CASE

PRESENTATION
ON

POST
ENCEPHALITIS

NURSING PRO.
MR.JITENDRA BARDE
 INTRODUCTION

Encephalitis is an inflammation of the brain tissue. The most common cause is

viral infections. In rare cases it can be caused by bacteria or even fungi.

There are two main types of encephalitis: primary and secondary. Primary
encephalitis occurs when a virus directly infects the brain and spinal cord.
Secondary encephalitis occurs when an infection starts elsewhere in the body and
then travels to your brain.

Encephalitis is a rare yet serious disease that can be life-threatening. You should
call your doctor immediately if you have symptoms of encephalitis.
 HISTORY COLLECTION
Demographic Data:

Name: Miss Vaishnavi Santosh Mankape

Age : 12 yrs

Gender : Female

Marital Status : Unmarried

Religion: Hindu

Education : 8th Started (Still Schooling)

Family Income : 90 thousand per annum

Address : A/P Jategaon Tal Phulambri District Arungabad

IPD: IPD-1-19-053651

OPD: OPD-11-110919-00061

Ward: Pediatric ICU

Diagnosis: Encephalitis

Date of Admission: 06/02/2020

Chief Complaint:

Fever, Drowsiness, Headache, weakness, Irritability, Seizures.

History of Present Illness:

The paitent vaishanvi came to Dr. D.Y. Patil hospital and research centre with the
complaints of headache, weakness, drowsiness and occasional seizures. The patient
is suffering from the above symptoms for past one year. They had visited the local
doctors, but don’t have any records of it.

Past Medical History:

Other than the above complaints client has no medical history.

Past Surgical History:

No Significant surgical history

Family History:

Sr.No Name of Age Sex Occupatio Relation Health Health

the n with Patient Status Habits
Family
Member
1 Santosh 40 M Farmer Father Healthy Good
2 Sheela 35 F Housewife Mother Healthy Good
3 Vaibhav 17 M Student Bother Healthy Good
4 Vaishnavi 12 F Student Patient Unhealth Good
y

Family Tree:

Mr Santosh - - Mrs Sheela

Mr Vaibhav- - Vaishnavi (Patient)

➢ Male - Female - Patient

Socio- Economic Status:

Miss Vaishnavi belongs to a lower middle class family. There are 4 members in the
family. They have proper water are electricity supply in their house.

Health Habits:

A) Diet: Miss Vaishnavi is on Full-Mixed Diet, and has regular meals 3 times a
day.

B) Personal Hygiene: Personal Hygiene is maintained by the patient.

C) Activity and Exercise: The client walks around in the ward.

D) Sleep and Rest Pattern: Patient has normal sleep pattern. Client takes rest
in the afternoon and a short nap in the afternoon

E) Elimination Pattern: The client has normal bowel and bladder movement.

PHYSICAL EXAMINATION
Name: Miss Vaishnavi Santosh Mankape

Age: 12 yrs

Gender: Female

Surgery: Not applicable

Date of Surgery: Not applicable

I. General Appearance:
a) Level of consciousness – Conscious
b) Body Built – No Abnormality
c) Gait/ Walking – Normal
d) Hygiene Grooming- Maintained
e) Body Odor - Absent
f) Speech – Clear and Normal

II. Psychological / Emotional Status:

a) Appeareance – Calm, a bit anxious.
b) Conversation- Comforatble and relevant

III. Sensory – Percetual Status:

Eyes:

a) Vision: Normal ( No Spectacles)

b) Types of error: Not Applicable

Ears:

a) Hearing: Normal (No Hearing Aid)

Nose and Throat:

a) There is no nasal discharge

b) No Throat Infection

Touch:
a) Response to light torch – Normal Response
 b) Response to painful stimuli – Normal
c) Response to hot and cold – Normal

Taste:

a) Normal and active taste buds

IV. Skin Integumantary:

a) Condition /texture – Healthy
b) Head scalp status – No lesions present
c) Hair – dry

V. Respiratory System:
a) Rate – 19 beats per min
b) Breath sound – Normal
c) Chest Expansion – Equal chest expansion

VI. Cardiovascular Status:

a) Heart Rate – 72 beats per min
b) Blood Pressure – 120/70 mm Hg
c) Heart sound – Normal

