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It is an acute inflammation of the brain. Encephalitis with meningitis is known as meningoencephalitis.
Types of Encephalitis Herpes Simplex Virus Encephalitis Arthropod-Borne Virus Encephalitis Fungal Encephalitis .
Clinical Manifestations Fever Headache Stiff neck Vomiting Drowsiness Dysphasia Focal Seizure .
Hemiparesis Altered LOC Personality Changes Maculopapular Rash SIADH with hyponatremia Increased ICP .
and autonomic response (changes in vital signs). restlessness. .Nsg Diagnosis: Acute Pain may be related to inflammation/irritation of the brain and cerebral edema. possibly evidenced by verbal reports of headache. distraction behaviors.
In the midst of painful experiences a patient·s perception of time may become distorted. * Provide rest periods to facilitate comfort. sleep.Nsg Interventions: INDEPENDENT: Anticipate need for pain relief. . and relaxation. * Respond immediately to complaint of pain. * Eliminate additional stressors or sources of discomfort whenever possible.
o Relaxation exercises Techniques are used to bring about a state of physical and mental awareness and tranquility. subsequently reducing pain. o Biofeedback.o Imagery The use of a mental picture or an imagined event involves use of the five senses to distract oneself from painful stimuli. breathing exercises. o Distraction techniques Heighten one·s concentration upon nonpainful stimuli to decrease one·s awareness and experience of pain. music therapy . The goal of these techniques is to reduce tension.
evaluating effectiveness and observing for any signs and symptoms of untoward effects. * Notify physician if interventions are unsuccessful or if current . so their effectiveness must be evaluated from patient to patient. Analgesics may cause side effects that range from mild to life-threatening. Pain medications are absorbed and metabolized differently by patients.Dependent: Give analgesics as ordered.
and dehydration. flushed/warm skin. illness. possibly evidenced by increased body temperature. and increased pulse and respiratory rates.Nsg Diagnosis: Hyperthermia may be related to increased metabolic rate. .
Nsg Interventions: .
Nsg Diagnosis Risk for Trauma/Suffocation: risk factors may include restlessness. generalized weakness . cognitive impairment. altered LOC.
Nsg Interventions INDEPENDENT: 1. various drugs. and add floor pad if rails are not available or appropriate. and other stimuli. Explore with client the various stimuli that may precipitate seizure activity. flashing lights. but may benefit from becoming aware of risks. or place bed up against wall. Rationale: Minimizes injury should frequent or generalized seizures occur while client is in bed. 2. and prolonged television viewing. Knowing what to do when seizure occurs can prevent injury or complications and decreases SO·s feelings of helplessness. 3. Discuss seizure warning signs. Rationale: Alcohol. such as loss of sleep. may increase the potential for seizure activity. Client may or may not have control over many precipitating factors. . and usual seizure pattern. Keep padded side rails up with bed in lowest position. Rationale: Can enable client or SO to protect individual from injury and to recognize changes that require notification of physician and further intervention. Teach SO to recognize warning signs and how to care for client during and after seizure. if appropriate.
need to ambulate or even defecate during aural phase. only if jaw relaxed. 5. Explain necessity for these actions. Rationale: Helps maintain airway and reduces risk of oral trauma but should not be ´forcedµ or inserted when teeth are clenched because dental and soft-tissue damage may result. thereby inadvertently removing self from safe environment and easy observation. Stay with client during and after seizure. Rationale: Client may feel restless. Maintain strict bedrest if prodromal signs or aura is experienced. Understanding importance of providing for own safety needs may enhance client cooperation. 4. Insert soft bite block per facility protocol. . Turn head to side and suction airway as indicated. 6. Rationale: Promotes client safety and reduces sense of isolation during event. Note: Current practice is mixed regarding the use of airways during seizure activity.
