Core Exam 2 Review

what is inflammation

- an immune response
- the body's response to an injury and illness
- plasma, dissolved substances aid in healing injured tissues

is inflammation every a normal response

yes, all part of the healing process

Give an example of a Nursing Diagnosis indicating inflammation

risk for infection at injury site

can inflammation occur anywhere in the body?

yes, inflammation can occur internally and externally

Vascular cellular responses (First Phase)

- heat and redness due to vasodilation
- increased blood supply (hyperemia) cases swelling and edema
- pain is caused by lack of circulation and nerve ending stimulation by edema

what causes swelling and edema

vascular permeability resulting in swelling, pain, inflammation, and histamine response

Five cardinal signs of inflammation

- Pain
- heat
- redness
- swelling
- loss of function

Second stage of inflammation

exudate production

What is exudate

drainage from injury site

serous exudate

clear, watery, straw colored fluid accompanying mild inflammation

purulent exudate

opaque, milky white, contains potentially necrotic debris (pus) indicates infection

hemorrhagic/ sanguineous exudate

thick, bloody drainage, resulting of infection or injury

Third stage of inflammation

reparative phase

reparative phase includes

regeneration and granulation

what is regeneration

cells begin to repair and replace destroyed cells with identical copies

what is granulation

replacing damaged cells via scar tissues, early stage of scar tissue formation

tissues within the body that have good regenerative capacity

- skin cells, epithelial tissue
- digestive tissue
- respiratory tissue
- lymphoid tissue
- bone marrow tissue

First phase- Tissue injury

release of chemical signals such as histamines

Second phase- dilation and increased leakiness of local blood vessels

migration of phagocytes to the area

Third phase- macrophages and neutrophils consume bacteria and cell debris

tissue heals

examples of inflammation

- edema
- throbbing
- burning
- pain at site
- increased skin temperature
- erythema (redness)
- ecchymosis (bruise)

Rheumatoid arthritis

- autoimmune disease that attacks joints
- causes inflammation
- pain
- heat
- can range from mild to severe

What are you going to educate your patient about preventing inflammation?

- avoid injury
- hand hygiene
- diabetics should take special care for abrasions on neuropathic limbs
- advise adequate risks
- take medications regularly
- hydrate properly
- keep good nutritional goals

RICE

- rest
- ice
- compression
- elevation

what are risk factors related to inflammation?

- family history of rheumatoid arthritis
- age
- adequate rest
- low sodium and low sugar
- high fiber
- omega three and fatty acid needs should be met
- no smoking
- avoid allergens

Genetic predispositions for inflammatory process

- native Americans and Mexicans are at increased risk for gallstones
- family history
- female gender (hormones make women predisposed to RA)
- African Americans are at greater risk for nephritis

IV infiltration

cannula through vessel= fluid flowing into tissues causes edema, nonvesicant fluid

IV extraversion

leaking of vesicant fluid into vascular space, tissue damage

IV infiltration vs IV extravasaion

infiltration= edema, no tissue damage
extravasation= fluids causing tissue damage or necrosis

Phlebitis

- veins swell, red path in tissue
- very painful
- inflammation due to vessel wall injury
- can be caused by catheter placement or IV fluid administration

thrombophlebitis

inflammation of a vein due to a blood clot

Cellulitis

diffuse, acute infection of the skin marked by local heat, redness, pain, fever, and swelling

cellulitis priority treatment

stop infusion, elevate extremity,
apply warm compress three to four times a day

s/s of localized inflammation

- pain
- heat
- swelling
- redness
- loss of function
- edema
- can be in any part of the body

S/S of systematic inflammation

- widespread symptoms can cause a variety of symptoms
- temp of 104+
- RR 20+
- alter vitals

5 diagnostic tests for inflammation

- WBC greater than 10,000
- ESR Greater than 20mm/hr
- C reactive protein( less than 2.9)
- CMP/BMP

CMP/BMP

- complete or basic metabolic panels
- assessing for liver and kidney function
- albumin levels

albumin levels can indicate

- high levels= dehydration
- low levels indicate malnutrition, liver or kidney dysfunction, or infections

ESR (erythrocyte sedimentation rate)

normal ranges for men are 0-15 and 0-20 for women

what can the patient do for inflammatory process?

RICE, prevent further injury, ice for acute muscular injury, heat for chronic inflammatory conditions

what can the nurse do for inflammation?

ice packs, pt education, repositioning, elevate extremities with pillows

what are medications for inflammation?

NSAIDs, antipyretics, corticosteroids

what are some treatments for inflammation?

allergy shots, avoid triggers

what dietary changes will reduce inflammation?

