I.

Introduction

Encephalitis is an inflammation of the brain. Most often, it is caused by a

viral infection. Several different viruses can cause encephalitis. The most
common are the herpes viruses, childhood viruses such as measles, and viruses
transmitted by mosquito bite. There are two types of encephalitis -- primary and
secondary. In primary encephalitis, a virus attacks the brain and spinal cord
directly. In secondary encephalitis, the virus invades another part of your body
and travels to your brain. The virus causes inflammation of the nerve cells
(encephalitis) or the surrounding membranes (meningitis). Encephalitis is
different from meningitis, but these two brain infections often occur together.
Most cases of encephalitis are mild and don't last long. However, in some cases
encephalitis can be life threatening.

Arboviruses, or viruses carried by insects, are among the most common

causes of viral encephalitis. Some of the major arboviruses that are transmitted
by mosquito include:

• Eastern equine encephalitis -- This infection is relatively rare, with only a

few cases reported each year. However, about half the people who
develop severe symptoms die or suffer permanent brain damage.
• La Crosse encephalitis -- usually affects children under 16 years of age in
the upper Midwestern United States. It is rarely fatal.
• St. Louis encephalitis -- People in rural Midwestern and southern United
States are primarily affected. Many people have mild symptoms, although
symptoms can be severe in people over age 60. Up to 30% of infected
seniors die of the condition.
• West Nile encephalitis -- Primarily affects people in Africa and the Middle
East, but outbreaks have spread across the United States. Most cases are
mild. Symptoms are most severe in older adults and people with
weakened immune systems, and it can be fatal among those populations.
 • Western equine encephalitis -- People in the western United States and
Canada are most at risk. It usually causes a mild infection, except in
children under 1 year of age, who can suffer permanent brain damage.

Other viruses that commonly cause viral encephalitis include:

• Herpes simplex virus type 1 (HSV-1), which is responsible for cold sores
• HSV-2, which is responsible for genital herpes
• Varicella zoster virus, which causes chicken pox and shingles
• Epstein-Barr virus, which causes mononucleosis

Childhood viruses that can cause encephalitis include:

• Measles (rubeola)
• German measles (rubella)
• Mumps

Not all cases of encephalitis are caused by viruses. Some nonviral causes of
encephalitis include:

• Bacterial infection
• Fungal infection
• Parasitic infection
• Noninfectious causes, such as allergic reactions or toxins

Objectives:

Student Nurse Centered

1. To modify predisposing or causative factors that contributes to the health

deficit that was existed, that through history taking, and marking out of the family
genogram and constellation, the student nurse will try to study which factor
contribute to the recent situational crisis.

2. To accomplish comprehensive assessments (physical assessment) with due

regards to the role of the student nurse that may give him all the evidences and
supplemental details of the study that was conducted.

3. To critically analyze health needs and concerns of the individual who endure to
an existing health deficit provided the student nurse with activities to develop
SKILLS, KNOWLEDGE and ATTITUDE and values on health promotion and
identification and management of risk factors.

4. To acquire more knowledge about the disease and later on practice the
nursing process in carrying out the nursing plan of care and interventions.

Client Centered

The patient will be able to:

1.) Trust the student nurse, that he can offer the best and quality nursing
interventions prior to the patients coping behaviors.

2.) Acquire knowledge through the student nurse’s health teachings, that later
on within the absence of the student nurse, interventions that the patient may
benefit, and can be done by patient independence.

3.) Participate in the nursing plan of care, that both the nurse and the client) will
be participating in the care of the advocates.
II. Nursing Assessment

a. Personal History

The respondent of this study was “Girl X” (The student nurse made a
code for the patient to secure her right for every particular manner necessary;
The Student nurse named her after the code “Girl X”)

Girl X is a 10yr.old Filipino born on 17 th day of May year 2000 at San Isidro
Zaragoza Nueva Ecija. She is presently residing at Barangay San Rafael,
Zaragoza Nueva Ecija. She is the youngest daughter among seven children.

Girl X is a Grade four student at Zaragoza Elementary School. Her mother

and father work as farmers and raise pigs and other livestock’s to earn a living.
According to her mother, Girl X used to play near the fields where her parent
works which made her predisposed to her present condition. Her mother also
states that Girl X has complete immunization at the nearby health center.

c. History of Past illness

According to my interview with the mother of Girl X, this was the

first time she was admitted in the hospital. The mother also stated that Girl
X had cough and colds before due to climate change, and made visits to
the RHU near them to seek some medical assistance.

d. History of Present illness

Her condition apparently started about five days prior to

hospitalization as fever, vomiting and headache for two days. She was
admitted at La Paz Hospital. She was diagnosed to have CNS infection
and was given ampicillin, gentamycin for two days and dexamethazone for
 one day. Girl X was transferred to Jecson’s Medical Center per request of
her parents and on the way had convulsion with rolling of eyeballs.

