Encephalopathy is a general term used to describe damage or disease affecting brain function. The causes are varied and can be related to infection, liver conditions, drug toxins, and more. Some of the major types include the following:
- Chronic Traumatic Encephalopathy: This condition occurs due to direct injury to the brain, leading to nerve damage. This type is commonly found in athletes.
- Hepatic Encephalopathy: Often caused by liver cirrhosis, when the liver is not able to filter and function properly, toxins accumulate in the blood and brain.
- Glycine Encephalopathy: This type of encephalopathy is genetic with symptoms appearing after birth.
- Toxic Metabolic Encephalopathy: This type of encephalopathy results from toxins, infections, or organ failure. When chemical composition in the body becomes imbalanced, it can impact the brain’s normal function.
- Hypoxic-Ischemic Encephalopathy: When the brain does not get enough oxygen, permanent brain damage can result.
- Hypertensive Encephalopathy: Prolonged hypertension that is not treated can cause the brain to swell resulting in neurological damage.
- Uremic Encephalopathy: If the kidneys are not functioning properly, they cannot filter harmful substances. The buildup of uremic toxins can cause confusion and other symptoms.
Symptoms of encephalopathy include:
- Worsening confusion
- Loss of memory
- Drowsiness and changes in consciousness
- Difficulty speaking
- Poor coordination
If not treated, encephalopathy can progress to seizures, coma, irreversible brain damage, and death.
Blood tests, imaging studies like CT scans or MRI, spinal fluid examination, and electroencephalograms (EEG) may be performed to help diagnose the condition and determine its underlying cause.
Nursing Process
Nurses play an important role in the care of patients with encephalopathy as they require individualized care specific to the patient’s condition while promoting patient safety, and comfort, assisting in treatment regimens, providing accurate information about the condition, and determining potential risks and needs.
Meticulous assessment and proper diagnosis are important in the management and care of patients with encephalopathy so appropriate interventions can be initiated promptly. Treating the underlying cause of the condition is vital as this can improve the patient’s symptoms and prevent permanent structural changes and irreversible damage to the brain.
The treatment of encephalopathy varies, depending on the underlying cause of the condition. Treatment may include medications like anticonvulsants to treat symptoms like seizures and other treatment modalities targeting the underlying cause. Dialysis or surgery may be indicated for severe cases.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for encephalopathy, 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 encephalopathy.
Acute Confusion
An altered mental state is one of the main symptoms of encephalopathy, causing confusion and changes in consciousness. When a patient is confused, there are disturbances in cognition, attention, and perception.
Nursing Diagnosis: Acute Confusion
Related to:
- Hypoxia
- Disturbance in cerebral metabolism
- Accumulation of toxins in the brain
- Structural changes in the brain
As evidenced by:
- Cognitive dysfunction
- Altered psychomotor performance
- Tremors
- Fluctuation in the level of consciousness
- Agitation
- Misperception
- Neurobehavioral manifestations
- Difficulty initiating purposeful behavior
Expected Outcomes:
- The patient will have decreased episodes of delirium as evidenced by reduced agitation and combativeness, and improved follow-through with commands
- The patient will remain alert and oriented X 4
Assessment:
1. Assess for causative and contributing factors.
It is critical to evaluate and determine conditions that may be causing the patient to experience confusion. This will help in formulating an effective treatment regimen for the patient.
2. Assess and monitor the level of consciousness.
Sudden changes in a patient’s level of consciousness can indicate the progression and worsening of the disease.
3. Monitor lab work.
Ammonia levels, BUN and creatinine, urinalysis, white blood counts and more can signal abnormalities in the liver, kidneys, and infectious processes contributing to symptoms of confusion.
Interventions:
1. Assist in the treatment of the underlying conditions.
Once the underlying cause is determined, administer necessary interventions. Lactulose is often given to reduce ammonia in the blood. Oxygenation can be given for hypoxia. Antibiotics can be administered to treat infectious processes. Drug intoxication or withdrawal can be treated with medications.
2. Reorient the patient as necessary.
Increased reorientation may be required to decrease anxiety and provide safety. This can seem repetitive but is necessary for the confused patient.
3. Promote a calm environment.
The patient suffering from encephalopathy tends to misinterpret high levels of auditory and visual stimulation. Prevent overstimulation by eliminating loud noises and constant interruptions.
4. Encourage family members to engage in the reorientation process.
The presence of family members will increase the patient’s degree of comfort and promote a trusting relationship. They can help with supporting the patient to cooperate with care.
5. Provide optimal fluids and electrolytes.
Electrolyte imbalances can worsen bodily functions. Ensure adequate glucose levels to support brain functions and fluid intake to restore hemodynamic processes.
