- Monitor vital signs and check level of consciousnessfor increasing lethargy. Take vital signs more often as the patient’s condition deteriorates.
- Monitor fluid intake and output to prevent fluid overload. Maintain urine output at 1.0ml/kg/hr; plasma osmolality 290mOsm; and blood glucose 150mg/ml (Goal: Keep glucose high, osmolality normal, ammonia low).Also, restrict protein.
- Watch for seizures and maintain precautions.
- Immediately report any signs of coma that require invasive, supportive therapy, such as intubation.
- Keep head of bed at 30° angle.
- Monitor ICP (should be <20 before suctioning) or give thiopental IV as ordered, as necessary, hyperventilate the patient.
- If patient lapses into coma, immediately give 50% dextrose in water IV as ordered.
- When ventilating the patient, maintain PCO2 between 23 and 30 mmHg and PO2 between 80 and 100 mmHg.
- Closely monitor cardiovascular status with pulmonary artery catheter or central venous pressure line.
- Give good skin and mouth care and range-of-motion exercises.
- Check patient for loss of reflexes and signs of flaccidity.
- Give the family the extra support they need, considering their child’s poor prognosis.
- Help the family to face the patient’s impending death.
Davidson, S.L. Diseases Causes & Diagnosis Current Therapy Nursing Management Patient Education (Educational Publishing House. 1990)
Kumar Et Al. Robbins & Cotran Pathologic Basis of Disease (Elsevier Saunders Inc. 7th edition. 2005)
Huether, S. Et Al. Understanding Pathophysiology (Mosby, Inc. 2nd edition. 2000)
Reye’s Syndrome; http://en.wikipedia.org/wiki/Reye’s_syndrome