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The Acute Illness

By Dr. Ava Easton, The Encephalitis Society

On admission and also regularly throughout the patient’s stay, 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. 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 (percutaneous endoscopic gastrostomy) tube into their stomach ensuring that sufficient levels of nutrition and fluid are received. They will probably also have an intravenous (IV) 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. 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 should know that this is not within their relative’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 unfortunately a myth often 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 can be distressing 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 from falling, 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 have any concerns about the care of your loved one please contact the Patient Advice and Liaison Service (PALS) at the hospital.

FS050V2 Understanding the acute illness

Date Created: March 2007/ Last Updated: March 2016/ Review date: March 2019

Disclaimer: If you would like more information on the source material the author used to write this document please contact The Encephalitis Society. None of the authors of the above document has declared any conflict of interest which may arise from being named as an author of this document.Please refer to the Medical Terms Glossary if necessary. 

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Further information

Read and download the Intensive Care- A Guide for Patients and Relatives produced by the ICUsteps, a charity aiming to improve the care and support available to patients recovering from critical illness during their long recovery.

The Encephalitis Society is the operating name of the Encephalitis Support Group which is a registered Charity and Company Limited by Guarantee.

Registered in England and Wales No. 4189027. Registered Office as above. Registered Charity No. 1087843.