Resource Unit for Encephalitis

8/6/2019 Resource Unit for Encephalitis

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RESOURCE UNIT FOR ENCEPHALITIS

As Partial Requirement for Emergency Room Diseases (VSMMC Vicente Sotto Medical Memorial Center)

July 18, 2011

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TOPIC: ENCEPHALITIS

General Objective: After 2 3 hours of varied teaching learning strategies, the BSN 4 group 2 will be able to acquire knowledge, skills, and positive attitude to the concepts of ENCEPHALITIS.


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SPECIFICOBJECTIVES

CONTENT TIMEALLOTMENT

METHODOLOGY RESOURCES

Specifically, they willbe able to:

1. Define the related terms:

a.) Confusion

b.) Disorient ation

c.) Convulsion

d.) Hallucination

e.) Drowsiness

f .) Memory Loss

is a cha nge in ment al status in which a p erson is not able to think with his or her usual level of clarity . Frequently, confusion leads to the loss of ability to recognize peo ple and or places, or tell time and the date. Feelings of disorient ation are common in

confusion, and d ecision-m aking ability is im pa ired.Loss of one's sense of direction, position, or relations hi p wit hone's surroun dings . M ent al confusion or im pa ired awareness, es pecially regar ding place, time, or person al identity .

Any violent and irregul ar motion or agitation; a violent shaking; a tumult; a commotion . An unnatur al, violent, and unvolunt ary

contr action of the muscular parts of the body.

The act of hallucinating; a wandering of the mind; error; mist ake; a b lunder . Th e per ce ption of o bjects which ha ve no reality, or of sens ations which ha ve no corres ponding extern al cause, arising from disor der or the nervous system, as in delirium tremens; delusion .

Dull; stu pid, incline d to drowse; heavy wit h slee piness; lethargic; dozy. D is posing to slee p; lulling; so porifi c.

is unusu al forgetfulness . I t may refer to not being able to remem ber new events, not being able to recall one or more memories of the past, or both.

2 minutes

3 minutes

76 minutes

5 minutes

20 minutes

7 minutes

2 minutes

Opening Pr ayer

Intro duction

Present ation Pro per

Ice Breaker

Question andAnswer Portion

Con clusion

Closing Pr ayer

I. H uman R esour ces

II. Ma terials

a.) R esour ce Unit Bond Pap er Com puter Folder and S lider

b.) P resent ation

Discussion Visual AidUnique Present atio

c.) B ooks

d.) E lectroni c Servi ces

Overview: htt p://www .ncbi.nlm.n

.gov/ pu bmed/17676529

Patho physiology: htt p:// best pr actice.bm j

om/ best- pr actice/monogr aph/43

/ basics/ patho physiolog

html

Dictionary: htt p://www .medterms .

m/scri pt/m ain/hp.a s p


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2 . Discuss the overviewof Encephalitis

Ence pha litis is uncommon but is a neurologi cal emergen cy which must be consi dered in a pa tient presenting with a ltere dconsciousness . E nce pha litis is a d iffuse inflamm atory process of the br ain parenchyma asso ciated with evidence of br ain dysfun ction . Th e present ation of ence pha litis can be acute or chronic. Th e aetiology of ence pha litis can be broadly dividedinto two major su bty pes. (1) Infection-rel ated ence pha litis whichis a d irect consequen ce of pathogeni c vir al, bac teri al or par asiti cagents . H er pes sim plex virus (HSV) a nd varicella-zoster virus (VZV) a re the most common cause of acute infe ctious ence pha litis . (2) A utoimmune-me diated ence pha litis which is

mediated by an aberr ant immune res ponse . Th is can be triggere d by a recent vir al infe ction or vacc ination . A n exam ple of this woul d be acute dissemin ated ence pha litis (ADEM). Th is article will focus on the medical management of acute ence pha litis . Th is will involve an extensive overview of the liter ature reviewing the diagnosis, investig ation and treatment of acute vir al ence pha litis .

htt p://www .nlm.nih.go

medline plus/en cy/artic

/003257.h tm

R isk Factors: htt p://www .mayoclini c

om/ health/ence pha litis

DS00226 /DSE CTION=isk-f actors

Com plications: htt p://www .mayoclini c


DS00226 /DSE CTION=com plications

Anatomy andPhysiology of br ain: htt p://www .cliffsnotes

om/stu dy_gui de/The-

Br ain.to picArticleId-

22032 ,articleId-

21940.h tml

Patho physiology: htt p:// best pr actice.bm j

om/ best- pr actice/monogr aph/43

/ basics/ patho physiolog

html

Treatment: htt p://www .mayoclini c


DS00226 /DSE CTION=reatments- and-drugs

3. Discuss the different types of Encephalitis

a.) V ir al Ence pha litis

b.) W est Nile Ence pha litis

Each year, sever al thous and p eo ple contr act ence pha litis, whichis an infl ammation of the br ain. Th is eMedTV a rticle takes an in-de pth look at ence pha litis, including its causes, sym ptoms, andtreatment o ptions .