Rationale: Client may be confused. Rationale: Documents postictal state and time and completeness of recovery to normal state. erratic movements may increase. Note: If attempt is made to restrain client during seizure. and possibly amnesic after the seizure and need help to regain control and alleviate anxiety. and client may injure self or others. weakness or motor deficits. pulse. memory of incident. Reorient client following seizure activity. 8. . 9. ability to comply with simple commands. ability to speak. orientation. Do not attempt to restrain. 7. and respiratory rate. place on soft area. Cradle head. or assist to floor if out of bed. Rationale: Gentle guiding of extremities reduces risk of physical injury when client lacks voluntary muscle control. May identify additional safety concerns to be addressed. disoriented. blood pressure (BP). Perform neurological and vital sign checks after seizure: level of consciousness.
pad side rails of bed and have airway and suction equipment available at bedside. weakness. Provide fluid replacement through I. which may cause increase ICP. Maintain standard precautions and additional isolation according to hospital policy to prevent transmission. Administer antipyretics and other cooling measures as indicated. Reorient patient frequently. to avoid excessive stimulation and agitation. Provide supportive care if coma develops. Monitor fluid intake and output to ensure adequate hydration. Maintain quiet environment and provide care gently. or cranial nerve involvement. irregular pupils. . lines as needed. widening pulse pressure. Watch for subtle changes. irregular breathing hyperthermia).V. tachycardia. Encourage significant others to interact with patient with even while in coma and to participate in care to promote rehabilitation.Nsg Management: Monitoring pupils and vital signs frequently for increased intracranial pressure (ICP. such as behavior or personality changes. may last several weeks. Monitor the patient·s response to medications and observe for adverse reactions. Monitor neurologic status closely. Maintain seizure precautions.
to reduce brain swelling (in rare cases) Sedatives -. Steroids (such as dexamethasone) -.to prevent seizures.if the infection is caused by certain bacteria Anti-seizure medications (such as phenytoin) -. such as acyclovir (Zovirax) and foscarnet (Foscavir) -.Pharmacologic Management Antiviral medications.for fever and headache . no specific antiviral drugs are available to fight encephalitis) Antibiotics -.to treat herpes encephalitis or other severe viral infections (however.to treat irritability or restlessness Acetaminophen -.
Diagnostic Tools .
this test is rarely useful) Electroencephalogram Lumbar puncture and CSF examination Tests that detect antibodies to a virus (serology tests) Test that detects tiny amounts of virus DNA (polymerase chain reaction -. or urine (however. blood.PCR) . MRI CT scan Culture of cerebrospinal fluid (CSF).
New Trends .
Tobacco Plant-Made Therapeutic Thwarts West Nile Virus .
Seven days after the introduction of antibody genes into plants. homogenized and purified to remove extraneous material. 3. The strategy for gene insertion is to use the specific machinery of the tobacco mosaic virus and potato virus X (PVX) to carry the genes of interest into the plants. yielding a human monoclonal antibody known as huE16. The plants used to produce the antibodies are a relative of common tobacco. a member of the Solanceae family of plants. once injected into the recipient. the leaves are harvested. Feb. 2010 -The study examined antibodies against West Nile virus derived from mammalian cell lines and compared their effectiveness with those extracted from plants. making the production process highly efficient. where they can be expressed. the virus' cell-binding (and infectious) capacity is neutralized. That binding site is also the one used by the virus to attach itself to mammalian host cells. . binds to a particular surface protein of the virus. The gene expression occurs in just a week's time. The monoclonal antibody. and once it is occupied. which produce abundant leaves for harvesting material and are also prolific seed producers.
