VIRAL ENCEPHALITIS

INTRODUCTION
General Objective:
To improve the therapeutic
management of the health team towards
the promotion and/or restoration of the
patient’s health and optimal level of
functioning through active and
enthusiastic participation in case studies
relevant to health professionals thus,
acquiring further insight and
understanding of the disease topic’s
process and treatment regimen.
Specific Objectives:
a. To provide clear, concise, and up-to-date
information on the disease topic – it’s causality,
manifestations, and treatment
b. To correlate the patient’s demographic profile
and health history to the presenting signs and
symptoms of the disease and its pathophysiology
c. To discuss the medical, diagnostic, and nursing
management rendered to the patient during
his/her course in the ward and explain the
relevance of the abovementioned management
DEMOGRAPHIC PROFILE
Patient X
Admission Date:
February 22, 2017

Discharge Date:
March 2, 2017

Length of Stay:
8 days
Patient X
 Age: 31 years old
 Sex: Female
 Birth Date: December 22, 1985
 Civil Status: Married
 Address: San Agustin, Iriga City
 Religion: Roman Catholic
 Nationality: Filipino
Patient X
 Chief Complaint:
Fever for one week with convulsions

 Initial Vital Signs:

 BP: 120/70 mmHg
 T: 37.4C
 PR: 114 bpm
 RR: 21 bpm
Patient X
History of Present Illness:
Patient X had on and off fever for
5 days prior to admission; Had seizures

 History of Family Illnesses:

(-) TB
(-) DM
(-) HeartDisease
CASE DESCRIPTION
What is Encephalitis?
 a.k.a brain fever
 acute inflammation of the brain
 The most common cause is a viral infection.
What is Viral Encephalitis?
inflammation of the brain due to a viral
infection
What is Viral Encephalitis?
 Encephalitis may be life-threatening, but it is
rare
 Encephalitis is more likely to affect children,
older adults, individuals with weakened
immune systems, and people who live in
areas where mosquitoes and ticks that
spread specific viruses are common
Encephalitis VS Meningitis
Encephalitis VS Meningitis
 HOW DO YOU GET VIRAL
ENCEPHALITIS?
Primary Encephalitis
(Infectious)

When there is a direct

viral infection of the brain Secondary Encephalitis
(Post-Infectious)

Infection which started off

elsewhere in the body and
then spread to the brain
 ETIOLOGY
 Etiologic Agent:
Arboviruses:
Togaviridae
Bunyaviridae,
Flaviviridae

 Reservoir:
- birds

 Vectors:
- mosquitoes
- ticks
- insects
SIGNS AND SYMPTOMS
 INITIAL SIGNS AND SYMPTOMS

body weakness fever headache

OTHER SIGNS AND SYMPTOMS
 TESTS AND DIAGNOSIS

History Taking and Physical Assessment

TESTS AND DIAGNOSIS

Blood Tests
TESTS AND DIAGNOSIS

Lumbar Puncture
ASSESSMENT
 HEALTH PERCEPTION & MANAGEMENT
Prior to admission:
 With a complete immunization
 Visits a doctor to have a check up and seek for medical
assistance.
 Uses herbal medicines such as oregano, guava, bitter ground
and ginger.
 Buys and takes over the counter drugs such as Biogesic,
Solmux, Alaxan etc.
 Sometimes she goes to “manghihilot” when she is sick
 She doesn't smoke and drink alcohol occasionally
 Patient had on and off fever, convulsions and body pains few
days prior to admission associated with headache, after
experiencing it her relatives decided to see a physician.
 HEALTH PERCEPTION & MANAGEMENT
During Hospitalization:
 Disoriented
 Conscious
 GCS 9/15 (E3V1M5)
 (+) neck stiffness
 relatives are willing to accept and listen to health
teachings.
 “Sana bumalik pa iya sa dati” as verbalized by the S.O
 They show interest and compliance to treatment and
medication to recover faster
 NUTRITION AND METABOLISM
Prior to admission:
 Eats her meals 3x a day with snack in between.
 Can drink up to 1.5L of water or 4-5 glasses a day.
 Drinks coffee in the morning and in the afternoon.
 She is fond of eating isaw, fishballs, barbecue and other
street foods.
 No allergies to food
 good hygiene
 NUTRITION AND METABOLISM
During Hospitalization:
 Weight: 89kg
 Height: 5'7''
 Nothing per orem due to the presence of coffee ground
per nasogastric tube.
 After 3 days, able to feed per NGT.
 2 days prior to discharge, able to remove NGT and eat
per orem.
 ELIMINATION
Prior to admission:
 She voids 4-5 times a day.
 Normal urine color and frequency
 No burning sensation/ pain felt during urination
 She usually moves her bowel every morning
 with brown and formed stools.

