CHILD HEALTH NURSING

CASE PRESENTATION

1. Patient Information
Name of the patient: Master Sorav
Son of : Mr. Rodass
Cr no: 17137
Age: 2 year 6 month
Sex: Male
Weight at birth:10.4Kg
Classification/Developmental stage: Toddler
Ward: Medicine ward 1
Address : Noida central Delhi, Delhi
Final diagnosis:Encephalitis, with sequel with decreased vision with rt. UL monoparasis with
dystonia.
Doctor’s name:
Date of admission: 11-8-17
Date of discharge:

3. Introduction :

 General condition– child was apparently well 20days before then he had non
projectile multiple episodes of vomiting, not associated with fever, lose stools and
developed altered sensorium, taken to private hospital bulansher for one day, then
refer to chacha Nehru hospital admitted for 13 days, child also developed seizure after
8 day of stay in chacha Nehru hospital, decreased vision, right upper limb
monoparesis.

 Care taker of child- Mother

 Chief Complaints – child has C/O decrease vision, unable to speak
Unable to hold neck, unable to sit, coughing, decreased oral
intake, muscle dystonia.
Present medical history – child had non projectile vomiting, loose stools, seizures, decreased
vision, decreased oral intake.
4. Family History :
Family Genogram

Rodass(35yrs) vimlesh (32yrs)

keshav (9 yrs)sorav ( 2yr 6 months )

KEY:

: Male

: Female

: Child
S. no Name Relationship Age/sex Education Health
with child status/
1. Rodass Father 35/ M 12th pass Healthy
: Marriage

2. vimlesh Mother 32/ F 10th pass Healthy

3. keshav Brother 9/M Student Healthy

No history of any disease in family members.

5. Maternal history:
a) Obstetric history(At present) : G2P2L2A0

S.no. Gravida No. Gestation week Outcome Delivery type Remarks

1. G1 37 weeks ------- FTNVD Healthy child

G2
2. 38 weeks ------- FTNVD Healthy child

6. Antenatal history:

 Order of pregnancy— G2P1L1A0

 antenatal clinic attended: Yes
 Tetanus Toxoid: Yes
 No of doses: 2
 Consanguineous marriage: NO
 Exposure to; drugs / radiation: NO
 Illness during pregnancy: No
 Mode of delivery: NVD
 Birth injury: Nil
 Gestational age- Term baby

7. Postnatal history

 PPH- nil
 Puerperal sepsis-nil
 Breast engorgement-nil
 Puerperal psychosis-nil

8. Newborn

 Birth history: term baby, appropriate to gestational age, cried immediately after birth

 Cried and breathed at birth- yes

 APGAR Score – 1min. __8__ , 5 min. __9__

 Eye discharge-nil
 Breast feeding initiated within one hour-No
 Passed meconium within 24 hours- yes
 Passed urine within 24 hours- yes

9. Socioeconomic background:

• Name of place: Delhi

• Type of house: concrete
• Ventilation: having adequate ventilation through windows and doors.
• Water supply: tap water from delhijal board system
• Drainage system: closed
• Toilet facilities: own latrine available
• Recreational facilities: television and internet
• Medical facilities: From dispensaries
• Religion: Hindu
• Occupation of parents: father- private job, mother- housewife
• Total income of parents: 25,000/ month

10. DIET HISTORY

 Type of feed: Milk and solid food items

 The Method of feeding: spoon feed
 Present diet pattern: The child is on oral feed
 Weaning started at what age: At the age of 6 month

Height :91 cm

Weight :10.4 Kg

Find out expected weight by using formula:

Toddlers : Age in years x 2+8

2 x 2+8 = 12 Kg
Degree of malnutrition= Actual weight/Expected weight X 100
= 10.4 / 12× 100
= 86.6 %

Find out degree of malnutrition according to IAP classification :

(Normal : > 80, Grade 1 PEM : 71-80,Grade II PEM: 61-70,

Grade III PEM : 51- 60,Grade IV PEM : <50)

 Child nutrition is appropriate

Body Mass Index =Weight (kg)/Height (M) 2

= 10.4 / (0.91)2
= 12.6

Normal BMI : 18.50—24.99

BMI is less than normal
Inference: weight is not appropriate to age.

