Immunity, Inflammation, and Infection Review

Learning Objectives for Immunity, Inflammation, & Infection

  • AH1O-01-05: Differentiate between populations who are at an increased risk for each classification of shock and/or infection.
  • AH1O-01-06: Recognize abnormal lab values and determine corrective actions for a client with an infection/shock.
  • AH1O-01-07: Identify and prioritize diagnostic testing and/or therapeutic interventions for infection and/or shock.
  • AH1—01-08: Identify pharmacological interventions of infection and/or shock, including the nine rights, drug classification, mechanism of action, side effects, allergies, nursing assessment, interventions, drug response, and patient teaching for each related drug.
  • AH1O-01-09: Identify and prioritize teaching concepts for the client with an infection and/or shock.
  • AH1O-01-10: Identify barriers to client compliance to treatment plan and choose strategies to overcome these barriers.
  • AH1O-01-11: Identify nutritional needs/diets for patients experiencing infection and/or shock.
  • AH1O-01-12: Identify and prioritize safety risks and interventions to reduce harm for the client with infection/shock.
  • AH1O-01-13: Identify actions in the inflammatory process and how each action contributes to the signs and symptoms of infection.
  • AH1O-01-14: Identify and implement principles of infection control based on the adult client’s needs (Isolation precautions, PPE, Sterile technique, aseptic technique, clean technique, neutropenic/protective precautions, and universal/standard precautions).
  • AH1O-01-15: Differentiate between acquired and innate immunity.
  • AH1O-01-16: Differentiate between community acquired and health care associated infections.
  • AH1O-01-17: Collaborate with the multidisciplinary team, client, and caregivers to promote health promotion, self-advocacy, and client informed decision making.
  • AH1O-01-18: Identify and prioritize tasks that can be safely delegated to assistive personnel.
  • AH1O-01-19: Perform calculations needed for medication administration.

Immunity

  • Definition: Immunity is the body's ability to resist or fight off infection and disease through specific and non-specific mechanisms.
  • Innate (Natural) Immunity:
    • Present at the time of birth.
    • Specific to a species, race, or individual.
  • Acquired Immunity:
    • Develops after birth.
    • Occurs as a result of the body's natural immune responses to antigens.
    • Developed after direct contact with an antigen, which can occur through contracting an illness or receiving a vaccination.
    • The result is that the body now possesses antibodies to fight off future infections from that specific antigen.

The Inflammatory Process

  • Definition: A nonspecific response to cellular injury.
  • Causes of Inflammation:
    • Trauma.
    • Physical agents (e.g., sunlight).
    • Chemical stimuli (e.g., insect venom).
    • Biologic agents (e.g., bacteria, viruses). Infection is noted as the most common cause of inflammation.

The Four Actions of the Inflammatory Process

  1. Action 1: Cardiovascular (Hemodynamic) Changes
    • Involves the dilation of the capillary bed to increase blood flow to the affected area.
    • Signs & Symptoms: Warmth and redness.
  2. Action 2: Increased Vascular Permeability
    • Increased permeability allows protein-rich fluid to flow through vessel walls and into the interstitial space.
    • Signs & Symptoms: Swelling (edema).
  3. Action 3: Chemical Mediators
    • Release of Prostaglandins, Histamine, and Leukotrienes to trigger the inflammatory response.
    • Cytokines, Eicosanoids, and Bradykinin mediate the dilation of blood vessels.
    • Signs & Symptoms: Pain.
  4. Action 4: Anti-inflammation
    • The body releases Cortisol to slow down the inflammatory process.
    • This action protects the body from the adverse effects of excessive or prolonged inflammation.

Signs and Symptoms of Inflammation

  • Local Inflammation (At the site of injury):
    • Warmth (referred to as calor).
    • Redness (referred to as erythema).
    • Swelling (referred to as edema).
    • Pain (referred to as dolor).
    • Loss of function.
  • Systemic Inflammation (Throughout the body):
    • Fever.
    • Headache.
    • Muscle aches.
    • Chills.
    • Sweating (referred to as diaphoresis).
    • Leukocytosis (an elevated White Blood Cell count).

