Reye’s Syndrome Case Study

A 9-year-old female was last seen by the Emergency Department 4 days ago for complaints of a

sore throat and low-grade fever. She was diagnosed with a viral infection and her mother was

instructed to provide supportive care with acetaminophen, fluids, and popsicles. Today the

patient presents to the Emergency Department accompanied by her mother with complaints of

persistent vomiting. The vomiting began 24 hours ago, occurs multiple times an hour, and has

progressively worsened since it began. The mother states that the patient has been unusually

lethargic, and her behavior has been “different” since the vomiting began.

1. What is the most important actions for the nurse to take?

 Ensure patient is on side (risk of aspiration)

 Ensure patent airway

 Vitals

The patient is now turned on her side to prevent aspiration. All vitals were within normal limits

besides a slightly elevated temperature of 100.2 F. The last time the patient vomited was 15

minutes ago. The vomit was green and small in amount (65cc).

2. What assessments should the nurse prioritize?

 Focused abdominal, neuro assessments

 General head to toe assessment

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The abdomen was flat, symmetric, and non-distended, with active bowel sounds in all 4

quadrants. No guarding or tenderness noted. The patient is A&Ox4. Patient is lethargic and

wants to sleep. Speech and memory are intact. Bilateral sensation intact. Good muscle tone and

5+ strength. PERRLA, pupils 2+ bilaterally. Respirations are even, unlabored, with no

adventitious sounds. Capillary refill is < 3 seconds. S1, S2 auscultated.

3. What should the nurse expect providers to order at this time?

 Peripheral IV

 Labs

 POCT glucose

 Ondansetron

 Acetaminophen

4. What labs do you expect providers to order?

 CBC, CMP, PT/aPTT, ammonia, salicylates

The patient’s peripheral IV has been inserted successfully. She reports a decrease in nausea and

has not vomited following administration of ondansetron. Her temperature is 100.0 F after

receiving acetaminophen. She is resting with her eyes closed. Her labs show elevated WBCs,

elevated ammonia levels, and elevated liver enzymes. The patient’s glucose was also slightly

low, her PT/aPTT was prolonged, and she was positive for salicylates.

5. What questions should the nurse ask the mother at this time?
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 Did you give the patient any medication for her pain or fever after her last

hospital discharge?

The mother states that she did not have acetaminophen at home, so she gave her daughter aspirin

for the sore throat and fever.

6. What should the nurse suspect at this time?

 Reye’s Syndrome d/t positive salicylates (aspirin), elevated ammonia, elevated

liver enzymes, vomiting & lethargy

7. What does the nurse expect the child’s plan of care to include?

 ICU admission

 Continuous pulse ox & cardiopulmonary monitoring

 Frequent vitals

 Monitor ICP à elevated HOB to decrease pressure

 Monitor neuro, resp, & cardiac status

 Seizure precautions

 Strict I&O

 Monitor labs, glucose

 Medication administration (ondansetron for nausea, diuretics for excess fluid,

corticosteroids to reduce brain swelling, acetaminophen for fever)