Reye’s syndrome

 Inchildren has been clinically

characterized as a complex sign
and symptoms, including
encephalopathy and fatty
degeneration of the viscera. Mainly
affecting the liver, brain and kidney.
 Encephalopathy

 Seriousbrain function
abnormalities experienced by
some patients with advanced liver
disease. Symptoms most
commonly include confusion,
disorientation, insomnia, and may
progress to a coma.
  Fatty degeneration

 Fattydegeneration is the deposit

of fat globules in a tissue.*Also
sometimes called adipose
degeneration.
  Clinical manifestation

>Prodromal illness
 >sudden pernicious vomiting –fever
usually not present
 >irritation behaviour
 >hyperventilation, tachypnea
 >altered sensorium- from mild
lethargy to progressive stupor and
coma
  Stages of sign/symptoms
 stage I- vomiting, lethargy, difficult to
arouse, liver dysfunction, type I EEG
 stage II- disorientation, delirium,
hyperventilation, hyperactive reflexes,
and liver dysfunction, type II EEG
 stage III- decorticate positioning, coma
hyperventilation, liver dysfunction,
presence of papillary light reaction type
II EEG
 stage IV- deepening coma decerebrate
rigidity, costal-caudal progression of
brain stem dysfunction loss of
oculocephalic reflexes, fixed and
dilate pupils, improvement of liver
dysfunction type III EEG

 >stage V- seizure, loss of reflexes,

respiratory arrest, correction of liver
dysfunction, isoelectric EEG
 
  Screening and diagnosis

 Spinal tap (lumbar puncture)

 To identify or rule out other disease with

similar sign and symptoms, such as

infection of the lining that surrounds the
brain and spinal cord (meningitis) or
inflammation or infection of the brain
(encephalitis). During a spinal tap a needle
is inserted through the lower back into a
space below the end of the spinal cord.
Cerebrospinal fluid
  Liver biopsy
 Toidentify other condition that may
be affecting the liver. During a liver
biopsy. A needle is inserted through
the skin on the upper right side of the
abdomen and into the liver.
 Computerized tomography (CT) or magnetic
resonance imaging (MRI)

 To identify other causes of behaviour

changes or decreased alertness. A CT
scan uses a sophisticated X-ray
machine linked to a computer to
produce detailed two dimensional
images of the brain. An MRI scan uses
magnetic fields and radio waves to
generate images of the brain.
 
  Nursing Diagnosis

 Potential respiratory complication: apnea,

pulmonary congestion and obstruction, and
coma
 Potential cardiac complication from

hypovolemia, dehydration/or fluid overload,

altered electrolytes, cardiac instability, and
impaired autoregulatory mechanism.
 Increased intracranial pressure from cerebral

edema
 Hypoglycemia from altered liver function
 Potential complication from comatose

state: skin breakdown, corneal injury

 Anxiety and ineffective family coping

related to lack of knowledge, fear, and/

or guilt
 Anxiety related to acuteness of illness,

procedures, hospitalization, and

recollection of events that occurred
during critical phase of illness
 Hypoglycemia from altered liver
function
 Potential complication from comatose
state: skin breakdown, corneal injury
 Anxiety and ineffective family coping
related to lack of knowledge, fear,
and/ or guilt
 Anxiety related to acuteness of illness,
procedures, hospitalization, and
recollection of events that occurred
during critical phase of illness
  Nursing intervention

 Being aware of the medical plan of

treatment and being alert to the
rapidity of the course of the disease.
 Note and report immediately any
changes in the child status or stage of
progression
 Therapy is directed at maintaining
normal intracranial pressure and
adequate cerebral perfusion
 Protect the child from
complications that may result
from the comatose condition or
life saving medical intervention
 Maintain fluid and electrolyte

balance
 Before any procedure is done for

the child, consider the effects on

his intracranial pressure.