Encephalitis
Encephalitis -ENCEPHALITIS
Encephalitis literally means an inflammation of the brain, but it usually refers to brain inflammation caused by a virus. It may also be called “acute viral encephalitis or aseptic encephalitis”. Encephalitis is an infectious disease of the Central Nervous System characterized by pathologic changes in both the gray and white matter of the spinal cord and brain. It may be due to specific disease entity such as rabies or an arthropod-borne virus (arbovirus), or it may occur as a sequela of influenza, measles, German measles, chicken pox, herpes virus infection, small pox, vaccinia, or other diseases. The specific viruses involved may vary. Exposure can also occur through insect bites, food or drink, or skin contact.
Once the virus has entered the blood stream, it can localize the brain causing inflammation of brain cells and surrounding measures. White blood cells invade the brain tissue as they try to fight off the infection. The brain tissue swells (cerebral edema) and can cause destruction of nerve cells, bleeding with in the brain (intracerebral hemorrhage), and brain damage. This can cause neurologic deficits such as parplysis, speech changes, increased intracranial pressure, respiratory failure, seizure disorders, and shock can occur.
SIGNS AND SYMPTOMS
Mild cases absent superficial reflexes
Sudden fever *** exaggerated deep tendon reflexes
Poor appetite opisthotnos
Loss of energy nuchal rigidity
General sick feeling increases resp. tract problems
Severe Cases
High fever sore throat
Severe HA *** malaise
N/V *** muscle stiffness
Stiff neck *** photophobia
Pupils of different sizes visual disturbances
Confusion tremors
Disorientation spastic or flaccid paralysis
Personality changes irritability
Convulsions muscle weakness
Problems in speech or hearing lethargy
Hallucinations delirium
Double vision incontinence
Difficulty moving an arm or leg ptosis
Involuntary movement (including eye)
Difficulty walking diplopia
Loss of sensation in part of body strabimus
Memory loss changes in level of consciousness
Drowsiness increased restlessness
Coma *** projectile vomiting
Motor dysfunction
In infants VS changes
Vomiting
Bulging of soft spot (fontanelle)
Crying that doesn’t stop (intractable crying)
ENCEPHALITIS
NURSING MEASURES
Fluid balance monitored (I&O)
Body weight to prevent dehydration and fluid overload and attendant cerebral edema
Prescribed drugs (antiviral) IV manitol, corticosteriods, phenytoin, or other anticonvulsants, sedatives, analgesics, and antipyretics are administered and evaluated for effects and adv. Rxn. (esp those encountered when antiviral agents are administered IV
Lights dimmed to decrease HA with out shadows reorientate delirious and confused if risk of seizure protect from injury
Small frequent meals nutritional supplements and NGT feedings and parenteral nutrition
Oral hygiene and stool softeners or mild laxative
Repositioned to prevent neck discomfort and joint pain and to aid ventillatory excrusions and secretion removal
Assurance is offered that behavior changes are usually transitory and sometimes permanent. After acute phase pt is taken to rehabilitation tx of any residual effects.
Monitor vs and loc at frequent intervals, compare findings with previous assessments. If urinary retention or urinary incontinence develops, indwelling urethral cath. Measure fluid I&O to detect signs of fluid volume deficit and electrolyte imbalances.
Assess bowel elimination to determine if enema or stool softner.
Reye’s Syndrome
Braine swelling and Liver damage
Ammonia and damaging chemicals accumulate in blood and cause mental changes (delirium, coma and stupor
4 to 12 years. Winter epidemics and viral illnesses
Viral infections given aspirin
90% resp. tract infection
5 to 7% prior illnes (chicken pox)
S/S: 5-7 days after viral illness, n/v, mental changes, lethargy, indifference, confusion, delirious, rapid breathing as progresses breathing sluggish, seizures, coma may die
TX: no cure support heart, lung, and brain function Keep blood levels balanced. ICU. Blood samples, I&O, adjusting blood by IV, b/p, icp, breathing monitored
1st recognized in 1963 by acute encephalopathy and fatty infiltration of liver and pancreas, heart, kidney, spleen, and lymph nodes. Mortality rate as high as 80%
S/S: hepatomegaly without jaundice in 40%, encephalopathy and altered liver function, combative behavior
TX: blood electrolytes controlled carefully, liver biopsy
NI: Neurological assessment, temp, alleviate hyperthermia, seizure precautions, I&O, impaired hepatic function, (signs of bleeding), tell don’t give aspirin.
Peak incidence age 6. 1st noted in 1974 with 400 cases following epidemics of influenza B outbreak and chicken pox
TX: aggressive support to correct metabolic abnormalities (hypoglycemia) and hemorrhage from blood clotting disorders
Since 1987 no more than 35 cases/yr nation wide (usually