CHAPTER 5 Nervous System^227
- Motor responses obeys commands^6
localizes pain 5
withdrawal (normal) 4
abnormal flexion 3
extension 2
none 1 - Verbal responses oriented^5
confused conversation 4
inappropriate words 3
incomprehensible sounds 2
none 1 - Monitor vital signs for changes—widened pulse pressure with bradycardia
indicative of increased intracranial pressure. - Explain to the patient:
- Needs for homecare.
- When to call healthcare provider.
Encephalitis
WHAT WENT WRONG?
Encephalitis is the inflammation of the brain tissue, most often caused by a virus,
although it can also be due to bacteria, fungus, or protozoa. In the case of viral
encephalitis, the patient typically will have had viral symptoms prior to the current
illness. The virus enters the central nervous system via the bloodstream and begins
to reproduce. Inflammation in the area follows, causing damage to the neurons.
Demyelination of the nerve fibers in the affected area and hemorrhage, edema, and
necrosis occur, which create small cavities within the brain tissue. Herpes simplex
virus 1, cytomegalovirus, echovirus, Coxsackie virus, and herpes zoster can all
cause encephalitis. Some forms 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.
PROGNOSIS
Identification of the organism is important in order to individualize the treatment
for the patient. The earlier that symptoms are recognized and the earlier the patient
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