During Hospitalization:
 No pain or burning sensation during urination
 She experienced vomiting with coffee ground color
 A nasogastric tube is used for lavage.
 ACTIVITY & EXERCISE
Prior to admission:
 The patient ambulates
 She does simple exercises like biking, walking, gardening
and even fetching water.
 Able to bathe herself.

During Hospitalization:
 GCS of 9/15
 Stiffening of extremities
 Nuchal rigidity noted
 (+) restlessness
 SEXUALITY/REPRODUCTIVE
 Married
 With no child
 Her husband is an OFW.
 She has no history of Sexually Transmitted Disease or any
disease affecting her genitals.
 COGNITIVE/PERCEPTUAL
Prior to admission:
 No sensory deficits
 Oriented to people, time and place
 Responds to stimuli verbally and physically.

During Hospitalization:
 Unable to determined the name of people around her
 On the 5th day, she has visual hallucination
 With episodes of lapses in memory.
 ROLES/RELATIONSHIP
Prior to admission:
 Married
 No child
 Loves her husband and family so much.
 Well-supported and loved by her family with close
relationship.

During Hospitalization:
 Well-supported by the family.
 SELF-PERCEPTION-SELF-CONCEPT
Prior to admission:
 Manages to practice healthy lifestyle and seek to medical
assistance.

During Hospitalization:
 Hopeful and positive
 Major concern is her recovery
 VALUES/BELIEFS
Prior to admission:
 Roman Catholic
 Have strong faith in God
 She always brings with her a rosary and prays at night
 Goes to church and attends the Sunday mass.

During Hospitalization:
 The admission don't interfere with spiritual practices.
 COPING/STRESS
Prior to admission:
 Copes up with stress by doing household chores and by
taking nap or sleep.
 Copes up with problems by talking about it with her
family and find ways to resolve it together.
 Went to hospital and sought foe medical assistance.

During Hospitalization:
 Able to accept situation by cooperating with the medical
advices and procedures.
 SLEEP/REST
Prior to admission:
 Can sleep for 7-9 hours per night
 straight hours of sleep
 Sometimes takes a nap at noon for about 1-3 hours
 No difficulties in going to sleep.
 Doesn't uses any medication to promote sleep.

During Hospitalization:
 Her sleep is interrupted due to her condition.
COURSE IN THE WARD
DIAGNOSTIC TESTS
HEMATOLOGIC TEST
BLOOD CHEMISTRY
 MISCELLANEOUS TESTS
 Dengue Antibody Test
IgM – Negative
IgG – Negative

 Salmonella Typhi
IgM – Negative
Antibody Test
IgG – Negative
 ECG

Interpretation: Normal Sinus Rhythm

 CHEST X-RAY

Interpretation: Normal Chest

 CRANIAL CT OF HEAD WITH IODIDE
CONTRAST
 Comparison: None
 Interpretation:
Multiple axial images of the head were obtained with and without
intravenous contrast.
The ventricles, cisterns and sulci are normal in size and shape. There is
no focal enhancing lesion or meningeal enhancement. There is no acute
intracranial hemorrhage or extra-axial fluid collection. There is no
midline shift, mass or mass effect. The parenchymal gray-white pattern
is intact.
Opacities are seen in the maxillary, sphenoid and ethmoid sinuses. The
mastoids and the rest of the visualized paranasal sinuses are well-
developed and intact.The visualized osseous structures are normal
 Impression: Normal CT of the brain
Polysinusitis
 CSF ANALYSIS
 Color: Straw
 Transparency: Clear
 Sugar: 3.63 mmol/L
 Protein: 1.0 g/L
 CSF Cell Count : 3 cells/cu mm3
 Differential Count: 0.30 Segmenters
0.68 Lymphocytes
0.02 Monocytes
 CSF AFB: Negative for Cryptococcus Neoformans;
(No AFB Detected)
 India Ink : (?)
 CS: (?)
 GS :
(Preliminary Result) No growth after 24hrs of incubation
(Final Result) No growth after 72hrs of incubation
CSF ANALYSIS
ANATOMY AND PHYSIOLOGY
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
 NERVOUS SYSTEM
 Cells of the nervous system are neurons and neuroglia

