Present the Causes, Epidemiology, Clinical Symptoms, Treatment and Prevention of Japanese Encephalitis.

Lesson 20

JAPANESE ENTERUBITIS PATIENT CARE

TARGET

Maybe you are interested!

• Describe the clinical symptoms of acute appendicitis.
• Presenting Clinical Symptoms of Clavicle Fracture
• Managing medical ethics education for nursing students in medical colleges - 32
• Vietnam's international integration policy from 1995 to present - 16
• Study on Some Clinical and Paraclinical Features of Appendiceal Abscess

1. Describe the causes, epidemiology, clinical symptoms, treatment and prevention of Japanese encephalitis.

2. Develop a care plan for patients with Japanese encephalitis.

CONTENT

1. General

1.1. Definition

Japanese encephalitis is an acute, epidemic neurological infection caused by the Japanese encephalitis virus. The disease spreads from animals to humans through parasitic insects. Clinically, there are many neurological manifestations. The mortality rate is high, and after recovery, the disease often leaves sequelae.

1.2. Pathogens

Japanese encephalitis virus is a type of Arbovirus, belonging to group B, small in size, 15-50mm in diameter. It has poor resistance and is easily destroyed by common disinfectants.

1.3. Epidemiology

- Source of disease: Japanese encephalitis is a disease with natural outbreaks everywhere. Petrixepva-1969 is divided into: Grassland outbreaks (steppes), coastal outbreaks, sub-mountainous outbreaks and mountainous outbreaks. The virus circulates in natural outbreaks in mammals and birds. In Vietnam, the virus has been isolated from willow birds and from sick animals such as pigs.

- Transmission: The disease is transmitted through blood through infected insects, mainly Culex Triaeniarhynclus mosquitoes.

Bird

Mosquito

Mosquito

Pig

Mosquito

JAPANESE ENTREPRENEURIS CYCLE IN NATURE

People

Bird

Mosquito

Mosquito

Pig

Figure 20.1: Japanese encephalitis disease cycle in nature

Mosquitoes are active in and around the house, sucking blood at night from 6-10pm, gradually decreasing at 10pm and stopping at 8am. The disease is common in the summer, from May to August, with a peak in June.

- Sensitive body: Vietnamese children often get sick between the ages of 2-7.

Rural areas are more susceptible to the disease than urban areas, especially in areas with fruit trees such as lychees that attract seasonal migratory birds. Once infected, the disease leaves lasting immunity.

2. Pathogenesis

The virus is transmitted by mosquitoes into the blood, it develops in the blood and travels throughout the body. Due to its neurotropism, the virus penetrates the nerve cells, reproduces and develops rapidly there. After reaching a high density in the nerve cells, the second virus in the blood begins to cause a febrile reaction. Clinically it corresponds to the beginning of the acute phase of the disease.

The most obvious pathological changes are in the nervous system. Under the microscope, these changes can be seen as: meningeal edema, dilated and congested cerebral arteries and veins, and small spot hemorrhages in the brain tissue and pia mater. In the brain tissue, especially in the thalamus, striatum, and even the horn of Amon, there are foci of brain softening and hemorrhage.

3. Symptoms

3.1. Clinical

3.1.1. Incubation period: Average one week, minimum 5 days maximum 15 days.

3.1.2. Onset period: Lasts from 1-4 days.

The onset is very sudden with symptoms of high fever 390-40C , possibly chills, headache, body aches, vomiting or other symptoms like severe flu (sneezing, runny nose, cough...) or digestive disorders (abdominal pain, vomiting, diarrhea...). Mental disorders begin to appear but are vague such as: insomnia, crying, or drowsiness, sleeping all the time. Careful examination can find mild meningitis syndrome.

3.1.3. Full-blown period: The disease is often sudden with the following syndromes:

- Infection syndrome, poisoning, high fever 39 0 -40 0 C, dry lips, dirty tongue. Meningitis syndrome: Headache, vomiting, stiff neck (+), Kernig (+), meningeal streak (+).

- Acute brain syndrome manifestation.

+ Epileptic seizures, recurring many times a day, starting with half of the body, then spreading to the whole body.

+ Pyramidal tract injury: Cranial nerve paralysis, hemiplegia.

+ Extrapyramidal signs: Tremor, twisting, muscle stiffness, chorea.

+ Severe autonomic nervous system disorder: Skin is sometimes red, sometimes pale, sweating, increased phlegm secretion, high fever, rapid pulse, rapid breathing.

- Disorder of consciousness: Drowsiness, sleepiness, increasingly deep coma.

- If severe, the patient is in a decerebrate or decerebrate position.

