Enriquez, Patrick M.

BSN 308
Fernandez, Toni Marie M. Module 5 Formative Assessment 3: Natural History of Disease
The Natural History of Encephalitis “Brain Fever”
Inflammation of the brain
Incubation Period: 5 to 15 days
Predisposing Factors
The Host (Individual)
- Age (more common or more severe on younger children and older
adults)
- Individuals with weak immune systems (people with human
immunodeficiency viruses or acquired immunodeficiency
syndrome; individuals taking immune-suppressing drugs; or those
who have other conditions that weakened the immune system)
The Environment
- Geographical region is one of the contributing factors of
encephalitis because this disease is common geographical
regions.
- Mosquito-borne and tick-borne diseases are more prone in
summer in some countries like the United States.
The Agent
Viral
- Enteroviruses such as coxsackievirus, poliovirus and echovirus
- Herpes simplex virus
- Varicella zoster virus
- Epstein-Barr virus
- Cytomegalovirus
- Adenovirus
- Rubella
- Measles
- Murray Velley encephalitis (MVE) virus and Kunjin virus
- Japanese encephalitis virus
Non-viral
- Bacteria including Borrelia burgdorferi, Coxiella burnetii, Rickettsia
rickettsii, Erlichia chaffeensis, Listeria monocytogenes, and
Mycobacterium tuberculosis
 - Parasites such as Toxoplasma gondii, Trypanosoma brucei, and
Plasmodium falciparum
- Fungi such as Histoplasma capsulatum, Coccidioides species, and
Cryptococcus neofromans

Pre-Pathogenesis (Before Infection) Pathogenesis (During Infection) Terminal Phase

Primary Level of Prevention Secondary Level of Prevention Tertiary Level of Prevention
General Measures Specific Measure Early Detection, Treatment, and Monitoring Rehabilitation
- Educate the public - Do not share Diagnostic Test: Complete blood test (CBC) and - Provide the patient a safe
about encephalitis utensils CSF analyses environment and gentle
- Encourage people - Practice good Result stimulation to promote the
to practice healthy hygiene - Increase Protein process of recovery and to help
lifestyle - Wear long-sleeved - Increase White Blood Cells the patient and his family
- Get vaccination clothes to protect Other diagnostic exam includes understand and adapt to what
yourself from Electroencephalogram (EEG) which assess the happened.
mosquitoes extent of the brain damage. - Encourage the patient to
- Apply mosquito develop new habits, skills, and
repellent Isolation: A patient diagnosed with encephalitis ways to cope with his remaining
- Spray insecticides might be required to stay on the intensive care units difficulties.
to the surroundings to get monitored by health care workers for brain - A patient diagnosed with
- Remove water swelling, changes in heart rhythm, respiratory encephalitis needs to develop
sources outside failure, and seizures. systems, habits, aids, and
the home procedures to perform his daily
- Install mosquito Pharmacologic Treatment activities and reduce the need
nets on doors and Treatment for mild encephalitis consists of: for reminding, guidance, and
windows - Bed rest explanation.
- Plenty of fluid intake - Patient with post-acute brain
- Practice proper
- Anti-inflammatory drugs such as injury due to encephalitis is
handwashing
acetaminophen (Tylenol), ibuprofen (Advil encouraged to undergo a
and Motrin IB), and naproxen sodium rehabilitation program.
(Aleve). The said drugs help relive - Patients affected by encephalitis
headache and fever. are encouraged to attend group
 - Antiviral drugs or individual sessions to develop
- Acyclovir (Zovirax) decision-making, problem-
- Ganciclovir (Cytovene) solving, awareness, and
- Foscarnet (Foscavir) planning.
Supportive Management - Patients may also need
People who are hospitalized with severe behavioral therapy to help them
encephalitis might need: get motivated, shape self-
- Breathing assistance, as well as careful control, and develop adaptive
monitoring of breathing and heart function attitudes.
- Intravenous fluids to ensure proper
hydration of levels of essential minerals
- Anti-inflammatory drugs such as
corticosteroid to reduce swelling and
pressure within the skull
- Anticonvulsant medication such as
phenytoin (Dilantin) to stop or prevent
seizure

Nursing Diagnosis
Ineffective Cerebral Tissue Perfusion related to
inflammatory processes increased ICP
Nursing interventions:
- Observation of consciousness level
- Check the status of neurology every one to
two hours and if necessary, until a stable
state.
- Monitor the signs of elevated blood
pressure, irregular breath, anxiety, changes
in the pupil.
- Elevate the head by 30° and keep the head
and neck straight to improve venous return.
- Teach children to avoid the Valsalva
maneuver
- Monitor signs and symptoms of septic
shock
Risk for injury related to disorientation, seizure, and
the unfamiliar environment
Nursing interventions:
- Observation of consciousness level
- Check the status of neurology every 1-2
hours and if necessary, until a stable state.
- Provide a comfortable and calming
environment.
- Limit the number of patient’s visitors.
- Teach ROM exercises (passive, active) as
recommended and regularly.
- Collaboration of anticonvulsants.
Altered thought processes related to changes in
the level of consciousness
Nursing interventions:
- Observation level of consciousness.
- Check the status of neurology every 1-2
hours and if necessary, until a stable state.
- Monitor the signs of elevated blood
pressure, irregular breath, anxiety, changes
in the pupil.
- Speak clearly and slowly.
- Provide a comfortable and calming
environment.
- Limit the number of patient’s visitors.
Imbalanced Nutrition: Less than body requirements
related to anorexia, fatigue nausea, and vomiting
Nursing interventions:
- Ask the patient's favorite food.
- Provide the appropriate diet.
- Serve food frequently but in small portions.
- Encourage patient to eat slowly.
- Allow patient’s families to serve and provide
food for the patient.
- Monitor patient body weight each day.
 - Create a pleasing environment.
- Encourage patient’s family to accompany
the patient while having his meals.
- Limit intake of fluid during meals.
- Provide proper oral care.
Acute pain related to irritation encephalon
- Assess the pain level.
- Evaluation for pain (facial expression,
crying), duration, intensity, location, and
precipitating factors.
- Promote comfort support comfort by
teaching different distraction techniques
- Limit the number of patient’s visitors.
- Collaboration of analgesics.

Reference:
Encephalitis. (n.d.). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/encephalitis
Encephalitis - Symptoms and causes. (2020, April 17). Mayo Clinic. https://www.mayoclinic.org/diseases-
conditions/encephalitis/symptoms-causes/syc-20356136
Nursing Care Plan: Nursing Care Plan for Encephalitis - Assessment, Diagnosis and Interventions. (n.d.). Nursing Care Plan.
https://nanda-nursing-care-plan.blogspot.com/2014/08/nursing-care-plan-for-encephalitis.html
Rehabilitation after encephalitis. (2017, July 4). The Encephalitis Society. https://www.encephalitis.info/rehabilitation-after-encephalitis
Viral encephalitis - Better Health Channel. (n.d.). Better Health Channel.
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/viral-encephalitis