VII. Neurological Status:

1) Level of Consciousness:
➢ Lethagic
➢ Score of GCS- 8
2) Mental Status Examination
➢ General Appearance :- Groomed
➢ Speech :- Normal
➢ Thought process :- normal
➢ Mood :- Altered
➢ Cognitive Functions:- Orientated to Time, place and Person
3) Special Cerebral Function: Agnosia
4) Cranial Nerve Examination:
➢ Olfactory nerve:- present(Sense of Smell)
➢ Optic nerve:-
 Inspection of eye – No abnormalities
Visual Field examination- normal
➢ Oculomotor,trochlear and abducent nerve:-
Pupillary reaction to light – Reacting
Pupillary size- Equal
Eye movement- normal
➢ Trigeminal Nerve:-
Corneal reflex- absent
Facial sensory response- Present
➢ Facial Nerve:-
Facial expression- Normal
Taste sensation – Present
➢ Vestibular Cochlear nerve:-
Auditory acuity test- normal
Air conduction- normal
Bone conduction- normal
➢ Glassopharyngeal and vagus nerve:-
Gag reflex- present
Swallowing reflex- present
Position and movement of uvula- normal
Sensation of taste – present
➢ Hypoglossal nerve – Normal
5) Motor Function Assessment:-
Muscle strength – abnormal
Gait- present
Movements of all the joints – normal
Abnormal movement – absent

VIII. Gastrointestinal Status:

a) Gag reflex – Present
b) Peristalisis sound- Present

IX. Genito- Urinary Status:

a) Urine colour – Yellow
b) Odor – Absent
 c) Character – Normal

X. Musculo- Skeletal Status:

a) Muscle tone – Normal
b) Muscle Strength – Able to clamp the fingers
c) Gait / Stability – able to walk properly

DISEASE CONDITION
Definition:
Encephalitis is an acute inflammation of the brain. Encephalitis is an acute
inflammation (swelling) of the brain usually resulting from either a viral infection
or due to the body's own immune system mistakenly attacking brain tissue
Anatomy and Physiology of Brain
The brain is a three-pound organ that controls all functions of the body, interprets
information from the outside world, and embodies the essence of the mind and
soul. Intelligence, creativity, emotion, and memory are a few of the many things
governed by the brain. Protected within the skull, the brain is composed of the
cerebrum, cerebellum, and brainstem.
The brain receives information through our five senses: sight, smell, touch, taste,
and hearing - often many at one time. It assembles the messages in a way that has
meaning for us, and can store that information in our memory. The brain controls
our thoughts, memory and speech, movement of the arms and legs, and the
function of many organs within our body. The central nervous system (CNS) is
composed of the brain and spinal cord. The peripheral nervous system (PNS) is
composed of spinal nerves that branch from the spinal cord and cranial nerves that
branch from the brain.
Brain: The brain is composed of the cerebrum, cerebellum, and brainstem.

Cerebrum: Is the largest part of the brain and is composed of right and left
hemispheres. It performs higher functions like interpreting touch, vision and
hearing, as well as speech, reasoning, emotions, learning, and fine control of
movement.
Cerebellum: is located under the cerebrum. Its function is to coordinate muscle
movements, maintain posture, and balance.
Brainstem: acts as a relay center connecting the cerebrum and cerebellum to the
spinal cord. It performs many automatic functions such as breathing, heart rate,
body temperature, wake and sleep cycles, digestion, sneezing, coughing, vomiting,
and swallowing.

Incidence:

➢ Incidence varies between studies but is generally between 3.5 and 7.4 per
100,000 patient-years.
➢ Encephalitis affects peoples of all ages; however, incidence is higher in the
pediatric population.
➢ Although both sexes are affected, most studies have shown a slight
predominance in males.

Etiology:

➢ Bacterial Infection
➢ Viral Infection
➢ Herpes simplex virus (HSV)
➢ Other herpes viruses
➢ Enteroviruses
➢ Mosquito-borne viruses
➢ Tick-borne viruses
➢ Rabies virus
➢ Childhood infections- Measles, Mumps and Rubella

Risk Factors:
 ➢ Age - Some types of encephalitis are more common or more severe in
certain age groups. ...
➢ Weakened immune system - People who have HIV/AIDS, take immune-
suppressing drugs or have another condition causing a weakened immune
system are at increased risk of encephalitis.
➢ Geographical regions.
➢ Season of the year.

Clinical Manifestation:

The symptoms of encephalitis can range from mild to severe.