The above syndromes often occur irregularly, changing daily in a patient. They represent a state of widespread inflammation in a patient.

3.1.4. Progression: About 30% of patients have severe progression such as severe autonomic nervous system disorder, decerebrate coma or decerebrate (often death during the full-blown period). If the patient survives the first week, the temperature will decrease and disappear completely on the 10th-12th day.

The patient emerges from anesthesia, but remains confused and dazed for several weeks afterward. About 30% of patients show sequelae: spastic paralysis, aphasia, intellectual disability... Late sequelae can occur for many years (epilepsy, mental disorders...)

3.2. Testing

- Increased white blood cell count, increased neutrophils.

- Lumbar puncture: Clear fluid, increased pressure. Tests show normal or slightly increased protein and sugar, increased cells (from a few dozen to a few hundred, even a few thousand), initially neutrophils, then lymphocytes.

- Virus isolation, serological diagnosis.

4. Treatment and prevention

4.1. Treatment: There is currently no specific treatment. Treatment is mainly emergency resuscitation and symptomatic treatment.

- Anti-cerebral edema: Infuse Mannitol, Glucose, and possibly Corticoid.

- Anticonvulsant: Diazepam, Phenobarbital can be given for sedation.

- Cool down: Cool compress, Paracetamol

- Anti-respiratory failure: Suction of sputum, oxygen therapy, tracheostomy

- Support for water and electrolyte recovery: Intravenous isotonic fluid infusion, cardiac support

circuit.

Prevent secondary infection: Use antibiotics

4.2. Disease prevention

- Monitoring space hosts: Killing mosquitoes, preventing mosquito bites. Raising pigs away from home.

- Vaccination: 3 doses of vaccine: The first two doses are one week apart, the third dose is repeated after 1 year.

5. Care

5.1. Care assessment

The nurse conducts a nursing assessment by asking, observing, and examining for the following signs:

* Ask:

- How long has the patient been sick?

- Epidemiologically related to people around.

- Has the patient had a seizure? If so, when did it occur?

* Examination:

- Observe the intensity, nature and duration of the jerk.

- Observe the patient to see if he or she is awake? Consciousness disturbed? Drowsy, lethargic or comatose?

- Detect autonomic nervous system signs: Increased phlegm secretion, measure temperature to see if the patient has a fever? Is there sweating?

- Observe whether the patient can control urination or not. If the patient cannot control urination, catheterize the patient.

- Assess the level of coma according to the Glasgow score.

- Symptoms of meningitis: Stiff neck? Kernig?

- Pyramidal and extrapyramidal symptoms: Paralysis or damage to limbs? Muscle twisting and stiffness.

- Symptoms of cranial nerve damage, strabismus...

- Respiration: Count the breathing rate, is the patient in respiratory failure?

- Cardiovascular: Count heart rate and measure blood pressure.

* Perform full range of tests

* Prepare the lumbar puncture instrument

5.2. Diagnosis and care

- Patients with respiratory failure due to phlegm obstruction.

- Risk of cardiovascular collapse due to myocardial hypoxia and phlegm obstruction.

- Neurological disorders due to diffuse inflammation of the central nervous system.

- Increased body temperature due to disturbances in the body's thermoregulatory center.

- Inadequate nutrition due to patient's inability to swallow.

- Risk of secondary infection due to prolonged lying down.

- Patients and their families lack understanding of the disease.

5.3. Care planning

- Ensure ventilation and prevent respiratory failure.

- Anti-circulatory failure

- Reduce neurological disorders.

- Reduce the patient's body temperature.

- Enhance nutrition for patients.

- Anti-infection and secondary infection.

- Health education.

5.4. Implement the care plan

- Ensure air and prevent respiratory failure: Place the patient on one side, head elevated 30 degrees , to prevent inhalation of vomit and bleeding. Place a Mayo catheter to prevent tongue retraction, count breathing when the patient has difficulty breathing, is cyanotic, has convulsions, and provides intermittent oxygen. Suction phlegm when the patient secretes a lot.

- If endotracheal intubation is required, the nurse must prepare complete equipment.

- Prevent circulatory failure: Take the patient's blood pressure every 3 hours. Be ready for emergency cardiac arrest (Prepare Ambu bag, Adrenaline, long syringe). If the patient suddenly stops breathing: Perform external cardiac compression. Prepare isotonic solution to infuse water and electrolytes to the patient.

- Reduced neurological disorders: Assess the level of coma according to the Gasgow score.

+ Prevent cerebral edema by following the instructions to infuse Mannitol and Glucose, paying attention to the infusion time and rate.

- Monitor meningeal signs: stiff neck, meningeal lines, Kernig.