On June 17, 2010, Girl X was admitted at Jecson’ Medical Center

per request of her parents because along the way she had convulsion and
rolling of eyeballs. She was then transferred to Pediatric Intensive Care
Unit for close monitoring.

III. Physical Examination

SUMMARY OF FINDINGS

On the day of admission, “Girl X’s” vitals are: Temperature; 38.4 °C,
Cardiac Rate; 142bpm, Respirations; 21 cpm, Blood Pressure:
100/60mmHg which indicate fever and Tachycardia.

On the first day of visit, her vital signs are: Temperature; 37.5, Cardiac
Rate; 100bpm, Respiratory Rate; 14cpm,
a. Nasogastric Tube present
b. Clear breath sounds during auscultation.
c. Negative verbal output
d. Presence of lyses in scalp

f. Diagnostic and Laboratory Procedures

Diagnostic & Date Indications or Results Normal Analysis and Nursing
Laboratory Ordered Purposes Values Interpretation Responsibilities
Procedures Results
in
Hematology: DO: It measures the 13.8G/L 4.1-10.9G/L The White Before:
All result in 06-17- number of WBC blood cells Verify doctor’s
normal 10 in a cubic exceeds the order.
except for: millimeter normal value Instruct patient
 blood. It is used which about the
White to detect indicates the schedule of the
Blood Cell infection or presence of patient.
inflammation infection. Explain the
procedure and
Blood 06-21- To check for the 3.30meq/L 3.40-
purpose to the
Chemistry: 10 level of serum 5.60meq/L
patient.
All results are potassium in
Tell the patient
in normal the blood
that feeding not
values
required.
except for:
Instruct patient
Serum
there are no
Potassium
special
Hematology: 06-24- It evaluates the 107g/L 110- decreased
measures
10 patient’s 160.0g/L volume of
needed.
hemoglobin hemoglobin oxygen-
content and carrying
After:
thus the iron component
Apply pressure
status and of the blood
or a pressure
oxygen carrying
dressing to the
capacity of
venipuncture
erythrocytes by
site.
measuring the
Observe the
number of
venipuncture
hemoglobin per
site for
deciliter (100
bleeding.
ml) of blood.
Monitor for
It is the 0.35% 0.37-0.47% The White signs and
Hematocrit measure of the blood cells symptoms of
RBC’s in the exceeds the infection.
whole blood normal value
expressed as which
percentage. It is indicates the
used to presence of
measure and infection.
assess
decreased
volume related
to bleeding.

To determine 3.9million/ 4.2- Low volume

Red Blood the patient’s cubic 5.4million/ indicate
Cells number of red millimeter cubic bleeding
blood cell in the millimeter
blood.

It measures the 25,000cubi 5,000- Elevated

White Blood number of WBC c millimeter 10,000cubi white blood
Cells in a cubic c millimeter cell count
millimeter indicate
blood. It is used presence of
to detect infection
infection or
inflammation

The primary 928g/L 140-440g/L Increase

Platelet functions of a platelet count
platelet count indicates risk
are to assist in for
the diagnosis of obstruction in
bleeding the blood
disorders. vessels.
MCHC To check for 30.8g/dl 33-37g/dl decreased
anemia volume may
indicate
anemia
Hematology: 06-29- It evaluates the 101g/L 110-160g/L decreased
10 patient’s volume of
hemoglobin hemoglobin oxygen-
content and carrying
thus the iron component
status and of the blood
oxygen carrying
capacity of
erythrocytes by
measuring the
number of
hemoglobin per
deciliter (100
ml) of blood.

It is the 0.33% 0.37-0.4% Decrease

Hematocrit measure of the volume of
RBC’s in the hematocrit
whole blood determine a
 expressed as need for red
percentage. It is blood cell
used to trnsfusion
measure and
assess
decreased
volume related
to bleeding.

