NURS 2301 Module 2

What are the 3 phases of inflammation?

1. Vascular Phase

   • Vasodilation

   • Increased permeability

   • Edema

2. Cellular Phase

   • Neutrophils arrive

   • Chemotaxis

   • Phagocytosis

3. Resolution

   • Healing and tissue repair

What happens during the vascular phase?

• Vasodilation

• Increased permeability

• Edema (swelling)

• Histamine is a major mediator

What happens during the cellular phase?

• Neutrophils arrive first

• Chemotaxis occurs

• Phagocytosis removes pathogens and debris

Which cells dominate acute inflammation?

Neutrophils

Which cells dominate chronic inflammation?

• Macrophages

• Lymphocytes

What are the 5 cardinal signs of inflammation?

• Redness (Rubor)

• Heat (Calor)

• Swelling (Tumor)

• Pain (Dolor)

• Loss of Function (Functio Laesa)

Histamine

• Vasodilation

• Increased vessel permeability

opens highway

Prostaglandins

• Pain

• Fever

• Vasodilation

Leukotrienes

• Chemotaxis

• Leukocyte activation

Cytokines

Cell signaling proteins that regulate immune responses (cell phone)

Acute Inflammation

• Hours to days

• Neutrophils

• Localized

• Usually resolves

Chronic Inflammation

• Months to years

• Macrophages & lymphocytes

• Fatigue

• Malaise

• Weight changes

• Tissue damage/fibrosis

PLEASE

P = Past medical history

L = Last oral intake

E = Events leading to illness/injury

A = Allergies

S = Symptoms

E = Each medication (Rx, OTC, herbal)

PQRST

P = Pattern/Provoking factors

Q = Quality

R = Radiation

S = Severity

T = Time/Treatment

Allopurinol (Zyloprim)

Classification:

• Antihyperuricemic

• Uricosuric/Urate-lowering therapy

Used For:

• Gout

• Hyperuricemia (high uric acid levels)

Action:

• Inhibits xanthine oxidase

• Decreases uric acid production

Why It Works:

• Too much uric acid → uric acid crystals form in joints

• Crystals cause inflammation and pain

• Allopurinol lowers uric acid levels to prevent crystal formation

Major Adverse Effects:

• Rash 🚨 (MOST IMPORTANT)

• Nausea/Vomiting/Diarrhea

• Drowsiness

• Headache

• Vertigo

• Metallic taste

• Bone marrow suppression (rare)

• Cataracts

Nursing Interventions:

• Monitor uric acid levels

• Monitor CBC

• Monitor for hypersensitivity reactions

• Assess for dizziness/vertigo

Patient Teaching:

• Drink at least 3 L of fluid daily

• Report rash immediately

• Report unusual bleeding or bruising

• Wear UV-protective sunglasses

Prednisone

Classification:

• Glucocorticoid

• Corticosteroid

Used For:

• Inflammation

• Autoimmune disorders

• Allergic reactions

• Rheumatoid arthritis

• Organ transplant rejection prevention

Action:

• Mimics cortisol

• Suppresses inflammation

• Suppresses immune response

• Decreases prostaglandin production

• Decreases capillary permeability

• Decreases swelling and pain

Major Adverse Effects:

• Hyperglycemia 🚨

• Immunosuppression 🚨

• Increased infection risk

• Osteoporosis

• Cushing syndrome

• Cataracts

• Increased sodium

• Decreased potassium

Nursing Interventions:

• Monitor blood glucose

• Monitor for infection

• Monitor for signs of adrenal insufficiency

• Monitor for Cushing syndrome

• Give with food

Patient Teaching:

• Take exactly as prescribed

• Do NOT stop suddenly

• Requires tapering

• Avoid people who are sick

• Increase calcium and vitamin D intake

• Monitor blood sugar closely if diabetic

Contraindications/Use Caution:

• Systemic fungal infections

• Diabetes

• Osteoporosis

• Heart failure

• Cataracts

Celecoxib

• COX-2 inhibitor

• Only COX-2 inhibitor on market

• Developed to reduce GI side effects compared with traditional NSAIDs

Aspirin

• Salicylate

• Anti-inflammatory

• Antiplatelet

NSAIDs

Examples:

• Ibuprofen

• Naproxen

Know:

• Inhibit COX-1 and COX-2

• Reduce prostaglandins

• Decrease pain, fever, inflammation

Penicillins (Amoxiciilin)

Classification:

• Penicillin

• Broad-spectrum antibiotic

• Beta-lactam

Action:

• Weakens bacterial cell wall

• Causes bacterial death

Treats:

• Ear infections

• Strep throat

• Respiratory infections

• UTIs

Major Adverse Effects:

• Diarrhea

• Nausea

• Hives

• Anaphylaxis

• Candidiasis

• C. difficile

Patient Teaching:

• Finish entire prescription

• Report severe diarrhea

• Report rash or difficulty breathing

• May decrease effectiveness of oral contraceptives

Cephalosporins - Cephalexin (Keflex)

Classification:

• Cephalosporin

• Beta-lactam antibiotic

Action:

• Disrupt bacterial cell wall synthesis

Treats:

• Skin infections

• Respiratory infections

• UTIs

Major Adverse Effects:

• GI upset

• Allergic reactions

• Superinfection

Patient Teaching:

• Finish entire course

• Report rash or severe diarrhea

Tetracyclines (Tetracycline & Doxycycline)

