Encephalitis BNS 3rd year.CMC..._2.pptx.

Encephalitis

1. 1 10/17/2024 BNS 14th Batch

2. Disorders of Nervous Systems 2 10/17/2024 BNS 14th Batch

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4. Encephalitis Prepared by : Samikshya Banjara BNS 3 rd year 14 th batch Chitwan Medical College 4 10/17/2024 BNS 14th Batch

5. General Objective At the end of the session, BNS 3rd year students will be able to explain about encephalitis . 5 10/17/2024 BNS 14th Batch

6. Specific objectives At the end of the session, BNS 3rd year students will be able to: introduce encephalitis define encephalitis state incidence of encephalitis state the risk factors of encephalitis state the causes of encephalitis 6 10/17/2024 BNS 14th Batch

7. Specific objectives Contd.. 6. explain the types of encephalitis 7. explain pathophysiology of encephalitis 8. state the clinical features of encephalitis 9. discuss diagnostic evaluation of encephalitis 10. describe medical management of encephalitis 7 10/17/2024 BNS 14th Batch

8. Specific objectives Contd.. explain nursing management of encephalitis 12.discuss the preventive measures of encephalitis 13.discuss the prognosis of encephalitis 14. state the complications of encephalitis. 15. summarize the topic 8 10/17/2024 BNS 14th Batch

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11. Introduction Encephalitis is an acute infection and inflammation of the brain itself. This is in contrast to meningitis, which is an inflammation of the layers covering the brain. Encephalitis is irritation and swelling (inflammation ) of the brain (encephalon) usually due to infective agent that produces altered various parts of the brain and spinal cord . 11 10/17/2024 BNS 14th Batch

12. Introduction contd.. Encephalitis can be infectious or noninfectious, acute, subacute, or chronic. It involves – Cortex, white matter, basal ganglia and brain stem. The inflammation can affect one area of the brain or several different areas. Can be range from mild to severe. 12 10/17/2024 BNS 14th Batch

13. Definition Encephalitis is an acute inflammation and infection of the brain. Most often caused by virus although it can caused by bacteria. It can also be caused by problems with the immune system. 13 10/17/2024 BNS 14th Batch

14. Incidence Encephalitis strikes 10-15 people per 100,000 each year, with more than 250,000 patients diagnosed in the last decade alone in the U.S. The condition can affect anyone, but more often occurs in younger people (Hopkins,2015.) 14 10/17/2024 BNS 14th Batch

15. Incidence contd.. The annual incidence of clinical diseases varies both across and within endemic countries, ranging from <1 to >10 per 100000 population or higher during outbreaks. The incidence of encephalitis was 1.9% in the 5-year period, and the mortality rate was 37.3%. Also, 6.7% patients improved without any complications. 10/17/2024 BNS 14th Batch 15

16. Incidence contd.. Incidence varies between studies but is generally between 3.5 and 7.4 per 100,000 patient –years. It affects people of all ages; however ,incidence is higher in the paediatrics population. Both sex are affected, but most studies have shown a slight predominance in male. ( Grannerod , 2007). 16 10/17/2024 BNS 14th Batch

17. Risk factors Age:  Some types of encephalitis are more common or more severe in certain age groups. In general, young children and older adults are at greater risk of most types of viral encephalitis. Weakened immune system : People who have HIV/AIDS, take immune-suppressing drugs or have another condition 17 10/17/2024 BNS 14th Batch

18. Risk factors contd.. causing a weakened immune system are at increased risk of encephalitis. Geographical regions : Mosquito- or tick-borne viruses are common in particular geographical regions. 18 10/17/2024 BNS 14th Batch

19. Risk Factors contd.. Season of the year : Mosquito- and tick-borne diseases tend to be more common in summer in many areas of the United States. 19 10/17/2024 BNS 14th Batch

20. Etiology The exact cause of encephalitis is unknown. It may be primary and secondary that is caused by an infection which spreads from another part of the body. Acute viral encephalitis is most common. The cause of viral infection include Herpes simplex virus, Arbo virus, cytomegalovirus etc. 20 10/17/2024 BNS 14th Batch

21. Etiology contd.. Bacterial encephalitis is usually caused by bacterial meningitis spreading directly to brain. It is caused by Streptococcus, Staphylococcus. Hemophilus Influenza, Meningococcus, E.coli, etc. Other causative agents include Toxoplasma (Protozoa). Cryptococcus Neoformans (fungus). 21 10/17/2024 BNS 14th Batch

