Inflammation

what is inflammation?

an immunologic defense against tissue injury, infection, or allergy

what are the attributes of inflammation?

Acute and/or Chronic inflammation

what is the scope of inflammation?

not inflamed to inflames

Review: what does a cellular injury turn into during the inflammatory process?

mast cell

review: what does a mast cell turn into during the inflammatory process?

• release of chemicals mediators

  • histamine

  • bradykinin

  • complement

  • leukotrienes

review: what does the release of chemical mediators turn into during the inflammatory process?

• vasodilation (redness, heat)

• vascular permeability (edema)

• cellular infiltration (pus)

• thrombosis (clots)

• stimulation of nerve endings (pain)

Review: Acute vs. Chronic inflammation

local tissue damage from compression → can develop into chronic inflammation

What are examples of Acute inflammation?

• allergic reactions

• chemical irritants

• infections

• trauma injury

• burns

• dehiceration, wounds

• frostbite

what are examples of chronic inflammation?

• cardiovascular disease

• neurological disease

• autoimmune disease

• rheumatoid arthritis

• cancer

• lupus

• fibromyalgia

• chronic fatigue syndrome

• COPD

why does redness occur in inflammation?

an increase of blood flow → vasodilation

why does swelling occur in inflammation?

blood vessels expand → vasodilation →tissue: interstitial space

why does heat occur in inflammation?

vasodilation → increased metabolism

why does pain occur in inflammation?

increased swelling → increase nerve pressure

why does limitation of movement occur in inflammation?

increased pain and swelling

who is at risk for inflammation?

everyone!

Who is more vulnerable to have inflammation?

• youngest (infants, children)

• elderly

• chronic illness including autoimmune diseases

• low socioeconomic status

what are some primary prevention examples for inflammation?

• reducing risk for injury and infection

• maintaining good hygiene

• properly using safety equipment

• properly storing and preparing food

what is a collaborative intervention for inflammation?

• Rest

• Ice

• Compress

• Elevate

How does RICE help with inflammation?

• minimize swelling,

• usually helpful after a sprain, strain, or trauma,

• most beneficial for the first 24 to 48 hours after injury

what to consider for RICE?

• no ice directly on skin

• use for 20 minutes and take a break, and repeat for 3 hours

what are the Nonsteroidal anti-inflammatory drugs?

analgesic, antipyretic, and anti-inflammatory

what does analgesic do?

decrease pain

what does antipyretic do?

decrease fever

what does an anti-inflammatory do?

decrease inflammation

what are some common examples of NSAIDS?

• Asprin (anti clotting)

• Ibuprofen (Motrin, Advil)

• Naproxen (Aleve)

• Celecoxib (Celebrex)

what to assess for NSAIDS?

• is the med appropriate?

• pain, fever, or inflammation

With NSAIDS, what should we be cautious about?

• caution in pregnancy

• history of kidney disease

• bleeding (especially GI or when taking aspirin)

• who’s getting aspirin

Aspirin is contraindicated in?

children (can cause Reyes syndrome)

NSAIDS are nephrotoxic which is?

toxicity of the kidneys

what to monitor with NSAIDS and nephrotoxic?

urine output, urine color, and renal labs

Aspirin is also ototoxic which is?

toxicity of the ear

what to monitor with aspirin?

tinnutus and changes in hearing

with all NSAIDS, they should be taken with?

food or milk to reduce GI irritation

with all NSAIDS, what is the risk?

GI bleeding

What to monitor with ALL NSAIDS?

signs for GI bleed (blood in stool, vomiting blood)

Aspirin has what type of properties?

• anti-platelet properties which can cause more bleeding to occur

• monitor for bleeding

• stop 7-10 days before surgery

what to evaluate with NSAIDS?

how do we know the drug worked?

Acetaminophen (tylenol) is?

• analgesic

• antipyretic

• not anti-inflammatory

• MAX DOSE: do no give more than 4000mg or 4G in 24 hrs

what are the advantages of acetaminophen?

• decreased GI side effects

• decreased problems with clotting

what are the disadvantages of acetaminophen?

• hepatotoxic

• dose needs closely monitored 

• common ingredient (easy to overdose)

Corticosteroids have?

potent anti-inflammatory and immunosuppression properties

how does corticosteroids work?

mimic natural hormones secreted by adrenal cortex

what are the routes of corticosteroids?

• oral

• IV

• topical

• inhaled

what are examples of corticosteroids?

• betamethasone

• cortinsone

• dexamethasone

• hydrocrotisone

• methylprednisolone

• prednisone

what to assess for corticosteroids?

is the med appropriate?

what to be caution about with corticosteroids?

contraindicated in person with:

• pregnancy (category C)

• systemic infections

what are some side effects of corticosteroids?

more common with long term use or oral/IV

• sodium and water retention, potassium loss

• central obesity 

• hyperglycemia (monitor blood glucose level

• increased risk of bone fracture (osteoporosis)

• thinning of the skin and striae (also topical routes)

• mood/personality changes

monitor for Cushing syndrome

what should not be done with corticosteroids?

do not stop abruptly - adrenal insufficiency

what to evaluate for corticosteroids?

how do we know the drug worked

what are antihistamines?

block the effect of histamine

what are examples of antihistamines?

• diphendyramine (benadryl)

• cetirizine (zyrtec)

• Loratadine (Claritin)

• Fenofexadine (allegra)

what to assess for antihistamine?

is the med appropriate?

what are side effects of antihistamine?

• dizzy

• drowsiness

• dry mouth

• changes in vision and appetite

what are nursing considerations for antihistamines?

• safety when driving or operating machinery

• take as directed

• best if taken before the allergy is introduced

what to remember about antihistamine?

it does not replace epinephrine

what to evaluate for antihistamine?

how do you know the drug worked?