West Nile virus is a form of vir al ence pha litis, a grou p of illnesses that cause br ain swelling . Th is eMedTV sele ction covers ence pha litis that is cause d by a virus, including inform ation on how to prevent it and how to recognize its sym ptoms .

West Nile ence pha litis is a severe form of West Nile virus . Th is sele ction from the eMedTV W e b li br ary offers an in-de pth look at this condition, including inform ation on sym ptoms, tre atment, and how often it occurs .


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c.) H er pes Ence pha litis

d.) S u bac ute Sclerosing Panence pha litis

e.) E quine Ence pha litis

f .) Ea stern Equine Ence pha litis

g.) W estern Equine Ence pha litis

h.) A r boviruses

i.) La Crosse Ence pha litis

j.) Japa nese

Her pes ence pha litis is a r apidly progressing disease. As this eMedTV segment ex plains, it is the single most im port ant cause of f atal s por adic ence pha litis in the Unite d S tates . Th is page discusses sym ptoms, tr ansmission, and the im port ance of treatment .

Su bac ute sclerosing panence pha litis is a serious infe ction caused by an altere d form of the measles virus . Th is eMedTV a rticle presents a detailed overview of this condition, with inform ation on its sym ptoms, stages, treatment, and more .

Equine ence pha litis is an inflammation of the br ain that affects

horses and h umans. As this eMedTV a rticle ex plains, there are three ty pes: eastern, western, and V enezuel an. Th is page descri bes these different ty pes, including sym ptoms and

prognosis .

Eastern equine ence pha litis is a mosquito- borne vir al disease that can affect the centr al nervous system . Th is eMedTV resour ce discusses the causes, sym ptoms, tr ansmission, and p revention of

this disease.

Western equine ence pha litis is a d isease that can affect the centr al nervous system . As this eMedTV a rticle ex plains, it is s pread b y mosquitoes . Th is resour ce descri bes the condition in detail, including inform ation on sym ptoms, treatment, and more .

Arthro pod- borne viruses are also known as ar boviruses . A s this page on the eMedTV site ex plains, they are a large grou p of viruses that are s pread p rimarily by bloo d-sucking inse cts. Th is article also descri bes signs of infe ction, com plications, and more .

Caused b y a mosquito- borne virus, LaCrosse ence pha litis is ar are disease that usually affects children . Th is eMedTV a rticle ex plains how this disease got its name, tr ansmission met hods,

possi ble sym ptoms, treatment o ptions, and more .

Japa nese ence pha litis is a potenti ally serious disease s pread b y

Prevention: htt p://www .mayoclin

.com/ health/ence pha lit/DS00226 /DSE CTION

prevention

htt p://kidshealth.org/ rent/infe ctions/ bac teria _vir al/ence pha litis .htm


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Ence pha litis

k .) S t. Louis Ence pha litis

l.) E nce pha litis Lethargi ca

m.) Ra smussen's Ence pha litis

infe cted mosquitoes in parts of Asia. Th is eMedTV resour ce discusses this disease in detail, including inform ation on tr ansmission, sym ptoms, treatment o ptions, and more .St. Louis ence pha litis is the most common human disease caused

by mosquitoes in the Unite d S tates . Th is eMedTV segment offers an in-de pth look at this condition, including inform ation on its causes, sym ptoms, and p revention met hods.

Ence pha litis lethargica is a d isease that causes fever, delayed physica l res ponse, and lethargy . Th is eMedTV W e b pa ge provides a detailed descri ption of this medical condition, withinform ation on possi ble sym ptoms, treatment o ptions, and more .

Rasmussen's ence pha litis is a r are disease that usually affects only one hemis ph ere of the br ain. A s this eMedTV a rticle ex plains, it occurs mainly in children under the age of 10. Th is

page discusses Rasmussen's ence pha litis in detail.