 PHYSICAL ASSESSMENT:
GENERAL SURVEY
Vital signs:
Temp- 37.4*C
Pulse- 112/mt
Resp- 30/mt
Spo2- 80/60mmhg
Appearance
Face : Dull
Overall hygiene : Maintained
Body built : Moderately built
Mental status : Oriented to mother
Body posture : Normal
Integumentary System:
Skin color : Normal and dry in texture.
Temperature : warm (38.40C)
Nails : Normal no clubbing, cyanosis.

Head:
Fontanellae : Normal.
Size : Normal.

Hair:
Color : Black
Distribution : Equal.
Dandruff : Absent.
Eyes:
Eye brows : present.
Eye lashes : normal
Follicle/ sty : absent
Eyelids /odema: edema present
Lesions : absent.
Eyeballs : normal.
Conjunctiva : pink
Eye movements : normal
Vision : decreased vision
Ears:
Discharges : absent.
Hearing acuity : normal
Nose:
Crust/ discharge : crust present
Nasal septum : normal
Polyps : absent.
Rhinorrhoea: present
Mouth and pharynx:
Membrane : normal
Breath : normal
Throat : normal, no enlarged tonsils.
Gum : No bleeding.
Teeth : missing teeth with dental carries
Tongue : dry
Oral hygiene : Brushing _2___ times/ day.
Material used : Brush
Dentifrices : Tooth paste
Neck:
Lymph nodes : Not palpable
Thyroid gland : Normal
Chest:
Shape : normal
Chest movements : symmetrical
Heart position : Normal.
Heart sounds : normal, no murmurs.
Respiration rate : 32breaths/mt
Dyspnea : absent
Respiratory sound : No wheeze
Auxiliary Lymph:
Nodes :not palpable.
Abdomen:
Skin : No lesions or scars.
Umbilicus : normal
Peristalsis : not visible.
Size : normal.
Bowel sounds : present.
Abdominal sounds
on percussion : Tympanic.

Back
Spinal alignment : No Kyphosis, Lordosis, scoliosis
spinal abnormalities : Absent

Upper extremity
Range of motion : muscle dystonia present
Congenital anomaly : absent

Lower extremity
Range of motion : muscle dystonia present
Clubfoot : Absent
Plantar reflex : Normal flexion of toes.

Bladder
Urine output : Normal.
Painful micturition : Absent
Incontinence of urine : Absent
Urgency : Absent
Dribbling : Absent

Male External genitalia

Congenital abnormalities: Absent
Shape and symmetry : Normal
Inflammation/infection : Absent
Discharge : Absent

Rectum&anus
Skin color : Normal
Lesions : Absent
Rectum
Masses : Absent
Tenderness : Absent

GROWTH AND DEVELOPMENT

PARAMETERS BOOK PICTURE PATIENT’S REMARKS

PICTURE
ANTHROPOMET Anthropometric
RIC measurements
MEASUREMENT Ht: 86-100 cm 91 cm
S Wt: : 10-16 kg 10.4 Kg
CC : 48-54 cm 46 cm
HC: 47-52in cm 43 cm

Vital signs
VITAL Temperature: 36.5-37.50C 37.40C
SIGNS Pulse:98-140/ min. 112/ min.
Respiration: 22-37 / min. 30/min.
BP: 86-106/ 42-63 mmHg 80/60 mmHg

SENSORY Sensory development

DEVELOPMENT Vision:
•Looks at pictures attentively for Vision decreased
longer period
•Identifies geometric forms
•Places round objects into
appropriate hole
•Insert small objects into No
appropriate place.
•Recalls visual images
Hearing:
 Head movement in all planes for
sound localization Yes
Taste
 Taste buds savor the natural Developed
flavors of food
Smell & Touch
• Senses of smell and touch
moredeveloped.

