Pathophys - Inflammation, Tissue Repair, Wound healing

when the immune system is employed, ____ ___ will be produced such as erythema, heat, pain, and a lot of the time, loss of ____

local signs
function

Cytokines - short _____ used to communicate with other cells

proteins

Arachidonic acid metabolites:
_______ - short metabolized, vasodilators, pain, fever

Leukotrienes - attract and recruit ____

prostaglandins
WBCs

histamine is a ____ and increases ____ of the RBCs

vasodilator
permeability

_____ , prostaglandin, increase in blood quantity at site of damage

histamine

pain - inflammatory mediators (like prostaglandins), stimulate ____ receptors

pain

loss of function (functio laesa) 2/2 pain or _____

swelling

arachidonic acids are _____ and derived from ____ ____

lipids
cell membrane

how would NSAIDs work? blocker of ______ which inhibit creation of inflammatory mediators like ______

cyclooxygenase
prostaglandins

2nd line if NSAIDs dont work? ______ and they block ______ which prevents Cyclooxygenase and Lipooxygenase to create inflammatory mediators

Steroid
lipase

Why wouldn’t you give ASA to kids?

it inhibits COX1 which would lead to increased production of leukotrienes and thus bronchoconstriction which exacerbates asthma

Types of Inflammatory Exudates 

Serous Exudates
oWatery fluids low in _____ content 

oResult from _____ entering the inflammatory site

protein
plasma

Types of Inflammatory Exudates 

Hemorrhagic Exudates
oOccur when there is severe tissue injury that causes damage to blood _____ or when there is significant leakage of red cells from the _____

vessels
capillaries

_____ or Suppurative Exudates

oContain pus; composed of _____ white blood cells, proteins, and tissue debris

purulent
degraded

Basic Patterns of Inflammation

Acute inflammation
oOf relatively short duration; nonspecific early response to injury

oAimed primarily at removing the injurious agent and limiting tissue damage

oInfiltration of _______

oExudate 

neutrophils

Chronic inflammation
oLonger duration lasting for days to years

oA recurrent or progressive acute inflammatory process or a low-grade response that fails to evoke an acute _____

oInfiltration by mononuclear cells (______) and _______ 

oProliferation of fibroblasts

response
macrophages
lymphocytes

Systemic Manifestations of Inflammation

______

Alterations in white blood cell count (______)

Acute phase proteins

Fatigue, malaise, decreased appetite

Sepsis and ____ _____ (severe)

fever
leukocytosis
septic shock

increase of WBC in inflammation — why? normal count is 4-11k

increase in demand

pyrogenic effect: ______ are able to change the set point of temperature in the hypothalamus (normally 36.5)

pyrogens

the liver starts producing a lot of plasma proteins. most if not all proteins come from the liver. looking at an increase in ____ in a systemic manfestion of inflammation

proteins

_______ is also seen with inflammation. ______ in cells is increased, thus increase in oxygen, and thus increase in HR

tachycardia
metabolism

infectious disease:
disease caused by another ____ _____ which live in hosts

living organism

_____ could be human, animals, or in the environment based on their ability to survive

hosts

living microorganism can leave this host but need a way to _____. if the host is human, the organism can leave through cough, blood. now they are in a new environment, and are looking for a new host and need port of ____

exit
entry

Host—any organism capable of supporting the _____ and _____ growth requirements of another organism 

nutritional
physical

____ ______e—the disease state brought about by the interaction with another organism

infectious disease

Microflora—bacteria inhabiting exposed surfaces of the body (________ microorganism) 
live in skin and GI system

Vitamin K needs these bacteria in order to be _____, without Vitamin K, we cannot make a clot or stop bleeding. To inhibit vitamin K absorption, you would give what?

non-infective
absorbed
blood thinner

Virulence—the disease-inducing potential
ability of microorganism to cause _____

disease

Parasitic relationship: only the infecting organism ______ from the relationship

benefits

_____ _____ : are infections that occur more frequently and are more severe in people with weakened immune systems

opportunistic infections

______—microorganisms so virulent that they are rarely found in the absence of disease .
wherever they go they cause disease

pathogens

Agents of Infectious Disease

____ - tiny molecules made of non functional proteins. they live in the nervous system and make _____ . they are also transmissible. they can escape the brain through the BBB. they ultimately destroy _____

prions , holes,
neurons

Agents of infectious disease
______ -- cannot replicate ____ the cell. the enter body, find a weak cell, and _____.

• they are underneath the nails, on the tips of the fingers

viruses; outside; replicate

Agents of Infectious disease
_______

Rickettsiaceae 

Chlamydiaceae

Fungi

Parasites

bacteria

least specialized agent of infectious disease are what?

prions

Viruses 

Smallest pathogens

Atypical agent which has no organized cellular structure

Consist of a protein coat surrounding a nucleic acid core of DNA or RNA

Are incapable of replication outside a living cell

Classification of Bacteria

Classification by _____ that allow them to invade different ______

Cocci — spherical bacteriaExamples: Staphylococcus, Streptococcus

Bacilli — rod-shaped bacteriaExamples: E. coli, Bacillus

Coccobacilli — short rods that resemble cocciExample: Haemophilus

Spirochetes — thin, spiral-shaped organismsExamples: Treponema pallidum, Borrelia burgdorferi