4 . Discuss the different

risk factor for encephalitis.

a.) A ge

b.) W eakene d immune system

c.) G eogr aph ic regions .

Anyone can develo p ence pha litis . Fac tors that may increase the

risk of the condition include:

Some ty pes of ence pha litis are more prevalent or more severe in

cert ain age grou ps. In gener al, young children and older adults

are at greater risk of most ty pes of vir al ence pha litis . E nce pha litis

from the her pes sim plex virus tends to be more common in

peo ple 20 to 40 years of age.

Peo ple who have HIV /AIDS , take immune-su pp ressing drugs, or

have anot her condition causing a com promise d or weakene d

immune system is at increased risk of ence pha litis .

Mosquito- borne or tick- borne viruses are common in particular

geogr aph ic regions .


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d.) O utdoor activities

e.) S eason of the year

Outdoor activities or work that results in more ex posure to ticks

or mosquitoes increases the risk of ence pha litis .

Mosquito- and tick- borne diseases tend to be more prevalent in

summer and early f all in many areas. In warmer areas, however, mosquitoes and ticks may be present year-roun d.

5 . Discuss the different sign and symptoms of encephalitis.

a.) M ild ca ses sign andsym ptoms:

b.) S evere cases sign and sym ptoms

c.) S ign and sym ptoms for children

Because ence pha litis can follow or accom pa ny common vir alillnesses, there sometimes are signs and sym ptoms of theseillnesses

before hand. B ut often, the ence pha litis appears withoutw arning

fever headach e poor appetite loss of energy a gener al sick feeling

o severe headach e o nause a and vomiting o stiff neck o confusion o disorient ation o person ality cha nges o convulsions (seizures )o pro blems with s peech or hearing o hallucinations o memory loss o drowsiness o coma

vomiting a full or bulging soft s pot (font anel) crying that doesn't sto p or that seems worse when an inf a

nt is picked u p or handled in some way body stiffness


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6 . Discuss the possiblecomplications for encephalitis.

a.) Com plications of severe illness

b.) O ther com plications

The com plications resulting from ence pha litis de pend on sever al

f actors, including age, the cause of the infe ction, the severity of

the initi al illness and the time from disease onset to tre atment .

In most cases, peo ple with relatively mild illness recover wit hin a

few weeks wit h no long-term com plications .

In jury to the br ain from inflammation can result in a num ber of

pro blems . Th e most severe cases can result in:

y R es pir atory arrest y Com ay Death

varying gre atly in severity, may persist for many mont hs or be

permanent:

y Fatigue y Weakness y Mood d isor ders y Person ality cha nges y Memory pro blems y Intelle ctual disabilities y Lack of muscle coor dination y Par alysis y Hearing or vision defects y Speech im pa irments


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7 . Discuss the Anatomyof Brain.

Three cavities, called the primary brain vesicles, formduring the early embryonic development of the brain.These are the forebrain (prosencephalon), the midbrain(mesencephalon), and the hindbrain (rhombencephalon).During subsequent development, the three primary brainvesicles develop into five secondary brain vesicles. Thenames of these vesicles and the major adult structuresthat develop from the vesicles follow (see APPENDIX 1 ):

y The telencephalon generates the cerebrum (whichcontains the cerebral cortex, white matter, and basalganglia).

y The diencephalon generates the thalamus,hypothalamus, and pineal gland.

y The mesencephalon generates the midbrain portionof the brain stem.

y The metencephalon generates the pons portion of the brain stem and the cerebellum.

y The myelencephalon generates the medullaoblongata portion of the brain stem

A second method for classifying brain regions is by theirorganization in the adult brain. The following four divisionsare recognized (see Figure 1).


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FIGURE 1


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a.) Th e four divisions of the adult br ain

a.1) Cere brum Consists of two cerebral hemispheres connected by a bundle

of nerve fibers, the corpus callosum. The largest and mostvisible part of the brain, the cerebrum, appears as foldedridges and grooves, called convolutions. The following termsare used to describe the convolutions:

y A gyrus (plur al, gyri ) is an elev ated ridge among the convolutions .

y A sulcus (plur al, sulci) is a shallow groove among the convolutions .

y A fissure is a dee p groove among the convolutions .

The dee per fissures divide the cere brum into five lo bes (most named a fter bor dering skull bones ) the front al lo be, the pariet al love, the tem por al lo be, the occi pital lo be, andthe insul a. A ll but the insul a a re visi ble from the outsi de surf ace of the br ain.