- reduce salt intake
- avoid triggers
- decease sugar
- increase fiber and protein intake
- know what you are eating

do heat and cold application require an order

- yes, for major and constant application
- for smaller applications like IV upset may vary by facility

orders for application of heat or cold must contain

location on body, specific durations, frequency, temperature parameters

those at higher risk for complications with application of heat or cold

young children due to lack of communication and older adults due to lack of sensation and low adipose tissue

asses heat or cold therapy every

5-10 minutes

pathophysiology of infection

pathogens

underlying pathogen must be determined so we can better treat infection

bacteria example

Staphylococcus aureus, MRSA, treated with antibiotics

virus example

herpes zoster/varicella zoster virus , treated with antivirals

parasitic examples

protozoa- malaria
helminths- worms

fungi examples

Candida albicans or yeast infections

prion

causes malformation of protein, affects neuro system and brain
ex- mad cow disease

stages of infection

- incubation
- prodromal
- illness
- convalescence

incubation stage of infection

microorganism has entered body and is begging to manifest non specific signs and symptoms

prodromal stage of infection

more specific symptoms appear that are closely related to disease, organism is rapidly replicating/ multiplying

illness stage of infection

very specific disease presentation, more intense than prodromal stage, peak of illness

convalescence stage of infection

recovery, returning to normal, can take days to months depending on pathogen

nonspecific immunity

skin, mucous, hair, inflammatory response, NO MEMORY

specific immunity

antibody mediated, requires past exposure to antigen, lymphocytes, vaccines, MEMORY

largest risk factor for infection

inadequate hand hygiene and non intact skin

other risk factors for infection

- environment: alcohol, tobacco, malnutrition
- chronic illness
- medications: long term use of steroids, any cancer drugs, weakened immune system
- age: newborns and older adults
- internal: stress, poor nutrition, not immunized, exhaustion, poor hygiene

chain of infection

infectious agent, reservoir, portal of exit, mode of transmission, portal of entry, susceptible host

causative agent

pathogens, Bactria, prion, parasite, fungi

Revisor of infection

- infected thing or person, pathogen breeds and grows here
- can be a human, animal, food, water

portal of exit

- how pathogen leaves revisor
- often same as portal of entry
- skin to skin, respiratory system, GI to GI

Mode of transmission

how bug is spread
- droplet, airborne, vector borne(bugs), vehicle borne( non-living objects)

portal of entry

usually the same as portal of exit
- how pathogen enters susceptible host

susceptible host

the immunocompromised, older adults, neonates, risky behaviors

five classic symptoms of localized infection

- redness
- warmth
- edema
- pain
- loss of function

signs of systemic infection

- fever
- tachycardia
- tachypnea
- hypotension
- fatigue/ malaise
- N/V, anorexia
- enlarged lymph nodes

asepsis

Absence of pathogens

medical asepsis

"clean technique" disinfected but not entirely free from pathogens

surgical asepsis

"sterile technique" total elimination of pathogens

medical asepsis is used

- emptying cathether
- drawing meds (technique is clean, equipment is sterile)
- inserting IV ( skin can never be sterile)
- clean dressing change

surgical asepsis is used

- inserting an indwelling urinary Cath
- surgical procedures
- central line dressing changes
- sterile dressing changes

hand hygiene

- alcohol based disinfectants expect with C diff or soiled hands
- at least 20 seconds of friction / suds

clean from

leas soiled to most soiled

if you suspect something is contaminated/ no longer sterile

throw it out and start again

transmission based precautions are dependent on

mode of pathogen transmission

patients on any form of transmission based precautions are at risk for

social deprivation, isolation, and mental health decline

Standard Precautions

- always in effect
- all bodily fluids(except sweat), open wounds, and mucosal membranes
- hand hygiene
- gloves
- additional personal preferences on protection

airborne precautions

- negative pressure private rooms
- healthcare professionals wear N95 masks and face shield
- client wears surgical mask when outside the room

droplet precautions

- private room or shared room with matching precaution
- surgical mask
- client wears mask when leaving room

contact precautions

- private room or shared room with same precautions
- gloves and gown

reverse/neutropenic precautions

- to protect patent from outside, for immunocompromised pts
- positive and private pressure room
- patient wears mask when outside of room
- no plants in room
- fully cooked food
- RN wears mask when in room

protective environment

- neutropenic precautions
- protects patients from healthcare environment rather than healthcare environment protected from patient

varicella Zoster virus

responsible for
- chicken pox
- herpes zoster/shingles
- pearls

chicken pox

- highly contagious
- prevented with vaccine
- disseminated rash
- childhood illness
- self limiting
- lives in dorsal ganglia( why shingles follows nerve pathway)
- possible reactivation later in life

Herpes Zoster / shingles

- cannot be caught, only reactivated from previous infection( can transmit chickenpox)
- painful rash that follows from dermatomes
- does not pass midline
- treat with antiviral drugs

Pearls

-requires primarily contact precautions( blisters/ dermatomes)
- airborne precautions in severe cases
- no longer contagious once lesions are dry and crusted over
- pregnant women should not care for patients with shingles due to fetal risk

Diseases with transmission based precautions

Measles, TB, Varcilla ( MTV)

mumps is

droplet precautions

Hep B precaution level

standard and bloodborne

C. diff requires

contact precautions

Diagnostics for infection

X-ray, CT, Ultrasound, Biopies

Labs related to infection

- White Blood Cells over
10,000
- Erythrocyte sedimentation rate
- culture and sensitivity

RN care for infection

- follow precautions
- follow appropriate aseptic technique
- appropriate nutrition and hydration