To determine 3.7million/ 4.2- Low volume

Red Blood the patient’s cubic 5.4million/ indicates
Cell number of red millimeter cubic bleeding or
blood cell in the millimeter increased
blood. sequestratio
n of the
spleen
It measures the 15.5 cubic 5,000- Elevated
White Blood number of WBC millimeter 10,000cubi white blood
Cell in a cubic c millimeter cell count
millimeter indicate
blood. It is used presence of
to detect infection
infection or
inflammation

platelet The primary 1074g/L 140-440g/L

functions of a
platelet count
are to assist in
the diagnosis of
bleeding
disorders.
Hematology: 07-05- It evaluates the 109g/L 110-160g/L decreased
10 patient’s volume of
Hemoglobin hemoglobin oxygen
content and carrying
thus the iron component
status and of the blood
oxygen carrying
capacity of
erythrocytes by
measuring the
number of
 hemoglobin per
deciliter (100
ml) of blood.

It is the 0.36% 0.37-0.4% Decrease

Hematocrit measure of the volume of
RBC’s in the hematocrit
whole blood determine a
expressed as need for red
percentage. It is blood cell
used to transfusion
measure and
assess
decreased
volume related
to bleeding.

To determine 3.43T/L 4.20- decreased

Red Blood the patient’s red 6.30T/L volume
Cell blood cell in the indicates
blood. bleeding or
increased
sequestratio
n of the
spleen
Platelet The primary 665g/L 140-440g/L
functions of a
platelet count
are to assist in
the diagnosis of
bleeding
disorders.
White Blood 07-21- It measures the 13.6 cubic 5,000- Elevated
Cell 10 number of WBC millimeter 10,000cubi white blood
in a cubic c millimeter cell count
millimeter indicate
blood. It is used presence of
to detect infection
infection or
inflammation

Platelet The primary 517g/L 140-440g/L

functions of a
 platelet count
are to assist in
the diagnosis of
bleeding
disorders.

Bacteriology of the CSF 06-28-10

Exam Desired: Culture and Sensitivity Result
-Moderate growth of staphylococcus Epidermidis

Susceptible to: Resistant to:

• Gentamycin Linezoid
• Penicillin Trimethophrim
• Tigecycline sulfamethoxazole
• Imipenem oxacillin
• Cefoxitin
• Clindamycin
• Netilcimin
• Tetracycline
• Novobrocin
• Chloramphenicol
• Piperacillin-Tazobactam
• Ciprofloxacin
• Erythromycin
• Vancomycin
• azithromycin

Chest X-Ray 07-23-10

Steaky perihilar infiltrates arenoted

 Heart is not enlarged.
No other remarkable findings

IMPRESSION:
Consider pulmonary congestion

CT-Scan of the Head/Brain 06-18-10

IMPRESSION:
Normal plain cranial CT scan contrast study is suggested

IV. Anatomy and Physiology

As the most complex system, the nervous system serves as the body control
center and communications electrical-chemical wiring network. As a key
homeostatic regulatory and coordinating system, it detects, interprets, and
responds to changes in internal and external conditions. The nervous system
integrates countless bits of information and generates appropriate reactions by
sending electrochemical impulses through nerves to effector organs such as
muscles and glands. The brain and spinal cord are the central nervous system
(CNS); the connecting nerve processes to effectors and receptors serve as the
peripheral nervous system (PNS). Special sense receptors provide for taste,
smell, sight, hearing, and balance. Nerves carry all messages exchanged
between the CNS and the rest of the body.
CNS: neurons, brain, spinal cord

The neuron transmits electric signals like an electric wire. The perikaryon (cell
body) is the neuron central part. Dendrites, short branches, extend from the
neuron. These input channels receive information from other neurons or sensory
cells (cells that receive information from the environment). A long branch, the
axon, extends from the neuron as its output channel. The neuron sends
messages along the axon to other neurons or directly to muscles or glands.

Neurons must be linked to each other in order to transmit signals. The

connection between two neurons is a synapse. When a nerve impulse (electrical
signal) travels across a neuron to the synapse, it causes the release of
neurotransmitters. These chemicals carry the nerve signal across the synapse to
another neuron.

Nerve impulses are propagated (transmitted) along the entire length of an axon
in a process called continuous conduction. To transmit nerve impulses faster,
some axons are partially coated with myelin sheaths. These sheaths are
composed of cell membranes from Schwann cells, a type of supporting cell
outside the CNS. Nodes of Ranvier (short intervals of exposed axon) occur
between myelin sheaths. Impulses moving along myelinated axons jump from
node to node. This method of nerve impulse transmission is saltatory conduction.

