Need help with metabolic encephalopathy etiology!

shaas, ASN, RN · Dec 7, 2010

I don't know if this would be any help. By "metabolic," could it be due to release of or exposure to toxins/endotoxins (or something systemic), and that the disorder is caused literally by the dysfunctions (inability to catabolize the poison and make it into harmless substance) in metabolic process (be it catabolic or anabolic)?

Also, as you've pointed out, previous injurty to brain is cited as one of the contributing risk factors (e.g. "suspicious of a lesion and/or temporal epilepsy," or tumor or stroke).

http://www.doctorsofusc.com/condition/document/96854

Best of luck.

ashleepules · Dec 8, 2010

Thanks Shaas!!! It took me four hours to just work out the etiology to understand the patho, but i did it! I was about to throw up my books and say eff it, lol, but then i saw she was on haloperidol and bisperidone which are dopamine antagonists, so i thought, ahah! the problem we are treating is excess dopamine....thats causing inflammation , what are some of the causes of excess dopamine. Google is my best friend. I typed in excess dopamine and found that it is caused by oxidative stress, which is a metabolic issue. Oxidative stress is one of the problems associated with COPD, which is one of her past dx. It was like angels dropped out of heaven with harps and french horns! AAAAAAAAAAAh praise Jesus, lol. :yeah:Thanks for the support Shaas, your advice about the toxins pointed me in the right path :redpinkhe. Merry Christmas everybody, one more clinical and i am D-O-N-E Done! with my first semester.... :lol2:

Cessna172 · Dec 8, 2010

I am curious as to what your instructor thought about your care plan. Careplans can be tough sometimes. Good luck.

ashleepules · Dec 8, 2010

Well Bobby, I did complete the care plans, but they were just kinda thrown together enough for me to present to my clinical group. She was very pleased in a surprised kinda way, lol. I have until Friday to have them revised and my concept map complete. My priorities this morning were as follows....1. acute confusion r/t altered mental status aeb A&O x1 2. risk for falls r/t altered mental status 3. impaired gas exchange r/t alveolar-capillary membrane changes aeb need for continuous O2 therapy....ok, so we can all agree that the last one is a hot mess, and needs some work! We discussed however the priorities, she instructed me to change priority 3 to #1, leave 2, and #1 as 3. I see what shes saying, if we dont correct the problems with COPD then we won't be able to address the encephalopathy. I guess my thought process lead me to question the acuity of each problem first. Before we can start safely treating the COPD, we have to make her environment conducive to healing, and the only way we can safely treat her COPD is to address the confusion, get that under control with the antipsychotics, provide safety precautions and then focus on the COPD. And yes, i am 100% with ya on the fact that these things are tough...i'm having an extremely hard time giving her that perfect careplan...i almost loathe doing them :confused: . That worries me, b/c i've loved everything about this program until we started heavy on the careplans. My instructor is pretty tough on us, she expects a lot from her group. But any how, where i have the hardest time is my outcomes. we have to have at least 3, they have to have a time period (usually "during my shiftt...") and they have to be very specific and measurable....any advice/helpful hints would be fabuloso! :cool:

shaas, ASN, RN · Dec 8, 2010

ashleepules, totally awesome deduction and thought process! Right now, I'm just at the level of googling and taking a wild guess.

I wish I could get to where you are soon, as my program starts in two months...yikes. For now, reading nursing care plans give me the hives and welts... Please, keep posting so that I can save the cases for my learning.

Thanks and good luck!