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 appetiteopisthotnos Loss of energynuchal rigidity General sick feelingincreases resp. tract problems Severe Cases High feversore throat Severe HA ***malaise N/V ***muscle stiffness Stiff neck ***photophobia Pupils of different sizesvisual disturbances Confusiontremors Disorientationspastic or flaccid paralysis Personality changesirritability Convulsionsmuscle weakness Problems in speech or hearinglethargy Hallucinationsdelirium Double visionincontinence Difficulty moving an arm or legptosis Involuntary movement (including eye) Difficulty walkingdiplopia Loss of sensation in part of bodystrabimus Memory losschanges in level of consciousness Drowsinessincreased restlessness Coma ***projectile vomiting Motor dysfunction In infantsVS 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