The brain has billions of neurons that receive, analyze, and store information
about internal and external conditions. It is also the source of conscious and
unconscious thoughts, moods, and emotions. Four major brain divisions govern
its main functions: the cerebrum, the diencephalon, the cerebellum, and the brain
stem.
The cerebrum is the large rounded area that divides into left and right
hemispheres (halves) at a fissure (deep groove). The hemispheres communicate
with each other through the corpus callosum (bundle of fibers between the
hemispheres). Surprisingly, each hemisphere controls muscles and glands on
the opposite side of the body. Comprising 85 percent of total brain weight, the
cerebrum controls language, conscious thought, hearing, somatosensory
functions (sense of touch), memory, personality development, and vision.

Gray matter (unmyelinated nerve cell bodies) composes the cerebral cortex
(outer portion of the cerebrum). Beneath the cortex lies the white matter
(myelinated axons). During embryonic development, the cortex folds upon itself
to form gyri (folds) and sulci (shallow grooves) so that more gray matter can
reside within the skull cavity.

The diencephalon forms the central part of the brain. It consists of three
bilaterally symmetrical structures: the hypothalamus, thalamus, and epithalamus.
The hypothalamus 'master switchboard' resides in the brain stem upper end. It
controls many body activities that affect homeostasis (maintenance of a stable
internal environment in the body).
The hypothalamus is the main neural control center (brain part that controls
endocrine glands). The pituitary gland lies just below the hypothalamus. The
pituitary gland is a small endocrine gland that secretes a variety of hormones
(organic chemicals that regulate the body's physiological processes). When the
hypothalamus detects certain body changes, it releases regulating factors
(chemicals that stimulate or inhibit the pituitary gland). The pituitary gland then
releases or blocks various hormones. Because of this close association between
the nervous and endocrine systems, together they are called the neuroendocrine
system.

The hypothalamus also regulates visceral (organ-related) activities, food and fluid
intake, sleep and wake patterns, sex drive, emotional states, and production of
antidiuretic hormone (ADH) and oxytocin. The pituitary gland produces both
these hormones.

The thalamus is a relay and preprocessing station for the many nerve impulses
that pass through it. Impulses carrying similar messages are grouped in the
thalamus, then relayed to the appropriate brain areas.
The epithalamus is the most dorsal (posterior) portion of the diencephalon. It
contains a vascular network involved in cerebrospinal fluid production. Extending
from the epithalamus posteriorly is the pineal body, or pineal gland. Its function is
not yet fully understood; it is thought to control body rhythms.

At the rear of the brain is the cerebellum. The cerebellum is similar to the
cerebrum: each has hemispheres that control the opposite side of the body and
are covered by gray matter and surface folds. In the cerebellum, the folds are
called folia; in the cerebrum, sulci. The vermis (central constricted area) connects
the hemispheres. The cerebellum controls balance, posture, and coordination.

The brain stem connects the cerebrum and cerebellum to the spinal cord. Its
superior portion, the midbrain, is the center for visual and auditory reflexes;
examples of these include blinking and adjusting the ear to sound volume. The
middle section, the pons, bridges the cerebellum hemispheres and higher brain
centers with the spinal cord. Below the pons lies the medulla oblongata; it
contains the control centers for swallowing, breathing, digestion, and heartbeat.

The reticular formation extends throughout the midbrain. This network of nerves
has widespread connections in the brain and is essential for consciousness,
awareness, and sleep. It also filters sensory input, which allows a person to
ignore repetitive noises such as traffic, yet awaken instantly to a baby's cry.

The spinal cord is a continuation of the brain stem. It is long, cylindrical, and
passes through a tunnel in the vertebrae called the vertebral canal. The spinal
cord has many spinal segments, which are spinal cord regions from which pairs
(one per segment) of spinal nerves arise. Like the cerebrum and cerebellum, the
spinal cord has gray and white matter, although here the white matter is on the
outside. The spinal cord carries messages between the CNS and the rest of the
body, and mediates numerous spinal reflexes such as the knee-jerk reflex.

Meninges, three connective tissue layers, protect the brain and spinal cord. The
outermost dura layer forms partitions in the skull that prevents excessive brain
movement. The arachnoid middle layer forms a loose covering beneath the dura.
The innermost pia layer clings to the brain and spinal cord; it contains many tiny
blood vessels that supply these organs.

Another protective substance, cerebrospinal fluid, surrounds the brain and spinal
cord. The brain floats within the cerebrospinal fluid, which prevents against
crushing under its own weight and cushions against shocks from walking,
jumping, and running.

