Central nervous system disease

1. Salale University
College of Health Sciences
Department of Adult Health Nursing
Seminar Presentation on: ENCEPHALITIS
Presented by : Kedir Mohammed ID : 182/15
Presented to : Bikila (Assistant professor)
OCT 3/05/ 2023
Fiche

2. CONTENTS
• Definitions
• Etiology
• Pathophysiology
• Clinical Manifestations
• Investigations
• Treatment
• Nursing Management
• Complications
• Summary
• Reference

3. OBJECTIVE
• To introduce & define the topic
• To explain types of encephalitis
• To enlist risk factors & etiology
• To explain clinical manifestation & diagnostic evaluatio
n
• To explain medical & nursing management and prevent
ion of encephalitis.

4. ENCEPHALITIS
• Encephalitis is a rare yet serious disease that can be life-
threatening.
• Encephalitis is the inflammation of the brain parenchym
a.
• Encephalitis with meningitis is known as meningoencep
halitis.
• Encephalitis can be infectious or noninfectious and ac
ute, subacute,or chronic.

5. ENCEPHALITIS
TYPES
• There are two main types of encephalitis:
• Primary encephalitis- It occurs when a virus directly
infects the brain and spinal cord.
• Secondary encephalitis- It occurs when an infection s
tarts elsewhere in the body and then travels to your bra
in. Results from a faulty immune system reaction.
EPIDEMIOLOGY
• A rare disease
• Most common in children , elderly, and people with w
eakened immune systems (HIV/AIDS or cancer).

6. Etiology
• The cause of encephalitis is usually infectious.
• is viral infections.
• Viral Causes: The most common cause
 Enteroviruses (it is the most common cause of the viral
infection)
 HSV-1, Arboviruses, Adenoviruses, Rabies, Measles,
Mumps virus
• Bacteria -Mycoplasma, Toxoplasmosis , malaria , prim
ary amoebic meningoencephalitis.
• Fungus
• Immunosuppressed
• Upper respiratory infections

7. Risk Factors
• Anyone can develop encephalitis
• Factors that may increase the risk include:
 Older adults
 Children under the age of 1 year
 People with weak immune systems
 Geographical regions. Mosquito- or tick-borne virus
es are common in particular geographical regions.
 Season of the year. Mosquito- and tick-borne diseases
tend to be more common in summer in many areas of t
he United States.

8. PATHOLOGY

9. SIGN And SYMPTOMS
• Fever with hallucinations
• Headache – may be severe with double vision
• Nausea & Vomiting
• Raised ICP- Stiff neck, pupils, motor weakness
• Confusion, personality changes, convulsions
• Poor appetite
• Loss of energy
• problems with memory
• speech problems
• Seizures are common at presentation

10. SIGN And SYMPTOMS
• The specific prodrome in encephalitis caused by (herpe
sviruses ) such as varicella-zoster virus, Epstein-Barr vi
rus or cytomegalovirus, and measles or mumps viruses i
ncludes :
 lymphadenopathy, hepatosplenomegaly, and parotid enl
argement.

11. Widespread edema and subarachnoid hem
orrhage areas in medial temporal and orbit
ofrontal regions

12. DIAGNOSIS
• Signs & Symptoms
 Neurological examinations reveal a drowsy or con
fused patient.
 Stiff neck ,may indicate meningoncephalitis.
• CT/MRI - to check for cerebral swelling of the p
arenchyma or focal abnormalities in temporal lobe
.
• EEG – Is the definitive test and shows abnormal b
rain waves ( spike and slow wave activity) from th
e temporal lobe.
• Blood test - Confirm presence of bacteria/viruses i
n cerebrospinal fluid and antibodies to fight infecti
on

13. DIAGNOSIS
• LP Analysis of CSF - increased amounts of protei
n and white blood cells (mainly lymphocytes) with
normal glucose levels
• PCR - it is the best choice when you suspect herp
es simplex infection)
• BRAIN BIOBSY - Rare

14. TREATMENT
• Early therapy is a critical factor in outcome
• People with severe symptoms are likely to need tre
atment in an intensive care unit (ICU) admission.

15. TREATMENT
PHARMACOLOGICAL MANAGEMENT
• Anti-inflammatory drugs & antipyretics - aceta
minophen (Tylenol, others), ibuprofen (Advil, Mo
trin IB, others) and naproxen sodium (Aleve) — t
o relieve headaches and fever
• Pyrimethamine (Daraprim) and sulfadoxine (Fa
nsidar) are commonly used to treat Toxoplasma en
cephalitis.

