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Inflammation

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Inflammation & the Immune Response Keith Rischer, RN, MA, CEN, CCRN – PowerPoint PPT presentation

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Title: Inflammation


1
Inflammation the Immune Response
  • Keith Rischer, RN, MA, CEN, CCRN

2
Objectives for this content
  • Inflammatory response
  • 1-3
  • Infection/sepsis/chain of infection
  • 4-10
  • Physiologic immune response
  • 11-16

3
Three Lines of Defense
  • Anatomical Barriers
  • Acute Inflammatory Response
  • Immune System

4
Anatomical Barriers First Line of Defense
  • Skin
  • Mucous membranes
  • Normal bacterial flora
  • Clostridium difficile
  • Yeast infections

5
Normal Body Defenses
  • Skin
  • multilayer barrier, shed outer layer, contains
    fatty acids that kills some bacteria
  • Lungs
  • contain cilia in upper respiratory tract,
    macrophages
  • Urinary Tract
  • flush action of urine washes away bacteria
  • Perry and Potter pg. 647 Ch 34 Table 34-3

6
Inflammatory Response
7
Inflammatory Response
  • Occurs in response to injury
  • Localized
  • Immediate
  • Beneficial
  • Appropriate level of
  • response
  • Non Specific

8
Causes of Inflammation
  • Physical
  • Trauma
  • Lacerations
  • Burns
  • Chemical- Bites
  • Allergic response
  • Micro-organisms
  • Bacteria

9
Inflammatory Response
  • REDNESS
  • SWELLING
  • PAIN
  • HEAT
  • LOSS OF FUNCTION

10
Purpose of inflammation
  • Neutralizes and Dilutes Toxins
  • Removes necrotic materials
  • Provides an environment for healing
  • Add itis to affected body part

11
4 Phases of Inflammation
  • Vascular
  • Think blood vessels
  • Cellular
  • Think WBCs
  • Formation of Exudate
  • Fluid neutrophils
  • Healing
  • regeneration or repair of tissue

12

Vascular Phase Blood Vessels
  • Injury occurs
  • Mediators intervene
  • Vasodilation occurs
  • Capillaries become more permeable
  • Swelling and movement of fluid occurs

13
Cellular Phase Think WBCs
  • Injury occurs
  • Chemotaxis begins
  • White blood cells rush in to help
  • Neutrophils
  • Monocytes
  • Macrophages

14
Chemical Mediators
  • Coordinators of the inflammatory response
  • Histamine
  • Prostagladins
  • Cytokines

15
Laboratory tests
  • Erythrocyte sedimentation rate
  • (ESR or sed rate)
  • lt20 mm/hr
  • CRP C reactive protein
  • non specific test identifying the presence of
    inflammation
  • lt1.0 mg/dl

16
Nursing Diagnosis
  • Acute pain related to tissue trauma
  • Impaired physical mobility related to discomfort

17
Nursing Interventions
  • Care will vary with causative agent and physical
    condition of the patient
  • What are some nursing actions you might implement
    or anticipate
  • How will you as the nurse evaluate the outcome

18
Expected Outcomes
  • Healing of the wound or injury
  • Prevent minor infections from becoming
    overwhelming to the body
  • UTI vs. urosepsis
  • Goals and outcomes will vary with each patient
  • Remember that your outcomes will drive your
    interventions/cares

19
Systemic Manifestations of Acute Inflammation
  • Fever/chills
  • Cytokines
  • Benefits
  • Increased killing of microorganisms
  • Increased phagocytosis by neutrophils
  • Increased activity of interferon
  • Leukocytosis
  • Neutrophils
  • left shiftband cells

20
Medications NSAIDS
  • Ibuprofen, Toradol
  • Mechanism of action
  • Inhibits prostaglandin synthesis
  • Nursing implications
  • Give w/food
  • Elderly-high risk GI bleed
  • Prolongs bleeding times 1 day
  • Assess renal function-creatinine w/chronic use

21
Medications NSAIDS
  • Salicylates Aspirin
  • Mechanism of action
  • Inhibits production of prostaglandins
  • Decreases platelet aggregation
  • Nursing implications
  • Give w/food
  • Prolongs bleeding times 4-7 days

22
Medications Anti-histamines
  • Benadryl, Ranitidine (Zantec), Famotidine
    (Pepcid)
  • Mechanism of action
  • Block histamine at the receptor site
  • Decreases gastric acid secretion
  • Nursing implications
  • With meals
  • Drowsiness/dizziness

23
Medications Corticosteroids
  • Prednisone
  • Mechanism of action
  • Decrease inflammation by stabilizing neutrophils
    and lysosomes
  • Inhibit prostaglandin synthesis
  • Inhibits chemotactic cytokines
  • Decreases mast cell stimulation
  • Nursing implications
  • Meals
  • Chronic use complications
  • Risk of infection
  • Hyperglycemia
  • SE

24
Normal Course of an Infection
  • Incubation period
  • Prodromal stage
  • Full stage of illness
  • Convalescence

25
Infectious agents/pathogens
  • Bacteria
  • Virus
  • Fungi
  • Protozoa

26
Bacteria
  • Single cell
  • Human cells vs. bacteria count in body
  • Gram /-

27
Virus
  • Most common affliction of humans
  • Has no metabolism of its own
  • Is incapable of replicating outside a living cell
  • Takes over the metabolic machinery of host cells
    to survive and replicate

28
What influences Pathogen survival?
  • Food/Glucose
  • Water
  • Oxygen aerobic/anaerobic
  • Temperature
  • pH
  • light

29
Reservoir
  • A place where a pathogen can survive but may or
    may not multiply
  • What is the most common reservoir?
  • What is a carrier?