PNS: somatic (voluntary) nervous system, autonomic (involuntary) nervous

system

The peripheral nervous system includes sensory receptors, sensory neurons,

and motor neurons. Sensory receptors are activated by a stimulus (change in the
internal or external environment). The stimulus is converted to an electronic
signal and transmitted to a sensory neuron. Sensory neurons connect sensory
receptors to the CNS. The CNS processes the signal, and transmits a message
back to an effector organ (an organ that responds to a nerve impulse from the
CNS) through a motor neuron.

The PNS has two parts: the somatic nervous system and the autonomic nervous
system. The somatic nervous system, or voluntary nervous system, enables
humans to react consciously to environmental changes. It includes 31 pairs of
spinal nerves and 12 pairs of cranial nerves. This system controls movements of
skeletal (voluntary) muscles.

Thirty-one pairs of spinal nerves emerge from various segments of the spinal
cord. Each spinal nerve has a dorsal root and a ventral root. The dorsal root
contains afferent (sensory) fibers that transmit information to the spinal cord from
the sensory receptors. The ventral root contains efferent (motor) fibers that carry
messages from the spinal cord to the effectors. Cell bodies of the efferent fibers
reside in the spinal cord gray matter. These roots become nerves that innervate
(transmit nerve impulses to) muscles and organs throughout the body.

Twelve pairs of cranial nerves transmit from special sensory receptors

information on the senses of balance, smell, sight, taste, and hearing. Cranial
nerves also carry information from general sensory receptors in the body, mostly
from the head region. This information is processed in the CNS; the resulting
orders travel back through the cranial nerves to the skeletal muscles that control
movements in the face and throat, such as for smiling and swallowing. In
addition, some cranial nerves contain somatic and autonomic motor fibers.

The involuntary nervous system (autonomic nervous system) maintains

homeostasis. As its name implies, this system works automatically and without
voluntary input. Its parts include receptors within viscera (internal organs), the
afferent nerves that relay the information to the CNS, and the efferent nerves that
relay the action back to the effectors. The effectors in this system are smooth
muscle, cardiac muscle and glands, all structures that function without conscious
control. An example of autonomic control is movement of food through the
digestive tract during sleep.

The efferent portion of the autonomic system is divided into sympathetic and
parasympathetic systems. The sympathetic nerves mobilize energy for the 'Fight
or Flight' reaction during stress, causing increased blood pressure, breathing
rate, and bloodflow to muscles. Conversely, the parasympathetic nerves have a
calming effect; they slow the heartbeat and breathing rate, and promote digestion
and elimination. This example of intimate interaction with the endocrine system is
one of many that explain why the two systems are called the neuroendocrine
system.

The relationship between sensory and motor neurons can be seen in a reflex
(rapid motor response to a stimulus). Reflexes are quick because they involve
few neurons. Reflexes are either somatic (resulting in contraction of skeletal
muscle) or autonomic (activation of smooth and cardiac muscle). All reflex arcs
have five basic elements: a receptor, sensory neuron, integration center (CNS),
motor neuron, and effector.

Spinal reflexes are somatic reflexes mediated by the spinal cord. These can
involve higher brain centers. In a spinal reflex, the message is simultaneously
sent to the spinal cord and brain. The reflex triggers the response without waiting
for brain analysis. If a finger touches something hot, the finger jerks away from
the danger. The burning sensation becomes an impulse in the sensory neurons.
These neurons synapse in the spinal cord with motor neurons that cause the
burned finger to pull away. This spinal reflex is a flexor, or withdrawal reflex.

The stretch reflex occurs when a muscle or its tendon is struck. The jolt causes
the muscle to contract and inhibits antagonist muscle contraction. A familiar
example is the patellar reflex, or knee-jerk reflex, that occurs when the patellar
tendon is struck. The impulse travels via afferent neurons to the spinal cord
where the message is interpreted. Two messages are sent back, one causing the
quadriceps muscles to contract and the other inhibiting the antagonist hamstring
muscles from contracting. The contraction of the quadriceps and inhibition of
hamstrings cause the lower leg to kick, or knee-jerk.
V. The Patient and His Illness
Schematic Diagram of Pathophysiology
BOOK BASED
 Being very young or older adult,