GROSSMOTOR Grossmotor development

DEVELOPMENT
•Assume standing position No ( due to disease
•Walks with wide-based gait condition)-
.
•Kneels without support No
•Creeps upstairs No
•Can throw a large ball overhand
No
4 to 5 feet.
No
•Walks sideways and backwards
•Run stiffly, but falls
•Jump with both feet in place
Jumps with both feet
•Walks on tiptoe for few steps Yes
upon request.
Rides a pedal car.
•Rides a walker or pedal car.
FINEMOTOR
DEVELOPMENT: Finemotor development:
•Builds a tower of 2 blocks
. No
•Makes train of cubes Yes
•Turns pages of a book
Makes horizontal &
 scribble spontaneously
vertical strokes.

•Makes line with crayon and Yes

imitates a circular stroke
•Insert small objects in narrow- Yes
neck container
Yes
•Unscrews lid of a jar
•Opens door by turning door No
knob
Self-help skills developed
Feeding skills
Feeds self with little
•Ability to use cup spilling

•Ability to use a spoon

•Ability to take a drink
•Preference for finger feeding. Able to use a spoon
Dressing skills Yes
Yes
•Strikes out arms and legs to
help in dressing
•Removes socks
•Removes shoe No
•Unzips garments
Not removing socks
•Can button Yes
•Can unbutton
Yes
•Remove laces
No
•Helps put things away
Yes
Toileting and grooming skills
Yes
•Indicates the need for toileting
Yes
•Bowel control No
•Bladder control-day time, night
time Yes
No
•Verbalizes toileting need
•Brushes teeth
Yes but not able to hold
•Washes hands and attempts to
Yes
dry it

COGNITIVE Preoperational stage (2-7 years)

DEVELOPMENT 2-4 years ( Pre conceptual
phase) Yes
 Child learn a variety of words Yes
 Use one object to represent
another

PSYCHOSOCIAL Psycho social development

DEVELOPMENT Autonomy v/s shame and doubt (1-3
years)
•egocentric Yes
•separation anxiety Not present
•hugs and kisses parents
•kisses pictures in a book No
•Begins to imitate parents doing No
•Temper tantrum Yes
•Thump sucking Not present
•Achieve bowel control Not present
•achieve bladder control both
day and night No
•Tolerate separation from
parents. Yes
•Less fearful of strangers
•Imitates parents Yes
•Exhibits temper-tantrums, if Yes
things go wrong Not present
•Possessive about toys
No
And has great sense of
“mine”
•Resists Yes
simple/commands/requests.
•Take time in making decisions. Yes
•Gets upset by changes in
routines
•Pulls others to show them Yes gets irritated
something
•Knows own sex Yes
Yes

LANGUAGEDEV Language development

ELOPMENT •Comprehends more than Yes
communicate
•Says words (number of words) Verbalizes 3-4 sentences
•Names familiar picture/ objects Yes
•Responds to familiar simple Yes
commands No
•Shakes head to communicate “NO” Use words
•Gestures used are lesser than words Yes
•Enjoys stories with pictures Able to identify 5 body
•Identifies body-parts( body parts) parts
•Questions about events, objects Yes
MORAL Moral development
DEVELOPMENT
(Stage I– Pre conventional
morality 2-4 years)
• punish for doing -wrong Yes, present
• if not punished- right

SPIRITUAL Spiritual development

DEVELOPMENT  Imitate behavior(spiritual Yes
activity) of parents
 Learn about God through the Yes
words and actions

PSYCHOSEXUAL Psychosexual development

DEVELOPMENT (Anal stage 1-3 years)
 Obtain sensuous pleasure from
the feeling of a distended Yes
bladder and rectum.
•gender identity Recognizes own sex
•genital play No

PLAY: play
 Inspects toys Yes, explores them
 Talks to toy Yes
 Use dolls, utensils ,push and pull Yes
toys, balls
 Use finger paints, crayons, Large Use crayons
puzzles Yes
 Enjoys musical toys
Yes
 Enjoy picture books
Accidents
ACCIDENTS  Poisoning Not met with any of the
 Drowning accidents yet.
 Burns
 Falls
 Cuts and wounds
 Animal bite
 RTA

BEHAVIORALP Behavioral problems

ROBLEMS •Anxiety disorders Not present
•Disruptive behavior Not present
•Sleeping problems. Not present
•Feeding problems Not present
•Thumb sucking Not present
•Tics Not present
•Attention deficit hyperactivity Not present
disorder
• Temper tantrums Not present
•Pica Not present
•Sibling rivalry Not present
•Negativism. Present
 Nail biting Present

