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Introduction to Inflammation

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Title: Introduction to Inflammation


1
Introduction to Inflammation Immune Response
Chapter 23, Chapter 24 HIV Chapter 25
  • Goodwin College
  • Nursing 200

2
Introduction to Inflammation Immune Response
  • Inflammation Immunity are the 2 major defenses
    against diseases and other problems
  • Immunity is composed of many cell functions that
    protect against effects of injury/invasion
  • Purpose of inflammation/immunity is to
    neutralize, eliminate, or destroy organisms that
    invade internal environment. Immune system
    normally only uses defenses against non-self
    proteins and cells.

3
Self versus Non-Self
  • Self tolerance ability to recognize self vs.
    non-self is necessary to prevent healthy body
    cells from being destroyed along with invaders.
    Immune system cells are only body cells capable
    of determining self vs non-self. Possible due to
    different kinds of proteins present on cell
    membranes.
  • Non-self proteins cells include infected body
    cells, cancer cells, all invading cells
    organisms.

4
Inflammation Response
  • Provides immediate protection against the
    effects of tissue injury and invading foreign
    proteins.
  • Critical to health and well-being
  • Immediate, short-term protection
  • Nonspecific body defense
  • Cells Involved in Inflammation
  • Neutrophils
  • Macrophages
  • Eosinophils
  • Basophils

5
Leukocytes Their different roles
  • Neutrophil have many names as they grow from
    stem cell into mature neutrophil. 1st internal
    line of defense against invaders (especially
    bacteria) in blood ECF. Life span short. Only
    can do phagocytosis once.
  • Macrophages limited activity until mature. Move
    from blood into tissues where they may stay put.
    Name/appearance differs depending on location.
    Can do phagocytosis multiple times.
  • Basophils small in . Release chemicals that act
    on blood vessels cause inflammation

6
Inflammation OR Infection ??
  • Infection is different from inflammation in that
    it is inflammation that is associated with
    invading organisms.
  • Inflammations associated with infections include
    appendicitis, bacterial peritonitis, viral
    hepatitis, bacterial myocarditis, etc.
  • Cells involved in infection response
  • Macrophage ? Neutrophil
  • Monocyte ? T-helper cells
  • Fibroblasts ? Natural killer cells

7
Signs Symptoms of Inflammation
  • Cardinal Manifestations of Inflammation
  • Redness
  • Warmth
  • Swelling
  • Pain
  • Decreased function

8
Chapter 24 Connective Tissue Diseases
Autoimmune Disorders
  • Rheumatoid Arthritis
  • Rheumatoid Factors attack healthy tissue and
    cause inflammation
  • Most destructive to the joints
  • Inflammation in lining of joint
  • Causes cartilage damage, destroys bone and joint
    becomes less flexible
  • Systemic can affect blood vessels and organs

9
Autoimmune Disorders Rheumatoid Arthritis
  • Early detection of RA can help to avoid permanent
    joint damage
  • Causes (See Table 24-1, page 382)
  • Onset (See Chart 24-7, page 394)
  • Common Joint Deformities (Figure 24-4, page 395)
  • Lab Profile (Chart 24-8, page 396)

10
Rheumatoid Arthritis
  • Treatment
  • Drug Therapy (Chart 24-9, pg. 403/404)
  • Nonpharmacologic (Adequate rest, proper
    positioning and ice/heat applications)
  • Stress Management, Hypnosis, Music Therapy,
    Magnet Therapy
  • Good Nutrition (Omega-3 fatty acids, Antioxidant
    Vitamins A,C,E, Trace Elements Zinc,
    Selenium, Copper, Iron)

11
Rheumatoid Arthritis
  • Nursing Diagnoses pages 398-402
  • Impaired Physical Mobility (Pain, Discomfort,
    Musculoskeletal Impairment)
  • Chronic Pain (Physical and Psychological
    Disability)
  • Fatigue (Stress, Anxiety, Depression and
    Rheumatoid Arthritis)

