NURS 337: Pathophysiology Exam 4

Osteomyletis

Infection of the bone characterized by both local and systemic manifestations

S/S of osteomyelitis

-Bone pain

-Excessive sweating

-Fever and chills

-General discomfort or uneasiness

-Local swelling

-Open wound that may present pus

-Pain at site of infection

Complications of osteomyelitis

sepsis, gangrene, infected necrotic tissue commonly caused by a clostridium species of bacteria

Most common site for gout

the metatarsophalangeal joint great toe is most common presentation

Additional sites for gout

ankle, knee, wrist, or elbow

Medication intervention for osteomyelitis

IV antibiotics based off culture and sensitivity followed by oral antibiotics for 5 weeks

Lab tests to run for patients with osteomyelitis

Blood cultures, CBC, C-reactive protein, erythrocyte sedimentation rate

Diagnostic imaging tests for patients with osteomyelitis

X-ray, MRI, technetium-99 bone scintigraphy, and leukocyte scintigraphy

Physical intervention for patients with osteomyelitis

debridement of the wound by removing infected bone and necrotic tissue and potential surgical removal of orthopedic hardware

complication of long bone fracture

Fat emboli

Fat emboli

obstruction of the pulmonary vascular bed by fat globules

Normal WBC count

4,000-11,000

Leukocytosis

increase in the number of white blood cells

Leukopenia

Abnormally low white blood cell count

What does a raised eosinophil value indcate?

allergic reaction

Normal eosinophil range

1%-7%

What does increased basophil value indicate?

parasitic infection

Normal basophil range

0%-2%

What does increased neutrophil value indicate

bacterial infection

Normal neutrophil range

40%-80%

What does an increased lymphocyte value indicate?

viral infection

Normal lymphocyte range?

20%-40%

What does an increased monocyte value indicate?

inflammation, chronic infection, malignancy, or autoimmune disease

Normal monocyte range

2%-10%

RBC count male

4.5-5.5

RBC count female

4.0-.4.9

Hgb count males

13-18

Hgb count females

12-16

Hct count males

45%-52%

Hct count females

37%-48%

MCV normal range

80-100

MCH normal range

27-31

MCHC

32-36%

Platelets normal range

150,000-400,000

low MCH, MCV, MCHC indication and intervention?

iron deciency anemia, give iron supplements

high MCH/MCV/MCHC indication and intervention

macrocytic anemia, give patient oxygen, folate, and B12

Abnormal low blood values indication and intervention

anemia, oxygen, pain meds, fluids, and potential blood transfusions, folic acid, and antibiotics

aPPT

activated partial thromboplastin time, measures clot time and evaluates the intrinsic pathway of coagulation cascade

Medication used to control aPPT time

heparin

HIV/AIDS interventions

Antiretroviral therapy and education about infection

innate immunity

Immunity that is present before exposure and effective from birth. Responds to a broad range of pathogens.

What is adaptive immunity/ antibody mediated immunity synthesized by

B lymphocyte

Helper cells

easily recognize self cells versus non self and act as organizers in calling to arm various WBC groups to respond to protective actions

Supressor T cells

prevent hypersensitivity on exposure to non self cells or proteins

acquired immunity

Immunity that is present only after exposure and is highly specific

active acquired immunity

when an antigen enters your body naturally without human assistance and response by actively making antibodies against that antigen

artifical acquired immunity

produced through medical vaccination

passive acquired immunity

occurs when antibodies are made against an antigen in one person/animal body and then transferred to another

4 stages of wound healing

hemostasis, inflammation, proliferation, remodeling

Hemostasis

to stop or control bleeding through platelet aggregates and inflammatory mediators

Inflammation

Vasodilation, increased vascular permeability, and chemotaxis occur during this phase

proliferation phase

granulation tissue forms and serves as the foundation for scar tissue. Endothelial cells create new blood vessels (angiogenesis). Granulation tissue secretes growth factors and epithelial cells migrate and proliferate to form a new surface over the wound.

Remodeling phase

Approximately 3 weeks after injury scar tissue is structurally refined and reshaped

Inflammation is always present with infection (T/F)

true

Infection is always present with inflammation (T/F)

false

Step 1 of inflammatory response

bacteria and other pathogens enter wound

Step 2 of inflammatory response

platelets from blood release blood-clotting proteins at wound sites

Step 3 of inflammatory response

mast cells secrete factors that mediate dilation and constriction of blood vessels as well as delivering blood, plasma, and cells to injured area

Step 4 of inflammatory response

neutrophils secrete factors that kill and degrade pathogens

Step 5 of inflammatory response

neutrophils and macrophages remove pathogens by phagocytosis

Step 6 of inflammatory response

macrophages secrete cytokines, which attract immune system cells to the site and activate cells involved in tissue repair

Step 7 of inflammatory response

response continues until the foreign material is eliminated and the wound is repaired

localized infection symptoms

redness, heat, pain, swelling, and loss of function

systemic infection symptoms

malaise, nausea, anorexia, increased pulse & RR, fever, and pain

What type of reaction is anaphylaxis?

