Title: Introduction to Inflammation
1Introduction to Inflammation Immune Response
Chapter 23, Chapter 24 HIV Chapter 25
- Goodwin College
- Nursing 200
2Introduction 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.
3Self 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.
4Inflammation 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
5Leukocytes 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
6Inflammation 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
7Signs Symptoms of Inflammation
- Cardinal Manifestations of Inflammation
- Redness
- Warmth
- Swelling
- Pain
- Decreased function
8Chapter 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
9Autoimmune 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)
10Rheumatoid 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)
11Rheumatoid 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)
12Chapter 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
13Lupus 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
14Chapter 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
15Secondary 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
16Acquired 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
17T lymphocyte infected with HIV
18HIV 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
19HIV 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
20HIV 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
21Pathologic/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
22Opportunistic 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
23Protozoal 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.
24Fungal 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
25Bacterial 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
26Viral 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.
27AIDS related Malignancies
- Kaposi's sarcoma (KS)
- Hodgkin's lymphoma
- Non-Hodgkin's lymphoma
- Invasive cervical cancer
- Seminoma
- Plasmocytoma
- Squamous carcinoma conjunctivitis
28Techniques 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.
29Nursing 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)
30Impaired 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
31Impaired 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
32Highly 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
33Highly 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
34Highly 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