22. Etiology contd.. Post ischemic inflammatory encephalitis occurs due to brain inflammation following CVA; brain injury, cerebral ischemia. Post infections encephalitis due to measles, mumps, rubella but incidence is decreased due to immunization. Respiratory or GI infection may lead to secondary encephalitis. It occurs more often in the first year of life and decreases with age . 22 10/17/2024 BNS 14th Batch

23. Etiology contd.. The very young and the elderly are more likely to have a severe case. Encephalitis is most often caused by a viral infection . Many types of viruses may cause it. Exposure to viruses can occur through: 23 10/17/2024 BNS 14th Batch

24. Etiology contd.. Breathing in respiratory droplets from an infected person Contaminated food or drink Mosquito, tick, and other insect bites Skin contact 24 10/17/2024 BNS 14th Batch

25. Etiology contd.. Weakened immune system Non-infectious causes Acute disseminated encephalomyelitis (ADEM) Allergy : Post vaccine Electrolyte imbalance, Chemical lead Organophosphorus, Carbonmonoxide 25 10/17/2024 BNS 14th Batch

26. Types of encephalitis Herpes Simplex Virus Encephalitis. Arthropod Borne Virus Encephalitis. Fungal Encephalitis. Japanese Encephalitis. 26 10/17/2024 BNS 14th Batch

27. 1.Herpes Simplex virus 27 It is the most common cause of acute encephalitis in the United States(2006). There are two herpes simplex viruses:-HSV-1 and HSV-2, HSV-1 typically affects children and adults. 10/17/2024 BNS 14th Batch

28. Herpes Simplex virus contd.. The initial symptoms of HSV-1 encephalitis include fever, headache, and confusion. Focal neurologic symptoms reflect the areas of cerebral inflammation and necrosis and include fever, headache, behavioral changes, focal seizures, dysphasia, hemiparesis, and altered LOC . 28 10/17/2024 BNS 14th Batch

29. 2.Arthropod Borne Virus Encephalitis Arthropod vectors transmit several types of viruses that cause encephalitis. The primary vector in North America is the mosquito. In cases of West Nile virus, humans are the secondary host; birds are the primary host. Arbovirus infection (transmitted by arthropod vectors) occurs in specific geographic areas during the summer and fall. 29 10/17/2024 BNS 14th Batch

30. 3.Fungal encephalitis Fungal infections of the CNS occur rarely in healthy people. The presentation of fungal encephalitis is related to geographic area and a compromised immune system. Causes of fungal infections include Cryptococcus neoformans, Blastomyces dermatitidis, Histoplasma capsulatum, Aspergillus fumigatus, Candida, and Coccidioides immitis . 30 10/17/2024 BNS 14th Batch

31. 4.Japanese encephalitis Japanese encephalitis virus JEV is the most important cause of viral encephalitis in Asia. It is a mosquito-borne flavi virus , and belongs to the same genus as dengue, yellow fever and West Nile viruses. 31 10/17/2024 BNS 14th Batch

32. Japanese encephalitis contd.. Although symptomatic Japanese encephalitis (JE) is rare, the case-fatality rate among those with encephalitis can be as high as 30%. Permanent neurologic or psychiatric sequelae can occur in 30%–50% of those with encephalitis There is no cure for the disease. Treatment is focused on relieving severe clinical signs 32 10/17/2024 BNS 14th Batch

33. Japanese encephalitis contd.. and supporting the patient to overcome the infection Safe and effective vaccines are available to prevent JE. WHO recommends that JE vaccination be integrated into national immunization schedules in all areas where JE disease is recognized as a public health issue. 33 10/17/2024 BNS 14th Batch

34. Japanese encephalitis contd.. Transmission:- JEV is transmitted to humans through bites from infected mosquitoes of the  Culex species (mainly Culex Tritaeniorhynchus ). 34 10/17/2024 BNS 14th Batch

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36. Mode of transmission Blood stream Direct implantation ( traumatic or pathogenic through lumbar puncture) Local exterior ( otitis media, sinusitis) Direct extension( fracture of frontal or facial bone)

37. Pathophysiology When the viruses enters the Bloodstream, it may cause inflammation of brain tissue and surrounding membranes White Blood cells invade the brain tissue as it tries to fight off the infection The brain tissue swells ( cerebral edema ), which may destroy nerve cells, cause bleeding in the brain( Intracerebral hemorrhage),brain damage 37 10/17/2024 BNS 14th Batch

