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

July 18, 2011

Submitted to: 0V9LOODHVWHU   Submitted by: -RHYHO9LOODYHU 0DULFHO0DULTXLW 0DQXHO-R\5DPD :HQGHO\Q-XPRQRQJ /HRQHO2SLPR &DPHOOH$OH[LV*RGRIUHGR 6HUJLR9DFDODUHV    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.

SPECIFIC OBJECTIVES Specifically, they will be able to: 1. Define the related terms: a.) Confusion


TIME ALLOTMENT 2 minutes 3 minutes 76 minutes

METHODOLOGY Opening Prayer Introduction Presentation Proper Ice Breaker Question and Answer Portion Conclusion Closing Prayer

RESOURCES I. Human Resources II. Materials a.) Resource Unit Bond Paper Computer Folder and Slider b.) Presentation Discussion Visual Aid Unique Presentation c.) Books d.) Electronic Services Overview: http://www.ncbi.nlm.nih .gov/pubmed/17676529 Pathophysiology: http://bestpractice.bmj.c om/bestpractice/monograph/436 /basics/pathophysiology. html Dictionary: http://www.medterms.co m/script/main/hp.asp


is a change in mental status in which a person is not able to think with his or her usual level of clarity. Frequently, confusion leads to the loss of ability to recognize people and or places, or tell time and the date. Feelings of disorientation are common in confusion, and decision-making ability is impaired. Loss of one's sense of direction, position, or relationship with one's surroundings. Mental confusion or impaired awareness, especially regarding place, time, or personal identity. Any violent and irregular motion or agitation; a violent shaking; a tumult; a commotion. An unnatural, violent, and unvoluntary contraction of the muscular parts of the body. The act of hallucinating; a wandering of the mind; error; mistake; a blunder. The perception of objects which have no reality, or of sensations which have no corresponding external cause, arising from disorder or the nervous system, as in delirium tremens; delusion. Dull; stupid, inclined to drowse; heavy with sleepiness; lethargic; dozy. Disposing to sleep; lulling; soporific. is unusual forgetfulness. It may refer to not being able to remember new events, not being able to recall one or more memories of the past, or both.

5 minutes 20 minutes

7 minutes b.) Disorientation 2 minutes

c.) Convulsion

d.) Hallucination

e.) Drowsiness

f.) Memory Loss

2. Discuss the overview of Encephalitis

Encephalitis is uncommon but is a neurological emergency which must be considered in a patient presenting with altered consciousness. Encephalitis is a diffuse inflammatory process of the brain parenchyma associated with evidence of brain dysfunction. The presentation of encephalitis can be acute or chronic. The aetiology of encephalitis can be broadly divided into two major subtypes. (1) Infection-related encephalitis which is a direct consequence of pathogenic viral, bacterial or parasitic agents. Herpes simplex virus (HSV) and varicella-zoster virus (VZV) are the most common cause of acute infectious encephalitis. (2) Autoimmune-mediated encephalitis which is mediated by an aberrant immune response. This can be triggered by a recent viral infection or vaccination. An example of this would be acute disseminated encephalitis (ADEM). This article will focus on the medical management of acute encephalitis. This will involve an extensive overview of the literature reviewing the diagnosis, investigation and treatment of acute viral encephalitis.

http://www.nlm.nih.gov/ medlineplus/ency/article /003257.htm Risk Factors: http://www.mayoclinic.c om/health/encephalitis/ DS00226/DSECTION=r isk-factors Complications: http://www.mayoclinic.c om/health/encephalitis/ DS00226/DSECTION= complications Anatomy and Physiology of brain: http://www.cliffsnotes.c om/study_guide/TheBrain.topicArticleId22032,articleId21940.html Pathophysiology: http://bestpractice.bmj.c om/bestpractice/monograph/436 /basics/pathophysiology. html Treatment: http://www.mayoclinic.c om/health/encephalitis/ DS00226/DSECTION=t reatments-and-drugs

3. Discuss the different types of Encephalitis

Each year, several thousand people contract encephalitis, which is an inflammation of the brain. This eMedTV article takes an indepth look at encephalitis, including its causes, symptoms, and treatment options. West Nile virus is a form of viral encephalitis, a group of illnesses that cause brain swelling. This eMedTV selection covers encephalitis that is caused by a virus, including information on how to prevent it and how to recognize its symptoms. West Nile encephalitis is a severe form of West Nile virus. This selection from the eMedTV Web library offers an in-depth look at this condition, including information on symptoms, treatment, and how often it occurs.