A c ross section of the cere brum shows three distin ct layers of nervous tissue:

y The cere br al cortex is a thin outer layer of gr ay

matter . Such ac tivities as s peech, evaluation of stimuli, cons cious thinking, and control of skelet al mus cles occur here . Th ese activities are grou ped into motor areas, sensory areas, and a ssociation areas.

y The cere br al white matter underlies the cere br al cortex . It cont ains mostly myelin ated axons that conne ct cere br al hemis pheres (asso ciation fi bers),

conne ct gyri wit hin hemis pheres (commissur al fi bers), or conne ct the cere brum to the s pinal cor d


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a.2) D ience pha lon

(pro jection fi bers ). Th e cor pus callosum is a major assem blage of association fi bers that forms a nerve tr act that conne cts the two cere br al hemis pheres .

y Basal gangli a (ba sal nuclei) a re sever al pockets of gr ay matter located dee p inside the cere br al white matter . Th e major regions in the basal gangli a the caudate nuclei, the putamen, and the glo bus

pa llidus a re involve d in relaying and modifying nerve im pulses passing from the cere br al cortex to the s pinal cor d. A rm swinging while walking, for exam ple, is controlle d here .

connects the cerebrum to the brain stem. It consists of thefollowing major regions:

y The thalamus is a relay station for sensory nerve im pulses tr aveling from the s pinal cor d to the cere brum . Some nerve im pulses are sorte d andgrou ped here before being tr ansmitte d to the cere brum . Cert ain sens ations, such a s pain, pressure, and tem per ature, are evaluated here also .

y The epithalamus cont ains the pineal gland. Th e pineal gland secretes melatonin, a hormone that hel ps regulate the biologi cal clock (slee p-wake

cycles).y The hy pothalamus regul ates numerous im port ant

body activities . It controls the autonomi c nervous system and regul ates emotion, behavior, hunger, thirst, body tem per ature, and the biologi cal clock . I t also produces two hormones (ADH a nd oxyto cin) andvarious rele asing hormones that control hormone

production in the anterior pituit ary gland.


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a.3) B r ain Stem

The following stru ctures are either included or asso ciatedwith the hy pothalamus .

y The mammill ary bodies relay sens ations of smell .

y The infun di bulum conne cts the pituit ary gland to the hy pothalamus .

y The o ptic ch iasma pa sses between the hy pothalamus and the pituit ary gland. H ere, portions of the o pticnerve from each eye cross over to the cere br al hemis ph ere on the o pposite side of the br ain.

connects the diencephalon to the spinal cord. The brain stemresembles the spinal cord in that both consist of white matterfiber tracts surrounding a core of gray matter. The brainstem consists of the following four regions, all of whichprovide connections between various parts of the brain andbetween the brain and the spinal cord.

The prominent stru cture of the br ain stem:

y The midbr ain is the u ppermost part of the br ain stem .

y The pons is the bulging region in the middle of the br ain stem .

y The medulla o blong ata (medulla) is the lower portion of the br ain stem that merges with the s pinal cor d at the for amen magnum .

y The reticular form ation consists of small clusters of gr ay matter inters perse d wit hin the white matter of the br ain stem and cert ain regions of the s pinal cor d, dience pha lon, and cere bellum . Th e reticular

activation system (RAS) , one com ponent of the reticular form ation, is res ponsi ble for maintaining wakefulness and a lertness and for filtering out


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a.4) L im bic S ystem

unim port ant sensory inform ation . O ther com ponents of the reticular form ation are res ponsi ble for maintaining muscle tone and regul ating viscer al motor muscles.

y The cere bellum consists of a centr al region, the vermis, and two winglike lo bes, the cere bellar hemis pheres . L ike that of the cere brum, the surf ace of the cere bellum is convolute d, but the gyri, called foli a, are par allel and give a p leated app ear ance. Th e cere bellum evaluates andcoor dinates motor movements by com paring actual skelet al movements to the movement that was inten ded.

is a network of neurons that extends over a wide range of areas of the brain. The limbic system imposes an emotionalaspect to behaviors, experiences, and memories. Emotionssuch as pleasure, fear, anger, sorrow, and affection areimparted to events and experiences. The limbic systemaccomplishes this by a system of fiber tracts (white matter)and gray matter that pervades the diencephalon andencircles the inside border of the cerebrum. The followingcomponents are included:

y The hi ppocam pus (located in the cere br al hemis ph ere)

y The denate gyrus (located in cere br al hemis ph ere)

y The amygdala (a myg daloid body) (a n almon d-shaped body asso ciated with the caudate nucleus of the basal gangli a)

y The mammill ary bodies (in the hy pothalamus )

y The anterior thalamic nuclei (in the thalamus )

y The fornix (a b undle of fi ber tr acts that links com ponents

of the lim bic system )