Indeed. there is a chance in the case of the mammalian cell-derived therapy to actually worsen the condition. Chen emphasizes that plantbased antibodies lack the capacity to bind with a critical receptor implicated in the antibody dependent enhancement effect. a related flavivirus.an increase from 500 micrograms of antibody per gram of leaf tissue to 800 micrograms per leaf." The strategy permitted the group to set a record for the antibody yield produced by the transgenic tobacco plants -. The process has been studied in some detail in dengue fever. making them potentially safer for use. another advantage of plantderived as opposed to animal-derived antibodies becomes important. it can be effective against a variety of West Nile virus stains and potentially against other flaviviral strains. "Optimization helps. Because the monoclonal antibody therapeutic binds to a conserved region of the viral surface. through an effect known as antibody dependent enhancement. is effective in very small dosages. Chen's research shows comparable effectiveness using tobaccoplant derived monoclonal antibodies. If an individual is exposed to a variant strain of virus differing in some particulars from the antibody used to treat it. protecting mice from WNV-induced mortality even several days after infection. were essentially indistinguishable. The therapeutic. "The goal is to make more of the protein and for it to persist longer before it is degraded. Cell-derived versions of this antibody have already demonstrated impressive effectiveness. " said Chen. . which helps to ensure a high level of expression in the plants. the results in the groups of mice tested. Chen emphasizes. Here. The effectiveness of the plant expression system is dependent in part on the optimization of the antibody DNA sequence. and only one dose is required to clear the virus from an infected individual's system. (50-200 micrograms).
Toward this end. interdisciplinary team. Michael Diamond of Washington University collaborated in studies with the mouse model. if the successes in mice can be replicated in humans. The completion of this research relied on the efforts of a large. including lead author Huafang "Lily" Lai. "This was a very remarkable achievement for an undergraduate student. The research was supported by grants from the National Institute of Allergy and Infectious Diseases. Chen believes the plantbased antibody approach could provide highly effective. including related flavivirus infections such as dengue fever and Japanese encephalitis. due to the existence of the blood brain barrier. Thomas Keller. having carried out much of the critical protein expression and characterization work. cost efficient therapeutics for other diseases." Chen points out. capable of binding with virus particles as well as attaching to receptors in the brain. and Keller's work was supported in part through the Howard Hughes Fellowship for Undergraduate Research. currently intractable infectious and neurological diseases. is that current antibody therapeutics are unable to pursue the virus into its sanctuaries in the human brain. the technique may allow treatment of other. Chen is now working on bifunctional antibodies." said Chen. when a significant amount of virus has colonized brain tissue. In addition to Chen's ASU scientist colleagues. it may be possible to produce therapeutics capable of eradicating the infection even after 6 or 7 days. One challenge in treating a virus like West Nile. allowing the antibody to migrate past the blood brain threshold. which targets the central nervous system. . "If we can find a way to deliver therapeutics of this sort into the brain it will be really significant. While the group's focus has been on West Nile Virus. an undergraduate in ASU's School of Life Sciences Undergraduate Research program appears as a co-author of the PNAS paper. If successful. If this obstacle can be overcome.
Visualizing Brain Invasion by a Fungus .
2010) ³ Infection with the fungus Cryptococcus neoformans can cause meningitis (inflammation of the membranes surrounding the brain) and encephalitis (inflammation of the brain itself). at Albert Einstein College of Medicine. Only after stopping abruptly was the fungus seen to cross the wall of the blood vessel and enter the brain. was that Cryptococcus neoformans stops suddenly in mouse brain capillaries that are similar or smaller in diameter than it is. the protein urease was required for Cryptococcus neoformans to invade the brain. The authors therefore suggest that therapeutics that inhibit urease might help prevent meningitis and encephalitis caused by infection with Cryptococcus neoformans. to visualize in mice the process of brain invasion by Cryptococcus neoformans. and treatment with a urease inhibitor reduced brain infection. but little is known about how it does this. Arturo Casadevall. which enables researchers to observe events in real-time in live animals. conditions that are often lethal. the fungus must somehow leave the blood stream and enter the brain. Interestingly. To elicit these effects. However. A key observation of the team. New York. because most patients already have substantial brain infection when they first seek medical help. suggests that such inhibitors might not be applicable in the clinic. In an accompanying commentary. he highlights that the study opens up numerous new avenues of research that could be exploited in the clinic in the future. A team of researchers. Apr. has now used a form of microscopy known as intravital microscopy. Canada. led by Christopher Mody. 27. . at the University of Calgary.