Encephalitis: Mariano Marcos State University College of Health Sciences Department of Nursing Batac City, Ilocos Norte

Mariano Marcos State University
COLLEGE OF HEALTH SCIENCES

Department of Nursing
Batac City, Ilocos Norte
ENCEPHALITIS
Presented by:
Sharmaine D. Medina
BSN III-A
Presented to:
Prof. Joy Leilanie Ilagan
Clinical Instructor
Encephalitis
I. Brief Description
Encephalitis is an acute inflammatory process of the brain tissue. This is different from
meningitis since meningitis is the inflammation of the layers of tissue, or membranes, covering
the brain. Primary encephalitis is when a virus directly infects the brain and spinal cord.
Secondary encephalitis is when an infection that starts elsewhere travels to your brain.
There are many causes of encephalitis: viruses, bacteria, parasites, chemicals, and even
autoimmune reactions.
Viral encephalitis can be primary. Many forms of the disease are mild in nature and do
not cause significant morbidity. However, some forms of encephalitis can be life-threatening and
cause significant injury to the nervous system.
Transmission of this disease varies considerably depending on the type of virus. While
some, such as herpes viruses, are spread from direct human contact, others are spread only by
animal vectors, meaning they are spread by insect bites. Risk factors for transmission also vary
depending on the type. For example, for the insect-borne viruses, travel or residence in endemic
areas are risks. Warmer months of the year tend to increase the risk as mosquitos and other
insects are in abundance. The incubation period ranges 4-14 days.
Encephalitis can occur with certain childhood viral illnesses, such as mumps, measles,
varicella (chicken pox), rubella (German measles), or mononucleosis.
Encephalitis is a rare condition. It occurs more often in the first year of life and decreases
with age. According to the Centers for Disease Control, encephalitis occurs in one of every
2,000,000 people (CDC). Most people who contract it are young children, individuals over 65, or
those with weak immune system.When it strikes, it can be very serious, causing personality
changes, seizures, weakness, and other symptoms depending on the part of the brain affected.
Causes:
1. Viral Infection- Encephalitis caused by viruses are generally derived from two viral groups:
The primary cause of acute encephalitis is a group of viruses calledarboviruses, which

are transmitted by mosquitoes and ticks.
The other major cause of encephalitis in the US is the herpes virus family, including
herpes simplex, Epstein-Barr, cytomegalovirus, and varicella-zoster.
Measles (before the introduction of vaccinations for childhood diseases).
Encephalitis can develop shortly after a virus is introduced by the bite of an infected insect, or it
can be caused by a virus that has been latent in the body. Viruses are simple but powerful
infective agents:
The virus infects the host by penetrating a cell wall and ejecting its genetic material (its
DNA or RNA) into the cell.
The viral DNA or RNA takes control of important process in the cell, which redirects to
produce more viruses.
The cell ruptures, releasing new viral particles that infect other cells.
There are two ways that viruses can infect brain cells, where they replicate and cause
encephalitis:
They can invade the body and produce no damage until they are carried by the blood
stream to the nerve cells of the brain, where they lodge and multiply. Viruses that enter
the brain directly from the bloodstream usually become widely scattered throughout the
brain so that they causediffuse encephalitis.
Viruses can also first infect other tissue and secondarily invade brain cells. Viruses that
are transmitted from other tissues usually cause focalinfection and produce extensive
damage in a small area of the brain.
Arboviruses. Arboviruses multiply in blood-sucking vectors, nearly always mosquitoes.

There is no evidence that these infections can be transmitted from an infected person or
animal to an uninfected person. It should be stressed that only about 10% of people who
are infected by an arbovirus develop encephalitis. Arboviruses are responsible for only
about 150 to 3000 cases of encephalitis each year. Ticks can also carry related viruses that
cause brain inflammation, particularly one known as Russian spring-summer
encephalitis. This encephalitis is most common in China, Korea, and the eastern areas of
Russia. Only a very few viral tick-borne cases of encephalitis have been reported in the
US.
Herpes Viruses. The most common cause of encephalitis, acute. These viruses (herpes
simplex, varicella zoster) share certain features, including the capacity to cause an
infection and then to go into hiding. They can lie dormant for periods of time as short as
months or as long as a lifetime. In a few cases, when the viruses reactivate, they cause
encephalitis. Infected birds carry this virus, but mosquitoes can pick up the virus when
they bite infected birds and then spread the virus to humans through a bite.
2. Bacterial infection- such as bacterial meningitis, spreading directly to the brain (primary
encephalitis) or may be a complication of a current infectious disease (secondary encephalitis)
3. Autoimmune- results from an attack of the brain by the bodys immune system.
Pathophysiology
Encephalitis is transmitted to humans via the bite of infected mosquitos. The virus initially
propagates at the site of the bite and in regional lymph nodes. Subsequently, viremia develops,
leading to inflammatory changes in the heart, lungs, liver and reticuloendothelial system. Most
infections are cleared before the virus can invade the Central Nervous System (CNS), leading to
subclinical disease. However, neurologic invasion can develop, possibly growth of the virus
across vascular endothelial cells, leading to involvement of large areas of the brain, including the
thalamus, basal ganglia, brain stem, cerebellum, and cerebral cortex.
II. Risk Factors

