Introduction to Inflammation

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Introduction to Inflammation Immune Response
Chapter 23, Chapter 24 HIV Chapter 25

• Goodwin College
• Nursing 200

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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.

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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.

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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

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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

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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

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Signs Symptoms of Inflammation

• Cardinal Manifestations of Inflammation
• Redness
• Warmth
• Swelling
• Pain
• Decreased function

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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

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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)

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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)

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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)

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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

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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

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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

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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

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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

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T lymphocyte infected with HIV
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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

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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

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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

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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

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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

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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.

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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

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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

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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.

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AIDS related Malignancies

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

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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.

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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)

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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

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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

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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

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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

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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