12
Chapter 24 Lupus Erythematosus
  • 2 main classifications of Lupus
  • SLE systemic lupus erythematosus
  • DLE discoid lupus erythematosus
  • DLE affects small - only effects skin
  • SLE is chronic, progressive, inflammatory
    connective tissue disorder
  • Can cause major body organs and systems to fail
  • Characterized by spontaneous remissions
    exacerbations
  • Thought to be autoimmune process abnormal
    antibodies are produced and react with own tissues

13
Lupus Erythematosus
  • SLE clinical manifestations are extremely
    variable for both remissions exacerbations
  • Skin involvement for SLE or DLE
  • SLE dry scaly butterfly rash on face (increase
    w/ flare)
  • DLE individual round scarring lesions evident
    in UV light
  • Drug therapy for skin is same topical cortisone.
    Skin teaching protection (chart 24-12 page 412)
  • SLE treatment in exacerbations is aggressive, in
    remission avoid stressors/limit fatigue. May be
    on steroids or immunosuppressive meds

14
Chapter 25 Primary (Congenital) Immunodeficiency
  • Immune malfunction is present from birth either
    as defect in defect in development or function of
    one or more of immune components
  • Some are inherited as x-linked trait and some are
    recessive
  • Most congenital immunodeficiencies are rare see
    table 25-5 page 450

15
Secondary or Acquired Immunodeficiency
  • Failure of immune system is after birth
  • Person becomes immunodeficient as result of
    either a disease process, injury, exposure to
    toxins, medical therapy or sometimes unknown
    causes
  • Immune system is no longer able to distinguish
    what is normally in body from a foreign invader

16
Acquired Immunodeficiency Syndrome
  • ? Results from infection with human
    immunodeficiency virus (HIV)
  • ? Debilitating, eventually fatal
  • ? HIV is a retrovirus, with a special complex
    of enzymes called Reverse Transcriptase
  • ? These enzymes increases efficiency of viral
    replication once retrovirus enters a human cell
  • ? HIV virus can be transmitted at all stages
    and categories of HIV Positive status

17
T lymphocyte infected with HIV
18
HIV Infectious Process
  • CDC classifies HIV Infection (refer to CDC
    website table 25-1 page 426)
  • CDC classifications based on both clinical
    conditions and three ranges of CD4 T-lymphocyte
    counts
  • Categories A and B are HIV and Category C is
    related to AIDS- late stage of a continuum of
    symptoms resulting from HIV viral infection

19
HIV Transmission
  • Most important aspect for prevention of HIV is
    education. Many myths prevail to this day.
  • HIV is transmitted most often in following 3
    ways
  • Sexual genital, anal, or oral contact
  • Parental sharing of needles or contaminated
    equipment/blood products, accidental needle
    sticks
  • Perinatal from placenta, contact with maternal
    blood/body fluids during birth, or breast milk

20
HIV Progression
  • Initial HIV Infection to development of AIDS
    ranges from months to years
  • Dependent on how HIV was acquired, a variety of
    personal factors and therapeutic intervention
  • Clinical symptoms occur in multiple body systems
    and vary in severity

21
Pathologic/Opportunistic Infection
  • Pathologic Infection caused by virulent
    microorganisms can occur even among people
    whose immune systems are functioning at optimal
    levels
  • Opportunistic Infection microorganisms present
    in our normal environment and kept in check by
    our normal immune function

22
Opportunistic Infection
  • Can result from a primary infection or
    reactivation of a latent infection
  • Account for many of the symptoms in AIDS
    Patients/can be caused by more than one type of
    infection
  • Can include Protozoan, Fungal, Bacterial or Viral

23
Protozoal Infections
  • Pneumocystis carinii pneumonia (PCP) - S/S
    dyspnea on exertion, tachypnea, persistent dry
    cough, fever
  • Toxoplasmosis encephalitis (contaminated cat
    feces or undercooked meat) - S/S mental status
    changes, neurologic deficits, H/A fever. Other
    symptoms include difficulties with speech, gait,
    vision.
  • Cryptosporidiosis (gastroenteritis) - S/S
    illness ranges from mild diarrhea to cholera-like
    syndrome with wasting electrolyte imbalance.

