Pediatric Nursing Demystified

Demyelinationof the nerve fibers in the affected area and hemorrhage,

edema, and necrosis occur, which creates small cavities within the brain

tissue. Herpes simplex virus 1, cytomegalovirus, echovirus, coxsackie virus,

and herpes zoster can all cause encephalitis. Some causes of encephalitis can

be transmitted by insects (such as mosquitoes or ticks) to humans, such as

West Nile virus, St. Louis encephalitis, or equine encephalitis.

Identification of the organism is important to individualize the treatment for

the patient. The earlier symptoms are recognized and the patient enters the

health-care system, the better. Some patients incur permanent disability from

the irreversible damage that occurs to the brain. These patients may be in need

of long-term custodial care.

Signs and Symptoms

Fever due to infection

Nausea and vomiting due to increased intracranial pressure

Stiff neck due to meningeal irritation

Drowsiness, lethargy, or stupor due to increased intracranial pressure

Altered mental status: irritability, confusion, disorientation, personality

change

Headache due to increased intracranial pressure

Seizure activity possible due to irritation of brain tissue

Bulging fontanels in infant

Test Results

Blood cultures used to help identify organism when patient febrile

CT scan

MRI

Analysis of CSF for microorganism that is causing the infection

Treatment

Monitor respiratory status for compromise.

Monitor vital signs for widened pulse pressure and bradycardia, signs of

increased intracranial pressure.

Monitor neurologic function for change.

Administer corticosteroid to decrease inflammation:

• Dexamethasone
  Administer antipyretics to reduce fever:


• Acetaminophen
  Administer anticonvulsants to decrease chance of seizure activity:


• Phenytoin, phenobarbital
  Administer diuretics to decrease cerebral edema if indicated:


• Furosemide


• Mannitol

CHAPTER 10/ Neurologic Conditions^209