1. Age. Encephalitis can occur at any age, but the highest risk is in children under four years of
age, with a peak from three to six months, and among elderly adults, especially those over age
60. Both eastern and western equine encephalitis disproportionately affect infants. The eastern
variant also tends to affect children and the elderly. La Crosse encephalitis nearly always infects
children (not infants or adults). St. Louis encephalitis usually occurs in adults over 40 years old.
2. Immunocompromised Patients. Patients whose immune systems are compromised by
conditions such as AIDS or HIV, cancer therapies, or organ transplantation are more susceptible
than other individuals to any form of encephalitis. Of particular concern are varicella and
cytomegalovirus encephalitis because they tend to be more common and deadly in these patients
than in the normal population.
III. Manifestations
The location and severity of the infection largely determines the pattern of brain damage and
therefore its effects, which can be:
Physical (muscle control).
Behavioral and emotional (personality changes).
Cognitive (memory, speech).
Sensory (vision, hearing).
When the brain becomes inflamed and irritated it increases its volume, the normal circulation of
blood is impaired, leading to symptoms such as confusion, fever and severe headache.
A fever.
A headache (which can be very painful).
A stiff neck and back.
Light hurting your eyes.
Nausea and vomiting.
Lack of energy.
Drowsiness.
IV. Diagnostic Procedures

1. Brain imaging. Brain imaging is often the first test if symptoms and patient history suggest the
possibility of encephalitis. The images may reveal swelling of the brain or another condition that
may be causing the symptoms, such as a tumor.
2. Technologies may include magnetic resonance imaging (MRI), which can produce detailed
cross-sectional and 3-D images of the brain, or computerized tomography (CT), which produces
cross-sectional images.
3. Spinal tap (lumbar puncture). With a spinal tap, the doctor inserts a needle into the lower back
to extract cerebrospinal fluid (CSF), the protective fluid that surrounds the brain and spinal
column. Changes in this fluid can indicate infection and inflammation in the brain.
In some cases, samples of CSF can be tested to identify the virus or other infectious agent.
4. Samples of blood or urine, or of excretions from the back of the throat can be tested for
viruses or other infectious agents. Testing blood for finding antibodies can identify some causes
of encephalitis, including viruses transmitted by mosquitoes and viruses that cause
mononucleosis (Epstein-Barr virus), cytomegalovirus and toxoplasmosis.
5. Electroencephalogram (EEG). Your doctor may order an EEG, a test in which a series of
electrodes are affixed to the scalp. The EEG records the electrical activity of the brain. Certain
abnormal patterns in this activity may be consistent with a diagnosis of encephalitis.
6. Brain biopsy. Rarely, a procedure to remove a small sample of brain tissue (brain biopsy) is
used if symptoms are worsening and treatments are having no effect.
V. Medical Management
Bed rest
Plenty of fluid
Physical therapy to improve strength, flexibility, balance, motor coordination and

mobility
Occupational therapy to develop everyday skills and to use adaptive products that help
with everyday activities
Speech therapy to relearn muscle control and coordination to produce speech
Psychotherapy to learn coping strategies and new behavioral skills to improve mood
disorders or address personality changes with medication management if necessary
VI. Pharmacological Management

1. Anti-inflammatory drugs such as acetaminophen (Tylenol, others), ibuprofen (Advil,
Motrin IB, others) and naproxen sodium (Aleve, others) to relieve headaches and
fever
2. Antiviral drugs-- Antiviral drugs commonly used to treat encephalitis include:
Acyclovir (Zovirax) Intravenous acyclovir is the treatment of choice for encephalitis
caused by herpes simplex virus or varicella-zoster virus. It should be started immediately
and administered for at least 10 days.
Ganciclovir (Cytovene) or Foscarnet (Foscavir) May have some benefits for patients with
encephalitis from cytomegalovirus.
3. Some viruses, such as insect-borne viruses, don't respond to these treatments. However,
because the specific virus may not be identified immediately or at all, treatment with
acyclovir is often begun immediately. This drug can be effective against the herpes
simplex virus, which can result in significant complications, such as encephalitis, or
death when not treated promptly.
4. Seizures may be prevented using fosphenytoin (Cerebyx) and treated with intravenous
lorazepam (Ativan).
5. Sedatives may be prescribed for irritability or restlessness.
6. Simple pain relievers may be used for fever and headache.