Disturbed Thought Processes
Patients with encephalopathy exhibit altered mental status, causing them to experience disturbed thought processes. This refers to the alteration of perception and cognition, interfering with the patient’s activities of daily living.
Nursing Diagnosis: Disturbed Thought Processes
Related to:
- Insufficient oxygen supply to the brain secondary to encephalopathy
- Head trauma related to encephalopathy
- Infections
- Alcohol or substance abuse
As evidenced by:
- Incorrect perception of stimuli
- Difficulty performing activities of daily living
- Difficulty communicating verbally
- Impaired interpretation of events
- Impaired judgment
- Impaired decision making
- Inadequate emotional responses
- Disorientation
Expected Outcomes:
- The patient will maintain a realistic perspective and be able to communicate clearly with others
- The patient acknowledges and understands potential misinterpretations of other people’s verbalizations and behaviors
Assessment:
1. Assist with testing to evaluate mental capabilities.
Assist with the application or reviewing of results to determine the patient’s ability to understand abstract thoughts, decision-making, judgment, and insights.
2. Assess the patient’s attention span and ability to make good decisions.
This will help identify the patient’s ability to plan and comply with his or her treatment regimen and follow through with care after discharge.
3. Review medications.
Ensure the patient’s medication regimen is not contributing to their disturbed thought processes on top of their diagnosis.
Interventions:
1. Maintain safety.
The patient may not be able to make rational decisions and is at risk for poor judgment calls. As a top priority, maintain their safety by implementing fall precautions and keeping sharp objects out of reach.
2. Encourage the patient’s family to participate in patient care.
Patients with disturbed thought processes need to feel secure and safe. Involving the family in patient care can prevent anxiety and combative behavior.
3. 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.
4. Do not force.
Respect the patient’s space and do not force activities or communication. This may cause the patient to feel threatened and they may withdraw.
Impaired Memory
Memory loss is considered the most disabling effect of encephalopathy and can be a long-term result of severe encephalopathy.
Nursing Diagnosis: Impaired Memory
Related to:
- Neurological disturbances related to encephalopathy
- Inadequate intellectual stimulation
- Changes in brain structure and processes
- Irreversible brain damage
- Depressive symptoms
As evidenced by:
- Reports experiences of forgetfulness
- Consistently forgets to schedule or keep appointments
- Difficulty recalling events
- Difficulty recalling familiar names, objects, and words
- Inability to learn or retain new skills or information
- Inability to perform a previously learned skill
Expected Outcomes:
- The patient will report increased satisfaction with memory as evidenced by recalling facts or events
- The patient will be able to identify 2 techniques that help improve memory
Assessment:
1. Assess the patient’s cognition, perception, and memory.
This helps determine the patient’s general thinking and reasoning abilities. The patient’s cognitive abilities influence support provision, communication, and treatment.
2. Assess causative factors of the condition.
Assess other contributing factors of impaired memory along with encephalopathy such as dementia, substance abuse, or psychiatric conditions.
3. Determine the effect of impaired memory on daily life.
This can also be obtained from family members. Determine the severity of the impaired memory and if it affects the patient’s ability to perform tasks, participate in conversation, and remain safe.
Interventions:
1. Use memory aids.
Technological devices such as smartphones, watches, and medication-reminding systems can keep the patient on schedule and safe.
2. 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.
3. Assist patients in establishing a routine.
Establish a structured routine that aids the patient in performing certain tasks at specific times without deviation. This can support independence.
4. Educate the patient and family members about the patient’s condition.
Memory may or may not improve. Involving the family members in the patient’s treatment regimen helps the patient feel safe, comfortable, and supported. This will also improve the patient’s compliance with the treatment regimen.
5. Consider a psychologist.
A mental professional who specializes in memory disorders may be able to help implement strategies to improve memory and ease the burden on family members.
References
- Chronic traumatic encephalopathy. Mayo Clinic. May 25, 2021. https://mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/symptoms-causes/syc-20370921
- Encephalopathy. National Institute of Neurological Disorders and Stroke. Last reviewed on April 22, 2022. https://www.ninds.nih.gov/health-information/disorders/encephalopathy
- García-García, R., Cruz-Gómez, Á.J., Urios, A. et al. Learning and Memory Impairments in Patients with Minimal Hepatic Encephalopathy are Associated with Structural and Functional Connectivity Alterations in Hippocampus. Sci Rep 8, 9664 (2018). https://doi.org/10.1038/s41598-018-27978-x
- Hepatic Encephalopathy. Updated: May 18, 2020. Author: David C Wolf, MD, FACP, FACG, AGAF, FAASLD; Chief Editor: BS Anand, MD. https://emedicine.medscape.com/article/186101-overview
- Lewis’s Medical-Surgical Nursing. 11th Edition, Mariann M. Harding, RN, PhD, FAADN, CNE. 2020. Elsevier, Inc.
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