 Being exposed to mosquitoes or ticks,

 Having a weakened immune system,

 Not being immunized against measles, mumps, and rubella,

 Traveling to areas where viral encephalitis is prevalent

Ingestion of pathogen or vector bite

Invasion of pathogen into the CNS

Cerebral or cerebellar dysfunction

Infectious encephalitis

Infection is seeded from point of origin to CNS

Acute febrile illness

Neuronal phase

 flu-like symptoms, such as fever, sore throat, cough, and malaise

 person may experience headache, stiff neck, intolerance to light, and

vomiting

 50% of people with encephalitis may have seizures

 Other signs and symptoms of encephalitis depend on which area of the
brain is most affected. These may include an impaired ability to use or
comprehend words or coordinate voluntary muscle movements, muscle
weakness or partial paralysis on one side of the body, uncontrollable
tremors or involuntary movements, and an inability to regulate body
temperature

PATIENT BASED
 Being young,

 Being exposed to mosquitoes or ticks,

Ingestion of pathogen or vector bite

Invasion of pathogen into the CNS

Cerebral or cerebellar dysfunction

Infectious encephalitis

Infection is seeded from point of origin to CNS

Acute febrile illness

Neuronal phase

 flu-like symptoms, such as fever and malaise

 person may experience headache, stiff neck, intolerance to light, and

vomiting

 seizures
  Other signs and symptoms of encephalitis depend on which area of the
brain is most affected. These may include an impaired ability to use or
comprehend words or coordinate voluntary muscle movements, muscle
weakness or partial paralysis on one side of the body, uncontrollable
tremors or involuntary movements, and an inability to regulate body
temperature

VI. The Patient and His Care

a. Medical Management
i. NGT, IFC, IV Fluid
Medical Date Ordered General Indicator(s) or Client’s Nursing
Management Date Description Purpose(s) Response to Responsibilities
Treatment Performed the Treatment
Date Changed

IFC DO: To drain urine To prevent  Verify

06-18-10 using a further cause doctor’s
(indwelling
catheter of infection and order
foley DP: attached to prevent kidney  Explain the
catheter) 06-18-10 urine bag to failure procedure
prevent further to the
DR: cause of patient.
07-04-10 infection  Why the
catheter is
to be
inserted.
 How long it
is
anticipated
that the
catheter
will remain
in place.
NGT DO: The tube is The tube is  Verify
06-21-10 used for used for doctor’s
(Nasogastri
feeding or feeding or order
c Tube) DP: administration administration
 Explain the
06-21-10 of medications of medications
procedure
especially if the especially if the
to the
DR: patient has patient has
patient.
07-26-10 impaired impaired
 Why the
swallowing swallowing or
tube is to
is not able to
be
ingest sufficient
inserted.
calories
 How long it
secondary to
is
neurological or
anticipated
other deficits
that the
impairing ability
tube will
to ingest
remain in
sufficient
place.
nutrition.
 The
patient is
kept in
NPO prior
to the
procedure.
D50.3NaCl DO: It is an isotonic Restore The patient Prior:
06-17-10 solution which volume of had good  Verify the
means that it blood hydration doctor’s
DP: exerts the components status as order.
06-17-10 same osmotic evidenced by  Prepare the
pressure as To prevent good skin needed
DC: that found in dehydration turgor. materials.
06-17-10 plasma. and electrolyte  Inform the
imbalance The patient did patient of the
not manifest importance
Access for IV any untoward of
meds side effects. administering
IVF.
 Inform the
patient that
pain maybe
felt especially
 during the
insertion of
the needle.
 Check the IV
label for
details like
expiration
date.

After:
 Check IV
infusion and
amount
every two
hours.
 Manage the
flow rate.
Monitor
patient for
any signs of
infiltration.
 Monitor
patient’s
response to
fluid.
 Check the
regulation
from time to
time.

D5LR DO:06-19-10 Is an Restore The patient Prior:

DC:06-19-10 hypertonic volume of had good  Verify the
solution that blood hydration doctor’s
resembles the components status as order.
normal evidenced by  Prepare the
composition of To prevent good skin needed
blood serum dehydration turgor. materials.
and plasma; and electrolyte
 Inform
potassium level imbalance The patient did
the patient of
below body’s not manifest
the
daily Access for IV any untoward
importance
requirement; meds side effects.
 caloric value of
180. administering
IVF. Check
the IV label
for details
like
expiration
date.

After:
 Check IV
infusion and
amount
every two
hours.
 Manage the
flow rate.
Monitor
patient for
any signs of
infiltration.
 Monitor
patient’s
response to
fluid.
 Check the
regulation
from time to
time.

D5IMB DO: Is an It is commonly The patient Prior:

06-22-10 intravenous given to help had good  Verify the
DC: drip, it is rehydrate hydration doctor’s
06-22-10 balanced patients status as order.
multiple suffering from evidenced by  Prepare the
maintenance dehydration or good skin needed
solution to ensure that turgor. materials.
containing 5% an ill person  Inform the
dextrose take in enough The patient did patient of the
fluids. not manifest importance
any untoward of
side effects. administering
 IVF. Check
the IV label
for details
like
expiration
date.