Type 1 hypersensitivity

Interventions for anaphylaxis

IV or IM antihistamines, vasosupressors, glucocorticoids, corticosteroids, epinephrine (immediately), and continuous cardiac monitoring and periodic blood pressure management until recovery

Purpose of the fever

include increased killing of microorganism, increases phagocytosis by neutrophils, and increased proliferation of T cells

Fever above 40 C (104 F) can...

damage body cells and delirium and seizures can occur

Fever above 41 C (105.8 F) effects?

the regulation ability of the hypothalamic center becomes impaired, brain damage can occur

Primary intention healing

Edges of wound are clearly demarcated, cleanly lacerated, and easily brought together with no missing tissue in the area. (surgical wounds)

Secondary intention healing

Abundant granulation and fibrous tissue to fill the defect and restore the original structure of tissue. Requires extensive time to heal.

Tertiary intention healing

Wound is missing large amount of deep tissue and contaminated. The wound is cleaned and left open for 4-5 days before closure. Wound may require packing, drainage tube, and skin graft

Stage 1 pressure ulcer

Intact skin with non blanchable redness of a localized area usually over a bony prominence. Area may be painful, firm, soft, warmer, or cooler.

Stage 2 pressure ulcer

Partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough. May also present as an intact or open/ruptured serum filled serosanguineous filled blister. Presents as a shiny or dry shallow ulcer.

Stage 3 pressure ulcer

Full thickness tissue loss. Sub q fat may be visible but bone, muscle, or tendon are not exposed. Slough may be present but does not obscure depth of tissue loss. May include undermining and tunneling.

Stage 4 pressure ulcer

Full thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present. Often includes undermining and tunneling.

unstable/unclassified pressure ulcer

Full thickness tissue loss with unknown depth due to slough and/or eschar obscuring the wound bed. Once depth is to be determined by cleaning the wound it will be staged 3 or 4.

suspected deep tissue injury

Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear.

Interventions for general wound healings

requires supply of nutrients, oxygen flow, circulation promotion, as well as efficiently removing tissue debris and invading microorganism

What nutrient is particular necessary in wound healing?

protein

Vitamin C benefits

helps proteins and increases collagen strength

Vitamin B12 benefits

enables cell replication and supports RBC growth

Vitamin D benefits

fosters calcium absorption from the GI tract

Vitamin K benefits

enables synthesis of coagulation factors

Folate benefits

synthesizes nucleic acids

Calcium and phosphorus benefits

support bone growth

Iron benefits

essential for synthesis of hemoglobin and RBCs

Zinc, copper, manganese benefits

needed for cellular metabolism

Intervention for squamous cell carcinoma

potenial metastatic and surgical intervention

Where is squamous cell carcinoma normally found

on the back of the head and neck, this is where the highest degree of UV radiation occurs

Rule of 9's for adults

9% for each arm, 18% for each leg, 9% for head,18% for front torso, 18% for back torso.

Rule of 9's for children

head 18%, legs are 13.5%, arms are still 9%, front torso is 18%, and 18% for back torso

Acute Phase of Burn Injury

Begins 48-72 hours after injury and assessment involves respiratory, circulatory status, edema, infection prevention, and wound care

Sickle cell crisis treatment

opioid analgesics, adequate hydration, oxygen, prophylactic antibiotics, hydroxyurea (decreases occlusive areas), folic acid, and bone marrow transplants

sickle cell crisis

condition in sickle cell anemia in which the sickled cells interfere with oxygen transport, obstruct capillary blood flow (vaso-occlusive crisis), and cause fever and severe pain in the joints and abdomen

Interventions for cellulitis

assess area for further changes, perform wound care, prevent irritation, elevate extremity, monitor lab work, and antibiotics as prescribes

Cellulitis

inflammation of subcutaneous tissue

What can be a secondary complication or primary infection often following a break in the skin?

cellulitis

What are the normal causative agents of cellulitis

Staphylococcus aureus and streptococci

Who is at most risk for skin breakdown

older adults