Encephalitis

Content
Introduction
Definition
Incidence
Causes and risk factors
Patho-physiology
Clinical manifestations
Assessment and Diagnosis
Complications
Medical and Nursing management.
ANATOMY
Encephalitis.
Definition
Encephalitis (from Ancient

Greek, enképhalos “brain”) is

an acute inflammation of the brain.

Encephalitis with meningitis is known as

meningo-encephalitis. 
Incidence
In western countries incidence is 7.4 cases per 100,000

population per year.

In tropical countries, the incidence is 6.34 per 100,000

per year
In 2013: 77,000 deaths from encephalitis from 92,000

in 1990.
Etiology
Viral cause

 HSV (herpes simplex) encephalitis.

 Arthropod borne virus encephalitis.

Bacterial cause

Fungal cause

Auto immune
Herpes Simplex virus Encephalitis.
Caused by herpes Simplex virus;

Its of two types:

1. HSV-I typically affects children and adults

2. HSV-II common in neonates

 Treatment: Acyclovir or ganciclovir
Arbovirus Encephalitis.
Arthropod Borne virus belongs to several family of

viruses.
Most commonly due to mosquito bite.

Usually increases in summer and autumn when the

mosquitoes increases.
Contd.
Diagnosed by serology antigen-antibody of blood or

CSF
Treatment: no specific medication is prescribed.
Japanese Encephalitis.
Japanese encephalitis (JE) is a flavivirus

Spread by mosquitoes.

There is no cure for the disease.

Treatment is focused on relieving severe clinical

signs and supporting the patient to overcome the

infection.
Contd
Safe and effective vaccines are available to prevent

JE.
WHO recommends JE vaccination in all regions

where the disease is a recognized public health

problem.
Clinical manifestations
 Younger children or infants:

• Irritability

• Poor appetite

• Fever

• Drowsy or confused patient.

Contd
 In Adults:

 Acute onset of fever

 Headache

 Confusion

Seizures.

Malaise
Contd
Cranial nerve dysfunction

Hemi paresis

Dysphasia.

Change in LOC (level of consciousness)

Increased ICP related to hydrocephalus.

Assessment and Diagnosis
• MRI (determine inflammation.)

• EEG

• Lumbar puncture.

• Blood test.

• Urine analysis.
Complications
• Seizures

• Learning difficulty in children

• Behavioral difficulty

• Hemi paresis

• Death
Medical Management
Treatment (which is based on supportive care) are as

follows:
 Antiviral medications (if virus is cause)

 Antibiotics, (if bacteria is cause)

Steroids
Contd
Sedatives for restlessness

Acetaminophen for fever

Physical therapy (if brain is affected post-infection)

REHAB
MANAGEMENT
Assessment
 Admission history and physical exam.

 Baseline vital signs.

Ongoing assessment for disease progression is critical.

The patient is monitored for life-threatening

complications e.g, respiratory failure.

Nursing Diagnosis
Ineffective gas exchange ---decreased tissue perfusion

Impaired physical mobility ---paralysis, fatigue.

Pain ----- disease condition.

Altered nutrition less than body requirement ----

dysphagia ( c. nerve dysfunction).

Contd..
High risk for injury ---- seizures episodes

Impaired verbal function ---- cranial nerve

dysfunction.
Fear and anxiety --- loss of control and paralysis.

Potential for secondary complication (infections etc)

Maintain Respiratory function.
Assess respiratory rate and quality frequently.

Monitor perfusion with pulse oximetry.

Monitor the patient for respiratory insufficiency.

Ventilator support, oxygen therapy.

Contd
Chest physiotherapy.

Elevation of head of bed.

Monitor vitals

Suctioning.
Chest Physical Therapy
Chest Physical Therapy (CPT)
is something you can do to loosen your baby’s mucus.
The three parts to CPT are:
(1) postural drainage,
(2) percussion and
(3) deep breathing and coughing
Percussion
Percussion is clapping the chest.
Percuss means to tap sharply.
Percussion in CPT can be done with either a cupped
hand or a percussor. Percussors can also be electric.
The clapping shakes the inside the chest and loosens
mucus, so it is easier to cough out.
Postural Drainage
Postural Drainage moves the mucus by changing the
baby’s position..
The most mucus moves into the large airways when
you do both percussion and postural drainage
together.
Deep breathing and coughing helps to move the
loosened mucus.
Postural Drainage
Before Doing CPT:
• It is best to do CPT before meals or at least one to two
hours after eating.
• The best times for CPT are early morning and at bed
time
Cont..
Your doctor may prescribe medicine to open the
airways. This may come as an
SVN (small volume nebulizer) or as an
MDI (metered dose inhaler)
.
The medicine, positioning, and
percussion all work together to clear the mucus from
the lungs.
Positions

 Sit the baby up. Tilt the baby half way between sitting up
and laying flat.
 Percuss between the nipple and collarbone on the left side
of the chest for 2 or 3 minutes.
 Percuss between the nipple and collarbone on the right
side of the chest for 2 or 3 minutes.
Posterior Apical Segments

 Sit the baby up. Tilt the baby half way between sitting up
and laying flat.
 Percuss over the shoulder blade on the left side of the back
for 2 or 3 minutes.
 Percuss over the shoulder blade on the right side of the
back for 2 or 3 minutes.
Middle Lobe & lingual segments

 Lie baby on his or her stomach, feet higher than head.

 Turn the baby to his or her left, half way between back and
side.
 Percuss between the baby’s right nipple and underarm for 2
to 3 minutes.
Lateral basal sections
Lie baby down on his or her left side, feet higher
than head.
Percuss below the right arm but above the bottom
edge of the ribs for 2 to 3 minutes.
Anterior Basal Segments
Lie baby on his or her back, feet higher than head.
• Turn the baby to his or her right, half way between
back and side.
• Percuss between the baby’s left nipple and underarm
for 2 to 3 minutes.
Cont..
Lie baby down on his or her right side, feet higher than
head.
• Percuss below the left arm, but above the bottom
edge of the ribs,
for 2 to 3 minutes.
Posterior Basal Segments

 Lie baby on his or her stomach, head lower than feet.

 Percuss over the lower half of the left ribs, above the
bottom edge of the ribs, for 2 to 3 minutes.

 Percuss over the lower half of the right ribs, above the
bottom edge of the ribs, for 2 to 3 minutes
After the treatment:

 Baby may cough more during or after CPT. Coughing helps

your baby get rid of the loosened mucus.

 Baby may cough up to one or two hours after CPT. Even if

no mucus comes up, the CPT is working.

 • Infants and small children usually swallow their mucus.

You may use a bulb or syringe to remove mucus from the
back of baby’s throat
Reducing effects of physical immobility.
Change position 2hrly

The paralyzed extremities are supported in

functional positions,
ROM exercises every 2 hourly

Use of comfort devices

Contd.
Adequate nutrition and hydration

Use of elastic stocking

Massage

Hygiene maintenance
Nutritional Support.
NG tube feeding

Assess for bowel sounds

Check the weight of the patient.

Total parental nutrition if needed

Contd.
Assesses for the return of the gag reflex and bowel

sounds before resuming oral nutrition.

Monitor intake and output
Improving communication.
Lip reading.

Use of picture cards.

Speech therapy.

 Give pen and paper.

Relieving fear and anxiety.
Providing information about patient’s condition.

Positive appraisal

Encouraging relaxation exercise

Positive feedback

Clear their doubts.

Manage pain with analgesic

Any questions?