a.) Viral Encephalitis

b.) West Nile Encephalitis

c.) Herpes Encephalitis

Herpes encephalitis is a rapidly progressing disease. As this eMedTV segment explains, it is the single most important cause of fatal sporadic encephalitis in the United States. This page discusses symptoms, transmission, and the importance of treatment. Subacute sclerosing panencephalitis is a serious infection caused by an altered form of the measles virus. This eMedTV article presents a detailed overview of this condition, with information on its symptoms, stages, treatment, and more. Equine encephalitis is an inflammation of the brain that affects horses and humans. As this eMedTV article explains, there are three types: eastern, western, and Venezuelan. This page describes these different types, including symptoms and prognosis. Eastern equine encephalitis is a mosquito-borne viral disease that can affect the central nervous system. This eMedTV resource discusses the causes, symptoms, transmission, and prevention of this disease. Western equine encephalitis is a disease that can affect the central nervous system. As this eMedTV article explains, it is spread by mosquitoes. This resource describes the condition in detail, including information on symptoms, treatment, and more. Arthropod-borne viruses are also known as arboviruses. As this page on the eMedTV site explains, they are a large group of viruses that are spread primarily by blood-sucking insects. This article also describes signs of infection, complications, and more. Caused by a mosquito-borne virus, LaCrosse encephalitis is a rare disease that usually affects children. This eMedTV article explains how this disease got its name, transmission methods, possible symptoms, treatment options, and more. Japanese encephalitis is a potentially serious disease spread by

Prevention: http://www.mayoclinic .com/health/encephalitis /DS00226/DSECTION= prevention http://kidshealth.org/pa rent/infections/bacterial _viral/encephalitis.html#

d.) Subacute Sclerosing Panencephalitis

e.) Equine Encephalitis

f.) Eastern Equine Encephalitis

g.) Western Equine Encephalitis

h.) Arboviruses

i.) LaCrosse Encephalitis

j.) Japanese


k.) St. Louis Encephalitis

infected mosquitoes in parts of Asia. This eMedTV resource discusses this disease in detail, including information on transmission, symptoms, treatment options, and more. St. Louis encephalitis is the most common human disease caused by mosquitoes in the United States. This eMedTV segment offers an in-depth look at this condition, including information on its causes, symptoms, and prevention methods. Encephalitis lethargica is a disease that causes fever, delayed physical response, and lethargy. This eMedTV Web page provides a detailed description of this medical condition, with information on possible symptoms, treatment options, and more. Rasmussen's encephalitis is a rare disease that usually affects only one hemisphere of the brain. As this eMedTV article explains, it occurs mainly in children under the age of 10. This page discusses Rasmussen's encephalitis in detail.

l.) Encephalitis Lethargica

m.) Rasmussen's Encephalitis

4. Discuss the different risk factor for encephalitis. a.) Age

Anyone can develop encephalitis. Factors that may increase the risk of the condition include: Some types of encephalitis are more prevalent or more severe in certain age groups. In general, young children and older adults are at greater risk of most types of viral encephalitis. Encephalitis from the herpes simplex virus tends to be more common in people 20 to 40 years of age. People who have HIV/AIDS, take immune-suppressing drugs, or have another condition causing a compromised or weakened immune system is at increased risk of encephalitis. Mosquito-borne or tick-borne viruses are common in particular geographic regions.

b.) Weakened immune system

c.) Geographic regions.

d.) Outdoor activities

Outdoor activities or work that results in more exposure to ticks or mosquitoes increases the risk of encephalitis. Mosquito- and tick-borne diseases tend to be more prevalent in summer and early fall in many areas. In warmer areas, however, mosquitoes and ticks may be present year-round.