neurons
or “nerve cells” receive stimuli and
transmit action potentials to other
neurons or to effector organs

neuroglia
or “glial cells”, are non neuronal cells of
the CNS and PNS
 two types of processes

DENDRITES

function to receive information from

other neurons or from sensory receptors
and transmit the information toward the
neuron cell body

AXON

long cell process extending from the

neuron cell body
 five types of neuroglia

serves
line the as the major
fluid-filled cavities
ASTROCYTES supporting tissue
within the CNS. Some
epyndemal cells produce
in
CSFtheandCNS
others,and
with cilia
EPYNDEMAL onhelp
participate remove
with
the surface, the
help move
bacteria
blood and
the CSF through
vessel cellCNS
the
MICROGLIA debris from the
endothelium to
OLIGODENDROCYTES form a CNS
permeability
surrounding axons
barrier,
in the called
CNSthe
SCHWANN CELLS surrounding
BLOOD BRAIN axons
in the PNS
BARRIER, between
the blood and the
neurons
 BRAIN: MAJOR REGIONS

brainstem diencephalon

cerebrum cerebellum
 brainstem
 consists of medulla oblongata, pons,
and midbrain and contains several
nuclei involved in vital body
functions such as the control of
heart rate, blood pressure, and
breathing.
 -connects spinal cord to the
remainder of the brain.
 -first two cranial nerves are also
located in the brain stem

midbrain midbrain contains nuclei involved in the

coordination of eye movements and in the control
of pupil diameter and lens shape
medulla oblongata relay information between the
cerebellum
cerebrum and

with specific functions as regulation of heart rate,

pons blood vessel diameter, breathing, swallowing, vomiting,
coughing, sneezing, balance and coordination.
 diencephalon
 part between the brains and
cerebrum
 -main components are the
thalamus, epithalamus, and
hypothalamus

largest
thalamus part of the diencephalon. Most sensory
input that ascends through the spinal cord and
brain stem projects to the thalamus
it consists of a few small nuclei that are involved in
epithalamus the emotional and visceral response to others and
pineal body
Very important in maintain homeostasis. Placed a

hypothalamus central role in the control of body temperature,

hunger and thirst
 cerebrum
 largest part of the brain.
Divided into left and right
hemisphere by a longitudinal
fissure.
 each cerebral hemisphere is
divided into lobes named for
the skull bones overlying them

control of voluntary motor functions, motivation,

FRONTAL LOBE aggression, mode and olfactory (smell) reception

principal center for the reception and conscious

PARIETAL LOBE perception of most sensory information, such as
touch, pain, temperature, balance, and taste
olfactory (smell) and auditory (hearing) sensations
TEMPORAL LOBE and place an important role in memory

