Encephalitis NCLEX Review Care Plans
Nursing Study Guide for Encephalitis
Encephalitis is a disease characterized by the inflammation and infection of the brain.
The most common cause of encephalitis is a viral infection, so the signs and symptoms usually start as those similar with flu – headache, fever, body ache and weakness.
However, some cases can be asymptomatic at the beginning. The symptoms worsen as the patient may develop changes in the level of consciousness, seizures, or trouble with speech, movement, eyesight, and hearing. Encephalitis can affect infants and young children.
Early detection and treatment is necessary to reverse its effect on the patient.
Signs and Symptoms of Encephalitis
- Fever or hyperthermia
- Muscle or joint ache
- Myalgia or body weakness
- Decline in mental status, such as confusion, agitation, or hallucinations
- Paralysis or loss of sensation, usually on the face
- Trouble with speech or hearing
Infants may have symptoms of bulging fontanels or soft spots in the skull, as well as poor feeding. Young children may show irritability, nausea and vomiting.
Causes of Encephalitis
Primary encephalitis happens when a virus or another pathogen causes an infection in the brain.
The common viruses that may cause encephalitis include herpes simplex virus (HSV), Epstein-Barr virus, enteroviruses, tick-borne viruses, rabies virus, and mosquito-borne viruses,
On the other hand, secondary encephalitis involves a dysfunction immune response to an infection that is happening in another part of the body. The immune cells attack and damage the brain cells, instead of going to the infected body cells.
This can happen 2 to 3 weeks after an infection.
Measles and mumps are infections that can cause secondary encephalitis in children. However, the vaccination programs for these childhood infections have caused the decline in the case of secondary encephalitis.
Complications of Encephalitis
Encephalitis can progress to coma and can be fatal as well. Since it affects the brain, the patient may also develop speech impairments, paralysis, lack of muscle coordination, personality changes, and problems with hearing, vision, and memory.
Diagnosis of Encephalitis
- Imaging – to visualize any signs of inflammation in the brain using MRI or CT scan
- Lumbar puncture or spinal tap – to analyze the cerebrospinal fluid (CSF) from the lumbar spine area for signs of infection and inflammation in the brain
- Electroencephalogram (EEG) – to analyze the electrical activity of the brain
- Lab tests – urine, stool, sputum, blood, and other liquid samples may be required to check for any presence of virus or other pathogens
- Brain biopsy – the physician may sometimes require a small sample of brain tissue if symptoms become worse while the patient is already on active treatment
Treatment for Encephalitis
- Antivirals. Viral encephalitis needs to be treated with antivirals, which include Acyclovir (Zovirax), Ganciclovir (Cytovene), and Foscarnet (Foscavir). These antivirals may not be effective for insect-borne viruses, but the usual treatment of choice is Acyclovir.
- Supportive treatment. Mild encephalitis is usually treated with fluid hydration, bed rest, anti-inflammatory medications such as ibuprofen or acetaminophen, and close monitoring.
- Anticonvulsants. To prevent or treat seizures, anticonvulsants like phenytoin (Dilantin) may be given.
- Therapies. The complications of encephalitis may require the patient to undergo physical and occupational therapy, psychotherapy, and/or speech therapy in order to maintain an optimal quality of life.
Prevention of Encephalitis
- Vaccinations. Children and adults need to get vaccinated against mumps and measles, as these can cause secondary encephalitis. Before traveling to countries where insects such as ticks and mosquitoes are prevalent, specific vaccinations against these may be required.
- Avoid mosquitoes. DEET is a chemical found in mosquito repellents and is effective in preventing mosquitoes from getting near the skin. It is important to remove stagnant water in and around the house to remove the possible breeding grounds of mosquitoes.
Nursing Care Plans for Encephalitis
- Nursing Diagnosis: Hyperthermia secondary to infective process of encephalitis as evidenced by temperature of 38.5 degrees Celsius, rapid breathing, profuse sweating, and chills
Desired Outcome: Within 4 hours of nursing interventions, the patient will have a stabilized temperature within the normal range.
|Assess the patient’s vital signs at least every 4 hours.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment, particularly the antivirals/ antibiotics and fever-reducing drugs (e.g. Paracetamol) administered.|
|Remove excessive clothing, blankets and linens. Adjust the room temperature.||To regulate the temperature of the environment and make it more comfortable for the patient.|
|Administer the prescribed antibiotic and anti-pyretic medications.||Use the antiviral or antibiotic to treat infection (encephalitis), which is the underlying cause of the patient’s hyperthermia. Use the fever-reducing medication to stimulate the hypothalamus and normalize the body temperature.|
|Offer a tepid sponge bath.||To facilitate the body in cooling down and to provide comfort.|
|Elevate the head of the bed.||Head elevation helps improve the expansion of the lungs, enabling the patient to breathe more effectively.|
- Nursing Diagnosis: Ineffective Tissue Perfusion (Cerebral) related to cerebral edema and increased intracranial pressure (ICP) secondary to encephalitis as evidenced by drowsiness, hallucinations, irritability, and memory problems
Desired Outcome: The patient will maintain cerebral tissue perfusion as evidenced by increased level of consciousness (i.e. awake and alert) and will have an oriented with persons, places, and things.
|Assess the patient’s vital signs and neurological status at least every 4 hours, or more frequently if there is a change in them.||To assist in creating an accurate diagnosis and monitor effectiveness of medical treatment for encephalitis.|
|Observe the patient for any signs and symptoms of increased ICP, such as sudden headache, vomiting, and decreased alertness.||To facilitate early detection and management of increased ICP.|
Increased ICP can be life-threatening as it may lead to brain damage, stroke, or coma.
|Administer the prescribed antibiotic medications.||Use the antiviral or antibiotic to treat encephalitis, which is the underlying cause of the patient’s increased ICP.|
|Administer osmotic diuretics (e.g. Mannitol) as prescribed.||To promote blood flow to the brain and to reduce cerebral edema.|
|Elevate the head of the bed at 30 degrees.||To promote venous drainage from the patient’s head to the rest of the body in order to decrease ICP and reduce cerebral edema.|
Other Nursing Diagnoses:
- Risk for Injury
- Risk for Impaired Physical Mobility
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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