Alterations in Immunity and Inflammatory Process

Alterations in Immunity and Inflammatory Process

Pathophysiology

• Inflammatory Response:

  • Acute inflammation.

  • Chronic inflammation.

Osteoarthritis

• Damage to articular cartilage

• Causes:

  • Aging

  • Trauma

  • Bone spurs and cysts

Epidemiological and Etiological Risk Factors

• Most common arthritis.

• Risk factors:

  • Age

  • Injury

  • Repetitive trauma

  • Genetics

  • Obesity

  • Joint malalignment

  • Sedentary lifestyle

• Links:

  • Cardiovascular disease

  • Diabetes

  • Obesity

  • Hemochromatosis

Impact on Overall Health

• Joint pain

• Fatigue

• Mobility limitations

• Lower employment rates

• Higher missed workdays

• Psychosocial Impact

• Health promotion and prevention considerations for aging

Clinical Presentations

• Pain and joint stiffness

• Muscle atrophy

• Bone deformity

• Movement limitations

• Crepitus

• Joint tenderness

• Lab testing and diagnostic studies:

  • Radiography

  • MRI

  • Ultrasound

  • ESR

  • Arthrocentesis

  • CRP

Role of the Nurse

• Pain management

• Mobility aids

• ADL assistance

• Psychosocial support

• Client education

Clinical Judgement

• Recognize cues (assessment)

• Analyze cues

• Prioritize hypotheses (analysis)

• Generate solutions (planning)

  • Nonsurgical interventions

  • Pharmacological interventions

  • Surgical interventions

• Take actions (implementation)

• Evaluate outcomes (evaluation)

Peritonitis

• Inflammation of peritoneum

• Causes:

  • Infections

  • Trauma

  • Organ disease

Epidemiological and Etiological Risk Factors

• Two types:

  • Spontaneous

    • Complication of liver or kidney failure

  • Secondary

    • Result of ruptured organ

• Risk factors:

  • Cirrhosis

  • Ulcerative colitis

  • Stomach ulcer

  • Pelvic inflammatory disease

  • Peritoneal dialysis

  • Appendicitis

  • Diverticulitis

  • Pancreatitis

  • Weakened immune system

Impact on Overall Health

• Life-threatening if untreated

• Sepsis

• Health promotion and prevention considerations for aging

Clinical Presentation

• Symptoms:

  • Abdominal tenderness, rigidity, pain

  • Nausea and vomiting

  • Constipation

• Lab testing and diagnostic studies:

  • Peritoneal culture

  • Imaging

  • CBC

  • BUN

  • Creatinine

  • Hemoglobin/hematocrit

Role of the Nurse

• Minimize risk (Peritoneal dialysis)

• Observe for sepsis

• Client education

Clinical Judgement

• Recognize cues (assessment)

• Analyze cues

• Prioritize hypotheses (analysis)

• Generate solutions (planning)

  • Treatment and therapies

  • Surgical interventions

• Take actions (implementation)

• Evaluate outcomes (evaluation)

Rheumatoid Arthritis

• Chronic joint inflammation

• Autoimmune

  • Immune response

    • Active immunity

    • Passive immunity

  • Autoantibodies

Epidemiological and Etiological Risk Factors

• Risk factors:

  • Age

  • Genetics

  • Female gender at birth

  • Obesity

  • Smoking

  • Stress

  • Immune dysfunction

Impact on Overall Health

• Correlations:

  • Heart disease

  • Blood clots

  • Sleep apnea

  • Medication side effects

• Psychosocial impact

• Health promotion and prevention considerations for aging

Clinical Presentation

• Symptoms:

  • Fever

  • Malaise

  • Pain

  • Weakness

  • Joint stiffness and swelling

  • Nodules

• Lab testing and diagnostic studies:

  • Serology

  • Imaging

Role of the Nurse

• Minimize risk (Falls)

• Assistive devices

• Client education

Clinical Judgement

• Recognize cues (assessment)

• Analyze cues

• Prioritize hypotheses (analysis)

• Generate solutions (planning)

  • Treatment and therapies

  • Pharmacological interventions

  • Plasmapheresis

  • Surgical interventions

• Take actions (implementation)

• Evaluate outcomes (evaluation)

Case Study: Rheumatoid Arthritis

• Robin Jones, 37-year-old female, reports joint pain and swelling.