NUTRITION Nutrition
 Period of Breast feeding 1 year
 Weaning At the age of 6 months
IMMUNIZATION SCHEDULE:

Age Recommended Age Dose Route Age at which child received Remark
vaccination s

BCG, At birth 0.05ml I/D At birth Mark

OPV, 2 drops oral present
HEP B 0.5ml I/M

OPV1, At 6 weeks 2 drops Oral At 6

Pentavale 0.5ml I/M Week
nt-1 Nil
At 10 weeks 2 drops Oral At 10
OPV11, 0.5ml I/M Week
Pentavale Nil
nt-11
Nil
OPV111, At 14 weeks 2 drops Oral At 14 week
Pentavale 0.5ml I/M
nt-111 Nil

Measles + At 9 months 0.5 ml+ Subcuat At 9-10 month

Vitamin 1ml (1 eno-us,
A lakh IU) oral Nil

0.5ml+
At 15-18 month 2 ml (2 Subcuta At 18 month
MMR+ lakh IU) neous, Nil
VITAMIN oral
A 0.5ml+
A 2 drops
t 16-24 month Intra- At 24th month
DPT muscula Nil
Booster + r
OPV Oral
Booster 0.5ml+2
ml (2
At 2-5 year lakh IU) IM + At the age of 2.5 years
Typhoid oral
 DIAGNOSTIC AND LABORATORY DATA

S.NO DATE INVESTIGATIONS PATIENTS NORMAL REMARKS

VALUE VALUES
1. 17-8-17 Serum bilirubin(Total) 0.7 0.2-1 mg/dl Normal
Conjugated 0.3 0-0.2 mg/dl
Unconjugated 0.4 Upto 1 mg/dl
SGOT 56 10-40 IU/L
SGPT 25 10-45 IU/L
Total protein 7.9 6.6-8.0 gm%

2. 17-8-17 Biochemistry
Sodium 142 130-149 mg/dl Normal
Potassium 4.3 3.5-5.0 mg/dl Normal
Chloride 102 98-108 mg/dl Normal
Urea 25 10-40 mg/dl Normal
Creatinine 0.2 0.5-1.0 mg/dl Decreased
Uric acid 4.2 Normal
3.0-6.5 mg/dl

3. 18-8-17 Oximetry Values

Hb 14.2g/dl 11.0-17.5 g/dl

O2 95%
95.0-99.0%

Clinical haematology

WBC 11.9 x 10³ / u L

RBC 4.90 x 10 6 /u L
4.5-5.5MILL/C
HGB 7.8 g/dl
HCT 29.6 %
40-50%
MCV 60.4 f L Decreased
83-99 fL
MCH 15.9pg Decreased
27-32 pg
PLT 266 x 10³ / u L
150000-400000
/uL
4. 15-8-17 CSF
40-70mg/dl
Sugar 72 Normal
CSF protein 28 15-40mg/dl

MRI BRAIN WITH CONTRAST

FINDINGS:
Bilateral symmetrical altered signal intensity areas seen in bilateral fronto- parital white matter,
centrum semiovale and occipital lobes appearing hyperintenses on T2w & FLAIR images.

Altered signal intensity area seen in bilateral basal ganglia, cerebral peduncies and left fronto-
temporo-parietal lobe appearing hyperintense on T2w images and show restricted diffusion. On
post- contrast study gyriform enhancement seen in left fronto- temporo- parietal lobe with
enhancement in bilateral basal ganglia.

Thinning of corpus callosum seen.

Mild prominence of ventricular system seen.

Rest of the cerebral parenchyma is normal in signal intensity with maintained grey and white
matter differentiation.

Sella and parasellar region are normal

Rest of the brainstem is normal in signal intensity

Cerebellum is normal in signal intensity.

