Encephalopathy refers to a broad range of conditions that affect the brain's function, including brain damage and disease. Horizontal gaze nystagmus is the most common ocular finding in Wernickes encephalopathy, though complete ophthalmoplegia may be present in severe cases.4. Allow the patient to speak freely about prior experiences and health education. A medication box can help remind patients to take their medications at the appropriate times and replenish the box. The disoriented patient may not fully comprehend what is going on. F. M. Wijdicks, Metabolic encephalopathy: Behind the Name, Neurocritical Care, pp. Treatments such as sedation, mechanical ventilation, or neuromuscular junction blockade may mask the manifestations of ME. Updated: May 18, 2020. All Osmosis Notes are clearly laid-out and contain striking images, tables, and diagrams to help visual learners understand complex topics quickly and efficiently. Educating the patient and family should include discussing the reversible nature of ME and general cognitive improvement over time. Adams, M. Victor and A. Ropper, Delirium and other acute confusional states, in Principles of Neurology, 11e, New York, McGraw-Hill, 2019. Within 8 hours of nursing diagnosis and treatment, the patient will evaluate the causes that significantly raise their risk of injury and illustrate injury-avoidance behaviors. Rani Haley Lindberg, MDNothing to Disclose, 9700 W. Bryn Mawr Ave. Ste 200 Interview the significant or caregiver to determine the patients ordinary reasoning skills, behavioral changes, the length of time the problem has been going, and any other relevant information. This condition can lead to chronic brain damage or disturbance. 33 , p. 461519, 2017. Never leave the patient unattended during and after a seizure. Treating the underlying cause of the condition is vital as this can improve the patients symptoms and prevent permanent structural changes and irreversible damage to the brain. A detailed history, examination and investigations performed during the acute illness (blood sugar, blood gases, plasma ammonia, blood lactate, plasma ketones, plasma amino acids, liver function tests, and urinary organic acids) should identify those patients in whom a metabolic disorder is likely. Lactulose is often given to reduce ammonia in the blood. Determine the patients capacity for carrying out daily living activities safely and effectively on a regular basis. Epidemiology including risk factors and primary prevention St. Louis, MO: Elsevier. The patient will be able to function at his highest potential by making changes to compensate for deficiencies. Examine the attention span distractibility of the patient and their ability to make a good decision. Saunders comprehensive review for the NCLEX-RN examination. Many of the inborn errors of metabolism, including urea cycle defects, organic acidemias, and certain disorders of amino acid metabolism, present in the young infant with symptoms of an acute or chronic metabolic encephalopathy. Orient the patient to his or her surroundings, staff, and any necessary activities. The patient will report how comfortable they feel handling challenging circumstances in the future. Promote patient participation in decision-making, care planning, and planned activities. All rights reserved. Survivors of hepatic encephalopathy may have permanent cognitive or motor deficits. Encephalopathy refers to brain damage or disease that occurs when a variation in the way the brain operates or a change in the body affects the brain, resulting in a distorted mental state, leaving the patient confused and not acting normally. Some patients, particularly the elderly or terminally ill, see themselves as reliant on the care provider and, as a result, refuse to participate in the learning process. Typically, it is not until stages 4 to 5 (GFR < 30 mL/min/1.73 m) that endocrine or metabolic derangements or disturbances in water or electrolyte balance become clinically manifest (Arora & Batuman, 2023). The patient will exhibit behavioral and lifestyle modifications to lower risk components and safeguard themselves against harm. She earned her BSN at Western Governors University. This gradual decline may disguise the true nature and severity of encephalopathy from patients and family members. Ensure patient safety by asking a family member to accompany the patient especially when agitated or impulsive. The patient will express comprehension of the contributing factors to the risk of trauma and take steps to resolve the issue. Nursing Diagnosis: Disturbed Thought Processes. Professional athletes Hepatic Encephalopathy Liver failure Increased ammonia Cerebral edema Wernicke's Encephalopathy Thiamine deficiency Malnutrition Alcoholism Damage to midbrain . Give simple instructions.Allow the patient to participate in care by giving them simple directions to follow, using short sentences, and allowing them to make decisions using yes/no questions. The hallmark of encephalopathy is "altered mental status," a clinical symptom not a diagnosis. There are numerous types of encephalopathy and brain disorders with a variety of different etiologies. The impact on consciousness might result from the neocortexs diminished potential for integration. Chronic management includes successful community re-entry and gradual return to pre-morbid level of function. 1321-1339. People who have HIV/AIDS, use immune-suppressing drugs or have another condition that causes a weakened immune system are more likely to develop encephalitis. Demonstrate the use of any necessary assistive devices, such as a trapeze, crutches, or walkers. 9th Edition. may come from this or be made worse by it. Nausea related to stomach upset due to alcoholism secondary to metabolic encephalopathy as evidenced by gagging, an unpleasant taste in the mouth, and increased swallowing. Advice the patients family to assist the patient in daily activities. Patients should still be monitored for agitation/confusion and managed accordingly. Determine the decision-making capacity of the patient. Nursing Diagnosis: Deficient knowledge related to a lack of cognitive information or psychomotor ability required for health reconstruction, maintenance, or advancement secondary to encephalopathy as evidenced by lack of comprehension and progress of serious complications. Provide the patient with optimal electrolytes and fluids. 