Encephalitis is inflammation of the brain parenchyma that can be caused by viral infections. Common symptoms include fever, headache, and altered mental status ranging from confusion to coma. Diagnosis involves lumbar puncture showing lymphocytic pleocytosis and elevated proteins in CSF. Treatment involves antivirals, managing increased intracranial pressure, and treating complications like seizures. Outcomes depend on virus virulence and patient factors, with risk of long-term neurological deficits and even death in severe cases. Nursing care focuses on monitoring for neurological changes, preventing injuries, and providing comfort throughout the illness and recovery process.
This presentation focuses on Acute Bacterial Meningitis.
Viral and fungal cause is mentioned but focus is on bacterial meningitis in Pediatrics Patient.
Feel free to correct if there is any error.
Refer to other reference books for clarity.
This presentation focuses on Acute Bacterial Meningitis.
Viral and fungal cause is mentioned but focus is on bacterial meningitis in Pediatrics Patient.
Feel free to correct if there is any error.
Refer to other reference books for clarity.
PHYSIOTHERAPY MANAGEMENT IN CEREBRAL PALSY.pptxStutiGaikwad5
Physiotherapy management in Cerebral palsy is a vast topic to study and learn so here is a presentation in which all aspects have been tried to be covered. As it is essential for the children with cerebral palsy to be able to function with minimum dependence it becomes important for the therapists along with the caregivers to be aware of all the knowledge about what can be done further for the rehabilitation for this population. All the prerequisites and individual need of each patient might differ with age group and the severity of impairment. So specific goals both long term and short term need to be the focus of treatment planning. Each session requires evaluation and planning skills so to aid the child with the optimum treatment.
This ppt is related to the Meningitis for nurses. it gives you broad concept of Meningitis definition, types, sign and symptoms, etiology and risk factors, complications, pharmacological management, non pharmacological management, Nursing management, Home care management, concept care Map and quizzes for final evaluation
Lateral medullary syndrome (LMS) is a type of ischemic stroke
which occurs due to disruption of the blood flow in vertebral artery, or posterior inferior cerebellar artery. LMS can present with
various sign and symptoms, depending on the site of infarct at the
medullary area. Typical LMS often affects the pain and temperature sensation over the contralateral extremities and ipsilateral face
of the infarct area. We illustrate a case of LMS with predominant
bulbar symptoms which is sparse the sensation and our treatment
experience.
Autoimmune encephalitis a term used in children presenting with neurological syndrome associated with serum and/ or cerebrospinal fluid antibodies directed against ion channels, receptors and associated proteins.
It comprises group of clinical syndrome that can occur at all ages but preferentially affect younger adult and children.
Auto antibodies against:
Neuronal cell surface protein
Synaptic receptors involved in transmission ,plasticity ,excitability.
Triggers: Tumors, Post viral infections, Post vaccination.
Autoimmune encephalitis includes ADEM
Anti NMDAR encephalitis
Encephalitis a/w GABA R antibodies
NMOSD
Opsoclonus-myoclonus & cerebellar - brainstem encephalitis
Bickerstaff encephalitis
Hashimoto encephalitis
Rasmussen encephalitis
Basal ganglia encephalitis
CLIPPERS
ROHHAD.
ADEM is MC cause of autoimmune encephalitis in children and adolescents.
Acute onset of polyfocal neurological deficit accompanied by encephalopathy and changes compatible with demyelination on MRI brain.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
5. No.of cases
Average month wise distribution of
subjects(1993-20000
700
600
500
400
300
200
100
0
650
25
May
100
75
July
25
Sept.
Oct.
Nov
Months
Dr. RS MEHTA, MSND, CON
5
6. ENCEPHALITIS
• Encephalitis is the inflammation of the brain
parenchyma, presents as diffuse and/ or
focal neuropsychological dysfunction.