e.) Season of the year

5. Discuss the different sign and symptoms of encephalitis.

Because encephalitis can follow or accompany common viralilln esses, there sometimes are signs and symptoms of theseillnesses beforehand. But often, the encephalitis appears withoutwarning

a.) Mild cases sign and symptoms:

     o o o o o o o o o o o o

fever headache poor appetite loss of energy a general sick feeling severe headache nausea and vomiting stiff neck confusion disorientation personality changes convulsions (seizures) problems with speech or hearing hallucinations memory loss drowsiness coma

b.) Severe cases sign and symptoms

c.) Sign and symptoms for children

 vomiting  a full or bulging soft spot (fontanel)  crying that doesn't stop or that seems worse when an infa nt ispicked up or handled in some way  body stiffness

6. Discuss the possible complications for encephalitis.

The complications resulting from encephalitis depend on several factors, including age, the cause of the infection, the severity of the initial illness and the time from disease onset to treatment. In most cases, people with relatively mild illness recover within a few weeks with no long-term complications.

a.) Complications of severe illness

Injury to the brain from inflammation can result in a number of problems. The most severe cases can result in: y y y Respiratory arrest Coma Death

b.) Other complications

varying greatly in severity, may persist for many months or be permanent: y y y y y y y y y y Fatigue Weakness Mood disorders Personality changes Memory problems Intellectual disabilities Lack of muscle coordination Paralysis Hearing or vision defects Speech impairments

7. Discuss the Anatomy Three cavities, called the primary brain vesicles, form during the early embryonic development of the brain. of Brain.
These are the forebrain (prosencephalon), the midbrain (mesencephalon), and the hindbrain (rhombencephalon). During subsequent development, the three primary brain vesicles develop into five secondary brain vesicles. The names of these vesicles and the major adult structures that develop from the vesicles follow (see APPENDIX 1 ):

The telencephalon generates the cerebrum (which contains the cerebral cortex, white matter, and basal ganglia).

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

The mesencephalon generates the midbrain portion of the brain stem.

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

The myelencephalon generates the medulla oblongata portion of the brain stem

A second method for classifying brain regions is by their organization in the adult brain. The following four divisions are recognized (see Figure 1).


a.) The four divisions of the adult brain a.1) Cerebrum Consists of two cerebral hemispheres connected by a bundle of nerve fibers, the corpus callosum. The largest and most visible part of the brain, the cerebrum, appears as folded ridges and grooves, called convolutions. The following terms are used to describe the convolutions:

A gyrus (plural, gyri) is an elevated ridge among the convolutions. A sulcus (plural, sulci) is a shallow groove among the convolutions. A fissure is a deep groove among the convolutions.

The deeper fissures divide the cerebrum into five lobes (most named after bordering skull bones)the frontal lobe, the parietal love, the temporal lobe, the occipital lobe, and the insula. All but the insula are visible from the outside surface of the brain. A cross section of the cerebrum shows three distinct layers of nervous tissue:

The cerebral cortex is a thin outer layer of gray matter. Such activities as speech, evaluation of stimuli, conscious thinking, and control of skeletal muscles occur here. These activities are grouped into motor areas, sensory areas, and association areas. The cerebral white matter underlies the cerebral cortex. It contains mostly myelinated axons that connect cerebral hemispheres (association fibers), connect gyri within hemispheres (commissural fibers), or connect the cerebrum to the spinal cord

(projection fibers). The corpus callosum is a major assemblage of association fibers that forms a nerve tract that connects the two cerebral hemispheres.

Basal ganglia (basal nuclei) are several pockets of gray matter located deep inside the cerebral white matter. The major regions in the basal gangliathe caudate nuclei, the putamen, and the globus pallidusare involved in relaying and modifying nerve impulses passing from the cerebral cortex to the spinal cord. Arm swinging while walking, for example, is controlled here.

a.2) Diencephalon

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

The thalamus is a relay station for sensory nerve impulses traveling from the spinal cord to the cerebrum. Some nerve impulses are sorted and grouped here before being transmitted to the cerebrum. Certain sensations, such as pain, pressure, and temperature, are evaluated here also. The epithalamus contains the pineal gland. The pineal gland secretes melatonin, a hormone that helps regulate the biological clock (sleep-wake cycles). The hypothalamus regulates numerous important body activities. It controls the autonomic nervous system and regulates emotion, behavior, hunger, thirst, body temperature, and the biological clock. It also produces two hormones (ADH and oxytocin) and various releasing hormones that control hormone production in the anterior pituitary gland.