After:
 Check IV
infusion and
amount
every two
hours.
 Manage the
flow rate.
Monitor
patient for
any signs of
infiltration.
 Monitor
patient’s
response to
fluid.
Check the
regulation from
time to time.

ii. Drugs
Generic Date Route of Indication or Purpose Client’s Nursing
Name Ordered Administratio Response to Responsibilities
Brand Name Date n Dosage and Treatment
Performe Frequency
d Date
Changed
diazepam 06-17-10 5mg IVP Adjunct in the Decrease in  Clarify
management of: muscle doctors
anxiety disorder, spasm, order
treatment of status control  Check for
epilepticus/uncontrole seizures. drug
d seizures, skeletal allergies
muscle relaxant  Check for
 the 12 R’s
 Document
when drug
is given.
paracetamol 06-17-10 300mg,IVP, To decrease body Temperatur  Clarify
every 4 temperature to normal e returns to doctors
hours, round range. normal order
the clock  Check for
drug
allergies
 Check for
the 12 R’s
 Document
when drug
is given.
ceftriaxone 06-17-10 1g IVP every Treatment of the hinders or  Clarify
12 hours following infections kills doctors
caused by susceptible susceptible order
organisms: meningitis bacteria  Check for
and bone/joint including allergies
infection many gram- With
positive antibiotics
organism  Document
and enteric when drug
gram is given.
negative
 Check for
bacilli
the 15 R’s
in giving
medication
s
mannitol 06-17-10 60ml/soluset Adjunct in the Urine output  Clarify
every 8hours treatment of: acute is at least doctors
oliguric renal failure, 30ml, order
edema, increased reduction of  Document
intracranial or intra intracranial when drug
ocular pressure, toxic pressure. is given.
overdose.
 Check for
the 15 R’s
in giving
medication
s
phenobarbita 06-17-10 1g/tablet, Anticonvulsant in Decreased  Clarify
l twice a day, tonic-clonic (grand or cessation doctors
via mal), partiel, and of seizure order
nasogastric afebrile seizures in activity  Document
tube children. without when drug
excessive is given.
sedation
 Check for
the 15 R’s
in giving
medication
s

 Monitor
respiratory
status,
pulse, and
blood
pressure
frequently.
meropenem 06-24-10 950mg,IVP, Treatment of: intra- Resolution  Clarify
every 8hours abdominal infections, of signs and doctors
bacterial meningitis, symptoms of order
skin and skin structure infection.  Check for
infection. allergy
 Document
when drug
is given.
 Check for
the 12 R’s
 Observe for
signs and
symptoms
of
anaphylaxi
s
 Discontinue
the drug
and notify
the
physician if
symptoms
occur.
 Have
 epinephrin
e, an
antihistami
ne, and
resuscitativ
e
equipment
close by in
the event
of an
anaphylacti
c reaction
furosemide 06-26-10 30mg, IVP, Edema due to heart Decrease  Clarify
once a day failure, hepatic blood doctors
impairment or renal pressure, order
disease. increase  Document
Hypertension. urinary when drug
output, is given.
decrease in  Check for
edema. the 15 R’s
in giving
medication
s
 Monitor
respiratory
status,
pulse, and
blood
pressure
frequently.

iii. Diet
Diet Date General Indication Specific Client’s Nursing Responsibilities
Ordered Description or Purpose Foods Response
Date Taken to
Performed Treatment
Date
Changed
NPO 06-17-10 Nothing per This diet None No Prior:
Orem. This was also reaction  Check the doctor’s
means that prescribed noted. order.
nothing as a pre
 should be and post  Assure IV fluid
eaten and op diet therapy if the
nothing will because patient is NPO.
be taken. anesthesia  Instruct SO not to
has give anything
stopped through the mouth.
the gag During:
reflex and Assure is nothing
motility in is taken through
the GI the mouth either
tract. Thus liquid or solid.
if food is  Assess client’s
introduced condition.
through the
 Place
enteral
“NPO”signon the
route there
bed where the
is a high
patient can see it
risk of
always.
aspiration
 Remove foods
which may
and drinks on
even lead
patient’s side.
to death.
After:
 Observe
patient’s response
on the diet.
 Document
the date it was
ordered and
implemented.
Full 07-26-10 It serves to This diet is Soup There is Prior:
Fluid provide given to risk for  Check the doctor’s
Diet nutrition to patients aspiration order.
patients who are  Assure IV fluid
who cannot not able to therapy
chew or tolerate  Instruct SO not to
tolerate solid foods. give any solid food
solid foods through the mouth.
During:
Assure no solid
food is taken
through the mouth
  Assess client’s
condition.
After:
 Observe
patient’s response
on the diet.
Document the date it was
ordered and implemented.
iv. Activities
Activity Date General Indication Client’s Nursing Responsibilities
Ordered Description or Purpose Response
to
Treatment
Flat on 06-25-10 Patient is Before:
Bed maintained  Educate the patient and
flat on bed SO regarding the
importance of the activity.
Explain the purpose of the
activity.
 Discuss to patient some
of the specific activities to
be avoided
After:
 Provide health
teachings on the importance
of activity.
 Monitor patient’s reaction
and response to activity.

