Inflammation REVIEW

What is inflammation?

Inflammation is an immunologic defense against tissue injury, infection, or allergy

Inflammation: What does it look like?

A localized physical condition in which part of the body becomes reddened, swollen, hot, and often painful, especially as a reaction to injury or infection

Inflammation Pics

Inflammation: Scope

• Ranges from no inflammation to active inflammation

• May be localized or systemic

• Active inflammation may be:

  • Acute

  • Chronic

  • Repair/Restorative

Lymphoid tissues

These are specialized tissues where lymphocytes (a type of white blood cell) are formed and mature. The primary lymphoid tissues include the bone marrow (where B cells mature) and the thymus (where T cells mature). Secondary lymphoid tissues include the lymph nodes, spleen, and mucosa-associated lymphoid tissues (MALT), where immune responses are initiated.

Lymphocytes

These are crucial cells of the immune system that play a significant role in recognizing and responding to pathogens. The main types are B lymphocytes (B cells) and T lymphocytes (T cells). B cells produce antibodies, while T cells can either help other immune cells (helper T cells) or kill infected cells directly (cytotoxic T cells).

Immune response

This is the body’s defense mechanism against pathogens, toxins, or other harmful substances. It can be divided into two phases:

• Innate Immune Response: The body’s immediate, non-specific response that includes physical barriers (skin, mucous membranes), inflammatory response, and phagocytic cells (like neutrophils and macrophages).

• Adaptive Immune Response: A specific response that involves lymphocytes. B cells produce antibodies specific to antigens, and T cells recognize and destroy infected cells.

Types of immunity

• Innate Immunity: Non-specific defense mechanisms that are present from birth and respond quickly to any invader.

• Adaptive Immunity: A specific immune response acquired over time. It has two main types:

• Humoral Immunity: Mediated by B cells and antibodies that circulate in bodily fluids to neutralize pathogens.

• Cell-Mediated Immunity: Involves T cells targeting and destroying infected or abnormal cells.

Inflammatory response: Function

• Restitution of normal, functioning cells after injury

• Fibrous repair when restitution of functioning cells is impossible

Acute Inflammatory Response: Steps

1. Tissue injury and the release of chemical mediators

2. Vasodilation and increased blood flow

3. Swelling and retraction of activated endothelial cells

4. Increased vascular permeability and leakage of small plasma proteins

5. “Walling off”

6. Movement of immune response cells to the site of injury

7. Exudate formation

8. Movement of glucose and oxygen to the site needing repair

9. Release of chemical repair factors from activated endothelial cells

Acute Inflammatory Response: Step 1

Tissue injury and the release of chemical mediators

Acute Inflammatory Response: Step 2

Vasodilation and increased blood flow

Acute Inflammatory Response: Step 3

“Walling off”

Acute Inflammatory Response: Step 4

Movement of immune response cells to the site of injury

Acute Inflammatory Response: Step 5

Exudate formation

Acute Inflammatory Response: Step 6

Movement of glucose and oxygen to the site needing repair

Acute Inflammatory Response: Step 7

Exudate formation

Acute Inflammatory Response: Step 8

Movement of glucose and oxygen to the site needing repair

Acute Inflammatory Response: Step 9

Release of chemical repair factors from activated endothelial cells

Consequences of an Excessive or Ineffective Inflammatory Response

• Local tissue damage from compression

• Development of chronic inflammation

• Systemic pathology:

  • Atherosclerosis

  • Chronic renal disease

  • Neurological disorders

Risk factors: Populations at Greatest Risk

Inflammation can affect all individuals, regardless of age, gender, race, and socioeconomic status. The populations most at risk for a severe or ineffective inflammatory response are the:

• Very young

• Very old

• Uninsured

Blood Test: CBC

A CBC measures overall blood components, focusing on WBCs, which increase with inflammation.

Blood Test: WBC w/ differential

A WBC with differential breaks down WBC types, showing specific increases (e.g., neutrophils for bacterial infection, lymphocytes for viral). These tests help identify and assess inflammation and its potential causes.

Diagnostic Tests: C-reactive protein (CRP)

Measures levels of CRP, a protein that rises with inflammation, often linked to infection or autoimmune diseases.

Diagnostic Tests: Erythrocyte sedimentation rate (ESR)

Measures how quickly RBCs settle at the bottom of a test tube. A faster rate can indicate inflammation in the body.

Diagnostic Tests: Serological tests

To detect specific antibodies or viruses

Diagnostic Tests: Radiographic Tests

• X-rays

• MRI

• CAT

• PET scans

• Colonoscopy

What should you do to eliminate inflammation?

Provide appropriate nursing and collaborative interventions to eliminate inflammation

Clinical Management: Primary Prevention

• Reducing risk for injury and infection

• Maintaining good hygiene

• Properly using safety equipment

• Properly storing and preparing food

Clinical Management: Secondary Prevention

No specific screenings are performed for the general population as it relates to this concept

Collaborative Interventions: Rest, Ice, Compression, Elevation (RICE)

• Most helpful after sprain, strain, or minor trauma

• Helps minimize swelling

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

What is the best method for applying ice? What should the nurse monitor?

• Apply ice wrapped in a cloth (never directly on skin) for 15-20 minutes at a time, with 1-hour breaks between applications.

• Nurse should monitor for signs of tissue damage (e.g., frostbite, numbness, skin color changes), and assess for pain reduction and swelling.

After applying a compression device, the nurse should monitor for what developments?

Nurse should monitor for impaired circulation, such as changes in skin color (pallor, cyanosis), cold skin, tingling, numbness, increased pain, and swelling distal to the device. Also, check capillary refill and pulse in the area.

How high is “high enough” when elevating an extremity?

"High enough" means elevating the extremity above the level of the heart to promote venous return and reduce swelling. Usually, about 12–18 inches above the heart is recommended.