38. Degenerative changes in the nerve cells of Brain Causes neurological deficit Sometimes may also involve meninges causes meningoencephalitis 38 10/17/2024 BNS 14th Batch

39. Clinical manifestation The onset of infection is typically nonspecific, with fever, headache, nausea, and vomiting. Fever, headache, disorientation, neurological deficit. Increase in intracranial pressure result in alternation in consciousness level, nausea and vomiting. Restlessness, irritability, lethargy 39 10/17/2024 BNS 14th Batch

40. Clinical manifestation contd.. Nuchal rigidity Hemiparesis Neurological deficit like aphasia, dysphagia, ataxia, paresthesia. Memory loss and delirium. Seizure 40 10/17/2024 BNS 14th Batch

41. Diagnosis History Taking includes : acute onset of fever headache confusion and seizures. Neurological examinations usually reveal a drowsy or confused patient. 41 10/17/2024 BNS 14th Batch

42. Diagnosis contd.. Stiff neck, due to the irritation of the meninges , indicates that the patient has either meningitis or meningoencephalitis. Lumbar puncture for CSF analysis which reveals leukocytosis, increased protein level and normal or slightly lowered glucose. 42 10/17/2024 BNS 14th Batch

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45. Diagnosis contd.. Brain tissue MRI. Hematology, Biochemistry. CT scan, MRI The polymerase chain reaction (PCR) It identifies the DNA bands of HSV-1 in the CSF 45 10/17/2024 BNS 14th Batch

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47. Treatment The goals of treatment are to provide supportive care (rest, nutrition, fluids) to help the body fight the infection, and to relieve symptoms. Reorientation and emotional support for confused or delirious people may be helpful. Oxygen , NG feeding, IV Fluid 47 10/17/2024 BNS 14th Batch

48. Management Treatment is usually supportive and symptomatic. Medical 1 .Anti viral medication : Acylovir for Herpes Simple encephalitis, Gancilovir , Fascarnet for Cytomegalovirus encephalitis. 2.Pyrimethamine, Sulfadoxine ( Fansidar ) for Toxoplasma encephalitis. 48 10/17/2024 BNS 14th Batch

49. Management contd.. 3. Corticosteroid to reduce cerebral edema Antibiotics - if the infection is caused by certain bacteria Anti-seizure medications (such as phenytoin) - to prevent seizures 6.Anticonvulsant therapy. 49 10/17/2024 BNS 14th Batch

50. Management contd.. 7.Osmotic diuretics to reduce intracranial pressure. 8.Aspirin to relieve headache Acetaminophen - for fever and headache Sedatives - to treat irritability or restlessness 50 10/17/2024 BNS 14th Batch

51. Management contd.. OTHERS 11. If brain function is severely affected, interventions like physical therapy and speech therapy may be needed after the illness is controlled 12. Physical therapy: to improve strength, coordination, balance, and flexibility 51 10/17/2024 BNS 14th Batch

52. Management contd.. 13.Occupational therapy: to help redevelop everyday skills 14.Speech therapy: to help relearn muscle control needed for talking 15.Psychotherapy: to help with coping strategies, mood disorders, or personality changes 52 10/17/2024 BNS 14th Batch

53. Management contd.. Supportive Care Maintain adequate airway. Maintain calm and quiet environment. Maintain fluid and electrolyte balance. Manage pain and fever. 53 10/17/2024 BNS 14th Batch

54. Management contd.. Administer antibiotics. Provide basic hygiene care. Provide psychological support. Prevent complications. 54 10/17/2024 BNS 14th Batch

55. Nursing Management 10/17/2024 BNS 14th Batch 55

56. Assessment Obtain a history of recent infections such as upper respiratory infections Assess neurological status and vital signs Evaluate for signs of meningeal and brain tissue irritation. ( severe headache, vomiting, respiratory difficulties, e.t.c ) 56 10/17/2024 BNS 14th Batch

57. Nursing diagnosis Actual Diagnosis Impaired cerebral tissue perfusion related to infectious process and cerebral edema as evidenced by altered mental status. Pain related to brain tissue irritation as evidenced by headache 57 10/17/2024 BNS 14th Batch