30
Portal of exit
  • For the pathogen to cause an infection it must
    exit the reservoir
  • How can this happen?

31
Mode of Transmission
  • Direct or indirect
  • What is the major mode of transmission in the
    health care setting?
  • List the 4 categories of transmission

32
Portal of entry
33
Susceptible Host
  • What factors increase our susceptibility to
    infection?
  • Age
  • Stress
  • Nutritional status
  • Current medical therapies
  • Chemo
  • Steroids
  • Presence of disease

34
Leukocytes
  • Normal Blood Count of all WBC 4,000-11,000/ul
  • Neutrophils
  • Monocytes
  • Lymphocytes B cells mediate the humoral immune
    response
  • T cells Mediate cellular immunity
  • Elderly considerations

35
Laboratory Studies
  • CBC
  • Hgb (12-16 g/dl)
  • Hct (33-51)
  • Platelets (140-440 thou/cu mm)
  • WBC (4.5-11.0 thou/cu mm)
  • Differential
  • Never-neutrophils (42-72)
  • Let-lymphocytes (20-44)
  • Monkeys-monocytes (lt11.1)
  • Eat-eosinophils (lt7.1)
  • Bananas-basophils (lt3.0)

36
Cultures, gram stains and sensitivities
  • Wound and skin cultures, body fluids, blood
    cultures
  • Gram stains
  • Sensitivities

37
Anti-infective Drugs
  • Determine if hypersensitive to medication
  • Check for interactions with other drugs
  • Educational needs of client
  • Determining effectiveness

38
Antibiotic Therapy
  • Anti-fungal
  • Fluconazole, Nystatin
  • Cephalosporins
  • Cephalexin (Keflex)
  • Penicillins
  • Amoxicillin, Ampicillin
  • Sulfonamides
  • Bactrim
  • Tetracyclines
  • Doxycycline

39
Antibiotic Resistance
  • Bacteria adapt in ways which make an antibiotic
    less effective or ineffective
  • MRSA Methicillin resistant staphylococcus
    aureus
  • VRE Vancomycin resistant enteroccus

40
Vancomycin
  • Anti-infective class other
  • Effective against gram pathogens
  • Used in potentially life-threatening infections
    when other drugs are not effective
  • Action binds to bacterial cell wall and cell
    death results
  • Poorly absorbed in GI tract, may be given IV

41
NCLEX Concepts of Emphasis
  1. Define inflammation
  2. Is inflammation always present with infection?
  3. What are some patient examples that would limit
    or impair their inflammatory response?
  4. What are the five physical manifestations of the
    inflammatory response?
  5. Name each distinct phase of the inflammatory
    response and unique characteristics of each?
  6. What are other causes of inflammation besides
    micro-organisms?
  7. What are some common diseases of chronic
    inflammation?
  8. What are the medications that treat the
    inflammatory response?

42
Sepsis
  • Patho
  • Infection (susceptible host)
  • Inflammation-systemic
  • SIRS
  • Capillary permeability
  • Vasodilation
  • Progressive
  • Sepsis/SIRS
  • Septic shock
  • Multiple Organ Dysfunction Syndrome (MODS)

43
Article Case Study
  • 70 yr female from NH
  • CC
  • weakness, diarrhea x3 weeks
  • Assessment
  • PMH IDDM, HTN, CVA, COPD, UTIs
  • VS T-97101.8 P-109 R20-24 BP-93/41 91-98
  • a/o x3
  • Labs
  • WBC-26.5
  • Gluc 258

44
Article Case Study-Day 2
  • T-96.6 P-125 R-24 BP 80/43
  • Oriented to self only
  • u/o 180cc over 8 hours
  • Became more lethargic later in day
  • T-96.5 P-100 R-24 BP 70/30
  • Labs
  • WBC 41.9
  • Lactate 2.2

45
Article Case Study-Day 3
  • T-96.5 P-100 R 14-32 BP 70/50
  • Labs
  • WBC 41.9
  • Creatinine 4.3
  • Vasoactive gtts
  • Intubated
  • Died day 7

46
Key Nursing Assessments
  • Fever/chills
  • Hypothermia
  • Altered LOC/confusion
  • Break in skin integrity
  • Foley catheter
  • Wound or incision
  • Tachycardia
  • HR gt100
  • What if elderly or on beta blockers?

