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Encephalitis

Definition:-

 encephalitis is defined as infection and inflammation   of brain and  cerebral tissue which may cause increased ICP and may lead  to   hemorrhage. 

- If encephalitis  is  caused by the infection of  meninges then it is known as meningoencephalitis.

 Etiology:-

 -this condition is mostly caused by viral infection such as herpes zoster virus,  cytomegalo virus     [ rabies virus ,   polio, measles mumps virus.
- bacterial infection pneumococcal meningitis,   mycobacterium tuberculosis  or pneumococcus,     Streptococcus.
- Parasite  example;- toxoplasmosis.
- head injury.
- drug toxicity.
-  ischemia of brain.
- skull fracture.
- CVA [ cerebro  vascular accident].

 Clinical manifestation:-

1.  fever.
2. headache.
3. loss of consciousness.
4. nuchal rigidity.
5.  Convulsions.
6. ataxia.
7. hemiparesis.
8. Increased ICP.
9.  restlessness.
10. cerebral edema.
11. nausea and vomiting.

 Pathophysiology:-

due to etiological factor

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 entry of microorganism into brain and cerebral tissue

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 Infection occur in brain and cerebral tissue

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lesion formation in brain and cerebral tissue

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 Inflammatory process

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 decreased or  obstructed blood supply  to brain and cerebral tissue

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 Hypoxia and ischemia  occurs in  brain and cerebral tissue

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Encephalitis.

 Diagnostic evaluation:-

- CT scan.
- MRI.
-  Skull   x-ray.
-   EEG.
- lumber puncture for CSF examination.
- glass Coma Scale .
- ICP checkup.

 Medical management:-

- hospitalize the patient and  assess  the  patient condition and check diagnostic test result.
- Level of consciousness  by GCS.
- administered antipyretic and   analgesic  drugs such as PCM  to reduce pain.
- administer  the antibacterial drug such as rifampicin, cephalosporin drugs.
- Administer antiviral drugs such as  acyclovir,  famicyclovir.
- administer anticonvulsant drug such as benzotrophine to reduce the  risk of convulsion.
- administered corticosteroids drugs such as prednisolone  to reduce  the  inflammatory process.
- Maintain fluid and electrolyte balance by  intravenous therapy. 

Meningitis

Introduction of meninges:-

 Meninges :- 

- Membranious  covering  of    brain and the spinal cord is known as    meninges.
 -  Three layers present in the    meninges that are following -
1. dura matter .
2 .arachnoid matter.
3. Pia matter.
There are three space present around the brain   that  are  following-
   - epidural space[ it is a space between skull bone and dura matter].
  - subdural space[ space between dura matter and arachnoid matter].
   - subarachnoid space[ space between Urban and matter and pia matter].
There is no space between pia meter  and arachnoid matter is  directly  adhered to the brain.

Ventricle:-

The empty   space present   within  the  brain  is  called     ventricles.
-total  four    ventricle all present:-
1.  lateral ventricle[ right and left ventricle].
2.  third ventricle.
3.   fourth ventricals.

 -:Meningitis:- 

Meningitis is composed of two words.
1. meninges:-  membranius  covering of brain and spinal cord.
2.  itis:- inflammation.
meningitis is infectious disorder of brain and spinal cord   by the  infection of bacteria so it is also called bacterial meningitis.

definition:- 

 Meningitis is defined as infection and inflammation  of brain and spinal cord meninges and  this infection spread   in brain  and spinal cord through CSF.
- meningitis is a  life threatening condition which may require immediate treatment so it is also called “ medical emergency ”.

Etiology:-

1.Bacterial infection:-   Nesseria meningitis ,pseudomonas,  pneumococcus    and Streptococcus
2.Viral infection :-   herpes zoster, herpes  influenza,polio mumps virus, Cox  virus
3.Fungal infection - candida albicans.
4.Traumatic brain injury and head injury
5.Drugs  toxicity
6.Any systemic infection  can also cause meningitis
7.Open skull injury.

clinical manifestation:- 

[A]  initial symptoms:-

1. fever with severe headache with chills.
2.memory impairment / disorientation.
3. restlessness.
4. loss of consciousness.
5.convulsions
6.seizures. 
7.cold  extremities.
8.nausea / vomiting.
9. photophobia .
10. phonophobia.[  fever with noise].
11.anterior fontanelle  bulging .

[ B] confirmative symptoms:-

1. increased ICP.
2.nuctual rigidity[ stiffness of neck] .
3. kerning sign-[   patient is lying supine position with flexion  of  lup and knee on the abdomen then leg can not be extended due to the pain.
4. brudzinski sign:-  patient should be lying  in supine position and knee is flexed due to this stimulation the patient automatically flex the neck on the chest.

Pathophysiology:-

Due to etiological factor.

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entry of microorganism   in meninges.

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infection occurs and lesion formation in meninges .

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inflammation and exudate  formation.

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obstructed  blood supply  in meninges.

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decreased cerebral  blood flow.

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 meningitis.

 Diagnostic evaluation:-

1.  history collection and physical examination.
2. CBC  [ complete blood count].
3. CSF examination.
4. skull X-Ray
5. ICP  check.
6. ESR [ erythrocyte sedimentation rate].
7. bacterial culture  and gram  staining of CSF.
8. CT scan

Medical management:-

- hospitalize the patient  because meningitis is medical  emergency which may require immediate care , so  administer  the  benzyl   penicillin drugs:- pnicillin-G which is a narrow spectrum antibiotic as prescribed by  the  physician.
- Assess  the  patient  condition, confirmative sign and symptom of disease and positive diagnostic test result.
- administer antibiotic drugs such as rifampicin,   cephalosporin as prescribed   by the   physician to kill the  bacteria .
- Administer  the antiviral drugs    such as  acyclovir ,  famicyclovir  as prescribed by the doctor.
- administer antipyretic  drugs such  as  PCM and  NSAID to reduce the fever and relieve  from headache.
-  administer the corticosteroid drugs   such  as prednisolone to reduce the inflammation and  damage. 
- Maintain adequate fluid volume of the body .

Nursing management : - 

1.  Assess  the condition  of patient and vital sign .
2.  apply the cold   application to decrease the temperature.
3 .  monitor the temperature frequently or continuously.
4. administer the antipyretic drugs such as PCM to  reduce the   fever  as  prescribed  by the  physician.
5.  instruct  the patient  to use blanket.

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