In Book In Patient
Mild Symptoms:
➢ fever Present
➢ headache Present
➢ vomiting Not Present
➢ stiff neck Present
➢ lethargy (exhaustion) Present

Severe Symptoms: Not Present

➢ fever of 103°F (39.4°C) or higher Not Present
➢ confusion Present
➢ drowsiness Not present
➢ slower movements Irregular Episodes
➢ seizures Present
➢ irritability
➢ sensitivity to light
unconsciousness

Pathophysiology:
 Virus enters the body through the bite of the insect vetor- mosquito

After multiplication in Reticuloendothelial system, viremia of varying duration

enuses

Virus is transported to the target organ brain via blood

Virus proliferates and damage the neuronal tissues, thereby elicits nervous
manifestation

Resulting in brain inflammation

Investigation:
Sr.No Investigation Normal Value Client Value Inference
1 CBC
a) HB 12.0 -15.5 gram / 11.0 gram/deciliter Abnormal
deciliter
4,500 to
10,000 Per
b) WBC 11,000 WBCs per Microlite Abnormal
microlite 4.0 to 5.5 million
c) RBC 4.0 to 5.5 million mcL Normal
mcL
2 CT Scan of the Head Normal Images Abnormal Images Abnormal
3 Culture of CSF
a) Pressure Normal Incresed Abnormal
b) Glucose Normal Low
c) Cell count Normal PNL
d) Protein Normal High

4 MRI of the Brain Normal Abnormal Images Abnormal

NURSING DIAGNOSIS
1) Increased body temperature related to infection as manifested by vital signs.
2) Ineffective Tissue Perfusion related to increased intracranial pressure/
Inflammatory Process as manifested by Lab Reports.

3) Risk for injury related to the seizure as manifested by altered mental status
and decreased level of consciousness.
4) Impaired physical mobility related to neuromuscular damage relate to
decreased muscle strength, decreased consciousness, and damage perception
/ cognitive.
5) Imbalanced Nutrition Less Than Body Requirements related to anorexia,
fatigue, nausea, and vomiting as manifested by patient verbalization.
6) Altered thought processes related to changes in the level of consciousness as
manifested by self observation.
7) Deficient knowledge related to treatment or noncompliance
 ASSESSMENT NURSING GOAL NURSING PLANING NURSING RATIONAL EVALUATION
DIAGNOSIS INTERVENTION
Subjective data- Imbalanced The patient Assess the general Assess the general To plan for The EOC was
Nutrition Less will have condition of the patient condition of the patient further care partially met
Than Body balanced (t98.6F,P- as evidence by
Requirements r nutritional 86/M,RR22/M,BP-
absence of
elated status as 100/70mm of hg, ht-
to anorexia, evidence by 160cm,wt 45 kg, ) hyperglycemia
fatigue, nausea, increased and adequate
Objective data- and vomiting as weight 56 kg, Check daily weight of the Not done To know the TPN therapy
Patient is NBM manifested by Hemoglobin patient daily
and on TPN patient 15mg/dl, improvement
verbalization. normal Administer total parental Administered total To increased
Patient looks appetitide nutrition parental nutrition the appetite
weak and thin. and absence calories2400,protein-
of diabetic 44gm/day,CHO, fat-
Patient’s weight tendency 25gm/day)
45 kg
Hb-8.6mg/dl Monitor the intake output Monitor the intake output To know the
of the patient. of the patient(1950/2000) daily
Hyperglycemic monitoring
tendency
Once started oral give Food given(green leafy To know the
Malabsobtion due fliud diet according to ,soya,tomato, juice,etc) patient status
to loss of patient s like &dislikes
pancreatic
enzymes Administer insulin& Administered insulin& To supplements
pancreatic enzyme pancreatic enzyme therapy pancreatic
therapy as prescribed to as prescribed to patient function
patient
Subjective data Deficient .Explaining the -Explain the disease process in a simple language The patient
The patient knowledge Patient will be disease that the patient can understand. verbalized feeling
complain that he related to able to process. -Involve the family members also while explain of mental peace
is worried about treatment or understand the -Involvement the disease process and how it can be prevented and understand
his health and noncompliance. disease process of the family from transferring to other people. his disease
feels that he and treatment members in -Reinforce the importance of adhering to process.
cannot be regimen within designing the treatment regimen and keeping follow-up
completely 1 day of the treatment appointments.
recover from his nursing regime. -Help client to develop a simple, convenient
illness. intervention and -Supporting schedule for taking medication.
Objective data will look less and assisting - Explain prescribed medications along with their
Patient looks anxious, worried the patient. rationale, dosage, expected and adverse side
-anxious and decrease effects.
-worried feeling of fear - Explain the patient that the disease can be cure
-asked too many of death. completely with regular intake of medicine and
question about follow up.
prognosis. -assist and support the patient whenever needed
Fear of death. and clear any doubt related to the disease process
and treatment regime.
Subjective data Disturbed sleep -The patient will -To provide a -Provided calm and quiet environment, well Patient verbalized
Patient pattern related able to sleep calm and quiet ventilated room, decrease bright light. adequate sleep at
verbalized to anorexia, undisputedly environment. -Instruct the patient to scheduled exercise during night.
difficulty in fatigue, nausea, during night the day.
falling asleep, and vomiting as within 1 day of -To avoid stimulants like excessive tea, coffee etc.
interrupted evidence by nursing -Maintain consistent bed timing.
sleep. verbalization of intervention and -Use relaxation techniques like medication,
Objective data inability of day time prayer..
-Lethargy falling asleep sleeping will -Instruct patient to avoid too much day time
-Day time and day time decrease sleeping
sleepy. sleeping.
Management:
Medical Management:
In Book In Patient
Anti inflammatory Drug Not Present
Anti- Convulsant Drug Present (Cloba, Lovax) BD
Intravenous Fluid Not Present
Corticosteroids Not Present
Immunoglobulin Therapy Not Present

