Lecture 1B

1. Lecture 1B Disease transmission/ prevention

2. 1st line of Defense • Skin  • Barrier • Mucus  • Traps and removes

3. Inflammation • “Non-specific” response to injury • WHY? • Destroy pathogens • Limit spread • Begin to heal

4. Pathophysiology of Inflammation • 3 step process • Vascular response • Cellular response • Healing

5. 1. Vascular response Injury  Chemicals released  • Histamine • Bradykinin • Prostaglandins

6. 1. Vascular response • Histamine • Dilate • Vasodilation •  h blood flow •  h pressure • Redness

7. 1. Vascular response • Bradykinin • h permeability •  capillaries leak fluid into surrounding tissue • swelling

8. 1. Vascular response • Prostaglandins  • h Pain • hTemperature • Pain • Heat • Loss of function

9. 2. Cellular response • h blood flow  • h WBC • Neutrophils: • First responders! • Move from blood vessel  the injured tissue

10. 2. Cellular response (cont.) • 2nd responders • Monocytes  (mature)  MACROPHAGES

11. 2. Cellular response (cont.) • Neutrophils + Macrophages • Ingest • bacteria and • dead tissue • PHAGOCYTOSIS

12. Cellular response (cont.) • Neutrophils & Macrophages eat then die •  Pus Formation • “purulent drainage”

13. 3. Healing & Tissue repair • Minor injury: • Inflammatory process heals • Major injury • New cells are produced  • Scar tissue

14. Classic Signs & Symptoms of inflammation • Heat • Redness • Swelling • Pain • Loss of function

15. Geriatric Inflammation Older adult • Thin skin • i blood flow • i macrophages • iphagocytosis • Med interference

16. Geriatric Inflammation • Results • hrisk of injury • iwound healing • i S&S

17. Geriatric Inflammation • In 25% of the elderly, they do not have an elevated fever even with a serious infection

18. Geriatric Inflammation • Best indicator of serious infection in the elderly… • Delirium • Change in mental function

19. Small Group Questions • Define inflammation in your own words and describe the pathophysiology of the inflammatory response. • What are the cardinal signs of inflammation and what causes each one of them? • What is phagocytosis? What cells “do it”? • Why are the elderly more susceptible to inflammation, or are they? • How do the elderly typically manifest infection?

20. Acute vs. Chronic Acute inflammation • Short-term reaction • Immediate response • Duration • < 2 weeks Chronic inflammation • Slower onset • Lasts weeks - months

21. Diabetes mellitus & Inflammation • DM  • h risk of poor wound healing and infection • High blood glucose levels • iphagocytosis • Damages capillaries

22. Systemic manifestations • Enlarges lymph nodes • Appetite • i • Fatigue • Heart rate • Tachycardia

23. Systemic manifestations • Respiratory rate • Tachypnea • Leukocytosis • hWBC • Fever

24. Interdisciplinary Care: Diagnostic Tests • WBC c differential • Erythrocyte sedimentation rate (ESR) • C-reactive protein (CRP) • Cultures

25. WBC c differential • 5 leukocytes • Neurtophils • Eosinophils • Basophils • Monocytes • Lymphocytes

26. WBC c differential • Normal TOTAL WBC • 4,500 – 10,000 mm3 • > 10,000 mm3 • Leukocytosis = • Bacterial infection • < 4,500 mm3  • Leukopenia = • Viral infection

27. WBC c\ differential

28. Erythrocyte Sedimentation Rate (ESR) • Detects generalized inflammation • h = • Inflammation

29. C-reactive Protein (CRP) • Produces by the liverduring acute inflammation • += • inflammation

30. Cultures • Used to identify bacterial infection.

31. Small Group Questions • Differentiate between acute and chronic. • What affect does Diabetes Mellitus have on wound healing? • What are the systemic manifestations of infection? (use medical terms AMAP) • What will the following lab tests indicate? • WBC c/ differential; ESR; CRP; wound culture

32. Medications • Antibiotics • Acetaminophen • Anti-inflammatory agents

33. Antibiotics: Indications • Treat infection caused by bacteria • Preventinfection: • Prophylactic

34. Antibiotics: Rule • Culture done first!

35. Antibiotics: Patient Education • Teach client to FINSH all of the antibiotics

36. Acetaminophen • Is NOT an anti-inflammatory • Analgesic • ipain • Antipyretic • i fever

37. Anti-inflammatory agents • When inflammation  harm  anti-inflammatory drugs • 4 classification • Salicylates • Other Non-steroidal anti-inflammatory drugs (NSAID) • Corticosteroids • Cyclooxygenase-2 (COX-2) inhibitors

38. Salicylates • Aspirin • Acetylsalicylic Acid (ASA)

39. WARNING!!! • Do not give Aspirin to kids • chickenpox’s • influenza

40. Aspirin WARNING!!! • Aspirin + kids •  Reye’s syndrome • h intracranial pressure • Seizures

41. NSAIDS • Non-steroidal anti-inflammatory drugs • Action: • Anti-inflammatory • Anti-pyretic • Analgesic

42. Salicylates & NSAIDS • S/E • GI irritation • Bleeding

43. Corticosteroids • Action: • Anti-inflammatory • Anti-allergy • Anti-immunity

44. Corticosteroids • Indication: • Acute hypersensitivity reactions • Chronic inflammatory diseases

45. Corticosteroids • S/E • Delayed healing • Na+ & H2O retention

46. Corticosteroids • Rules: • Smallest effective dose • Never stop abruptly • Taper the dose

47. Small Group Questions • What 3 classification of medications are used to treat a patient with inflammation? • Give an example by name of each classification of medication. • What are the indications for each medication? • What are the actions of each type of medication? • What are the side-effects of each medication? • What are the Nursing Management (RULES) for each classification of medication?

48. Can you fill this out? Medications used to treat inflammation

49. Keys to wound healing • Healing requires • Adequate circulation • Adequate oxygenation • Adequate nutrition

50. Healing Nutrition • Carbohydrates • Protein • Vitamins • Minerals • Vitamin A • Capillary formation & tissue growth • B-complex • Wound healing • Vitamin C • Collagen synthesis • Vitamin K • Blood clotting • Zinc • Immune health