The following structures are either included or associated with the hypothalamus.
y y

The mammillary bodies relay sensations of smell. The infundibulum connects the pituitary gland to the hypothalamus. The optic chiasma passes between the hypothalamus and the pituitary gland. Here, portions of the optic nerve from each eye cross over to the cerebral hemisphere on the opposite side of the brain.

a.3) Brain Stem

connects the diencephalon to the spinal cord. The brain stem resembles the spinal cord in that both consist of white matter fiber tracts surrounding a core of gray matter. The brain stem consists of the following four regions, all of which provide connections between various parts of the brain and between the brain and the spinal cord. The prominent structure of the brain stem:
y y

The midbrain is the uppermost part of the brain stem. The pons is the bulging region in the middle of the brain stem. The medulla oblongata (medulla) is the lower portion of the brain stem that merges with the spinal cord at the foramen magnum. The reticular formation consists of small clusters of gray matter interspersed within the white matter of the brain stem and certain regions of the spinal cord, diencephalon, and cerebellum. The reticular activation system (RAS), one component of the reticular formation, is responsible for maintaining wakefulness and alertness and for filtering out

unimportant sensory information. Other components of the reticular formation are responsible for maintaining muscle tone and regulating visceral motor muscles.

The cerebellum consists of a central region, the vermis, and two winglike lobes, the cerebellar hemispheres. Like that of the cerebrum, the surface of the cerebellum is convoluted, but the gyri, called folia, are parallel and give a pleated appearance. The cerebellum evaluates and coordinates motor movements by comparing actual skeletal movements to the movement that was intended.

a.4) Limbic System

is a network of neurons that extends over a wide range of areas of the brain. The limbic system imposes an emotional aspect to behaviors, experiences, and memories. Emotions such as pleasure, fear, anger, sorrow, and affection are imparted to events and experiences. The limbic system accomplishes this by a system of fiber tracts (white matter) and gray matter that pervades the diencephalon and encircles the inside border of the cerebrum. The following components are included:
y y y

The hippocampus (located in the cerebral hemisphere) The denate gyrus (located in cerebral hemisphere) The amygdala (amygdaloid body) (an almond-shaped body associated with the caudate nucleus of the basal ganglia) The mammillary bodies (in the hypothalamus) The anterior thalamic nuclei (in the thalamus) The fornix (a bundle of fiber tracts that links components of the limbic system)

y y y

8. Discuss the Pathophysiology of encephalitis

Encephalitis is an inflammatory process in the brain parenchyma. It is associated with clinical evidence of brain dysfunction due to infective (usually viral) or non-infective processes. The pattern of brain involvement depends on the specific pathogen, the immunological state of the host, and a range of environmental factors. In viral encephalitis the virus initially gains entry and replicates in local or regional tissue, such as the GI tract, skin, urogenital system, or respiratory system. Subsequent dissemination to the CNS occurs by haematogenous routes (enterovirus, arboviruses, HSV, HIV, mumps) or via retrograde axonal transport as with the herpes or rabies virus. Depending on the interactions between the neurotropic properties of the virus and the host immune response (mediated by humoral antibodies, cytotoxic T cells and cytokines), infection and inflammation of brain parenchyma occur. In these cases, neuronal involvement occurs along with evidence of a productive viral infection. Autoimmune processes, with antibodies directed against normal brain components (e.g., myelin), play a role in acute disseminated encephalomyelitis (ADEM). Prominent perivascular inflammation and demyelination are seen. If the aetiological agent is unknown it is presumed that the inflammatory reaction in the brain parenchyma is directed against, or is mediated by, this elusive agent.

9. Discuss the different Questions about symptoms, risk factors and medical history are diagnostic exams for important in making a diagnosis of encephalitis. Diagnostic tests Encephalitis. that may be needed include the following: a.) Brain imaging . Brain imaging is often the first test if symptoms and patient history suggest the possibility of encephalitis. The images may

reveal swelling of the brain or another condition that may be causing the symptoms, such as a tumor. Technologies may include magnetic resonance imaging (MRI), which can produce detailed cross-sectional and 3-D images of the brain, or computerized tomography (CT), which produces cross-sectional images. b.) Spinal tap (lumbar puncture). With a spinal tap, the doctor inserts a needle into the lower back to extract cerebrospinal fluid (CSF), the protective fluid that surrounds the brain and spinal column. A particular profile of blood cells and immune system proteins can indicate the presence of infection and inflammation in the brain. In some cases, samples of CSF can be tested in a laboratory to identify the causative virus or other infectious agent c.) Electroencephalogram (EEG)