Turn the 07-03-10 The patient To avoid The patient Before:

patient turns side bed sores did perform  Educate the patient and
side to side to side for and to the said SO regarding the
at least 2-4 facilitate exercise, importance of the activity.
hours. proper however Explain the purpose of the
blood with limited activity.
circulation. range of  Discuss to patient some
motion. of the specific activities to
be avoided
During:
 Assist the patient in
moving about.
After:
  Provide health
teachings on the importance
of activity.

 Monitor patient’s reaction

and response to activity.

VII. Client’s Daily Progress in the Hospital

Client’s Daily Progress Chart

Days Admission 07-01-10 07-20-10 Discharge

Nursing Problems:
1. Risk for
aspiration. ‫٭‬ ‫٭‬ *

2. Ineffective
breathing pattern * *
related to pain.

3. Altered
Nutrition Less than ‫٭‬ ‫٭‬ *
body requirements
r/t difficulty of
swallowing
Vital Signs
BP 100/60mmHg 115/72mmHg
PR 142bpm 111bpm 100bpm
RR 21cpm 26cpm 14cpm
Temp. 38.4˚C 37.5°C 37.5°C
Medical
Management
IVF:
D50.3NaCl *
D5LR
D5IMB * *
Drugs/Medications
Diazepam ‫٭‬ ‫٭‬
Paracetamol ‫٭‬ ‫٭‬
Ceftriaxone ‫٭‬ ‫٭‬
Phenobarbital ‫٭‬ ‫٭‬
Mannitol *
Meropenem *
Furosemide *

Diet
NPO ‫٭‬ *
Full Fluid

Activities
Flat on Bed * * *
Turn patient side to
side

VIII. Learning Derived

With this undertaking, the student nurse is expected to carry out concepts
from the lectures and maximize the student’s responsibility to take care of his
patients as part of his Related Learning Experience in the Nursing Course
Curriculum.

Student nurse is expected to undergone, Physical Assessment, and other

health and patient related events with a review of the Nursing Care Management
100, 101, 102 and 103 Basics wherein the focus is to promote wellness and
health development from recent situational crisis, that the student nurse is
expected to accomplish the nursing process in carrying out the nursing plan of
care and interventions.
 In studying the case, the student nurse get familiar to the different sign
and symptoms and the different clinical manifestations of the said condition. The
student nurse is also able to find out what are the predisposing and causative
factors that is resulting for the occurrence of the clinical disorder, the
procedures/test that can be done, for a deeper evaluation of the clients condition;
what are their purposes, and how it is done, and the plan of nursing care through
carrying out the doctors’ order, the nursing interventions and considerations.

The student nurse also learned and realized that in order to make a better
case study, one must focus in reviewing the clients’ history, do comprehensive
assessments and review related articles that may help you justified the
evidences of your case.

The student nurse is also growing with his experiences at the exposures wherein
the sense of being critically and logically were developed and he can now
comprehensively analyze health needs and the concerns of his patients who
endure to an existing health deficit and then do the care and other health-
related/promotive activities to develop the student nurse’s SKILLS,
KNOWLEDGE and ATTITUDE and values on health promotion and identification
and management of risk factors with due concerns on the nursing process.

The United Methodist Church

Ecumenical Christian College
COLLEGE DEPARTMENT

Bachelor of Science in Nursing

4 Year Group VI BATCH 2011
rd

presents
 Viral
Encephalitis
A Case Study
Submitted By:

Dian Rei F. Musngi

Submitted To:

Ms. Gretchen Paras

Clinical Instructor

JECSON’S MEDICAL CENTER

AUGUST 4, 2010