MEDICATION:
 Syp. Phenytoin ( 30mg/ 5ml)- 3.5 ml PO BD
 INJ. Monocef 410 mg IV BD
 IVF N/2 iv 8 hourly
 Syp. Calcinol 5 ml OD
DISEASE DISCRIPTION

Encephalitis:
Encephalitis is an acute CNS condition with radiographic or laboratory evidence of brain
inflammation (Lewis & Glaser, 2005). Inflammation of the meninges is also common. The
incidence is estimated to be 7.3 cases for every 100,000 hospitalizations. Children under 1 year
of age have the highest incidence (Lewis & Glaser, 2005). The encephalitis may occur as a direct
or primary infection by an organism that successfully gets past the blood-brain barrier, such as
arbovirus, herpes simplex viruses, and rabies. Post infectious encephalitis occurs days or weeks
after an infection, such as with measles or varicella (Lewis & Glaser, 2005). Viruses are believed
to cause most cases of encephalitis.

Definition

Encephalitis is an inflammatory process of the CNS resulting in inflammation of the brain

parenchyma itself and is caused by a variety of organisms, including bacteria, spirochetes, fungi,
protozoa, helminthes, and viruses. Most infection are associated with viruses, and this discussion
is limited to those agents.

Etiology

 Encephalitis can occur as a result of (1) direct invasion of the CNS by a virus or (2) post
infectious involvement of the CNS after a viral disease. Often the specific type of
encephalitis may not be identified. The cause of more than half of the cases reported in
the United States is unkown. The majority of cases of known etiology are associated with
the childhood diseases of measles, mumps, varicella and rubeela and, less often , with the
enteroviruses herpeviruse, and west Nile virus.
 Viral-
 Arbo viruses- Japanese B encephalitis
 Bacterial –
 Spirochetal – syphilis
 Protozoa – toxoplasmosis, malaria
 Helminthiasis – cysticercosis
 Fungal – Cryptococcus
 Metabolic - hyperbilirubinimia
Causative agents

Dependent on type. Types are:

 Virus encephalitis
 Postinfectious: occurs with infection disease- measles, german measles, mumps, pertusis;
following immunizations
 Toxic encephalitis: occurs with acute infections or lead poisoning.

Method of spread

 Virus is maintained in nature by words and transmitted from bird to bird by mosquitoes
and mites.transmitted to horse and people by bite of infected mosquito.
 Occur with infection disease cannot be transmitted to others.

Pathophysiology

Pathological changes in these conditions are non- specific. Diffuse cerebral edema, congestion
and hemorrhage may be present. The neuron s may so necrosis and degenerations . Meningeal
congestion with mononuclear infiltration perivascular tissue and necrosis and myelin breakdown
may found. The ground substance may show glial proliferation. Demyelination vascular and
perivascular distraction, cerebral cortical involvement may develop according to the type of
infecting agent.

In case of rabies and herpes simplex infection, specific inclusion are identified. Characteristics
pathological changes found in falciparum malaria.

Acute disseminated encephalo-myelopathy is more commonly found in children with scattered

demylenation throughout the brain or spinal cord.

Clinical manifestation

Clinical presentation of these condition may vary depending upon severity of infections, host
susceptibility, localization of infectious agent and presence of increased ICP.
The clinical features may show rapid variations from time to time with confusing neurological
involvements. The features may be apparent or may found mild abortive type of illness or severe
encephalomyelitis.

The onset of the disease is usually sudden but may also be gradual.

IN BOOK IN CHILD
Initial symptom:  Convulsion (*in starting period of
 Fever illness)
 Confusion  Vomiting
 Headache  Irritability
 Vomiting  Hyperactivity
 Irritability  Neck stiffness
 Convulsion  Poor feeding
 Increased ICP  Fever

Specific symptoms:
 Increased ICP
 Temporal hiatal herniation
 Altered loss of consciousness
 Ptosis
 Pupillary abnormalities
 Paralysis of upper limb
 bradycardia

Features of increased ICP, meningeal involvement and neurological deficits like ocular palsies,
hemeplagia are usually present. Tense bulging fontalle, distended scalp veins, papilledema,
hyperventilation, cheyne- stroke respirations and bradycardia may develop due to sudden and
severe rises of intracranial pressure. Severe disturbances of vital centers resulting respiratory
problems and cardiac arrest May found due to heriniation of cerebellum through
foramanmagneum and compression of medulla oblongata. Focal paralysis and focal seizures with
focal EEG changes usually found in herpes simplex encephalitis.