Infection: Specifics and Causes

  • Infection Causes:
    • Bacteria.
    • Viruses.
    • Fungi.
    • Protozoa.
    • Rickettsiae.
    • Helminths.
    • Prions.
  • Localized Signs and Symptoms:
    • Redness.
    • Pain.
    • Warmth.
    • Swelling.
    • Loss of function.
    • Pus (purulent exudate).
  • Generalized (Systemic) Signs and Symptoms:
    • Pain (ranging from mild to severe depending on location).
    • Fever.
    • Malaise.
    • Anorexia (loss of appetite).
    • Fatigue.

Nursing Management of Infection

  • Nursing Assessment:
    • Monitoring Vital Signs.
    • Physical examination of surgical incisions and wounds.
    • Laboratory Tests:
      • Increased total White Blood Cell (WBC) count.
      • Increased levels of neutrophils, lymphocytes, monocytes, and eosinophils.
      • Cultures: Taking samples of urine, blood, sputum, or specimens from the throat or wound surfaces.
  • Nursing Interventions:
    • Ensure adequate fluids and rest.
    • Provide a high-protein, high-vitamin diet.
    • Implement isolation precautions if required.
    • Administer antibiotics for bacterial infections.
    • Hyperbaric oxygen therapy.

Medical vs. Surgical Asepsis

  • Medical Asepsis:
    • Also known as Clean Technique.
    • Goal: To limit the spread of microorganisms as much as possible.
    • Actions: Changing bed linen, sanitizing surfaces, using Personal Protective Equipment (PPE), and performing Hand Hygiene.
  • Surgical Asepsis:
    • Also known as Sterile Technique.
    • Goal: Elimination of all microorganisms through physical or chemical sterilization.
    • Principles: Sterile items can only remain sterile when touched by other sterile items.
    • Applications: Surgery, placing a central line, placing a Foley catheter, and performing tracheostomy suctioning.

Categorization of Infection Types

  • Community-Acquired Infection:
    • Acquired through day-to-day contact in public spaces.
    • Viral infections are often pervasive and predictable.
    • Prevention & Control: Immunizations, educating food handlers, screening and early treatment, isolation of the infected person, and personal measures (e.g., hand hygiene, condoms).
  • Health-Care Associated Infection (HAI):
    • Acquired within a healthcare facility.
    • Strains involved are usually more virulent and resistant to antibiotics.
    • Often involves Multidrug-resistant organisms (MDROs):
      • Vancomycin-resistant enterococcus (VRE).
      • Methicillin-resistant Staphylococcus aureus (MRSA).

Hospital-Acquired Infections (HAI) Specifics

  • Causes of HAIs:
    • Contaminated Hospital Environment (instruments, fluids, food, air, medications).
    • Patient Flora (typically from the GI or respiratory tracts).
    • Invasive Devices (Foley catheters, endotracheal tubes, wounds, etc.).
    • Medical Personnel.
  • Prevention of HAIs:
    • Vaccination.
    • Early removal of catheters and invasive lines.
    • Performing culture and sensitivity tests to ensure the correct pathogen is treated.
    • Preventing transmission via proper precautions and hand hygiene.

Vaccines

  • Purpose: Vaccines help the immune system fight off infection faster by introducing an antigen so the body can create antibodies to fight it.
  • Applicability: Vaccines are given to healthy people to help them fight off infections should they be exposed in the future.

Transmission-Based Precautions

  • Standard Precautions:
    • Hand Hygiene.
    • PPE (specifically gloves).
    • Cough etiquette.
    • Disinfecting patient care equipment and the environment as needed.
    • Proper handling of laundry.
    • Use of surgical masks for Lumbar Punctures.
  • Contact Precautions:
    • Used for infections transmitted by direct or indirect contact.
    • Examples: RSV (Respiratory Syncytial Virus), MRSA, VRE, Scabies, Lice.
    • PPE Required: Gloves and Gown.
  • Droplet Precautions:
    • Used for infections spread by droplets or dust particles containing infectious agents.
    • Examples: Influenza (A, B), Pneumonia, Rubella.
    • PPE Required: Surgical mask (along with gown and gloves).
  • Airborne Precautions:
    • Used for infections spread through the air.
    • Examples: TB (Tuberculosis), Varicella (chickenpox), Measles.
    • PPE Required: N95 respirator for healthcare providers (along with gown and gloves).
    • Environment: Negative pressure room and a private room are required.