Your doctor may order an electroencephalogram (EEG), a test in which a series of electrodes are affixed to the scalp. The EEG records the electrical activity of the brain. Certain abnormal patterns in this activity may be consistent with a diagnosis of encephalitis.

d.) Brain Biopsy

Rarely, a procedure to remove a small sample of brain tissue (brain biopsy) is used if symptoms are worsening, treatments are having no effect, and there is no working diagnosis Your doctor or other members of the care team may take samples of blood, urine, or excretions from the back of the throat. These can be tested in the laboratory to identify some of the viruses or other infectious agents that can cause encephalitis.

e.) Other Lab Test

10. Discuss the treatment for encephalitis.

Some clients with very mild encephalitis can be monitored at

home, but most will need care in a hospital, usually in an intensive care unit. Doctors will carefully monitor their blood pressure, heart rate, and breathing, as well as their body fluids, to prevent further swelling of the brain. Because antibiotics aren't effective against viruses, they aren't used to treat encephalitis. However, antiviral drugs can be used to treat some forms of encephalitis, especially the type caused by the herpes simplex virus. Corticosteroids may also be used in some cases to reduce brain swelling. If a client is having seizures, anticonvulsants may also be given. Over-the-counter (OTC) medications, like acetaminophen, can be used to treat fever and headaches. Many people with encephalitis make a full recovery. In some cases, swelling of the brain can lead to permanent brain damage and lasting complications like learning disabilities, speech problems, memory loss, or lack of muscle control. Speech, physical, or begins, but some types of encephalitis are known to cause more serious complications, such as Japanese Encephalitis Rarely, if the brain damage is severe, encephalitis can lead to death. Infants younger than 1 year and adults older than 55 are at greatest risk of death from encephalitis. Occupational therapy may be necessary in these cases. It's difficult to predict the outcome for each patient at the time the illness

a.) Mild Cases Treatment

Treatment for mild cases mainly consists of:  Bed rest  Plenty of fluids  Anti-inflammatory drugs such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) to relieve headaches and fever.

b.) Medications/ Drugs

Antiviral drugs More-serious cases of encephalitis usually require aggressive antiviral treatments. Antiviral drugs commonly used to treat encephalitis include:  Acyclovir (Zovirax)  Ganciclovir (Cytovene) Some viruses, such as insect-borne viruses, don't respond to these treatments. However, because the specific virus causing the infection may not be identified immediately or at all, treatment with acyclovir is often begun immediately. This drug can be effective against the herpes simplex virus, which can result in significant complications or death when not treated promptly. Side effects of the antiviral drugs may include nausea, vomiting, diarrhea, loss of appetite, and muscle or joint soreness or pain. Rare serious problems may include abnormalities in kidney or liver function or suppression of bone marrow activity. Appropriate tests are used to monitor for serious adverse effects.

c.) Supportive Care

Supportive care Additional supportive care also is needed in the hospital for people with severe encephalitis. The care may include:  Breathing assistance, as well as careful monitoring of breathing and heart function  Intravenous fluids to ensure proper hydration and appropriate levels of essential minerals  Anti-inflammatory drugs, such as corticosteroids, to help reduce swelling and pressure within the skull  Anticonvulsant medications, such as phenytoin (Dilantin), to stop or prevent seizures.

d.) Follow up Therapy Follow-up therapy After the initial illness, it may be necessary to receive additional therapy depending on the type and severity of complications. This therapy may include:  Physical therapy to improve strength, flexibility, balance, motor coordination and mobility  Occupational therapy to develop everyday skills and to use adaptive products that help with everyday activities  Speech therapy to relearn muscle control and coordination to produce speech  Psychotherapy to learn coping strategies and new behavioral skills to improve mood disorders or address personality changes with medication management if necessary. 11.) Discuss the The best way to prevent viral encephalitis is to take precautions preventive measure for to avoid exposure to viruses that can cause the disease: encephalitis. Practice good hygiene. Wash hands frequently and thoroughly with soap and water, particularly after using the restroom and before and after meals. Don't share utensils. Don't share tableware and beverages. Teach your children good habits. Teach your children to practice good hygiene and to avoid sharing utensils at home and school. Get vaccinations. Keep your children's vaccinations current. Before traveling, talk to your doctor's office about recommended vaccinations for different destinations. Protection against mosquitoes and ticks To minimize your exposure to mosquitoes and ticks, follow these tips:

Dress to protect yourself. Wear long-sleeved shirts and long pants if you're outside between dusk and dawn when mosquitoes are most active and when you're in a wooded area with tall grasses and shrubs where ticks are more common. Apply mosquito repellent. The Environmental Protection Agency (EPA) recommends two products DEET and picaridin to repel mosquitoes. Products with higher concentrations of the active ingredient provide longer protection. The EPA also recommends oil of lemon eucalyptus but cautions that its effect is comparable to low concentrations of DEET and provides protection for about an hour. Mosquito repellents can be applied to both the skin and clothes. To apply repellent to your face, spray it on your hands and then wipe it on your face. If you're using both sunscreen and a repellent, apply sunscreen first. Use EPA-recommended insecticide. The EPA also recommends the use of products containing permethrin. These products, which repel and kill tics and mosquitoes, are sprayed on clothing, tents and other outdoor gear. Permethrin shouldn't be applied to the skin. Avoid mosquitoes. Refrain from unnecessary activity in places where mosquitoes are most prevalent. If possible, avoid being outdoors from dusk till dawn, when mosquitoes are most active. Keep mosquitoes out of your home. Repair holes in screens on doors and windows. Get rid of water sources outside your home. Where possible, eliminate standing water in your yard, where mosquitoes can lay their eggs. Common problems include flowerpots or other

gardening containers, flat roofs, old tires and clogged gutters. Control mosquitoes in standing water. Fill ornamental pools with mosquito-eating fish. Use mosquito dunks products that are toxic to mosquito larvae in birdbaths, ponds and garden water barrels. Look for outdoor signs of viral disease. If you notice sick or dying birds or animals, report your observations to your local health department. Protection for young children y The American Academy of Pediatrics advises parents not to use insect repellents on infants younger than 2 months of age. Instead, cover an infant carrier or stroller with mosquito netting. y Tips for using mosquito repellent with children include the following: y Always assist children with the use of mosquito repellent. y Spray on clothing and exposed skin. y Apply the repellent when outdoors to lessen the risk of inhaling the repellent. y Spray repellent on your hands and then apply it to your child's face. Take care around the eyes and ears. y Don't use repellent on the hands of young children who may put their hands in their mouths.

12 Nursing Care Plan


14 Discharge Plan




The Vesicles and Their Components Secondary Vesicles Adult Structure cerebral (cerebral hemispheres) Important Components or Features cerebral cortex (gray matter): motor areas, sensory areas, association areas

Primary Vesicles prosencephalon (forebrain)


Primary Vesicles prosencephalon (forebrain)

Secondary Vesicles telencephacerebrum

Adult Structure cerebral (cerebral hemispheres) cerebral (cerebral hemispheres) diencephalon diencephalon diencephalon diencephalon diencephalon diencephalon diencephalon brain stem

Important Components or Features cerebral white matter: association fibers, commisural fibers, projection fibers

prosencephalon (forebrain)


basal ganglia (gray matter): caudate nucleus & amygdala, putamen, globus pallidus

prosencephalon prosencephalon (forebrain) prosencephalon (forebrain) prosencephalon (forebrain) prosencephalon (forebrain) prosencephalon (forebrain) prosencephalon (forebrain) mesencephalon (midbrain)

diencephalon diencephalon diencephalon diencephalon diencephalon diencephalon diencephalon mesencephalon

thalamus: relays sensory information hypothalamus: maintains body homeostasis mammillary bodies: relays sensations of smells to cerebrum optic chiasma: crossover of optic nerves infundibulum: stalk of pituitary gland pituitary gland: source of hormones epithalamus: pineal gland midbrain: cerebral peduncles, sup. cerebellar peduncles, corpora quadrigemina, superior colliculi pons: middle cerebellar peduncles, pneumotaxic area, apneustic area

rhombencephalon (hindbrain)


brain stem

Primary Vesicles rhombencephalon (hindbrain) rhombencephalon (hindbrain)

Secondary Vesicles metencephalon

Adult Structure cerebellum

Important Components or Features sup. cerebellar peduncles, middle cerebellar peduncles, inferior cerebellar peduncles


brain stem

medulla oblongata: pyramids, cardiovascular center, respiratory center




Nursing Diagno sis

Scientific Basis





Risk factors: Environmental factor Decreased tissue perfusion Nutritional imbalances

. High risk of infection associat ed with lower body resistanc e to infection

Due to the Low immune system there is an increased risk for being invaded by pathogenic organisms. Viruses destroy the bodys first line of defense.

