- This page has been taken from Encephalitis – a guide, which is available from our
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Nursing staff will undertake careful and repeated observation, which will include
temperature, pulse, respiration, bloods, input and output of any fluids and checking
the functioning of equipment. This will occur on admission and also regularly throughout
the patients stay. The patient may also need a catheter inserting in place of using
the toilet when they are very poorly. If they are at risk of choking a tube may
be inserted into the nose (Nasogastric tube) in order to provide essential nutrients
and fluids. If long term artificial feeding is required, the patient may require
the insertion of a PEG tube into their stomach ensuring that sufficient levels of
nutrition and fluid are received. They will probably also have an intravenous line
inserted into a vein enabling essential drugs to be administered as and when necessary.
Because Encephalitis may make a person very ill, this may cause immobility and as
such they may be at risk of a Deep Vein Thrombosis (DVT). The nursing staff may
suggest that the patient wears anti-embolism stockings to reduce this risk.
The Glasgow Coma Scale (GCS) is used to assess levels of consciousness, eye opening
and motor response and any deterioration in their score is be immediately reported
by the nursing staff to a doctor or consultant.
Agitated and aggressive behaviour is not uncommon during the acute phase of Encephalitis
and after. This may occur because the patient is neurologically agitated due to
the swelling and inflammation in the brain. As the patient begins to recover, they
may enter a phase called post-traumatic amnesia (PTA) and behave extremely out of
character, becoming aggressive, uncooperative or violent. The family must realise
that this is not within their loved one’s control, they are not conscious
or aware of their behaviour or the impact it is having on those around them. The
image of a patient who experiences injury to the brain and perhaps coma, who are
calm and waking serenely to the delight of their family is a myth perpetuated by
television and other media. A loved one is more likely to be confused, disoriented,
aggressive, and rude. It has not been unknown for patients to abscond from their
bed during these stages of agitation.
These experiences are distressing for all and can present a number of management
problems for those trying to care for them. If you feel your loved one is at risk,
discuss your concerns with the nursing staff – they may be able to reassure
you and show you strategies or interventions they have in place to prevent this
from occurring. Sometimes nursing staff use bedrails to prevent injury, especially
where the patient is having or at risk of having seizures. However if they are very
agitated it may be necessary to nurse them on a specially adapted bed that lowers
to the floor, preventing any secondary injuries that may be caused by falling.
If you want to understand further about any interventions used to restrain your
loved one in hospital, the National Patient Safety Agency is a useful source of
guidance and information:
www.npsa.nhs.uk If you have any concerns about the care of your loved one
please contact your hospital PALS service.
Read more about PALS.
Last modified: July 2009