58. Nursing diagnosis Contd.. 3.Hyperthermia related to infection process and cerebral edema as evidenced by increased axillary temperature. 4.Disturbed Thought Processes due to personality changes as evidenced by disorientation 5. Impaired physical mobility related to prolonged bed rest as experienced by lethargy. 58 10/17/2024 BNS 14th Batch

59. Nursing Diagnosis Potential Diagnosis 6.Risk for fluid volume deficit related to fever and decreased intake. 7.Risk of Infection related to viral transmission. 8.Risk for Injury related to seizures and cerebral edema. 59 10/17/2024 BNS 14th Batch

60. Nursing Intervention 60 10/17/2024 BNS 14th Batch

61. 1. Enhance cerebral perfusion Assess level of consciousness, vital sign and neuralgic parameter frequently Maintain quiet and calm environment to prevent agitation caused by increase ICP Notify any changes to doctor Repeat spinal tapping if indicated 61 10/17/2024 BNS 14th Batch

62. Enhance cerebral perfusion contd.. Observe for signs and symptoms of ICP (e.g. decreased LOC, dilated pupils). Administer oxygen 62 10/17/2024 BNS 14th Batch

63. Enhance cerebral perfusion contd.. Prepare patient for a lumbar puncture for CSF evaluation and repeat spinal tap, if indicated. Notify the health care provider of signs of deterioration: increasing temperature, decreasing LOC, seizure activity, or altered respirations. 63 10/17/2024 BNS 14th Batch

64. 2. Reducing pain Assess the location and intensity of discomfort whenever you assess vital signs. Report a continuous headache or one that is unrelieved. Assist with position of comfort for stiffness and turn patient slowly and carefully with head and neck in alignment. 64 10/17/2024 BNS 14th Batch

65. Reducing pain contd.. Elevate head of bed (30 degree) to decrease ICP and reduce pain. Administer analgesic as prescribed. Avoid opioids, which may mask a decreasing LOC. Provide a quiet, non stimulating environment with the shades drawn. 65 10/17/2024 BNS 14th Batch

66. 3. Reducing fever Monitor vital signs . Remove unnecessary clothing and blankets. Provide tapid spongings . Apply a cooling blanket beneath the client, but avoid shivering. Provide plenty of fluids. 66 10/17/2024 BNS 14th Batch

67. Reducing fever contd.. Administer antipyretics as prescribed. Be alert to signs of other coexisting infections, such as UTI or pneumonia, and notify health care provider so cultures can be obtained and treatment started 67 10/17/2024 BNS 14th Batch

68. 4. Promoting return to optimal level of functioning Implement rehabilitation intervention offer admission ( eg . Turning, positioning) Progress from passive to active exercise based on patient’s neurologic status. Encourage adequate rest and sleep 68 10/17/2024 BNS 14th Batch

69. Promoting return to optimal level of functioning contd.. Nutrition: high calorie in small, frequent feeding Teach the patient about stress reduction technique 69 10/17/2024 BNS 14th Batch

70. 5.Maintaining fluid balance Record input and output carefully and observe signs of dehydration Give intravenous fluid as prescribed Observe the signs of fluid overload Monitor CVP frequently Monitor fluid intake to ensure adequate hydration. 70 10/17/2024 BNS 14th Batch

71. Maintaining fluid balance contd.. Monitor for fluid volume deficit Measure and compare intake and output every 2 to 4 hours Monitor daily body weights Monitor skin turgor 71 10/17/2024 BNS 14th Batch

72. Maintaining Fluid Balance contd.. Monitor condition of mucous membranes Monitor urine amount, color, and odor Monitor BUN; creatinine ratio. 72 10/17/2024 BNS 14th Batch

73. 6.Preventing injury Maintain quiet environment and provide care gently, avoiding over activity and agitation, which may cause increased ICP. Maintain seizure precautions with side rails padded, airway, and suction equipment at bedside. Administer medications as ordered; monitor response and adverse reactions 73 10/17/2024 BNS 14th Batch

74. 7.Managing Aberrations in Thought Processes Orient to person, place, time. Maintain memory book, and provide cues to perform required activities. 74 10/17/2024 BNS 14th Batch

75. 8.Avoiding Infectious Disease Transmission Maintain strict standard precautions. Initiate and maintain isolation. 75 10/17/2024 BNS 14th Batch