• From an epidemiologic and pathophysiologic
perspective, encephalitis is distinct from
menningitis though on clinical evaluation the
two often coexist with the sign and
symptoms of meningeal inflammation such
as photophobia, headache or a stiff neck.
Dr. RS MEHTA, MSND, CON
6
7. • Viral infection is the most
common and important cause,
with over 100 viruses implicated
worldwide
Dr. RS MEHTA, MSND, CON
7
8. PATHOPHYSIOLOGY
Portal of Entry
Mosquito
Transmit virus to the body
Hematogeneous Spread or neural and
olfactory pathways.
Crosses BBB
Enters neural cells
Disruption in cell functioning
Perivascular congestion
Haemorrhage
Inflammatory response
Dr. RS MEHTA, MSND, CON
8
9. • In acute encephalitis, cerebral edema and
petechial hemorrhages occur throughout the
hemispheres, brain stem, cerebellum, and,
occasionally, spinal cord.
• Direct viral invasion of the brain usually
damages neurons, sometimes producing
visible inclusion bodies.
• Severe infection, particularly untreated
encephalitis, can cause brain hemorrhagic
necrosis.
Dr. RS MEHTA, MSND, CON
9
10. Sign and Symptoms
Initial Signs
•
•
•
•
•
Headache
Malaise
Anorexia
Nausea and Vomiting
Abdominal pain
Dr. RS MEHTA, MSND, CON
10
11. • Symptoms
– Fever
– Headache
– Behavioral changes
– Altered level of consciousness
– Focal neurologic deficits
– Seizures
Dr. RS MEHTA, MSND, CON
11
12. Developing Signs
• Altered LOC – mild lethargy to deep coma.
• Altered Mental State – confused, delirious,
disoriented.
• Mental Disorders:
–
–
–
–
–
hallucinations
agitation
personality change
behavioral disorders
occasionally frank psychosis
• Focal or general seizures in >50% severe cases.
• Severe focused neurologic deficits.
Dr. RS MEHTA, MSND, CON
12
13. • The classic presentation is
encephalopathy with diffuse or focal
neurologic symptoms, including the
following:
–Behavioral and personality changes,
decreased level of consciousness
–Stiff neck, photophobia, and lethargy
–Generalized or localized seizures
–Acute confusion or amnestic states
–Flaccid paralysis (10%)
Dr. RS MEHTA, MSND, CON
13
16. Neurologic Signs
• Virtually every possible focal neurological
disturbance has been reported.
• Most Common
– Aphasia
– Ataxia
– Hemiparesis with hyperactive tendon reflexes
– Involuntary movements
– Cranial nerve deficits (ocular palsies, facial
weakness)
Dr. RS MEHTA, MSND, CON
16
19. Lab findings: Summary
•
•
•
•
•
•
CSF: LP all suspected cases
DLC: Lymphocyte
Protein: Mildly elevated
Sugar: Normal (> 45 mg/dl) in viral
RBC in CSF: 20%, RBC > 500 /L
MRI/CT: Mass lesion / basal meningitis /
hydrocephalus
• Brain biopsy: previously gold standard – now CSF
• CSF PCR has become the primary diagnostic test
for CNS infections caused by CMV, EBV, VZV,
Dr. RS MEHTA, MSND,
19
HHV-6, and enteroviruses. CON
20. CSF Parameters
CONDITION
CELL TYPE
CELL
COUNT
NORMAL
LYMPHOCYTES
0-4*108 /L
VIRAL
LYMPHOCYTES 10-2000
BACTERIAL
POLYMORPHS
TUBERCULO P+L MIXED
US
GLUCOSE PROTEIN
GRAM
STAIN
>60% of
Blood
glucose
Upto 0.45g/l
(-)
Normal
Normal
(-)
10005000
Low
Normal/
elevated
+
50-5000
Low
Elevated
Often (-)
FUNGAL
LYMPHOCYTES 50-500
Low
Elevated
(+/-)
MALIGNANT
LYMPHOCYTES 0-100
Low
Normal/
elevated
(-)
Dr. RS MEHTA, MSND, CON
20
21. TREATMENT
1. EMERGENCY MANAGEMENT
• Evaluate and treat for shock or hypotension.