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8 . Discuss the Pathophysiology of encephalitis

Ence pha litis is an infl ammatory process in the br ain parenchyma.It is associated wit h c lini cal evidence of br ain dysfun ction due to infe ctive (usually vir al) or non-infe ctive processes . The pattern

of br ain involvement de pends on the s pecific pa thogen, the immunologi cal state of the host, and a r ange of environment al f actors . In vir al ence pha litis the virus initi ally gains entry andre plicates in local or region al tissue, such a s the GI tr act, skin, urogenit al system, or res pir atory system . S u bsequent dissemin ation to the C NS occurs by haematogenous routes

(enterovirus, ar boviruses, HSV , HIV , mum ps) or via retrogr ade axonal tr ans port as with the her pes or r abies virus .De pending on the inter actions between the neurotro pic p ro perties of the virus and the host immune res ponse (mediated by humor al anti bodies, cytotoxi c T c ells and c ytokines ), infe ction andinfl amm ation of br ain parenchyma occur . In these cases, neuron al involvement occurs along with evidence of a p roductive vir al infe ction . Autoimmune processes, wit h anti bodies directedagainst norm al br ain com ponents (e.g., myelin ), play a role in acute dissemin ated ence pha lomyelitis (ADEM). P rominent

perivascular inflammation and d emyelin ation are seen . I f the aetiologi cal agent is unknown it is presume d that the infl amm atory reaction in the br ain paren chyma is directed

against, or is mediated b y, this elusive agent .

9. Discuss the different diagnostic exams for

Encephalitis.

a.) Brain imaging

Questions about sym ptoms, risk f actors and medica l history are

im port ant in making a d iagnosis of ence pha litis . D iagnosti c tests

that may be needed include the following:

. Br ain imaging is often the first test if sym ptoms and pa tient

history suggest the possi bility of ence pha litis . Th e images may


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b.) Sp inal tap ( lum bar puncture ).

c.)

Electroen ce pha logr am (EEG)

d.) B r ain Bio psy

e.) O ther Lab T est

reve al swelling of the br ain or anot her condition that may be

causing the sym ptoms, such a s a tumor . Technologies may

include magneti c reson ance imaging (MRI) , which ca n produce

detailed c ross-se ction al and 3 -D images of the br ain, or

com puterize d tomogr aph y (CT), which p roduces cross-se ction al

images .

With a s pinal tap, the doctor inserts a needle into the lower back

to extr act cere bros pinal flui d ( CSF) , the prote ctive fluid that

surroun ds the br ain and s pinal column . A pa rticular profile of

blood cells and immune system proteins can indicate the presen ce of infe ction and infl ammation in the br ain. In some

cases, sam ples of CSF ca n be teste d in a labor atory to identify

the causative virus or other infe ctious agent

Your doctor may or der an electroen ce pha logr am (EEG) , a test in

which a series of electro des are affixe d to the scal p. Th e EEG

recor ds the electrical activity of the br ain. Cert ain abnorm al

patterns in this activity may be consistent with a d iagnosis of

ence pha litis .

Rarely, a p rocedure to remove a small sam ple of br ain tissue (br ain bio psy) is used if sym ptoms are worsening, tre atments are having no effe ct, and there is no working diagnosis

Your doctor or other mem bers of the care team may take

sam ples of blood, urine, or excretions from the back of the throat.

These can be teste d in the labor atory to identify some of the

viruses or other infe ctious agents that can cause ence pha litis .


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10. Discuss thetreatment for encephalitis.

a.) M ild Cases Treatment

Some clients with very mild ence pha litis can be monitore d a t home, but most will need ca re in a hos pital, usually in an intensive care unit . Doctors will carefully monitor their blood

pressure, heart r ate, and breathing, as well as their body flui ds, to prevent furt her swelling of the br ain.

Because anti biotics aren't effe ctive against viruses, they aren't used to treat ence pha litis . H owever, antivir al drugs can be usedto treat some forms of ence pha litis, es pecially the ty pe cause d by the her pes sim plex virus . Corti costeroi ds may also be used in some cases to r educe brain swelling. If a client is having seizures, anticonvuls ants may also be given . Over-t he-counter (OT C)medications, like acetamino phen, can be used to treat fever andheadach es.