- Detect paralyzed limbs, monitor the paralysis process, massage the muscles, especially the muscles in paralyzed limbs to increase blood circulation and avoid muscle atrophy.

+ To reduce muscle stiffness and contraction, keep the patient in the correct position, place pillows and pads to keep the legs straight, feet perpendicular to the lower legs.

+ Monitor sequelae of hemorrhage: Loss of language, personality disorder, neurological and motor sequelae...

- Reduce the patient's body temperature: Place the patient in a cool place, loosen clothing.

+ Take patient's temperature every 3 hours

+ Cool compress on spleen, groin, forehead.

+ Use Paracetamol to reduce fever.

+ Body temperature often increases after consecutive seizures, so Diazepam should be used to prevent seizures and also to reduce the patient's body temperature.

- Enhance nutrition for patients.

+ Because the patient is in a coma and cannot swallow, to ensure 3,000 calories/day of nutrition for the patient, a gastric tube is placed to pump food, water, and medicine through the tube.

+ Foods: Pureed soup, filtered porridge, nutritional milk powder. Ensure milk. Isocal and fruit juice. At the same time, intravenous nutrition.

- Anti-infection and secondary infection.

- The patient's room must be airy and clean.

- Ensure professional procedures such as: Injection, vein exposure, hand washing, wearing gloves when aspirating sputum, changing suction catheters and soaking bottles.

- After a seizure, the patient often sweats. It is necessary to wipe sweat and change the patient's clothes frequently.

- Patients who are in a coma or lie down for a long time are prone to pressure ulcers. The patient's position needs to be changed every 2 hours. Place pressure areas: stump, shoulder, heel, head, and put on a water mattress.

+ Signs of ulcer risk: Red skin that does not go away after 15 minutes. If there is an abrasion, treat it immediately to avoid infection.

+ To avoid pneumonia: Regularly percuss and vibrate the patient's chest.

+ Wash and apply eye drops to patients.

+ Oral, ear, nose and throat hygiene.

+ Cut and wash hair for patients.

+ The patient is in a coma and cannot control urination and defecation. Place a bladder catheter to drain urine, the catheter is connected to a sterile bottle.

+ Urine bottles must be changed and washed immediately.

+ Clean the patient after each bowel movement.

- Health education:

+ As soon as a patient is admitted to the hospital, it is necessary to explain to the patient's family the importance of the patient and to fully comply with the department's regulations to coordinate treatment and care for the patient.

+ The recovery period is long, so patients should be instructed in exercise and physical therapy to avoid stiffness and leg cramps.

+ Practice moving the hip and shoulder joints, massage the limbs to improve circulation.

+ Help children recover memory by recognizing objects.

+ Increase nutrition, eat enough nutrients and energy.

+ When discharged from hospital: Instruct family members to help patients gradually adapt to the community.

5.5. Evaluation: Re-evaluate the patient care process with the proposed plan. Evaluated as good care: After one week, the fever gradually decreased and disappeared on the 10th-12th day. The patient recovered but remained confused in the following weeks.

VALUATION

1. Could you please explain the definition, cause and pathogenesis of Japanese encephalitis?

2. Could you describe the clinical symptoms and complications of Japanese encephalitis?

3. How do you present your assessment, plan, and implement a care plan for Japanese encephalitis patients?

* Choose the best answer for the following questions:

4. Treatment of Japanese encephalitis is still difficult due to:

A. There is no specific medicine yet.

B. Due to the patient arriving late

C. Due to poor disease propaganda

D. Due to lack of emergency equipment.

5. The most effective treatment for Japanese encephalitis is:

A. Anti-brain edema, ensure nutrition

B. Anticonvulsant, cardiovascular support

C. Cool down, rehydrate and detoxify.

D. All three of the above.

6. The most nutritious food to be pumped through a tube for patients in a coma due to Japanese encephalitis.

A. Thin rice water

B. Mixed soup

C. Ensure Milk

D. Nutritional powder

7. To plan care for a patient with Japanese encephalitis, it is necessary to ask carefully:

A. Disease progression

B. Surrounding epidemiology

C. Thorough examination, assessment according to Glasgow score

D. Is nutrition adequate?

8. To avoid ulcers, it is best to give Japanese encephalitis patients who have been lying down for a long time:

A. Lying on a waterbed

B. Constant worry

C. Support the pressure area

D. Rub talcum powder into the pressure area

9. The best way to prevent Japanese encephalitis is:

A. Kill mosquitoes, prevent mosquito bites

B. Raising pigs away from home

C. Vaccination

D. Clear the bushes around the house

Lesson 21

HIV/AIDS PATIENT CARE

TARGET

1. Describe the HIV/AIDS infection situation in the world and Vietnam.

2. Describe the definition, transmission methods, stages and main clinical manifestations of HIV/AIDS infection.

3. Make a care plan for HIV/AIDS patients.

4.Propagate and educate the industry and community about HIV/AIDS prevention.

