# A nurse is assessing a 7-year-old child who was recently treated with aspirin for influenza and is now suspected of having Reye's syndrome. Which assessment finding would be most characteristic of this condition? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542439 > language: ko > subject: Child Health ## 문제 A nurse is assessing a 7-year-old child who was recently treated with aspirin for influenza and is now suspected of having Reye's syndrome. Which assessment finding would be most characteristic of this condition? ## 보기 1. Bradycardia and decreased blood pressure 2. Hyperactive bowel sounds and abdominal distention 3. Altered level of consciousness and vomiting **✔ 정답** 4. Increased urinary output and dehydration **정답: 3** ## 해설 Altered level of consciousness and vomiting are hallmark signs of Reye's syndrome, reflecting cerebral edema and hepatic dysfunction. Other options represent less characteristic findings. ## 심화 해설 Core Pathophysiology of Reye's Syndrome Reye's syndrome is an acute, non-inflammatory encephalopathy associated with hepatic dysfunction. The condition is characterized by a catastrophic failure of the mitochondria, particularly within the liver and brain. As noted in the provided research, a general impairment of liver mitochondrial enzymes is central to the disease process [3]. This mitochondrial injury leads to a disruption in metabolic processes, resulting in hyperammonemia, hypoglycemia, and cerebral edema. The cerebral edema increases intracranial pressure (ICP), which directly causes the neurological deterioration seen in these patients. This mechanistic link explains why the clinical presentation is dominated by a combination of hepatic and neurological symptoms. When assessing a child with a recent history of aspirin use during a viral illness like influenza, the most characteristic findings of Reye's syndrome are a sudden onset of altered level of consciousness and protracted vomiting. The prodromal phase of the illness is often nonspecific, with research indicating that upper respiratory symptoms were present in 61% of cases, while others had even less specific features [1]. Following this, the child rapidly progresses to severe, repetitive vomiting and a change in mental status, which can range from lethargy and confusion to combativeness, stupor, or coma. This clinical picture is a direct result of the rising intracranial pressure and hepatic metabolic failure. The other assessment findings listed are not characteristic of Reye's syndrome. While direct arterial blood pressure monitoring is crucial in managing severe cases, the condition does not typically present with bradycardia and decreased blood pressure; instead, the focus is on maintaining adequate cerebral perfusion pressure (CPP), which is greatly reduced in more severe forms of the syndrome [2]. Gastrointestinal symptoms like hyperactive bowel sounds and abdominal distention are not a hallmark of this condition, as the primary abdominal manifestation is vomiting due to cerebral irritation and hepatic dysfunction. Similarly, increased urinary output and dehydration are not defining features; the primary fluid and electrolyte concerns are related to managing cerebral edema and the underlying metabolic acidosis. The strong association between aspirin use during a viral illness, particularly influenza and varicella, and the development of Reye's syndrome is a critical point for clinical assessment. In the study by Glasgow, two of the patients had varicella as their prodromal illness [1]. The diagnosis is made based on this history combined with the classic dual presentation of acute non-inflammatory encephalopathy and hepatic steatosis. The severity is staged clinically based on the level of consciousness, making the assessment of an altered mental status the most critical and defining nursing assessment finding. References (research sources) - [1]Clinical features and prognosis of Reye's syndrome.Research articleJ. F. T. Glasgow (1984) · DOI: 10.1136/adc.59.3.230 - [2]Reye's syndrome: assessment of intracranial monitoring.Research articleJ. G. Jenkins, J. F. T. Glasgow, G. W. BLACK, T. F. Fannin, Elaine Hicks, S. R. Keilty (1987) · DOI: 10.1136/bmj.294.6568.337 - [3]Effect of Reye's syndrome serum on isolated chinchilla liver mitochondria.Research articleJames H. Tonsgard, Godfrey S. Getz (1985) · DOI: 10.1172/jci112039 ## 임상 시나리오 Reye's Syndrome: Clinical RecognitionKey assessment findings after aspirin use in viral illness Suspect Reye's syndrome in any child with recent aspirin use during a viral illness (e.g., influenza, varicella) who presents with a sudden change in level of consciousness and protracted vomiting. This reflects acute cerebral edema and hepatic mitochondrial failure. Neurological deterioration can progress rapidly from lethargy and confusion to combativeness, stupor, or coma as intracranial pressure rises. Liver enzymes and ammonia levels will be markedly elevated, often with hypoglycemia. CautionAvoid aspirin in children with febrile viral illnesses to prevent this life-threatening condition. Early recognition and management of increased ICP are critical; anticipate intensive care monitoring and neurological assessments. ## 핵심 개념 - **Reye's syndrome** — Acute non-inflammatory encephalopathy with hepatic dysfunction, linked to mitochondrial failure, primarily in children given aspirin during viral illness. - **Cerebral edema** — Swelling of the brain due to fluid accumulation, a key consequence of mitochondrial injury in Reye's syndrome that increases intracranial pressure. - **Hyperammonemia** — Elevated ammonia levels in the blood resulting from hepatic mitochondrial dysfunction, contributing to encephalopathy. - **Intracranial pressure (ICP)** — Pressure inside the skull; rising ICP from cerebral edema causes the progressive neurological deterioration seen in Reye's syndrome. ## 같은 주제 문제 - [A nurse is assessing a 7-year-old child diagnosed with Reye's syndrome. 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