Many peo ple wit h ence pha litis make a full recovery . I n some cases, swelling of the br ain can lead to permanent br ain damage and lasting com plications like learning disabilities, s peech

pro blems, memory loss, or lack of mus cle control . Sp eech,

physica l, or begins, but some ty pes of ence pha litis are known to cause more serious com plications, such a s Japa nese Ence pha litis

Rarely, if the br ain damage is severe, ence pha litis can lead to death. I nf ants younger than 1 year and ad ults older than 55 a re at greatest risk of death from ence pha litis . Occ u pational ther apy may be necessary in these cases . I t's diffi cult to predict the out come for each pa tient at the time the illness

Treatment for mild ca ses mainly consists of: Bed rest Plenty of flui ds Anti-infl ammatory drugs such a s acetamino phen

(Tylenol, others), i bu profen (Ad vil, Motrin, others) andnaproxen (Aleve, others) to relieve headach es andfever .


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b.) M edications/ Drugs

c.) S u pportive Care

Antiviral drugsMore-serious cases of ence pha litis usually require aggressive antivir al tre atments . Antivir al drugs commonly use d to treat ence pha litis include:

Acyclovir (Zovir ax) Ganciclovir (Cytovene )

Some viruses, such a s inse ct- borne viruses, don't res pond to these treatments . However, because the s pecific virus causing the infe ction may not be identifie d imme diately or at all, tre atment with ac yclovir is often begun imme diately . Th is drug can be effe ctive against the her pes sim plex virus, which ca n result in signifi cant com plications or death when not treated p rom ptly.Side effe cts of the antivir al drugs may include nause a, vomiting, diarr hea, loss of app etite, and muscle or joint soreness or pain.Rare serious pro blems may include abnorm alities in kidney or liver function or su pp ression of bone marrow activity .App ro priate tests are used to monitor for serious adverse effe cts.

Supportive careAdd ition al su pportive care also is needed in the hos pital for peo ple wit h severe ence pha litis . Th e care may include:

Breathing assistance, as well as careful monitoring of breathing and heart function

Intravenous fluids to ensure pro per hydr ation andapp ro priate levels of essenti al miner als

Anti-inflammatory drugs, such a s corticosteroi ds, to hel p reduce swelling and p ressure within the skull Anticonvulsant medications, such a s phenytoin

(Dilantin ), to sto p or prevent seizures .


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d.) F ollow u p Th er apy F ollow-up therapyAfter the initi al illness, it may be necessary to receive add ition al ther apy de pending on the ty pe and severity of com plications .This ther apy may include:

Physical therapy to im prove strengt h, flexi bility, balance, motor coor dination and mo bility

O ccupational therapy to develo p every day skills and to use adap tive products that hel p wit h every day activities

Speech therapy to rele arn muscle control andcoor dination to produce s peech

Psychotherapy to learn co ping str ategies and new behavior al skills to im prove moo d disor ders or address person ality cha nges with medication management if necessary.

11.) Discuss the preventive measure for encephalitis.

The best way to prevent vir al ence pha litis is to take precautions

to avoid ex posure to viruses that can cause the disease:

Practice good hygiene. Wa sh ha nds frequently and thoroug hly

with soap a nd water, particularly after using the restroom and

before and a fter meals.

Don't share utensils. Don't share tableware and bever ages .

Teach your children good habits. Teach your children to

pr actice goo d hygiene and to avoid sharing utensils at home and

school .

G et vaccinations. K ee p your children's vacc inations current .

Before tr aveling, talk to your doctor's offi ce about recommen ded

vacc inations for different destin ations .

Protection against mosquitoes and ticks

To minimize your ex posure to mosquitoes and ticks, follow these

ti ps:


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Dress to protect yourself. Wear long-sleeve d shirts and long

pants if you're outsi de between dusk and da wn when mosquitoes

are most active and when you're in a woo ded a rea with tall

gr asses and shru bs where ticks are more common .

Apply mosquito repellent. The Environment al Prote ction

Agen cy (EPA) recommen ds two products DEET a nd p icaridin

to re pel mosquitoes . Products with h igher concentr ations of

the active ingre dient provide longer protection . Th e EPA a lso

recommen ds oil of lemon eucaly ptus but cautions that its effe ct is

com par able to low concentr ations of DEET a nd p rovides protection for about an hour . Mosquito re pellents can be app lied

to both the skin and c lothes. T o app ly re pellent to your f ace,

s pr ay it on your hands and then wi pe it on your f ace. I f you're

using both suns creen and a re pellent, app ly suns creen first .