16. TREATMENT
• Mannitol or glycerol may be needed to reduce I
CP.
• Antibiotics
• Vitamin and mineral supplementation
• IV fluid therapy and dopamine to be given to tre
at shock and fluid electrolyte imbalance.
• Anticonvulsive drugs

17. TREATMENT
• Corticosteroids are used to reduce brain swelling
and inflammation (Reduce ICP and to suppress the
activity of their immune system.
• Sedatives may be needed for irritability or restless
ness.
• Antiviral drugs - Acyclovir (Zovirax) Ganciclovi
r (Cytovene)
• Acyclovir - Iv injection is the treatment of choice
(for 14 days). When the diagnosis of HSE is suspe
cted or has been established.

18. TREATMENT
NON- PHARMACOLOGICAL MANAGEMENT
• close monitoring (neuro obs, vital signs & body fl
uids to prevent further swelling
• Oxygenation to be provided by nasal cannula
• Mechanical ventilation is necessary in cardio-respi
ratory insufficiency
• Timely detection of electrolyte abnormalities
• position -Reduce ICP

19. NURSING MANAGEMENT
1. ASSESSMENT
• Obtain a history of recent infections such as upper respir
atory infection, and exposure to causative agents.
• Assess neurologic status and vital signs.
• Evaluate for signs of meningeal irritation.
• Assess sensorineural hearing loss (vision and hearing), c
ranial nerve damage (eg, facial nerve palsy), and diminis
hed cognitive function.

20. NURSING MANAGEMENT
2. Nursing Diagnosis
• Ineffective Tissue Perfusion (cerebral) related to infecti
ous process and cerebral edema
• Risk for Imbalanced Fluid Volume related to fever and
decreased intake
• Hyperthermia related to the infectious process and cere
bral edema.
• Acute Pain related to meningeal irritation
• Impaired Physical Mobility related to prolonged bed re
st.

21. NURSING MANAGEMENT
3. Goal
• To Enhanced Cerebral Tissue Perfusion
• To Maintain Fluid Balance
• To Reduce Fever
• To Reduce Pain
• To Return to Optimal Level of Functioning/ mobility

22. NURSING MANAGEMENT
4. Intervention
• Enhancing Cerebral Perfusion
 Assess LOC, vital signs, and neurologic parameters freq
uently. Observe for signs and symptoms of ICP
 Maintain a quiet, calm environment to prevent agitation,
which may cause an increased ICP.
• Maintaining Fluid Balance
 Prevent I.V. fluid overload, which may worsen cerebral
edema.
 Monitor intake and output closely.

23. NURSING MANAGEMENT
• Reducing Fever
 Administer antimicrobial agents on time to maintain o
ptimal blood levels.
 Monitor temperature frequently or continuously, and ad
minister antipyretics as ordered.
• Promoting Return to Optimal Level of Functioning
 Implement rehabilitation interventions after admission (
eg, turning, positioning).
 Progress from passive to active exercises based on the
patient's neurologic status.

24. NURSING MANAGEMENT
• Reducing Pain
 Administer analgesics as ordered; monitor for response
and adverse reactions.
 Avoid opioids, which may mask a decreasing LOC.
 Darken the room if photophobia is present.
 Assist with position of comfort for neck stiffness, and tu
rn patient slowly and carefully with head and neck in ali
gnment.
 Elevate the head of the bed to decrease ICP and reduce
pain.

25. NURSING MANAGEMENT
5. EXPECTED OUTCOMES
 Enhanced Cerebral Tissue Perfusion
 Reduced Fever
 Fluid Balance Maintained
 Reduced Pain
 Return to Optimal Level of Functioning

26. COMPLICATIONS
• Most people make a full recovery
• Infants younger than 1 year and adults over 55 are at grea
test risk of death
• Herpes encephalitis is usually fatal if no anti viral drugs u
sed

27. PREVENTION
• Practice good hygiene.
• Don't share utensils.
• Get vaccinations.
• Protection against mosquitoes and ticks
• Dress to protect yourself.
• Apply mosquito repellent.
• Use insecticide.
• Avoid mosquitoes.
• Get rid of water sources outside your home.

28. SUMMARY
• Encephalitis is an inflammation of the brain.
Usually the cause is a viral infection, but ba
cteria can also cause it. It can be mild or sev
ere.
• Most cases are mild. People may have flu-li
ke symptoms.

29. REFERENCE
• Boyer Jo Mary(2004), Textbook Of Medical Surgi
cal Nursing, Philadelphia, Lippincott William &
Wilkins.
• Lewis Mantik Sharon et. Al. (2000), Medical Surg
ical Nursing, Assessment & Management Of Clini
cal Problems, St. Louis, Missouri, Mosby Publishe
rs.
• Lippincott (2001), Manual of Nursing Practice, J.P
. Brothers,Philadelphia.