Vibrios — curved/comma-shaped rodsExample: Vibrio cholerae

shapes
structure

should know the classification of bacteria through the ______ in their cell wall

enzyme

Classification by Gram Stain

Gram positive bacteria
oStain purple

oHave a ____ peptidoglycan cell wall

oRetain the crystal violet–iodine complex

o__ outer membrane

thick
No

Gram negative bacteria
oStain pink/red

oHave a ____ peptidoglycan layer

oHave an outer membrane containing _____

thin
lipopolysaccharide

the ____ gram negatives secrete is more virulent than gram positive

toxins

if you kill gram _____, then they cannot secrete their toxins that are harmful to us

positive

if you kill gram negative bacteria, the pieces of the cell wall will remain and still can produce _____ which are highly toxic

endotoxins

Toxins

o ______: are a group of soluble proteins that are secreted by the bacterium, enter host cells, and catalyze the covalent modification of a host cell component. Grampositive bacteria. ______ toxin produced by _____ botulinum; Corynebacterium diphtheriae toxin, produced during life-threatening symptoms of ______; tetanospasmin produced by Clostridium tetani

exotoxins
botulinum; clostridium
diptheria

Endotoxins: are agents reacts with lipopolysaccharide-sensitive cells producing ____ _____ ; it is highly toxic Gram negative.Salmonella typhi (Typhoid),Vibrio cholerae (Cholera)

endogenous mediators

Fungi

Groups
o____

o____

yeasts
molds

Modes of Transmission

take them from exit or entry and take to target host

Skin Penetration - needles, cuts

Direct contact - sexual contact

Ingestion -

Inhalation - airborne

Source of an Infectious Disease

Location
|o_____: develop in hospitalized patients. very ____ microorganism

o_____ ______: acquired outside of health care facilities

nosocomial; resistant
community acquired

Symptomatology

• microorganisms enter through body, inflammatory systems are employed
  
  

________: Tell you there is something wrong, any infectious disease can cause them, even cancer. can be shared by a number of diverse infectious diseases (e.g., symptoms such as fever, myalgia, headache)

Specific: reflects the ____ of _______ (e.g., diarrhea, rash, convulsions, hemorrhage, pneumonia)

_______: predictable patterns (e.g., chickenpox and measles)

______: may require laboratory testing to detect (e.g., hepatitis or increased white blood cell count)

Nonspecific
site; infection
Obvious
Covert

Disease Course in Infection

______ period - host does not show any signs or _____ of dysfunction of pathophysiology, microorganisms ______. from exposure to first sign. can take years

incubation
symptoms
replicates

Disease Course in Infection

Incubation period

________ stage - build the troops (immune cells like T lymphocytes, neutrophils, etc), confront and fight with the microorganisms. but they are still much larger in number. this is when nonspecific!! signs begin to appear

Acute stage

Convalescent stage

Resolution stage

prodromal

Disease Course in Infection

Incubation period

Prodromal stage

______ stage - more ______ symptoms and signs. Dyspnea, diarrhea, etc. most patient’s are in this stage when you see them and when you will HELP THEM. how will you help? make the dx. start the tx.

Convalescent stage

Resolution stage

Acute

specific

Disease Course in Infection

Incubation period

Prodromal stage

Acute stage

_________ stage - symptoms start disappearing

Resolution stage

convalescent

Disease Course in Infection

Incubation period

Prodromal stage

Acute stage

Convalescent stage

_______ stage - back to normal

resolution

why dont ______ really work? because viruses are in our cells, and to kill the virus we would have to kill our cells. so instead, we would use antibodies

antivirals

Criteria for Diagnosis of an Infectious Disease

• comes from your dx from a _____ of the patient including HPI

The recovery of a probable pathogen or evidence of its presence from the infected sites of a diseased host 

Accurate documentation of clinical signs and symptoms (symptomatology) compatible with an infectious process 

workup

Techniques for Laboratory Diagnosis of an Infectious Agent

______ - body fluid, blood, tissue

Serology or detection of characteristic antigens - detect _____ against _____ of specific microorganism

___ and ____ sequencing - late stage

culture
antibodies; antigens
DNA; RNA

Treatment: Types of Antimicrobial Agents

_____ agents - only targets bacteria

Antiviral agents

Antifungal agents - only against fungus and takes some time to destroy cell membrane

Antiparasitic agents -

antibacterial

Intravenous Immunoglobulin and Cytokine Therapy

• expensive

• IgG (fancy antibody) prepare antibodies and use against _____ and chronic _____. neutralized antigen. macrophage comes and kills. we use because they are safe. they do not kill. used for viral and autoimmune

• ______ therapy - inflammatory mediators ??? normalize. recruit immune system. suppresses immune system ???

virus; inflammation
cytokine

Nonpharmacological Intervention

Surgical interventions
oProviding access to an infected site by antimicrobial agents (_______ of an abscess)

oCleaning of the site (______)

oRemoving infected organs or tissue (e.g., appendectomy)

oSurgical therapy is used in _____ with antibiotic treatment in some cases of severe infection.

draining
debridement
tnadem

Preventing Infection

• isolated room

• aireborne diseases require ____ ____ in the room to bacteria cannot be inhaled
  
  

Appropriate hand hygiene

Personal protective equipment 

Appropriate patient placement 

Safe handling of laundry

Sharps safety (i.e., engineering and work practice controls)

Aseptic technique for invasive nursing procedures such as parenteral medication administration

negative pressure