Administer a crystalloid infusion until the patient is
euvolemic.
• Consider airway protection in patients with an
altered mental status.
• Consider seizure precautions. Treat seizures
according to usual protocol (ie, lorazepam 0.1
mg/kg given intravenously [IV]).
• Stabilize alert patients with normal vital signs by
administering oxygen, securing IV access, and
providing rapid transport to the ED.
Dr. RS MEHTA, MSND, CON
21
22. Medication
Antivirals
• The goal of the use of antivirals to shorten the
clinical course, prevent complications,
prevent the development of latency and/or
subsequent recurrences, decrease
transmission, and eliminate established
latency
1. Acyclovir (Zovirax)
Adult
• 10 mg/kg (infuse over 1 h) IV q8h for 14-21 d
Dr. RS MEHTA, MSND, CON
22
23. 2. Foscarnet (Foscavir)
• Adult
• 40 mg/kg IV q8h for 14-26 d
3. Dexamethasone
• Adult
• 10 mg IV q6h
Dr. RS MEHTA, MSND, CON
23
24. Managing complications
• Signs of hydrocephalus and increased ICP
– General measures: Manage fever and pain,
control straining and coughing, and avoid
seizures and systemic hypotension.
– In otherwise stable patients, elevating the head
and monitoring neurologic status usually are
sufficient.
Dr. RS MEHTA, MSND, CON
24
25. - When more aggressive maneuvers are indicated,
some authorities favor the early use of diuresis
(eg, furosemide 20 mg IV, mannitol 1 g/kg IV)
provided circulatory volume is protected.
Dexamethasone 10 mg IV q6h helps in managing
edema surrounding space-occupying lesions.
- Hyperventilation (PaCO2 30 mm Hg) may cause a
disproportional decrease in cerebral blood flow
(CBF), but it is used to control increasing ICP on
an emergency basis only.
Dr. RS MEHTA, MSND, CON
25
26. –Intraventricular ICP monitoring is
controversial because some authorities
believe dangerous focal edema with a
pressure gradient between the temporal
lobe and the subtentorial space usually is
not detected by the monitor, leading to a
false sense of security. In fact, monitor
placement may potentially aggravate a
pressure gradient.
Dr. RS MEHTA, MSND, CON
26
27. Follow up
1. Further inpatient care:
• Admission of the patient to the hospital, as
necessary.
2. Prevention
• Immunization against JE is recommended
for those traveling into endemic areas
during high-risk times of year and this must
be explained to the patient
Dr. RS MEHTA, MSND, CON
27
29. Prognosis
•
The prognosis depends on the virulence of the
virus and on variables associated with the
patient's health status, such as extremes of age,
immune status, and preexisting neurologic
conditions.
–
–
–
high rates of mortality and severe morbidity, including
mental retardation, hemiplegia, and seizures.
Increased mortality and morbidity rates are found in
patients who are older than 60 years.
Long-term sequelae include behavioral disorders,
memory loss, and seizures.
Dr. RS MEHTA, MSND, CON
29
30. CONTROL
• Biological control of natural vertebrate :
impractical
• Arthropod control : effective method
• Personal protection
Dr. RS MEHTA, MSND, CON
30
31. NURSING ASSESSMENT
• Poor personal hygiene
• High fever and convulsions
• Dehydration
• Irritability and restlessness
• Baby's parents, anxiety about
prognosis, complications & life
threatening sequences.
Dr. RS MEHTA, MSND, CON
31
32. NURSING PRIORITIES
The top most Nursing priorities are:
1. Vital status and neurological status
2. Hygienic needs - care of mouth hair and skin.
2. Physical comfort - support of mother(child), calm &
clean environment, comfortable position and bed.