U se EPA-recommended insecticide. The EPA a lso

recommen ds the use of products cont aining permet hrin. Th ese

products, which re pel and kill tics and mosquitoes, are s pr ayed

on clothing, tents and other out door gear . Permet hrin shouldn't be

app lied to the skin .

Avoid mosquitoes. R efr ain from unne cessary activity in places

where mosquitoes are most prevalent . I f possi ble, avoid being out doors from dusk till dawn, when mosquitoes are most active .

K eep mosquitoes out of your home. R e pa ir holes in screens on

doors and windows .

G et rid of water sources outside your home. Where possi ble,

elimin ate standing water in your yar d, where mosquitoes can lay their eggs . Common pro blems include flower pots or other


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12 Nursing Care Plan

14 Discharge Plan

gar dening cont ainers, flat roofs, old tires and c logge d gutters .

Control mosquitoes in standing water. Fill orn ament al pools

with mosquito-e ating fish. U se mosquito dunks p roducts that

are toxic to mosquito larvae in bir dba ths, ponds and gar den water barrels .

L ook for outdoor signs of viral disease. If you notice sick or

dying bir ds or animals, re port your o bserv ations to your local

health de partment .

Protection for young childreny The Ameri can Acad emy of Pediatrics advises parents not

to use inse ct re pellents on inf ants younger than 2 mont hs of age. Inste ad, cover an inf ant carrier or stroller withmosquito netting .

y Ti ps for using mosquito re pellent with ch ildren include the following:

y Always assist children with the use of mosquito re pellent .y

Spr ay on clothing and ex posed skin .y App ly the re pellent when out doors to lessen the risk of inhaling the re pellent .

y Spr ay re pellent on your hands and then app ly it to your child's f ace. Ta ke care aroun d the eyes and ears.

y Don't use re pellent on the hands of young children who may put their hands in their mout hs.

APPENDIX B

APPENDIX C


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$33(1',; $

Primary Vesicles Secondary

Vesicles Adult Structure Important Components or F eatures

prosen ce pha lon (fore br ain) telen ce phac ere brum cere br al (cere br al hemis ph eres )

cere br al cortex (gr ay matter ): motor areas, sensory areas, association a

The Vesicles and Their Components


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cere br al white matter: association fi bers, commisur al fi bers, pro jection


basal gangli a (gr ay matter ): caudate nucleus & a mygdala, putamen, gl

prosen ce pha lon dience pha lon dience pha lon thalamus: relays sensory inform ation

prosen ce pha lon (fore br ain) d ience pha lon dience pha lon hy pothalamus: maintains body homeost asis

prosen ce pha lon (fore br ain) d ience pha lon dience pha lon mammill ary bodies: relays sens ations of smells to cere brum

prosen ce pha lon (fore br ain) d ience pha lon dience pha lon o ptic ch iasma: crossover of o ptic nerves

prosen ce pha lon (fore br ain) d ience pha lon dience pha lon infun di bulum: stalk of pituit ary gland

prosen ce pha lon (fore br ain) d ience pha lon dience pha lon pituit ary gland: sour ce of hormones

prosen ce pha lon (fore br ain) d ience pha lon dience pha lon e pithalamus: pineal gland

mesen ce pha lon (midbr ain) mesen ce pha lon br ain stem midbr ain: cere br al peduncles, su p. cere bellar peduncles, cor por a quadcolliculi

r hom bence pha lon

(hindbr ain)

meten ce pha lon br ain stem pons: middle cere bellar peduncles, pneumot axic a rea, apneusti c a rea


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r hom bence pha lon (hindbr ain)

meten ce pha lon cere bellum su p. cere bellar peduncles, middle cere bellar peduncles, inferior cere be

r hom bence pha lon (hindbr ain)

myelen ce pha lon br ain stem medulla o blong ata: pyr amids, car diovascular center, res pir atory center


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Cues NursingDiagno

sis

Scientific Basis Objective Intervention Rationale Evaluation

R isk f actors:

Environment al f actor

Decreasedtissue

perfusion

Nutrition al im ba lances

. High

risk of infe ction associated withlower

body resist ance to infe ction

Due to the Low immune

system there is an increased risk for

being invaded by pathogeni corg anisms . V iruses destroy the bodys first line of defense .