47
Key Nursing Assessments
  • Tachypnea
  • RR gt20
  • Hypotension
  • SBP lt90
  • SBP drop of gt20-30mm/Hg
  • Decreasing urine outputlt30cc/hr
  • Labs
  • WBC
  • Neutrophils
  • Creatinine

48
Nursing Diagnosis statements w/infection/sepsis?
  • Ineffective breathing pattern
  • Decreased cardiac output
  • Ineffective tissue perfusionmanifested by
  • Altered mental status
  • Behaviorial changes (restlessness)
  • Renalcreatinine
  • Acute confusion

49
NCLEX Concepts of Emphasis
  • Why is the older adult at risk for infection and
    cancer development?
  • Inflammation and immunity are provided primarily
    through what body cells?
  • Differentiate the 5 types of leukocytes and what
    each type does to protect the body from
    micro-organisms
  • Which leukocyte is elevated in bacterial
    infection?
  • Why
  • What body cell is able to recognize and destroy
    non-self cells?
  • What vital sign changes are seen in sepsis?
  • What assessment findings are seen in sepsis?

50
Immune Response
  • Passive Acquired Immunity
  • Present at birth
  • Short lived
  • Body needs to develop own
  • Active Acquired Immunity
  • After birth
  • Active
  • Long-term
  • Exposure to micro-organisms
  • immunizations

51
What comprises the immune system?
  • Bone Marrow
  • WBC
  • Lymph system
  • Thymus Gland
  • Misc Tonsils, Spleen, Mucosa, Appendix

52
Lymphocytes
  • WBC that allow the body to remember and recognize
    previous invaders.
  • Two types
  • B lymphocytes
  • T lymphocytes.
  • NK or natural killer cells

53
Specific Defenses
  • Humoral (circulating) immunity
  • Reside in B lymphocytes
  • Mediated by antibodies (immunoglobulin) produced
    in B cell
  • Produce antibodies when activated
  • Cell-mediated defenses
  • T cells released when exposure to an antigen
    occurs
  • 70-80 total lymphocytes

54
Antigens
  • An antigen is a substance that elicits an immune
    response
  • Mostly comprised of protein
  • A foreign substance that invades the body is
    called an antigen
  • All cells have antigen unique to that individual
    allowing the body to recognize itself

55
Humoral (antibody) Immunity
  • Antibody mediated immunity
  • Antibodies are produced by B cells
  • Antibodies can bind to antigens
  • Immunoglobulins (IgG, IgA, IgM, IgD, IgE)

56
Cell Mediated
  • T-cells
  • able to recognize infected cells
  • Cytotoxic
  • Natural killer cell

57
Cytokines
  • Soluble, hormone-like protein produced by white
    blood cells
  • act as a messengers between cells
  • Stimulate or inhibit the growth and activity of
    various immune cells
  • Can be beneficial or harmful

58
Antipyretics
  • Acetaminophen
  • Ibuprofen
  • Aspirin

59
Immunopathology
  • Alterations in Immunity and Inflammation
  • Hypersensitivity
  • Autoimmunity

60
Hypersensitivity
  • Immediate
  • Allergy
  • Anaphylaxis
  • Delayed
  • Poison Ivy
  • Mantoux Test

61
Hypersensitivity
  • Nursing Assessment
  • Think ABCs
  • How fast is the allergic response?
  • How serious?
  • What to ask the patient?
  • Is this an allergic response or drug side effect?

62
Name that response
  • Baby is crying continually and pulling at her
    ear. Mom is frantic.
  • Young man- ate shellfish and then went to play
    tennis. Now is having difficulty breathing.
  • Young woman went hiking in the woods last week
    now has hives present and is scratching.
  • 12 year old girl crying and shaking, holding her
    very swollen arm/elbow - injured playing baseball

63
Autoimmunity
  • Recognizes self antigens as foreign
  • Produces antibodies against own tissue
  • Examples
  • Lupus
  • Rheumatoid Arthritis

64
How do immunizations work?
  • The exposure (usually injection) to a small amt
    of virus triggers an immune response
  • Help body prepare antibodies
  • Type of immunity
  • Active artificial

65
NCLEX Concepts of Emphasis
  1. What are the similarities and differences between
    cellular and humoral immunity?
  2. How do vaccinations work?
  3. To be fully immune requires which three essential
    components of the inflammation/immune response?
  4. What is the mechanism of Prednisone and the
    nursing considerations when giving?
  5. What is the difference between an allergic
    reaction and side effect of a medication?
  6. What is the similarities differences between
    hypersensitivity and anaphylactic reaction?

66
Bronchospasm associated with hypersensitivity
reaction is the result of
  • A. histamine release
  • B. pulmonary ventilation
  • C. dilation of the alveoli
  • D. inadequate antibody production

67
Which symptom indicates a possible allergic
reaction?
  • A. fever
  • B. diaphoresis
  • C. rash
  • D. chills
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