OCCIPITAL LOBE reception and perception of visual input

PATHOPHYSIOLOGY
DRUG STUDY
 PARACETAMOL
antipyretic/analgesic

 Indication:
headache, toothache, fever
 Contraindications and
Cautions:
- contraindicated with
allergy to paracetamol
- use cautiously with renal
and hepatic failure
 CEFTRIAXONE
antibiotic
 Therapeutic action:
bactericidal; inhibits synthesis
of bacterial cell wall, causing
cell death
 Indication:
meningitis caused by S. pneumoniae,
H. influenzae, S. aureus,
N. meningitidis
 Contraindications and Cautions:
- contraindicated with
allergy to cephalosporins or
penicillins
- use cautiously with
pregnancy, lactation, renal failure
 ACYCLOVIR
antiviral
 Therapeutic action:
antiviral activity; inhibits viral
DNA replication
 Contraindications and
Cautions:
- contraindicated with
allergy to acyclovir
- use cautiously with
pregnancy, lactation, renal
disease
 DIAZEPAM
antiepileptic/anxiolytic/benzodiazepine
 Therapeutic action:  Contraindications and Cautions:
MOA: Unknown - contraindicated with
potentiates the effects of allergy to benzodiazepines,
GABA
shock, coma, pregnancy, lactation
 Indication:
- management of anxiety disorders or - use cautiously with elderly
for short-term relief of symptoms of patient; impaired liver and renal
anxiety function; patients with history
- relief of anxiety and tension and to of substance abuse
lessen recall in patients prior to surgical
procedures
- adjunct in status epilepticus and severe
recurrent convulsive seizures
 METOCLOPRAMIDE
antiemetic/GI stimulant
 Therapeutic action:
- relaxes pyloric sphincter
- stimulates motility of upper
GI without stimulating gastric,
biliary or pancreatic secretions
 Indication:
- prevention and treatment of
nausea and vomiting
 Contraindications and Cautions:
- contraindicated with
allergy to metoclopramide
- use cautiously with
pregnancy, lactation, renal
impairment,
 PHENYTOIN
antiepileptic/hydantoin
 Therapeutic action:
- has antiepileptic activity without
causing general CNS depression;
stabilizes neuronal membranes and
prevents hyperexcitability caused by
excessive stimulation
 Indication:
- control of grand mal and
psychomotor seizures
 Contraindications and Cautions:
- contraindicated with allergy to
hydantoins, sinus bradycardia, pregnancy
- use cautiously with myocardial
insufficiency and hypotension
 OMEPRAZOLE
proton pump inhibitor
 Therapeutic action:
- gastric acid pump inhibitor;
suppress gastric acid secretion
 Indication:
- short term treatment of active
duodenal/gastric ulcer
- reduction of risk of upper GI
bleeding
 Contraindications and Cautions:
- contraindicated with
allergy to omeprazole
- use cautiously with
pregnancy and lactation
 LANSOPRAZOLE
proton pump inhibitor
 Therapeutic action:
- gastric acid pump inhibitor;
suppress gastric acid secretion
 Indication:
- short term treatment of active
duodenal/gastric ulcer
- reduction of risk of upper GI
bleeding
 Contraindications and Cautions:
- contraindicated with
allergy to lansoprazole
- use cautiously with
pregnancy and lactation
NURSING CARE PLAN
DISCHARGE PLANNING
 HOME MEDICATIONS
 Acyclovir 800 mg 1 tab every 6 hours
(6am- 12nn – 6pm – 12mn)
to complete for two weeks
 Phenytoin (Dilantin) 100 mg 1 cap 3x/
day
 Olanzapine 10 mg ½ tab once a day at HS
(8pm)
 Multivitamins (Centrum) 1 tab once a
day (8pm)
 Febuxostat 40 mg 1 tab once a day
(8am)
 EXERCISE
 Exercise that improves blood flow to the brain.
This may include walking, massage, etc.
 And meditations that helps to relieve stress.
Meditate for at least 10 to 15 minutes daily.
 TREATMENT OR THERAPY
 Treatment includes compliance to medications
and regimen, careful observation and rest,
proper nutrition, and fluids, to allow body to
fight infection.
 HEALTH TEACHING
 Start healthy lifestyle. Take more rest. Eat
healthy diet and keep your immune system
healthy. Drink plenty of water. Protect yourself
from mosquitoes like using of mosquito
repellants and etc.
 OUT PATIENT REFERRAL
 See doctors if you noted symptoms of
encephalitis
 DIET AND SEX
 Eat antioxidant foods, including fruits such as
berries. Use healthy oils in foods, such as olive
oil or vegetable oil. Avoid caffeine, alcohol and
tobacco. Drink plenty of water.
 Since patient is married with long distance
relationship then we suggest sex as tolerated
once her husband come back from other
country
PROGNOSIS
 PROGNOSIS
 Full recovery from encephalitis can take weeks or
months. People recovering from serious cases may
have complications ranging from fatigue and
trouble concentrating to tremors and personality
changes.
 The most severe problems from encephalitis
come from the destruction of nerve cells in the
brain. Complications depend on the person’s
immune system – whether it is healthy or weak –
and what infection caused the encephalitis.
 MOST CASES OF ENCEPHALITIS ARE MILD
AND PEOPLE MAKE A FULL RECOVERY.
THANK YOU!