 hours or as ordered.
Rationale: Allows for early detection of changes in neurological function and prompt intervention. - Elevate the head of the bed 30-45 degrees.
Rationale: Promotes venous drainage and helps reduce intracranial pressure. - Minimize environmental stimuli and cluster care activities.
Rationale: Reduces metabolic demands on the brain and helps prevent increases in intracranial pressure. - Administer osmotic diuretics (e.g., mannitol) as ordered.
Rationale: Helps reduce cerebral edema and intracranial pressure. - Monitor for signs of increased intracranial pressure (headache, vomiting, altered level of consciousness).
Rationale: Early recognition allows for prompt intervention and prevention of further complications.
Desired Outcomes:
- The patient will maintain stable intracranial pressure as evidenced by normal neurological status and absence of signs of increased ICP.
- The patient will demonstrate improvement in the level of consciousness as measured by the Glasgow Coma Scale.
Care Plan 2: Impaired Gas Exchange
Nursing Diagnosis Statement:
Impaired Gas Exchange related to altered cerebral metabolism and potential respiratory failure secondary to Reye’s syndrome.
Related factors/causes:
- Cerebral edema affecting the respiratory center
- Potential for respiratory muscle weakness
- Altered level of consciousness
Nursing Interventions and Rationales:
- Assess respiratory rate, depth, and pattern every 2 hours.
Rationale: Allows for early detection of respiratory distress or failure. - Monitor oxygen saturation continuously and arterial blood gases as ordered.
Rationale: Provides information about oxygenation and ventilation status. - Position the patient to optimize respiratory function (e.g., semi-Fowler’s position).
Rationale: Improves lung expansion and oxygenation. - Suction airway as needed, maintaining sterile technique.
Rationale: Helps maintain a patent airway and prevent aspiration. - Collaborate with respiratory therapy for chest physiotherapy and incentive spirometry as appropriate.
Rationale: Helps mobilize secretions and prevent atelectasis.
Desired Outcomes:
- The patient will maintain oxygen saturation >95% on room air or prescribed oxygen therapy.
- The patient will demonstrate a normal respiratory rate and pattern without signs of respiratory distress.
Care Plan 3: Risk for Deficient Fluid Volume
Nursing Diagnosis Statement:
Risk for Deficient Fluid Volume related to excessive fluid losses and altered metabolism secondary to Reye’s syndrome.
Related factors/causes:
- Vomiting
- Increased metabolic rate
- Potential for diabetes insipidus
Nursing Interventions and Rationales:
- Monitor fluid intake and output strictly every 4 hours.
Rationale: Allows for accurate assessment of fluid balance. - Assess for signs of dehydration (dry mucous membranes, poor skin turgor, oliguria).
Rationale: Early detection of fluid deficit allows for prompt intervention. - Administer IV fluids as ordered, monitoring infusion rate closely.
Rationale: Helps maintain adequate hydration and electrolyte balance. - Monitor serum electrolyte levels and osmolality.
Rationale: Allows for detection of electrolyte imbalances and guides fluid therapy. - Weigh the patient daily or as ordered.
Rationale: Provides information about overall fluid status.
Desired Outcomes:
- The patient will maintain adequate hydration as evidenced by stable vital signs, moist mucous membranes, and urine output >0.5 mL/kg/hr.
- The patient will demonstrate stable serum electrolyte levels within the normal range.
Care Plan 4: Impaired Liver Function
Nursing Diagnosis Statement:
Impaired Liver Function related to hepatic inflammation and metabolic disturbances secondary to Reye’s syndrome.
Related factors/causes:
- Hepatocellular damage associated with Reye’s syndrome
- Altered metabolism of toxins
- Potential for coagulopathy
Nursing Interventions and Rationales:
- Monitor liver function tests (AST, ALT, bilirubin) daily or as ordered.
Rationale: Allows for assessment of liver function and disease progression. - Assess for signs of hepatic encephalopathy (confusion, asterixis, jaundice).
Rationale: Early detection of worsening liver function allows for prompt intervention. - Administer lactulose or other medications as ordered to manage hepatic encephalopathy.
Rationale: Helps reduce ammonia levels and improve mental status. - Monitor coagulation studies (PT, INR) and observe for signs of bleeding.
Rationale: Liver dysfunction can lead to coagulopathy; early detection prevents complications. - Provide a low-protein diet as tolerated and avoid hepatotoxic substances.
Rationale: Reduces metabolic load on the liver and prevents further damage.
Desired Outcomes:
- The patient will demonstrate improving liver function tests trending towards the normal range.
- The patient will show no signs of hepatic encephalopathy or coagulopathy.
Care Plan 5: Anxiety
Nursing Diagnosis Statement:
Anxiety (Patient/Family) related to critical illness and uncertain prognosis secondary to Reye’s syndrome.
Related factors/causes:
- Life-threatening nature of Reye’s syndrome
- Rapid onset and progression of symptoms
- Potential for long-term complications
Nursing Interventions and Rationales:
- Provide clear, concise information about Reye’s syndrome and its management.
Rationale: Knowledge helps reduce anxiety and promotes understanding of the situation. - Allow family to express concerns and ask questions; provide emotional support.
Rationale: Helps family cope with the stress of the situation and feel supported. - Include family in care decisions when appropriate.
Rationale: Promotes a sense of control and involvement in the patient’s care. - Offer resources for additional support (social services, chaplain, support groups).
Rationale: Provides additional avenues for coping and support. - Teach relaxation techniques to family members and patients if conscious.
Rationale: Helps manage stress and anxiety associated with the illness.
Desired Outcomes:
- The patient/family will verbalize understanding of Reye’s syndrome and its management.
- The patient/family will demonstrate the use of effective coping strategies to manage anxiety.
References
- Beers, M. H., Porter, R. S., Jones, T. V., Kaplan, J. L., & Berkwits, M. (2022). The Merck Manual of Diagnosis and Therapy (21st ed.). Merck Sharp & Dohme Corp.
- Glasgow, J. F. (2006). Reye’s syndrome: the case for a causal link with aspirin. Drug Safety, 29(12), 1111-1121. https://doi.org/10.2165/00002018-200629120-00003
- Hockenberry, M. J., & Wilson, D. (2018). Wong’s Nursing Care of Infants and Children (11th ed.). Elsevier.
- Pugliese, A., Beltramo, T., & Torre, D. (2008). Reye’s and Reye’s-like syndromes. Cell Biochemistry and Function, 26(7), 741-746. https://doi.org/10.1002/cbf.1465
- Schrör, K. (2007). Aspirin and Reye syndrome: a review of the evidence. Paediatric Drugs, 9(3), 195-204. https://doi.org/10.2165/00148581-200709030-00008
- Uppala, R., Dudiak, B., Beck, M. E., Bharathi, S. S., Donti, T. R., & Grange, D. K. (2017). Reye syndrome, Reye-like syndrome, and elevated ammonia. Molecular Genetics and Metabolism, 122(1-2), 28-32. https://doi.org/10.1016/j.ymgme.2017.07.006