Diagnostic evaluation
Diagnosis based on history and laboratory findings .information about recent immunization,
insects bite, travel to areas where cases of encephalitis are present should be obtained (e.g. west
Nile virus or eastern equine encephalitis). Cerebrospinal fluid analysis, blood serologic test and
nasopharyngeal and stool specimen are evaluate in an attempt to identify pathogenesis causing
the symptoms. Testing for virus- specific immunoglobulin M antibodies with enzyme linked
immune sorbent assay (ELISA) is performed after 5 days of acute illness. The polymerase chain
reaction test is used to assess for herpes DNA in the spinal fluid. A CT scan, MRI, and EEG may
also be performed. An EEG may help assess seizure activity and help localized and area of the
brain affected. Brain biopsy may be performed to diagnose herpessimpex and parasitic
infections. Rotine blood chemistry and hematology tests are often normal.

IN BOOK IN CHILD
 Cerebrospinal fluid analysis (CSF)  CSF
 CT  MRI
 MRI  Urine R/M, C/S
 EEG  Blood culture
 blood serologic test
 nasopharyngeal
 urine R/M C/S, stool specimen
 cell count ( biochemistry, serology
and culture)
 serum electrolyte, urea, ammonia,
blood sugar, ABG analysis

Treatment

Symptomatic and supportive management are important for better prognosis of these conditions.
Initial management should be done promptly to save the life and prevent complications.

General management:

 Anti-pyretic, IV mannitol.
 Airway clearance is the prime important for positioning and frequent suctioning.
 Oxygenation to be provided.
 Hydrotherapy and antipyretics is administered to relief from hyperpyrexia.
 IV fluid therapy and dopamine to be given to treat shock and fluid electrolyte imbalance.
 Anticonvulsive drugs may be needed to reduce ICP.
 Steroid (dexamethasone) therapy may given, though the role of drug is not established.

Specific management

 Antiviral (acyclovir- 20 mg/kg/day 8 hourly – 21 days )is administered in herpes simplex

encephalitis.
 Specific detoxification therapy is given in lead or insecticide poisoning.
 Cerebral malaria should be treated with antimalarial agent.
 Antibiotics to be prescribed to prevent secondary infections.
 Vitamin and mineral supplementation are usually given.
 Human immunoglouglobin( IVIG) may be administered 200-500 mg/kg in early stage,
which reduces the mortality rate.

Supportive nursing care

 Special attention to be given on skin care

 Continuous bladder drainage
 Care of eyes
 Changes of positioning and monitoring of patient’s conditioning with features of
complications.
 Nasogastric tube feeding followed by gradual acceptance
 Intake of nutritional diet is very significant for promotion of better health in recovery
period

Nursing care management

Nursing care focuses on monitoring cardiorespiratory function, preventing complications

resulting from immobility, reorienting the child, and teaching the parents about the child’s
condition. This child is usually admitted to the intensive care unit during acute stages.

Monitor the child’s cardiorespiratory function.

 Check the child’s airway and ability to handle secretions.

 Monitor respiratory status by observing color, pulse oximetery readings, and arterial
blood gas values.
 Observe cardiopulmonary status by monitoring heart rate, blood pressure, capillary refill
time, and urine output
 Provide seizure precautions, and have appropriate equipment for managing seizures at the
bedside.

Maintain skin integrity

 Proper positioning with frequent turning is important.

 When indicated by the physician, perform chest physiotherapy to prevent pneumonia.

Monitor the level of consciousness

 The child whose level of consciousness begins to improve may at first be confused and
disoriented and may have residual effects of the disease.
 Orient the child to the hospital environment.
 Have the family help to reorient to child by bringing favorite stuffed animals or music
from home.
 Engage in therapeutic play.
 Give the child age-appropriate toys to encourage a return to normal behavior.

Provide knowledge

 Give the parent information about their child’s condition and prognosis.
 Provide support to the parents and family as they cope with the life-threatening nature of
this condition.
 If the child receives physical, occupational, or speech therapy, explain the treatment
regimen to the parents.