After 2 hours of nursing care the patients immune system will be stable.

Defense aseptic technique and proper hand washing techniques either nurses or visitors. Monitor and limit visitors.

reduce the risk of patients exposed to secondary infection. control the spread of the source of infection.

After proper nursing care the patients immune system are now stable.

Source: http://www.scribd.com/doc/12 232899/NursingCribcomNursing-Care-Plan-Risk-forUterine-Infection

Measure the temperature on a regular basis and clinical signs of infection.

Detecting early signs of infection

Give antibiotics as indicated

Drugs are selected depending on the type of infection and sensitivity of the individual.

Give safety to patients by giving bearings, fixed the bed barriers and give a booster attached to the mouth, the airway remains free.

Protect patients in case of seizure, booster mouth somewhat tongue is not bitten. Note: enter the booster mouth when the mouth just relaxation.


Nursing Diagnosis Disturbed Thought Processes

Scientific Basis





Objective: Non-realitybased thinking, Disorientation, Labile affect, Short attention span, Impaired judgment, Distractibility Disruption in cognitive operations and activities.

http://davisplus.fadavis.com/t ownsend6/Care_Plans/CarePl an0501.cfm?title=Disturbed%20Th ought%20Processes

Long term Goal: By time of discharge from treatment, client will experience (verbalize evidence of) no delusional thoughts Short term Goal:

Be sincere and honest when communicating with the client. Avoid vague or evasive remarks. Be consistent in setting expectations, enforcing rules, and so forth.

Delusional clients are extremely sensitive about others and can recognize insincerity. Evasive comments or hesitation reinforces mistrust or delusions. Clear, consistent limits provide a secure structure for the client.

After discharge the client verbalized evidence of no delusional thought.

Encourage the client to talk with you, but do not pry for information

Broken promises reinforce the clients mistrust of others

By the end of 2 weeks, client will recognize and verbalize that false ideas occur at times of increased anxiety.

Explain procedures, and try to be sure the client understands the procedures before carrying them out. Give positive feedback for the clients successes

Probing increases the clients suspicion and interferes with the therapeutic relationship.

Positive feedback for genuine success enhances the clients sense of wellbeing and helps make non-delusional reality a more positive situation for the client

Cues Disruption of skin surface at the abdominal surface. -Wound is depth diameter. -Localized erythema -Purulent discharge

Nursing Diagnosis

Scientific Basis Impaired tissue integrity refers to the damage to mucous membrane, corneal, Integumentary, or subcutaneous tissue. An incision is a cut or wound produced by cutting into the body tissue using sharp objects/ instrument. References: Blackwells Nursing Dictionary, 2nd Edition (2005). P286

Objective Following a 3day nursing intervention, the client will be able to display improvement in wound healing as evidenced by: -Intact skin or minimized presence of wound. -Wound is less

Intervention Sterile dressing changes will be made twice a day

Rationale -to prevent infection and to keep intact in the skin integrity

Evaluation After 3day of nursing intervention the skin integrity of the abdomen displays improvement as evidence by intact skin, absence of redness and absence of purulent discharges.

Impaired skin integrity related to inflammatory response secondary to infection.

The size, depth, presence of drainage and erythematic and any odor will be noted Monitor skin around wound for reaction to tape used to hold dressings in place

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

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

(+)pruritus on the site of the wound. (+) pain

than 5mm in diameter. -Absence of redness or erythematic. -Absence of purulent discharge. -Absence of itchiness.

Teach the patient why the dressing change is being done as a sterile procedure

-so that the patient or S.O. knows the essence of sterility for further infection and damage of the skin integrity.

Teach the patient what wound care may be expected to be done upon discharge

-so that the pt. or the S.O. knows what to do and what are the standard way on doing it.