Immunodeficiency and Neutropenic Precautions

  • Definition: A condition where the body's self-defenses against foreign invasion fail to function normally.
  • Terms: Immunocompromised or immunosuppressed.
  • Causes:
    • Congenital.
    • Acquired: Autoimmune diseases, viral infections, malignancies, chronic diseases (e.g., diabetes), drugs (e.g., antineoplastics, steroids), aging, stress, and malnutrition.
  • Signs & Symptoms:
    • Recurrent infections.
    • Low platelet count.
    • Low WBC (defined as a count less than 35003500).
  • Protective Precautions:
    • Also known as Neutropenic precautions or Protective Environment precautions.
    • The purpose is to protect the compromised patient from contracting an illness from the environment or others.
  • Nursing Assessment for Immunodeficiency:
    • Vitals: Signs and symptoms of infection may be absent or masked. A small change in temperature could indicate a serious infection; therefore, monitor temperature regularly.
    • Physical Examination: Check the mouth, perineal area, wounds, and IV sites.
    • Labs: Monitor WBC and platelet counts.
  • Nursing Interventions for Immunodeficiency:
    • Prevent infection through rigorous hand hygiene.
    • Ensure adequate nutrition.
    • Turn, cough, and deep breathe to prevent respiratory complications.
    • Implement protective isolation.

Patient Education for the Immunocompromised

  • Educate the patient that they are at an increased risk for infection.
  • Educate on the specific signs and symptoms of infection to watch for.
  • Provide a supportive environment (the patient may experience anxiety, stress, or powerlessness).
  • Medication Adherence: Crucial to educate the patient to complete the entire course of antibiotics.

Protective Environment (Fungal Prevention)

  • Goal: To reduce the risk of fungal infections for highly vulnerable patients.
  • Actions/Requirements:
    • HEPA Filtration.
    • Directed room airflow.
    • Positive air pressure in the room (must be sealed).
    • Surfaces must be easy to clean.
    • Prohibitions: No potted plants or live/dried flowers are allowed in the room.

Autoimmune Diseases

  • Definition:
    • Natural/Self-tolerance: The body's ability to determine self from non-self.
    • Autoimmunity: A breakdown in self-tolerance where the immune system reacts against and destroys its own tissues. It can affect any tissue or organ system.
  • Causes and Triggers:
    • Initiated by tissue injury, infection, or malignancy.
    • Often poorly understood, though genetic factors are involved.
    • High-Risk Population: Black, Hispanic, and Native American women.
  • Common Autoimmune Diseases:
    • Multiple Sclerosis (MS).
    • Rheumatoid Arthritis (RA).
    • Type 1 Diabetes Mellitus (DM).
    • Ulcerative Colitis (UC).
    • Crohn's Disease.
    • Systemic Lupus Erythematosus (SLE).
    • Psoriasis.
  • Treatment:
    • Varies based on the system involved.
    • For Inflammation: Corticosteroids, NSAIDs.
    • To Moderate Response: Immunosuppressive drugs.
  • Nursing Care:
    • Promote rest.
    • Ensure hydration and nutrition.
    • Prevent infection.
    • Assist with the development of the patient’s coping skills.

Mathematics Review for Nursing

  • Converting pounds to kilograms (1 kg=2.2 lbs1\,kg = 2.2\,lbs).
  • Dosage calculations: DH×V\frac{D}{H} \times V (Desired divided by Have times Volume).
  • Calculating DH\frac{D}{H}.
  • Calculating infusion rates: mL/hr\text{mL/hr}.
  • Converting minutes to hours.