2. Intracranial pressure monitoring should be considered if cerebral edema is suspected. Computed tomography (CT) or magnetic resonance imaging (MRI) of the head is indicated when focal signs are present on physical examination and to exclude acute stroke and multifocal inflammatory lesions. This happens when another health condition, such as diabetes , liver disease, kidney failure, or heart failure , makes it hard for the brain to work. In order to detect hypoxemia, electrolyte imbalances, BUN/creatinine, ammonia levels, blood sugar levels, infection symptoms, and medication levels, it is crucial to monitor laboratory findings (including maximum average as necessary). She has worked in Medical-Surgical, Telemetry, ICU and the ER. Metabolic encephalopathy (ME) represents a syndrome of temporary or permanent disturbance of brain functions that occurs in different diseases and varies in clinical presentation. Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. By using our website, you agree to our use of cookies. Method: Descriptive study developed in four stages: 1) Identification and validation of terms relevant to care with health priority; 2) Cross-mapping of the terms identified . Ensure that safety requirements are met, including those for monitoring, side rails, seizure prevention, positioning a call button within range, placing necessary items within reach/clearing pedestrian areas, and walking with assistive equipment. coma).9 Metabolic encephalopathy encompasses delirium and acute confusional state.1,2. Decreased level of consciousness. Assess and monitor the level of consciousness.Sudden changes in a patients level of consciousness can indicate the progression and worsening of the disease. Minimize the chest and limb restrictions for the patient. As an Amazon Associate I earn from qualifying purchases. Subtle cognitive deficits may persist. Often there are multiple potential contributing factors, and a more generic term is used (i.e., metabolic encephalopathy). 1/30/14. The appearance of jaundice might suggest hepatic failure; breath may smell of uremic fetor or ketones. Structures of gray matter (cerebral cortex, basal ganglia, hippocampi) are most affected. Mosquito and tick-borne diseases are more common in many parts of the United States during the summer. Continuous EEG monitoring for 48 hours is recommended over spot EEG monitoring. J. Gavito-Higuera, C. Mullins, et al, MRI of toxic, metabolic, and autoimmune encephalopathies: a review, Applied Radiology, p. 10-19, 2020. Liver problems cause hepatic encephalopathy. Multiple etiologies may contribute to the clinical picture.2,10 For example, secondary effects of acute renal failure, including acidosis and electrolyte abnormalities, can compound uremic encephalopathy. Patient with hypoglycemic encephalopathy may incur cortical and meso-temporal injury with long-term memory impairment.4. Neuroimaging should be used selectively rather than routinely but may be necessary when diagnosis is not clear.3,4, 5 Neuroimaging is not required if there is an obvious treatable medical condition, no signs of trauma, no focal neurological signs, patient is arousable and following commands, and the condition resolves with treatment.14, Neuroimaging is required if the condition does not improve despite appropriate treatment of underlying problem. This is done to avoid accidents and increase safety. If infection is suspected. The causes are numerous and often multifactorial but include infections, metabolic disorders, mitochondrial disorders, brain tumor, increased intracranial pressure, chronic progressive trauma, poor nutrition, hypoxia, or prolonged exposure to toxic elements.1 When etiology is known, then an etiology-specific term is used (i.e., hepatic encephalopathy). Metabolic Encephalopathy. Oxygenation can be given for hypoxia. Additionally, it prevents contracture deformity, that can quickly accumulate and impair the use of a prosthesis. Nursing Diagnosis: Ineffective Coping related to changes in mental state secondary to metabolic encephalopathy as evidenced by expressing being unable to deal with a new reality, incapable of handling responsibilities from day to day, and disregarding personal hygiene. Nursing diagnoses handbook: An evidence-based guide to planning care. Describe why taking these activities is necessary. The neurophysiologic mechanism of ME includes interruption of polysynaptic pathways and altered excitatory-inhibitory amino acid balance. 1. Make their home memory-friendly.This can be accomplished by labeling cabinets to indicate where items are, hanging calendars, keeping important phone numbers by the phone, and keeping notes by the door to remind them to take their wallet, phone, etc. This should include review of prescription medications taken for nonmedicinal or recreational use as well as over-the-counter supplements/vitamins. Knowledge is used to correct erroneous assumptions about encephalopathy. Nursing Diagnosis: Risk for Trauma related to possible seizure secondary to metabolic encephalopathy. This condition makes it difficult for the brain to function correctly. Place the call light in easy reach and teach the patient how to use it to summon help. The causes are varied and can be related to infection, liver conditions, drug toxins, and more. Provide optimal fluids and electrolytes.Electrolyte imbalances can worsen bodily functions. Assess the patients cognitive abilities and behavior routinely and continuously throughout the day and at night as necessary. Additional resources could be required for patients who have a history of unhealthy coping. She received her RN license in 1997. Brain imaging is a technique for examining the brain. Patients suffering from encephalopathy may misinterpret increased levels of visual and auditory stimulation. Chvostek and Trousseau signs are classic findings in hypocalcemia. Chronic traumatic encephalopathy (CTE). Metabolic encephalopathy is a diffuse but potentially reversible disorder of cerebral function that often impairs the state of arousal and cognitive function and is due to a metabolic or toxic cause. Prion diseases are another name for transmissible spongiform encephalopathies. Items that are too far away from the patient may pose a risk. Patients must see the need or a reason to learn. Symptoms include an accelerated heartbeat, confusion and fatigue. Encephalopathies can be chronic, i.e., anoxic brain injury, Wernicke-Korsakoff syndrome, etc. Glycine Encephalopathy. 