Discharge planning and home care teaching

 Encourage parents to take an active role in the child’s physical and emotional care in the
hospital.
 Give them written instructions about home care.
 Encourage the parents to learn specific physical, occupational, and speech therapies so
they can work with their child at home between home care visits.
 Refer parents to home care, social services, family counseling, and support groups.
 Plan follow- up visits so the child can be evaluated for neurologic sequelae.

Complications

 Shock
 Cardio- respiratory disorders
 Epilepsy
 Paralysis
 Cerebellar ataxia
 Mental retardation
 Obesity
 Behavioral problem
Prevention of encephalitis

Vaccines - keeping up-to-date with vaccines is the most effective way of reducing the risk of
developing encephalitis. These include vaccines for measles, mumps, rubella, and if the virus
exists in those areas, Japanese encephalitis and tick-borne encephalitis. Dependent on type of
organism involved. Virus encephalitis some vaccines are available, but not generally used for
humans.

In areas known to have mosquitoes that carry encephalitis causing viruses, take measures to
reduce the risk of being bitten. This may include wearing appropriate clothing, avoiding
mosquito-infested areas, avoiding going outside at specific times during the day when there are
lots of mosquitoes about, keeping your home mosquito-free, using mosquito repellant, and
making sure there is no stagnant water about your house. Insects such as mosquitoes and mites
should be destroyed by insecticides.

Prognosis

The prognosis for the child with encephalitis depends on the child’s age, type of organism,
residual neurologic damage. Long-term outcomes of HSV encephalitis in children can be serious,
and deficits include visual, auditory, motor, and psychiatric. Very young children (younger than
2 years of age) may exhibit increased neurologic disabilities, including learning difficulties and
seizures disorder. Follow- up care with periodic reevaluation is important because symptoms are
often subtle, and rehabilitation is essential for patients who develop residual effects of the
disease.

PROGRESS NOTES:

DAY 1: ( 16-8-17)
Child is afebrile, having complaints of right sideddystonia, poor feeding, irritability, vomiting,
constipation, and decreased vision, child is not able to hold his neck not able to speak , sit, neck
stiffness present.
suppository was given to child as per doctors order, after that child passed stool,
LP was planned for child but refused by parent’s, i/v cannula present at left leg, site is clean and
healthy, IV fluid N/2 is on flow, morning care and medications given to child.

DAY 2: ( 17-8-17)

Child is afebrile, taking orally, tolerating well, vomiting reduced, decreased vision and right
sided dystonia present, child is not able to hold his neck not able to speak , sit, neck stiffness
present.

Parents were counselled about the LP by the doctor and LP performed,

IV cannula present at left leg site is clean and healthy, morning care and medication given.

DAY 3: ( 18-8-17)

Child is stable, taking orally tolerating well, vomiting reduced, irritability present, child is not
able to hold his neck not able to speak , sit, neck stiffness present.
IV site is clean and healthy, morning care and medication given.

DAY 4: ( 19-8-17)
Child is stable, but there is no improvement In child’s vision, parents asking for ophthalmologist
review but there is no order for eye appointment, parents planned for LAMA, because they are
unsatisfied with the treatment.
IV cannula present at left leg site is clean and healthyMorning care and medications given to
child.
SUMMARY:

Master Sorav, 2y/6month old child, admitted in kalawati saran children hospital, with the
complaints of decrease vision, unable to speak,Unable to hold neck, unable to sit, coughing,
decreased oral intake, muscle dystonia, child receives Syp. Phenytoin ( 30mg/ 5ml)- 3.5 ml PO
BD, INJ. Monocef 410 mg IV BD, IVF N/2 iv 8 hourly, Syp. Calcinol 5 ml OD, child condition
is getting better but vision is not improving, due to that child’s parents took LAMA from the
hospital and took the child back to bulandsher for further management.
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 Hockenberry J.M, Wilson D, Wong’s Essentials of Paediatric Nursing, 1 sted, Elsevier

publishers;2015.
 Ball W. Jane and Bindler C. Ruth, Pediatric Nursing,4thed, Pearson Education
publishers;2009.
 Marlow .A . Dorothy and Redding .A . Barbara, Textbook of Pediatric Nursing, 6 thed,
Elsevier publishers;2013.