Classification:

• Tetracycline antibiotic

Action:

• Inhibits bacterial protein synthesis

Treats:

• Acne

• Lyme disease

• Respiratory infections

Major Adverse Effects:

• Photosensitivity

• GI upset

• Tooth discoloration

Patient Teaching:

• Wear sunscreen

• Avoid taking with dairy products

• Take entire prescription

Nitrofurantoin (Macrobid)

Classification:

• Urinary anti-infective

Action:

• Damages bacterial DNA

Treats:

• UTIs only

Major Adverse Effects:

• Peripheral neuropathy

• Pulmonary fibrosis

• Hepatotoxicity

• Brown urine

Nursing Considerations:

• Monitor CBC

• Monitor respiratory status

• Monitor liver function

Patient Teaching:

• Finish medication

• Brown urine is expected

• Report numbness or tingling

Do not use for viral illnesses

Antibiotics

Vancomycin (Vancocin®)

Classification:

• Glycopeptide antibiotic

• Broad-spectrum

Action:

• Effective against Gram-positive bacteria

• Treats MRSA (IV)

• Treats C. diff (PO)

• Alternative for penicillin allergy

Major Adverse Effects:

• Renal failure (nephrotoxicity)

• Ototoxicity

• Red Man Syndrome

• Thrombophlebitis

• Anaphylaxis

Nursing Interventions:

• Monitor BUN & Creatinine

• Monitor trough levels

• Assess IV site frequently

• Infuse over at least 60 minutes

Patient Teaching:

• Report facial flushing or feeling faint

• Report tinnitus, vertigo, hearing loss

• Report redness, pain, swelling at IV site

Macrolides (Erythromycin)

Classification:

• Macrolide antibiotic

• Broad-spectrum

Action:

• Treats:

  • Legionnaires' disease

  • Pertussis

  • Diphtheria

• Alternative for penicillin allergy

Major Adverse Effects:

• GI upset

• Ototoxicity

• Superinfection

• QT prolongation 🚨

• Torsades de Pointes 🚨

Nursing Interventions:

• Monitor ECG

• Monitor liver function

• Monitor for superinfection

• Monitor hearing changes

Patient Teaching:

• Take 1 hour before or 2 hours after meals

• Drink 8 oz water after taking

• Report palpitations

• Report syncope

• Report bloody/watery diarrhea

• Report tinnitus or hearing loss

Contraindications:

• Long QT syndrome

• Hypokalemia

• Hypomagnesemia

Sulfonamides (Bactrim®)

Prototype:

• Trimethoprim/Sulfamethoxazole (TMP-SMX)

Classification:

• Sulfonamide antibiotic

• Broad-spectrum

Action:
Treats:

• UTIs

• Bronchitis

• Otitis media

• Pneumocystis pneumonia

• Shigella

Major Adverse Effects:

• GI symptoms

• Stevens-Johnson Syndrome 🚨

• Blood dyscrasias 🚨

• Urinary crystals

• Superinfection

Nursing Interventions:

• Monitor CBC

• Monitor I&O

• Monitor for rash/blisters

• Monitor for infection

Patient Teaching:

• Drink 1.2–1.5 L water daily

• Report fatigue

• Report pallor

• Report bruising

• Report rash

• Report signs of superinfection

Important Interactions:
🚨 Decreases effectiveness of oral contraceptives

Contraindications:

• Pregnancy

• Folic acid deficiency

• Celecoxib allergy

• Renal/liver dysfunction

What are the three layers of the skin?

• Epidermis = protection

• Dermis = glands, blood vessels, nerves, temperature regulation

• Hypodermis = fat storage, insulation, cushioning

Name 4 major functions of the skin.

• Protection

• Thermoregulation

• Sensation

• Vitamin D production

What are the four stages of wound healing?

1. Hemostasis

2. Inflammatory

3. Proliferation

4. Remodeling

What occurs during hemostasis?

• Vasoconstriction

• Platelet aggregation

• Clot formation

What occurs during the inflammatory phase?

Neutrophils and macrophages remove pathogens and debris

What occurs during the proliferation phase?

• Fibroblasts produce collagen

• Angiogenesis

• New tissue formation

What occurs during the remodeling phase?

• Collagen strengthens

• Scar formation

Name 5 factors that delay wound healing.

• Diabetes

• Infection

• Smoking

• Poor oxygenation

• Poor nutrition

What does ABCDE stand for?

• A = Asymmetry

• B = Border irregularity

• C = Color variation

• D = Diameter > 6 mm

• E = Evolving

Which ABCDE finding is most sensitive for melanoma?

Evolving

What skin infection is known for honey-colored crusts?

Impetigo

What is folliculitis?

Infection of one or more hair follicles.

What is a carbuncle?

A cluster of connected skin abscesses.

What bacteria commonly causes carbuncles?

Staphylococcus aureus

Cellulitis is usually unilateral or bilateral?

Unilateral (legs)

What is the hallmark symptom of eczema?

Itching

Acute eczema presents how?

Red, oozing, crusted lesions.

Chronic eczema presents how?

Dry, thickened skin.

What is tinea?

A fungal infection (ringworm).

Tinea pedis

Feet (athlete's foot)

Tinea cruris

Groin (jock itch)

Tinea capitis

Scalp

Tinea corporis

Body (face, arms, trunk, legs).

Tinea barbae

Beard area

Tinea unguium

Fingernails and toenails.