76. 9.Community and Home Care Considerations Promote vaccination of patient, family, and significant others for measles, mumps, and rubella. Pregnant women who have a history of genital herpes simplex, or their partners, should inform their physician of this history. Contacts of rabies-infected patients should be offered rabies prophylaxis. 76 10/17/2024 BNS 14th Batch

77. 10.Patient Education and Health Maintenance Explain the effects of the disease process and the rationale for care. Reassure significant others based on patient's prognosis . Encourage follow-up for evaluation of deficits and rehabilitation progress. Educate others about the signs and symptoms of encephalitis if epidemic is suspected. 77 10/17/2024 BNS 14th Batch

78. Patient Education and Health Maintenance Contd.. Advise the use of repellants when outdoors and removal of standing water that acts as a breeding ground for mosquitoes. 78 10/17/2024 BNS 14th Batch

79. Preventive Measures There has already been considerable progress in preventing some causes of encephalitis. Children and adults should avoid contact with anyone who has encephalitis. 79 10/17/2024 BNS 14th Batch

80. Preventive Measures contd.. Controlling mosquitoes (a mosquito bite can transmit some viruses) may reduce the chance of some infections that can lead to encephalitis. Wear long-sleeved shirts and pants when outside, particularly at dusk. Vaccinate animals to prevent encephalitis caused by the rabies virus. 80 10/17/2024 BNS 14th Batch

81. Preventive Measures contd.. Human vaccinations that are available include : A vaccination to prevent a form of viral encephalitis that often affects people in the military Herpes zoster Measles Japanese encephalitis 81 10/17/2024 BNS 14th Batch

82. Preventive Measures contd.. The elimination of smallpox and the use of vaccines against mumps, measles, and rubella have reduced the incidence of encephalitis, especially in children. Vaccines have been developed for people who travel to high-risk areas as well. 82 10/17/2024 BNS 14th Batch

83. Preventive Measures contd.. Other ways to prevent it are to avoid viruses that can lead to the disease (like herpes) and to protect yourself against mosquito and tick bites. 83 10/17/2024 BNS 14th Batch

84. Prognosis The outcome varies. Some cases are mild and short, and the person fully recovers. Other cases are severe, and permanent impairment or death is possible. The  acute phase normally lasts for 1 - 2 weeks. Fever and symptoms gradually or suddenly disappear. Some people may take several months to fully recover. 84 10/17/2024 BNS 14th Batch

85. Prognosis Contd.. Acute phase of illness different from person to person. Some recover with slight disability, others profound disability and a few need residential care for life time. 85 10/17/2024 BNS 14th Batch

86. Prognosis Contd.. Degree and type of damage Cause of inflammation Severity of the infection Area affected Delay in seeking treatment. 86 10/17/2024 BNS 14th Batch

87. Complications Encephalitis can damage the brain and cause long-term problems including: memory problems personality and behavioral changes  speech and language problems swallowing problems 87 10/17/2024 BNS 14th Batch

88. Complications contd.. repeated seizures or fits-known as epilepsy emotional and psychological problems, such as anxiety, depression and mood swings problems with attention, concentrating, planning and problem solving 88 10/17/2024 BNS 14th Batch

89. Complications contd.. problems with balance, co-ordination and movement persistent tiredness 89 10/17/2024 BNS 14th Batch

90. Summary 90 10/17/2024 BNS 14th Batch

91. References Basavanthappa , BT. Medical Surgical Nursing 2 nd (ed.) . Newdelhi : Jaypee Brothers Medical Publishers (p) Ltd.( 821-822). Black, M.J & Hawks, H.J (2015). Medical –Surgical Nursing.8 th (ed.) volume-2 , India, Haryana: Reed Elsevier India Private Limited.(1837) 91 10/17/2024 BNS 14th Batch

92. References contd.. Shrestha, H., Paudyal , P. & Giri, S. (2072). A textbook of Medical Surgical Nursing I & II. 2 nd (ed.), Kathmandu, Nepal: Heritage Publishers & distributors Pvt. Ltd. (358-360). 92 10/17/2024 BNS 14th Batch

93. References contd.. Smeltzer, C.S., Bare, G.B, Hinkle, L.J., & Cheever, H.K (2011). Brunner & Suddarth’s Textbook of Medical – Surgical Nursing. 12 th (ed.). Wolters Kluwer Pvt. Ltd; (1953-1955). Net References https://www,cdc.gov 93 10/17/2024 BNS 14th Batch

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