7. In patients who are otherwise stable, the only other treatment measures are to keep the
head elevated and monitor the patient's status.
8. Vaccines
Prevention
Practice good hygiene. Wash hands frequently and thoroughly with soap and water,
particularly after using the toilet and before and after meals.
Don't share utensils. Don't share tableware and beverages.
Get vaccinations. Keep your own and your children's vaccinations current. Before
traveling, talk to your doctor about recommended vaccinations for different destinations.
wearing long sleeves and pants in areas wWearing trousers and long-sleeved shirts,
particularly at dusk. One survey suggested that this measure may significantly reduce the
incidence of mosquito-born disease.
Sleeping only in screened areas.
Air-conditioning may reduce mosquito infiltration. Where air-conditioning is not

available, fans may be helpful. Mosquitoes appear to be reluctant to fly in windy air.
Smoke from burning certain plants, including ginger, beetlenut, and coconut husks, have
reduced mosquito infiltration, but the irritating and toxic effects on the eyes and lungs
may be considerable.
keeping standing water away from your house
Nursing Care Plan for Encephalitis :

1. Ineffective Tissue Perfusion related to increased intracranial pressure.
2. Acute pain related to the irritation of the brain lining.
3. Risk for injury related to the seizures, altered mental status and decreased level of
consciousness.
4. Impaired physical mobility related to neuromuscular damage, decreased muscle strength,
decreased consciousness, damage perception / cognitive.
Nursing Interventions
Alleviation of pain or a reduction in pain to a level of comfort that is acceptable to the

patient
Use of pharmacologic agents to reduce or eliminate pain
Environmental Management: Comfort: Manipulation of the patients surroundings for
promotion of optimal comfort
Anxiety Reduction: Minimizing apprehension, dread, foreboding, or uneasiness related to
an unidentified source or anticipated danger
Provision of a modified environment for the patient who is experiencing a chronic
confusional state
Calming Technique: Reducing anxiety in patient experiencing acute distress
Delusion Management: Promoting the comfort, safety, and reality orientation of a patient
experiencing false, fixed beliefs that have little or no basis in reality
Environmental Management: Safety: Manipulation of the patients surroundings for
therapeutic benefit
Temperature Regulation: Attaining and/or maintaining body temperature within a normal
range
Fever Treatment: Management of a patient with hyperpyrexia caused by
nonenvironmental factors
Nutrition Management: Assisting with or providing a balanced dietary intake of foods
and fluids
Weight Gain Assistance: Facilitating gain of body weight
Eating Disorders Management: Prevention and treatment of severe diet restrictions and
over exercising or binging and purging of foods and fluids
Respiratory Monitoring: Collection and analysis of patient data to ensure airway patency
and adequate gas exchange
Oxygen Therapy: Administration of oxygen and monitoring of its effectiveness
Airway Management: Facilitation of patency of air passages

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Mariano Marcos State University

COLLEGE OF HEALTH SCIENCES

The primary cause of acute encephalitis is a group of viruses calledarboviruses, which

Measles (before the introduction of vaccinations for childhood diseases).

Arboviruses. Arboviruses multiply in blood-sucking vectors, nearly always mosquitoes.

II. Risk Factors

Physical (muscle control).

Behavioral and emotional (personality changes).

Cognitive (memory, speech).

Sensory (vision, hearing).

A headache (which can be very painful).

A stiff neck and back.

Light hurting your eyes.

Nausea and vomiting.

IV. Diagnostic Procedures

Physical therapy to improve strength, flexibility, balance, motor coordination and

VI. Pharmacological Management

6. Simple pain relievers may be used for fever and headache.

Don't share utensils. Don't share tableware and beverages.

Sleeping only in screened areas.

Air-conditioning may reduce mosquito infiltration. Where air-conditioning is not

keeping standing water away from your house

Nursing Care Plan for Encephalitis :

Alleviation of pain or a reduction in pain to a level of comfort that is acceptable to the

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