5. Given the wide range of etiologies and heterogeneous nature of ME, environmental needs will vary. Patients could be disoriented, uncooperative, and lethargic. Lewiss Medical-Surgical Nursing. An increased degree of orientation guarantees the patients safety. Metabolic encephalopathy (ME) is one of the most common and broadly defined diagnoses encountered by physicians. Anna Curran. It is also important to review recently discontinued medications as withdrawal states may contribute to delirious states. Acute management (ICU, medical or surgical unit): Focus on treating underlying etiology. Confusion, behavioral changes, a drop in consciousness, and neurological deficits are its hallmarks. Causes range from low blood sugar to excess fluid in your brain. It is difficult to perform a comprehensive physical examination on a confused or uncooperative patient; instead, a focal exam specifically concentrating on certain aspects such as vital signs, the state of hydration, skin condition and potential infectious foci may be performed. Vomiting and nausea often occur together. The patient with encephalopathy may be confused and not fully comprehend what is going on. The patients agitation, agitation, and confusion are all growing worse. Bring in familiar objects, clocks, and watches from home to help the patient maintain their orientation. Encephalopathy is a general term used to describe damage or disease affecting brain function. Evaluate the extent, frequency, duration, and history of nausea. Additionally, neurologic recovery often lags behind recovery of the underlying condition. Hashimotos encephalopathy. Buy on Amazon. Please follow your facilities guidelines, policies, and procedures. Provide the information simply and briefly. Buy on Amazon, Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Affects cortex, hippocampus, basal ganglia, though may be limited to white matter structures (corpus callosum, internal capsule, corona radiata) in milder cases. Learn how your comment data is processed. Placing the patient in a room near the nurses station is good. The patient will engage in physical activity on their own or within their conditions limitations. Its important to find and address the underlying reasons for acute confusion once it has been identified. Although it may seem redundant, this is essential for the patient who is confused. Repetition allows the patient to build confidence in their ability to care for themselves. Nurses play an important role in the care of patients with encephalopathy as they require individualized care specific to the patients condition while promoting patient safety, and comfort, assisting in treatment regimens, providing accurate information about the condition, and determining potential risks and needs. Generally, young children and the elderly are more vulnerable to viral encephalitis. Wernickes encephalopathy presents with a classic triad of mental status changes, gait abnormalities, and visual disturbances.2,13, Focal examination findings warrant further work-up and should alert the practitioner to the possibility of an underlying structural lesion.2,12. This intervention aims to ascertain the patients cognitive performance, cognitive assessment tools such as the General Practitioner Assessment of Cognition (GPCOG) can be used. American Psychiatric Association, Diagnostic and Statistical Manual, 5th edition, Washington, DC: APA Press, 2013. She received her RN license in 1997. She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse. Maintaining a low stimulation environment, including a quiet private room. Patients with encephalopathy exhibit altered mental status, causing them to experience disturbed thought processes. If the patient has complications of encephalitis, he or she may need additional treatment, such as the following therapies: Muscle, agility, posture, balance and coordination, and movement can all be improved with physical therapy. You also have the option to opt-out of these cookies. Avoid factors known to cause or aggravate confusion, altered mentation, and/or delirium such as polypharmacy, dehydration, and sleep disturbance. R. Maldonado, Acute Brain Failure Pathophysiology, Diagnosis, Management, and Sequelae of Delirium, Critical Care Clinics, vol. This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment. CNS ( drugs, metabolic encephalopathy, CNS infections, increased ICP, OSA, Central alveolar hypoventilation) spinal cord (trauma, transverse myelitis) neuromuscular system ( polio, tetanus, M.S., M.Gravis, Guillain-Barre, critical care or steroid myopathy) chest wall ( Kyphoscoliosis, obesity) Here are some sample nursing diagnostic statements using the acute confusion diagnosis: "Acute confusion related to electrolyte imbalance as evidenced by confusion, agitation, disorientation secondary to dehydration " Diagnosis. Francis, Delirium in older patients, J Am Geriatr Soc, vol. A nursing diagnosis is defined by NANDA International (2013) as a clinical judgment concerning a human response to health conditions/life processes, or vulnerability for that response, by an individual, family, group, or . 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