Sour ce:

htt p://www .scri bd.c om/ doc/12232899 / NursingCri bcom-

Nursing-C are-Plan-R isk-for-Uterine- Infection

After 2

hours of nursing care the patients immune system will

be stable.

Defense ase ptictechnique and p ro per hand washing techniques either nurses or visitors .Monitor and limit visitors .

reduce the risk of patients ex posed to secondary infe ction . control the s preadof the sour ce of infe ction .

After pro p patients imnow stable

Measure the tem per ature on a regul ar basis andclinical signs of infe ction .

Dete cting early signs of infe ction


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Give anti biotics as indicated

Give safety to patients by giving bearings, fixe d the

bed ba rriers and give a booster attached to the mout h, the airway remains free .

Drugs are sele cted de pending on the ty pe of infe ction and sensitivity of the individual.

Prote ct patients in case of seizure, booster mout h somew hat tongue is not bitten . Note: enter the booster mout h when the mout h just relaxation .

Cues NursingDiagnosis

Scientific Basis Objective Intervention Rationale Evaluation

Objective:

Non-re ality- basedthinking, Disorient ation, Lab ile affect, Short attention

s pa n, Im pa ired judgment, Distr acti bility

Distur bedThoug ht Processes

Disru ption in cognitive o per ations and ac tivities .

Source:

h ttp://davisplus.fadavis.com/townsend6/Care_Plans/CarePlan05-01.cfm?title=Disturbed%20T houg h t%20Processes

Long term Goal: By time of discha rge from tre atment, client will ex perien ce

(ver ba lize evidence of )no delusion al thoug hts

Short term Goal:

Be sincere and honest when communi cating with the client . Avoidvague or evasive remarks .

Delusion al clients are extremely sensitive about others and ca n recognize insin cerity . E vasive comments or hesit ation reinfor ces mistrust or delusions .

After disverbalize

delus

Be consistent in setting ex pectations, enfor cing

rules, and so fort h.

Clear, consistent limits provide a secure stru cture for the client .

Encour age the client to talk with you, but do not

pry for inform ation

Broken promises reinfor ce the clients mistrust of others


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By the endof 2 weeks, client will recognize

andver ba lize that f alse ideas occur at times of increasedanxiety .

Ex plain procedures, andtry to be sure the client underst ands the

procedures before carrying them out .

Pro bing increases the clients sus picion and interferes wit h the ther apeuticrelations hi p.

Give positive feedbac k for the clients successes

Positive feedbac k for genuine success enhances the clients sense of well-

being and hel ps make non- delusion al reality a more positive situ ation for the client

Cues NursingDiagnosis

Scientific Basis Objective Intervention Rationale Evaluatio

D isruptionof skinsurface atthe abdominalsurface.-Wound is

depthdiameter.

-Localizederythema

-Purulentdischarge

Im pa iredskin integrity related to infl ammatory res ponse secondary to infe ction .

Impaired tissue integrity refers tothe damage to mucousmembrane, corneal,Integumentary, or subcutaneoustissue. An incision is a cut or wound produced by cutting intothe body tissue using sharp

objects/ instrument.

References:Blackwells Nursing D ictionary,2 nd Edition (2005). P286

Following a3day nursingintervention, theclient will beable to displayimprovement inwound healing

as evidencedby:-Intact skin or minimizedpresence of wound.

-Wound is less

Sterile dressingchanges will be madetwice a day

-to prevent infection and to keepintact in the skin integrity

After 3dintervenof the aimprovintact skrednesspurulen

The size, depth,presence of drainage

and erythematic andany odor will be noted

-checking on any sign of swelling willhelp to prevent further damage/

complications.

Monitor skin aroundwound for reaction totape used to holddressings in place

- checking on any sign of changeswill help to prevent further damage/complications.


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(+)prurituson thesite of thewound.

(+) pain

than 5mm indiameter.

-Absence of redness or erythematic.

-Absence of purulentdischarge.

-Absence of itchiness.

Teach the patient whythe dressing change isbeing done as a sterileprocedure

-so that the patient or S.O. knows theessence of sterility for further infection and damage of the skinintegrity.

Teach the patient whatwound care may beexpected to be doneupon discharge

-so that the pt. or the S.O. knowswhat to do and what are the standardway on doing it.

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Documents

Resource Unit for Encephalitis