Nursing management:
• Monitoring pupils and vital signs frequently for increased intracranial
pressure (ICP, irregular pupils, widening pulse pressure, tachycardia and
irregular breathing, hyperthermia)
• Maintain adequate fluid intake to prevent dehydration, but avoid fluid
overload, which may increase cerebral edema.

• Maintain adequate nutrition. Give small, frequent meals, or supplement

meals with nasogastric tube or parenteral feedings.
• To prevent constipation and minimize the risk of increased ICP resulting
from straining at stool, provide a mild laxative or stool softener.
• Carefully positioned the patient to prevent joint stiffness and neck pain, and
turn the patient often.
• Provide thorough mouth care.
• Maintain a quiet environment. Darkening the room may decrease headache.
• If the patient has seizures, take precautions to protect him from injury.
• Measure and record intake and output.
• Teach the patient and his family about the disease and its effects.
• Administer antipyretics and other cooling measures as indicated.
• Provide fluid replacement through I.V. lines as needed.
 Health Education

Diet:
Miss Vaishnavi Mankape has been advice to have mixed diet. To have a
proper balanced diet. Instructed the client to have three time meal in a day. The
client is advised to have adequate water to maintain the water balance of the body.
Sleep:

Patient is advised to take proper rest or sleep daily in the afternoon for
some while and then to have adequate sleep for 7- 8 hours.

Medication:

Instructed the patient and her family about the course and schedule of her
medication. Explained the patient the importance and benefits of taking the
medication on time.

Follow up care:

Explained the client the importance of follow up care. Advised the

patient to come for regular follow up care till the patient is fully recovered.
 SUMMARY
Miss Vaishnavi Santosh Mankape, 12 years old, female was admitted in
Dr.D.Y.Patil Hopsital on 06/02/2020 due to severe headache. Post the Examination
and investigation the client was diagnosed with Encephalitis.

The client was given the required treatment as per the disease condition. Post the
treatment the client verbalized her health condition stable. The client and the
family were taught the immediate precautions that are to be taken at the time of the
occurrence of seizure.

Proper health education is given to the patient as well as the family members.

CONCLUSION
Miss Vaishnavi Santosh Mankape, 12 years old, female was admitted in
Dr.D.Y.Patil Hopsital on 06/02/2020 due to severe headache. The patient was
diagnosed and treated for encephalitis. The client responded well to the care and
treatment to her. Her stress was relieved by giving psychological and non-
pharmacological support. Health education was given to the client and family on
the disease condition. Medications were administered on time and the patient is
recovering.
 BIBILOGRAPHY

1) “Brunner & Suddarth’s text book of Medical – Surgical Nursing, 4 th

Edition, jaypee publication, pg no 412- 415”

2) “Ashalata, Textbook of anatomy and physiology, 4th edition, jaypee

publication, pg no – 345-347”

3) “ Joyce M black, The textbook of Medical surgical nursing, 5th edition,

Authar Publication, pg no 567-568”

4) “ Lewis, The Textbook of Medical Surgical Nursing, Emmess Publication,

pg 1123-1124”

5) https://www.ncbi.nlm.nih.gov/pubmed/28183838