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Inflammation & the Immune Response

Inflammation & the Immune Response. Keith Rischer, RN, MA, CEN, CCRN. Objectives for this content. Inflammatory response #1-3 Infection/sepsis/chain of infection #4-10 Physiologic immune response #11-16. Three Lines of Defense. Anatomical Barriers Acute Inflammatory Response

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Inflammation & the Immune Response

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  1. Inflammation & the Immune Response Keith Rischer, RN, MA, CEN, CCRN

  2. Objectives for this content • Inflammatory response • #1-3 • Infection/sepsis/chain of infection • #4-10 • Physiologic immune response • #11-16

  3. Three Lines of Defense • Anatomical Barriers • Acute Inflammatory Response • Immune System

  4. Lines of Defense

  5. Anatomical Barriers: First Line of Defense • Skin • Mucous membranes • Normal bacterial flora • Clostridium difficile • Yeast infections

  6. Normal Body Defenses Skin multilayer barrier, shed outer layer, contains fatty acids that kills some bacteria Lungs contain cilia in upper respiratory tract, macrophages Urinary Tract flush action of urine washes away bacteria Perry and Potter pg. 647 Ch 34 Table 34-3

  7. Inflammatory Response

  8. Inflammatory Response • Occurs in response to injury • Localized • Immediate • Beneficial • Appropriate level of response • Non Specific

  9. Causes of Inflammation • Physical • Trauma • Lacerations • Burns • Chemical- Bites • Allergic response • Micro-organisms • Bacteria

  10. Inflammatory Response • REDNESS • SWELLING • PAIN • HEAT • LOSS OF FUNCTION

  11. Purpose of inflammation • Neutralizes and Dilutes Toxins • Removes necrotic materials • Provides an environment for healing • Add “itis” to affected body part

  12. 4 Phases of Inflammation • Vascular • Think blood vessels • Cellular • Think WBC’s • Formation of Exudate • Fluid & neutrophils • Healing • regeneration or repair of tissue

  13. Vascular Phase: Blood Vessels • Injury occurs • Mediators intervene • Vasodilation occurs • Capillaries become more permeable • Swelling and movement of fluid occurs

  14. Cellular Phase – Think WBC’s • Injury occurs • Chemotaxis begins • White blood cells rush in to help • Neutrophils • Monocytes • Macrophages

  15. Chemical Mediators Coordinators of the inflammatory response • Histamine • Prostagladins • Cytokines

  16. Laboratory tests Erythrocyte sedimentation rate (ESR or sed rate) <20 mm/hr CRP – C reactive protein non specific test identifying the presence of inflammation <1.0 mg/dl

  17. Application of the Nursing Process Data/Assessment: • History • Local signs and symptoms including pain assessment • WILDA • Applicable lab work

  18. Nursing Diagnosis Acute pain related to tissue trauma Impaired physical mobility related to discomfort

  19. Nursing Interventions Care will vary with causative agent and physical condition of the patient What are some nursing actions you might implement or anticipate How will you as the nurse evaluate the outcome

  20. Expected Outcomes… • Healing of the wound or injury • Prevent minor infections from becoming overwhelming to the body • UTI vs. urosepsis • Goals and outcomes will vary with each patient • Remember that your outcomes will drive your interventions/cares

  21. Systemic Manifestations of Acute Inflammation • Fever/chills • Cytokines • Benefits • Increased killing of microorganisms • Increased phagocytosis by neutrophils • Increased activity of interferon • Leukocytosis • Neutrophils • “left shift”…band cells

  22. Medications: NSAIDS Ibuprofen, Toradol Mechanism of action Inhibits prostaglandin synthesis Nursing implications Give w/food Elderly-high risk GI bleed Prolongs bleeding times 1 day Assess renal function-creatinine w/chronic use

  23. Medications: NSAIDS • Salicylates – Aspirin • Mechanism of action • Inhibits production of prostaglandins • Decreases platelet aggregation • Nursing implications • Give w/food • Prolongs bleeding times 4-7 days

  24. Medications: Anti-histamines Benadryl, Ranitidine (Zantec), Famotidine (Pepcid) Mechanism of action Block histamine at the receptor site Decreases gastric acid secretion Nursing implications With meals Drowsiness/dizziness

  25. Medications: Corticosteroids • Prednisone • Mechanism of action • Decrease inflammation by stabilizing neutrophils and lysosomes • Inhibit prostaglandin synthesis • Inhibits chemotactic cytokines • Decreases mast cell stimulation • Nursing implications • Meals • Chronic use complications • Risk of infection • Hyperglycemia • SE

  26. 26 yr female with no medical history CC Severe epigastric abd pain the last 2 days Severe pain all night, rates 10/10-sharp-nothing relieves. Appears uncomfortable T-101.2 P-110 R-24 BP 168/88 sats 98% RA Tender epigastric area, BS active x4 Labs K+-3.4 Na+ 138 Creatinine 0.6 ALT-81 AST-81 WBC-28.7 Lipase-1633 Inflammation Case Study

  27. Case Study continued • Outcomes • Nursing diagnosis priorities • Plan of care • Evaluation

  28. What is an infection?

  29. Normal Course of an Infection Incubation period Prodromal stage Full stage of illness Convalescence

  30. Infectious agents/pathogens • Bacteria • Virus • Fungi • Protozoa

  31. Bacteria • Single cell • Human cells vs. bacteria count in body • Gram +/-

  32. Virus • Most common affliction of humans • Has no metabolism of it’s own • Is incapable of replicating outside a living cell • Takes over the metabolic machinery of host cells to survive and replicate

  33. What influences Pathogen survival? Food/Glucose Water Oxygen – aerobic/anaerobic Temperature pH light

  34. Reservoir • A place where a pathogen can survive but may or may not multiply • What is the most common reservoir? • What is a carrier?

  35. Portal of exit • For the pathogen to cause an infection it must exit the reservoir • How can this happen?

  36. Mode of Transmission • Direct or indirect • What is the major mode of transmission in the health care setting? • List the 4 categories of transmission

  37. Portal of entry

  38. Susceptible Host • What factors increase our susceptibility to infection? • Age • Stress • Nutritional status • Current medical therapies • Chemo • Steroids • Presence of disease

  39. Breaking the Chain

  40. Leukocytes=Braveheart

  41. Leukocytes • Normal Blood Count of all WBC: 4,000-11,000/ul • Neutrophils • Monocytes • Lymphocytes B cells: mediate the humoral immune response • T cells: Mediate cellular immunity • Elderly considerations

  42. Laboratory Studies CBC Hgb (12-16 g/dl) Hct (33-51%) Platelets (140-440 thou/cu mm) WBC (4.5-11.0 thou/cu mm) Differential Never-neutrophils (42-72%) Let-lymphocytes (20-44%) Monkeys-monocytes (<11.1%) Eat-eosinophils (<7.1%) Bananas-basophils (<3.0%)

  43. Cultures, gram stains and sensitivities • Wound and skin cultures, body fluids, blood cultures • Gram stains • Sensitivities

  44. Anti-infective Drugs Determine if hypersensitive to medication Check for interactions with other drugs Educational needs of client Determining effectiveness

  45. Antibiotic Therapy Anti-fungal Fluconazole, Nystatin Cephalosporins Cephalexin (Keflex) Penicillins Amoxicillin, Ampicillin Sulfonamides Bactrim Tetracyclines Doxycycline

  46. Antibiotic Resistance Bacteria adapt in ways which make an antibiotic less effective or ineffective MRSA – Methicillin resistant staphylococcus aureus VRE – Vancomycin resistant enteroccus

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