3. Nutritional needs - Nutritional balance during illness.
4. Elimination needs - change of soiled linen
5. Safety needs providing bed railings, pads, splinting etc.
6. Special care during fever, fits, lumbar puncture, etc.
7. Communication needs - reassurance and confidence.
8. Psychological and spiritual needs - mental and moral
support
Dr. RS MEHTA, MSND, CON
32
33. NURSING INTERVENTIONS
1. Monitor vital signs and neurological status and record
a. Tepid sponging if febrile.
b. Hot water bottle if chill
c. Attach to nasal oxygen if needed
2.Provide a comfortable bed with pillows or soft pads
supported by railings to prevent injuries due to fall.
3. Provide a mackintosh and draw sheet to reduce
complications of bed-wetting.
4. Change soiled linens as frequently as needed to avoid
bed sores.
5. Provide calm and dim - lighted environment to reduce
irritability.
Dr. RS MEHTA, MSND, CON
33
34. 6. Give morning, evening and bed time care or as
required viz. oral hygiene, partial bath, combing
and nail cutting to maintain good personal
hygiene.
7. Give parentral nutrition as needed & maintain I.V.
Infusion / naso gastric tube.
8. Encourage small frequent feeds.
Dr. RS MEHTA, MSND, CON
34
35. 9. Admit timely attention and
aseptic precautions.
10. Administer medicine after
checking the orders, labels, etc.
under direct supervision to avoid
confusions or misuse of drugs.
11. Change the bed linen whenever
necessary.
Dr. RS MEHTA, MSND, CON
35
36. 12. During fever
a. Give plenty of oral fluids.
b. Maintain fluid balance
c. Provide additional warmth by blanket if
needed
d. Provide proper ventilation.
Dr. RS MEHTA, MSND, CON
36
37. 13. WHILE CONVULSIONS
1. Apply suction if needed to avoid secretions to
block airway,
2. Provide an air way to prevent tongue bite and
falling of tongue which blocks the air way.
3. Prefer lateral position for secretions to come out
and prevent aspiration.
4. Splint IV line to avoid unnecessary variation in
position of canula.
5. Protect the patient from injuries such as
chocking, aspiration of vomitus, a fall of head,
etc.
Dr. RS MEHTA, MSND, CON
37
38. 14. During LUMBAR PUNCTURE
1.Follow aseptic precautions.
2.Assist the doctor to do the procedure.
3.Put the patient in lateral position.
4.Have the patient's back arched so that his head
almost touch his knees.
5.Collect label and send the specimen promptly.
6.Don't disturb the patient from bed for 24 hours.
7.Elevate foot end of patient after lumbar
puncture
Dr. RS MEHTA, MSND, CON
38
39. 15. Frequently change the position to left lateral
& right lateral and give back care.
16. Maintain records of intake, output, vital
signs, convulsions (time, frequency,
duration, parts included type, etc), drug
administration, etc.
17. Explain the patient party about the
procedure to relieve anxiety and fear.
18. Provide facilities for daily prayers if desired,
allow visitors for particular time without
disturbing the patient
Dr. RS MEHTA, MSND, CON
39
40. ADVICE ON DISCHARGE:
1. Regular medication should be followed.
2. Regular health check-up should be done.
Dr. RS MEHTA, MSND, CON
40
41. Some Common nursing Diagnosis of the client may be:
1. Altered thought process RT failure in memory and lack
of self protective behaviour.
2. Risk for injury RT the unpredictable behaviour and
inability to interpret environmental stimuli.
3. sleep pattern disturbance RT alteration in usual sleep
habits
4. Altered cerebral tissue perfusion RT increased ICP
5. Impaired verbal communication RT neuronal
degeneration.
6. Self care deficit RT loss of memory and motor
impairment.
7. Incontinence RT neural degeneration and
forgetfulness.
Dr. RS MEHTA, MSND, CON
41