POST ENCEPHALITIS case study Jitendra bhargav

1. CASE
PRESENTATION
ON
POST
ENCEPHALITIS
NURSING PRO.
MR.JITENDRA BARDE

3. 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.

4. 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.

5. Past Surgical History:
No Significant surgical history
Family History:
Sr.No Name of
the
Family
Member
Age Sex Occupatio
n
Relation
with Patient
Health
Status
Health
Habits
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
y
Good
Family Tree:
Mr Santosh - - Mrs Sheela
Mr Vaibhav- - Vaishnavi (Patient)
➢ Male - Female - Patient

6. 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

7. 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

8. 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:-

9. 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

10. 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
Definition:
DISEASE CONDITION

11. 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

12. 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:

13. ➢ 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
➢ headache
➢ vomiting
➢ stiff neck
➢ lethargy (exhaustion)
Present
Present
Not Present
Present
Present
Severe Symptoms:
➢ fever of 103°F (39.4°C) or higher
➢ confusion
➢ drowsiness
➢ slower movements
➢ seizures
➢ irritability
➢ sensitivity to light
unconsciousness
Not Present
Not Present
Present
Not present
Irregular Episodes
Present
Pathophysiology:

14. 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
b) WBC
c) RBC
12.0 -15.5 gram /
deciliter
4,500 to
11,000 WBCs per
microlite
4.0 to 5.5 million
mcL
11.0 gram/deciliter
10,000 Per
Microlite
4.0 to 5.5 million
mcL
Abnormal
Abnormal
Normal
2 CT Scan of the Head Normal Images Abnormal Images Abnormal
3 Culture of CSF
a) Pressure
b) Glucose
c) Cell count
d) Protein
Normal
Normal
Normal
Normal
Incresed
Low
PNL
High
Abnormal
4 MRI of the Brain Normal Abnormal Images Abnormal
NURSING DIAGNOSIS

15. 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

16. ASSESSMENT NURSING
DIAGNOSIS
GOAL NURSING PLANING NURSING
INTERVENTION
RATIONAL EVALUATION
Subjective data-
Objective data-
Patient is NBM
and on TPN
Patient looks
weak and thin.
Patient’s weight
45 kg
Hb-8.6mg/dl
Hyperglycemic
tendency
Imbalanced
Nutrition Less
Than Body
Requirements r
elated
to anorexia,
fatigue, nausea,
and vomiting as
manifested by
patient
verbalization.
The patient
will have
balanced
nutritional
status as
evidence by
increased
weight 56 kg,
Hemoglobin
15mg/dl,
normal
appetitide
and absence
of diabetic
tendency
Assess the general
condition of the patient
Check daily weight of the
patient
Administer total parental
nutrition
Monitor the intake output
of the patient.
Once started oral give
fliud diet according to
patient s like &dislikes
Administer insulin&
pancreatic enzyme
therapy as prescribed to
patient
Assess the general
condition of the patient
(t98.6F,P-
86/M,RR22/M,BP-
100/70mm of hg, ht-
160cm,wt 45 kg, )
Not done
Administered total
parental nutrition
calories2400,protein-
44gm/day,CHO, fat-
25gm/day)
Monitor the intake output
of the patient(1950/2000)
To plan for
further care
To know the
daily
improvement
To increased
the appetite
To know the
daily
monitoring
The EOC was
partially met
as evidence by
absence of
hyperglycemia
and adequate
TPN therapy
Malabsobtion due
to loss of
pancreatic
enzymes
Food given(green leafy
,soya,tomato, juice,etc)
Administered insulin&
pancreatic enzyme therapy
as prescribed to patient
To know the
patient status
To supplements
pancreatic
function

18. Subjective data
The patient
complain that he
is worried about
his health and
feels that he
cannot be
completely
recover from his
illness.
Objective data
Patient looks
-anxious
-worried
-asked too many
question about
prognosis.
Fear of death.
Deficient
knowledge
related to
treatment or
noncompliance.
Patient will be
able to
understand the
disease process
and treatment
regimen within
1 day of the
nursing
intervention and
will look less
anxious, worried
and decrease
feeling of fear
of death.
.Explaining the
disease
process.
-Involvement
of the family
members in
designing the
treatment
regime.
-Supporting
and assisting
the patient.
-Explain the disease process in a simple language
that the patient can understand.
-Involve the family members also while explain
the disease process and how it can be prevented
from transferring to other people.
-Reinforce the importance of adhering to
treatment regimen and keeping follow-up
appointments.
-Help client to develop a simple, convenient
schedule for taking medication.
- Explain prescribed medications along with their
rationale, dosage, expected and adverse side
effects.
- Explain the patient that the disease can be cure
completely with regular intake of medicine and
follow up.
-assist and support the patient whenever needed
and clear any doubt related to the disease process
and treatment regime.
The patient
verbalized feeling
of mental peace
and understand
his disease
process.

19. Subjective data
Patient
verbalized
difficulty in
falling asleep,
interrupted
sleep.
Objective data
-Lethargy
-Day time
sleepy.
Disturbed sleep
pattern related
to anorexia,
fatigue, nausea,
and vomiting as
evidence by
verbalization of
inability of
falling asleep
and day time
sleeping.
-The patient will
able to sleep
undisputedly
during night
within 1 day of
nursing
intervention and
day time
sleeping will
decrease
-To provide a
calm and quiet
environment.
-Provided calm and quiet environment, well
ventilated room, decrease bright light.
-Instruct the patient to scheduled exercise during
the day.
-To avoid stimulants like excessive tea, coffee etc.
-Maintain consistent bed timing.
-Use relaxation techniques like medication,
prayer..
-Instruct patient to avoid too much day time
sleeping
Patient verbalized
adequate sleep at
night.

21. 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.

22. 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.

23. 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.

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