CONTENT

1. General

1.1. HIV/AIDS infection situation in the world and Vietnam

1.1.1. In the world

* Detection process:

- In June 1981, in the US, 5 young homosexuals were found to have severe pneumonia caused by Pneumocystis Carini in Los Angeles. Before that, in March 1981, many cases of Kaposi's sarcoma deaths were reported in New York. What is special here is that these patients all had severe immune system impairment, before getting sick they were all healthy people with normally developed immune systems. At this time, the cause was unknown, but based on geographical factors, it was believed to be an infectious disease.

- In 1982, many places announced similar diseases seen in hemophiliacs, patients with multiple blood transfusions, drug addicts, mothers giving birth to children, etc., from which it was suspected to be caused by a virus (similar to hepatitis virus in transmission).

- May 1983 began to detect viruses.

- In 1986, the international nomenclature conference agreed to call this virus HIV (Human Immunodeficiency Virus): Causes Acquied Immunodeficiency Syndrome (ADIS: Acquied Immunodeficiency Syndrom).

* Development process:

The epidemic began in developed industrial countries: North America, Australia and Western Europe, Asia the epidemic came late but developed very quickly. The epidemic trend will occur in developed countries. According to WHO estimates, when a person is diagnosed with HIV, there are actually about 10 to 100 people infected with this virus.

1.1.2. In Vietnam

- The first HIV-infected person was discovered in December 1990 in Ho Chi Minh City.

- In our country, the main transmission methods are drug injection (accounting for 65% to 70%) and sex (accounting for 18.2%, mainly through prostitution). As sexual transmission increases, the rate of HIV infection in women and children increases.

1.2. Definition of AIDS

AIDS is caused by the human immunodeficiency virus (HIV), which causes the body to lose its resistance to disease-causing microorganisms and normal microorganisms that do not cause disease.

This disease becomes infectious, creating opportunistic infections as well as making it easier for cancer to develop and for damage caused by HIV itself.

1.3. Pathogens

HIV is the cause of AIDS, HIV belongs to the Retroviridae family of the Lentivirus group, causing slow infection, with an incubation period of 5 to 10 years.

- Resistance: In solution the virus is destroyed at 56 0 C/20'.

+ The active form is inactivated at 68 0 C after 2 hours.

+ Kill the virus by: Boiling for 20' to 30', steaming, drying or: Chemicals: 0.1% javen water

Chloramine 2%,….ethanol….

- HIV has a primary affinity for immune cells, causing the body's immune system to collapse, creating conditions for opportunistic infections and cancers leading to death.

1.4. Epidemiology

- Source of infection: HIV-infected people and AIDS patients.

- Transmission routes: Epidemiological studies show that: Blood, semen, and vaginal secretions play an important role in the transmission of HIV. From there, 3 transmission methods are formed:

+ By sexual route

+ By blood.

Transfusion of HIV-infected blood and blood products: Risk of infection over 90%. When the HIV blood test is negative, the possibility of infection can still occur (window period of the first 6 to 12 weeks).

When the syringe is infected with HIV: High incidence in people who inject drugs intravenously. HIV-infected tools: tooth extraction, surgery, etc.

+ From mother to child: Infection occurs during pregnancy, during labor and shortly after birth (through breastfeeding).

+ Receptive block: Everyone, of all ages can be infected with HIV.

2. Clinical: 3 stages

2.1. Acute HIV infection stage

About 70% of cases after HIV infection have symptoms from 2 to 8 weeks:

+ Fever, sweating, abdominal pain, increasing fatigue, muscle and joint pain, headache.

+ Swollen lymph nodes in the neck, armpits, and enlarged spleen.

+ Digestive disorders.

+ Measles-like rash, itchy rash on the skin.

* About biology:

+ Lymphocyte increase

+ Detect P24 antigen in blood.

* After the primary infection with or without symptoms about 6 to 12 weeks, specific antibodies appear, which means the HIV diagnostic serum is positive.

2.2. Asymptomatic infection stage: Lasts from 2 to 8 years or longer, HIV test positive

2.3. Clinical manifestation stage

2.3.1. Clinical stage 1: Persistent lymphadenopathy throughout the body, lasting more than 3 months: swollen lymph nodes larger than 1cm in diameter. Appear in at least two areas outside the groin. Fever, weight loss, sweating, diarrhea (about 50% of cases).

2.3.2. Clinical stage 2: Early stage (mild).

- Weight loss less than 10% of body weight