• Assessment data:

  • Extremity joint pain (6/10) and morning stiffness in hands for two months.

  • Tenderness when hand joints palpated and moved passively.

  • Episodic swelling of hands and feet interfering with mobility.

  • Difficulty with hand movement; hands look deformed.

  • Concave curvature in thumbs and slight ulnar deviation of fingers bilaterally.

  • Works in day care; stressful job.

  • Smokes 1.5 packs of cigarettes every two days.

  • Poor nutritional intake and lack of sleep.

• Diagnosis: Suspected rheumatoid arthritis.

• Laboratory studies ordered:

  • Rheumatoid factor

  • Erythrocyte sedimentation rate

  • C-reactive protein

  • Antinuclear antibody

  • CBC

  • Liver Enzymes (ALP/ALT/AST)

  • BUN

  • Creatinine

• Diagnosis confirmed after one week; need for immunosuppressive medication regimens discussed.

• Prescribed dexamethasone, hydroxychloroquine, and methotrexate.

• Three-month follow-up: Expresses concerns about working in day care with medications, frequent upper respiratory infections, constant tiredness, and increased smoking (one pack daily).

Lupus

• Chronic autoimmune disease

• Two types:

  • Systemic lupus erythematosus (SLE)

    • Most common

    • Affects tissues of multiple organs

  • Discoid lupus erythematosus (DLE)

    • Affects skin

    • Can progress to SLE

Epidemiological and Etiological Risk Factors

• Triggers:

  • Hormones

  • Genetics

  • Infection

  • Stress

  • Medications

  • Toxins

  • Epstein-Barr virus

  • UV light

  • Silica dust

• Occurs mostly in females

• Inflammatory effects:

  • Kidneys

  • Central nervous system

  • Cardiovascular system

  • Serositis

Impact on Overall Health

• Cardiovascular disease (Stroke, Myocardial infarction)

• Kidney disease

• Psychosocial:

  • Chronic pain

  • Fatigue

  • Cognitive issues

  • Anxiety

  • Depression

• Health promotion and prevention considerations of aging

Clinical Presentation

• Symptoms:

  • SLE

    • Skin rash (butterfly)

    • Arthritis

    • Inflammation of feet and eyes

    • Fatigue

    • Low-grade fever

  • DLE

    • Scaly, red rash on face or scalp

    • Sores in nose or mouth

• Lab testing and diagnostic studies:

  • Serology

  • Imaging

Role of the Nurse

• Minimize triggers (UV light, Exhaustion, Stress)

• Client education

Clinical Judgement

• Recognize cues (assessment)

• Analyze cues

• Prioritize hypotheses (analysis)

• Generate solutions (planning)

  • Treatment and therapies

• Take actions (implementation)

• Evaluate outcomes (evaluation)

HIV/AIDS

• Retrovirus affecting immune system

• Targets and destroys CD4 white blood cells (T Cells)

• Results in opportunistic infections:

  • Tuberculosis

  • Fungal infections

  • Bacterial infections

  • Cancers

Epidemiological and Etiological Risk Factors

• Spread through infected body fluid contact:

  • Blood

  • Semen

  • Rectal fluids

  • Vaginal fluids

  • Breastmilk

• Viral load:

  • HIV-positive

  • AIDS

• Worldwide epidemic

• Populations at risk:

  • Sexual activities

  • Sharing drug needles

  • Use of drugs/alcohol

  • Incarceration

Impact on Overall Health

• Weakened immune system (Opportunistic infections and cancers)

• Prone to other disorders (Tuberculosis, Fungal infection, Lung cancer, Hypertension, Salmonella infection complications, Dementia, Herpes, Eczema)

• AIDS related conditions:

  • Cytomegalovirus (CMV)

  • Kaposi sarcoma

  • Lymphoma

  • Tuberculosis

  • Heart failure

• Psychosocial impact

• Health Promotion and prevention considerations for aging

Clinical Presentation

• Initially asymptomatic

• May include:

  • Fever

  • Headache

  • Rash

  • Sore throat

• With progression:

  • Swollen lymph nodes

  • Weight loss

  • Fever

  • Diarrhea

  • Cough

• Stages:

  • Acute infection

  • Chronic infection

  • AIDS

• Lab testing and diagnostic studies:

  • HIV testing

  • Viral load testing

  • CD4 counts

  • Antigen/antibody testing

  • Related conditions testing

Role of the Nurse

• Environmental factors (Healthcare exposure precautions and prevention)

• Individual factors (Client education)

Clinical Judgement

• Recognize cues (assessment)

• Analyze cues

• Prioritize hypotheses (analysis)

• Generate solutions (planning)

  • Treatment and therapies

• Take actions (implementation)

• Evaluate outcomes (evaluation)

Anaphylaxis

• Severe allergic reaction

• Occurs after sensitization

• Affects multiple body systems

• Histamine release/blood vessel permeability/hypotension

• Flushing/rash/edema/urticaria

• Nausea/vomiting/diarrhea

• Dizziness/confusion/headaches/fainting

• Anaphylactic shock (Cardiovascular and respiratory failure)

Epidemiological and Etiological Risk Factors

• Triggers:

  • Insect stings

  • Food

  • Medications

  • Other substances

  • Exercise

• High risk:

  • Asthma

  • Chronic lung disease

  • Medications (Beta blockers, Alpha adrenergic blockers)

  • Mastocytosis

Impact on Overall Health

• Physiological

• Psychosocial

• Health promotion and prevention

Clinical Presentation

• Initial symptoms:

  • Rash/urticaria

  • Shortness of breath/wheezing

  • Stomach pain/nausea

  • Facial swelling

  • Fainting

• Anaphylactic shock if untreated:

  • Hypotension

  • Hypoxia

• Lab testing and diagnostic studies

Role of the Nurse

• Environmental factors:

  • Food

  • Medication

  • Latex

• Individual factors:

  • Client education

Clinical Judgment

• Recognize cues (assessment)

• Analyze cues

• Prioritize hypotheses (analysis)

• Generate solutions (planning)

  • Treatment and therapies

• Take actions (implementation)

• Evaluate outcomes (evaluation)

Bacterial and Viral Infections

• Invasion of pathogens:

  • Bacteria

  • Viruses

  • Fungi

  • Protozoa

• Immune response:

  • Fever

  • Interferon

  • Antibodies

  • White blood cells

• Antimicrobial resistant infections (Multidrug-resistant organisms (MDROs))

Epidemiological and Etiological Risk Factors

• Spread via:

  • Skin

  • Body fluids

  • Feces

  • Airborne

  • Contaminated food/water

• Sepsis

• Antimicrobial resistant infections

Impact on Overall Health

• Post-sepsis syndrome

• Psychosocial Impact

• Health promotion and prevention

• Antimicrobial resistant infection

• Psychosocial Impact

• Health promotion and prevention considerations for aging

Clinical Presentation

• Local: Abscess

• Systemic:

  • Fever

  • Tachycardia

  • Confusion

  • Seizures

  • Coma

• Sepsis and septic shock

• Lab testing and diagnostic studies

• Anti-microbial resistant infections

  • Streptococcus pneumoniae:

    • Pneumonia

    • Ear infection

    • Sinus infection

    • Meningitis

  • Enterobacteriaceae (Gastroenteritis)

  • MRSA

• Lab testing and diagnostic studies

Role of the Nurse

• Determine risks

• Aseptic technique

• Personal protective equipment

• Client education

Clinical Judgement

• Recognize cues (assessment)

• Analyze cues

• Prioritize hypotheses (analysis)

• Generate solutions (planning)

  • Treatment and therapies

• Take actions (implementation)

• Evaluate outcomes (evaluation)

Influenza

• Viral infection

• Compromises alveolar function

• Types A and B

Epidemiological and Etiological Risk Factors

• Types A and B subtypes

• Epidemic from October to May

• Transmitted person-to-person

  • Respiratory aerosol droplets

  • Inhalation

  • Contact

• Incubation 1 to 4 days

• Greatest risk:

  • Indigenous

  • Age less than 5

  • Pregnancy

  • Immunocompromised

  • Chronic conditions

Impact on Overall Health

• Psychosocial Impact

• Health promotion and prevention considerations for aging

Clinical Presentation

• FACTS:

  • Fever

  • Aches (muscle, head, body)

  • Chills

  • Tiredness

  • Sudden onset

  • Cough

  • Nasal discharge

  • Congestion

  • Sore throat

• Lab testing and diagnostic studies

Role of the Nurse

• Personal protective equipment

• Client education

• Vaccination (Reduce rate of transmission)

• Antiviral medications

Clinical Judgement

• Recognize cues (assessment)

• Analyze cues

• Prioritize hypotheses (analysis)

• Generate solutions (planning)

  • Treatment and therapies

• Take actions (implementation)

• Evaluate outcomes (evaluation)

Sinusitis

• Inflammation of sinus cavities

• Bacterial or viral

• Follows cold or allergies

Epidemiological and Etiological Risk Factors

• Acute vs. Chronic

• Correlations

Impact on Overall Health

• Psychosocial Impact

• Health promotion and prevention

Clinical Presentation

• Facial pain/pressure

• Congestion

• Alterations in taste and smell

• Postnasal drip

• Fever

• Headache

• Fatigue

• Malaise

• Dental pain

• Bad breath

• Cough

• Earache

Role of the Nurse

• Client education

Clinical Judgement

• Recognize cues (assessment)

• Analyze cues

• Prioritize hypotheses (analysis)

• Generate solutions (planning)

  • Treatment and therapies

• Take actions (implementation)

• Evaluate outcomes (evaluation)

Meningitis

• Inflammation of meninges

• Affects subarachnoid fluid

• Mostly bacterial or viral

Epidemiological and Etiological Risk Factors

• Causative agents:

  • Bacteria

  • Viruses

  • Fungi

  • Parasites

  • Amoeba

  • Trauma

  • Medications

• High risk:

  • HIV/AIDS

  • Group settings

  • Travel

Impact on Overall Health

• Psychosocial Impact

• Health promotion and prevention, vaccination

Clinical Presentation

• Infants:

  • Anorexia

  • Vomiting

  • Diarrhea

  • Irritability

  • Rash

  • Respiratory symptoms

• Adults:

  • Fever

  • Headache

  • Stiff neck

  • Seizures

  • Photosensitivity

• Lab testing and diagnostic studies:

  • Lumbar puncture

    • CSF proteins

    • Culture

Role of the Nurse

• Identify risks

• Client education

Clinical Judgment

• Recognize cues (assessment)

• Analyze cues

• Prioritize hypotheses (analysis)

• Generate solutions (planning)

  • Treatment and therapies

• Take actions (implementation)

• Evaluate outcomes (evaluation)

Term 1: HIV/AIDS
Definition 1: Retrovirus affecting immune system
Term 2: HIV/AIDS Target
Definition 2: Targets and destroys CD4 white blood cells (T Cells)
Term 3: HIV/AIDS Spread
Definition 3: Blood, Semen, Rectal fluids, Vaginal fluids, Breastmilk
Term 4: Viral load
Definition 4: HIV-positive, AIDS
Term 5: Populations at risk
Definition 5: Sexual activities, Sharing drug needles, Use of drugs/alcohol, Incarceration
Term 6: Impact on Overall Health
Definition 6: Weakened immune system (Opportunistic infections and cancers)
Term 7: AIDS related conditions
Definition 7: Cytomegalovirus (CMV), Kaposi sarcoma, Lymphoma, Tuberculosis, Heart failure
Term 8: Initial Symptoms
Definition 8: Fever, Headache, Rash, Sore throat
Term 9: Lab testing and diagnostic studies
Definition 9: Related conditions testing
Term 10: Environmental factors Role of Nurse
Definition 10: Healthcare exposure precautions and prevention
Term 11: Opportunistic Infections
Definition 11: Tuberculosis, Fungal infections, Bacterial infections, Cancers