24
Fungal Infections
  • Candida stomatitis or esophagitis S/S food
    tasting funny, mouth pain, difficulty in
    swallowing, retro-sternal pain
  • Vaginal candidiasis S/S severe pruritus,
    perineal irritation, thick/white vaginal
    discharge
  • Cryptococcosis (severe meningitis) - S/S fever,
    headache, blurred vision, nausea/vomiting, nuchal
    rigidity, mild confusion

25
Bacterial Infections
  • Mycobacterium avium-intracellulare complex
    (affects repiratory/GI tract) - S/S fever,
    debility, weight loss, malaise
  • Mycobacterium Tuberculosis - S/S fever, chills,
    night sweats, weight loss, anorexia, cough,
    dyspnea and chest pain
  • Recurrent pneumonia from bacterial infections
    occurs frequently

26
Viral Infections
  • Cytomegalovirus (CMV) infect many sites. Cause
    many nonspecific problems such as fever, malaise,
    etc. Also causes colitis, encephalitis, etc.
  • Herpers Simplex Virus (HSV) infections in
    HIV/AIDS occur in perirectal, oral genital
    areas. More widespread longer duration.
  • Varicella-zoster virus (VZV) aka shingles
    usually not new infection. Very painful large
    fluid filled blisters form and crust over.

27
AIDS related Malignancies
  • Kaposi's sarcoma (KS)
  • Hodgkin's lymphoma
  • Non-Hodgkin's lymphoma
  • Invasive cervical cancer
  • Seminoma
  • Plasmocytoma
  • Squamous carcinoma conjunctivitis

28
Techniques to reduce risk for infection
  • Client with HIV/AIDS is susceptible to
    opportunistic infection
  • Interventions should include caregiver technique
    focus and client education focus
  • Refer to chart 25-5 6, page 438, and chart
    25-9, page 443.

29
Nursing Care Impaired Gas Exchange
  • Nursing Diagnosis Impaired Gas Exchange related
    to anemia, respiratory infection or malignancy as
    evidenced by pain, fatigue or dyspnea
  • Expected Outcome client will maintain adequate
    oxygenation/perfusion and will experience minimal
    dyspnea/discomfort
  • Interventions Drug Therapy (IV/PO)
  • PCP treated with antibiotics (Bactrim,
    Apo-Sulfatrim, Cotrim, Septa)

30
Impaired Gas Exchange
  • Antibiotics can cause adverse reactions (nausea,
    vomiting, hyponatremia, rashes, fever,
    leukopenia, thrombocytopenia and hepatitis)
  • When taking Bactrim, patient is encouraged to
    drink lots of water drug can crystallize and
    increase patients risk for kidney failure
  • Pentamidine is used either IV, IM or aerosolized
  • Steroid treatment to reduce inflammation

31
Impaired Gas Exchange
  • Respiratory Support and Maintenance assess
    respiratory function, vital signs and check for
    cyanosis q 8 hours.
  • Oxygen therapy and room humidification as
    ordered. Monitor mechanical ventilation, performs
    suctioning and provides chest physical therapy,
    as needed. Evaluate blood gas results.
  • Comfort assess client comfort elevate head of
    bed for client comfort, pace activities to
    minimize shortness of breath and exhaustion
  • Rest and Activity Fatigue common, so nurse paces
    activities to conserve patients energy

32
Highly Active Antiretroviral Therapy (HAART)
  • Multiple drug regimen that is utilized in HIV
    clients to inhibit viral replication
  • This therapy does not kill virus
  • Many drawbacks to this therapy cost, numerous
    side effects and volume of daily medications
  • Without this therapy, client progress in HIV
    disease and opportunistic infections

33
Highly Active Antiretroviral Therapy (HAART)
  • HAART Therapy helps preserve CD4 Cells - increase
    in preservation of these cells in an HIV patient
    is indicator that medication(s) is effective in
    suppressing viral replication
  • Nursing Helping clients to increase adherence
    with drug regimen can reduce hospitalizations and
    contribute to health maintenance

34
Highly Active Antiretroviral Therapy (HAART)
  • Drug Categories of HAART see chart 25-8 page
    441-442
  • Nucleoside Analog Reverse Transcriptase
    Inhibitors
  • Non-nucleoside Analog Reverse Transcriptase
    Inhibitors
  • Protease Inhibitors
  • Fusion Inhibitors
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