Ch. 14 Inflammation & Healing Flashcards by Tisha Liim

What are the body’s 3 lines of defense?

1st line of defense: Non-specific mechanism
2nd line of defense: Non-specific processes of phagocytosis and inflammation
3rd line of defense: specific defense mechanism known as immune response

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Body’s 1st line of defense:
1.)
It’s a ___ barrier such as __ or __ __ that blocks entry of bacteria or harmful substances in tissues. Associated with these barriers are __ __ such as __ or __ that contain __ or __ that inactivate or destroy a potentially damaging material.

1.) Non specific mechanism
mechanical; skin; mucous membrane
body secretions; saliva; tears; enzymes; chemicals

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Body’s 2nd line of defense:

1.)

1.) Non specific processes of phagocytosis and inflammation

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Body’s 2nd line of defense: phagocytosis is the process by which __ and __ destroy __, __ __, or __ ____.

neutrophils; macrophages; bacteria; cell debris; foreign matter

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Body’s 3rd line of defense:
1.)
It provides protection by simulating the production of unique ___ or __ __ following exposure to specific substances.

1.) specific defense mechanism known as immune response

antibodies, sensitized lymphocytes

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Inflammation is a __ __ __ in the body and is intended to __ and remove any injurious agent whatever it may be

normal defense mechanism; localize

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3 purposes of the inflammatory response:

) Neutralize and destroy invading harmful agents
) Limits the spread of these harmful agents to other tissue
) Prepare damaged tissue for repair

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Inflammation can also be caused by: (7)

direct physical damage such as cuts or sprains
caustic chemicals such as acids or drain cleaners
ischemia or infarction
allergic reaction
extremes of heat or cold such as with a burn
foreign bodies such as splinters or glass
infection

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Bradykinin is an

inflammatory mediator that causes blood vessels to enlarge and is released from the injured cells

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Bradykinin activates __ __ , which stimulate __ __ and __ to release __.

pain receptors; mast cells; basophils; histamine

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Histamine along with __ causes __ __ and __ __. This increases __ __.

bradykinin; capillary dilation; local vasodilation; capillary permeability

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Globulins serve as __ against bacteria.

antibodies

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__ then forms a __ __ around the area in an attempt to __ the injurious agent.

Fibrinogen; fibrin mesh; localize

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___ phagocytose bacteria and __ then leave the bloodstream and phagocytose microbes

Neutrophils; macrophages

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Acute inflammation involves both __ __ __ and __ __ __.

plasma derived mediators; cell derived mediators

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Plasma derived mediators deal with

fever, swelling, clotting that causes scab formation, and kinin which is responsible for capillary vasodilation and stimulates pain

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Cell derived mediators include

WBCs for phagocytosis ; the release of histamines and other cytokines

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When tissue injuries occur, the damaged __ cells and __ release __ __ including __, __, __, and __ into the interstitial fluid and blood. The chemicals affect __ __ and __ in the damaged area.

mast; platelets; chemical mediators; histamine, serotonin, prostaglandins, and leukotrienes; blood vessels

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Cytokines serve as communicators in the tissue fluids by sending messages to: (3)

lymphocytes and macrophages
immune system
hypothalamus to induce fever

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Chemical mediators such as __ are released immediately from __ and __ __. Other chemical mediators such as __ and __ are responsible for the __ effects prolonging inflammation.

histamine; granules and mast cells

leukotrienes; prostaglandins; later

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During the cellular response, __ are attracted by chemotaxis to the area of inflammation as damaged cells release their contents.

leukocytes

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Several chemical mediators at the site of injury act as potent __ to attract __.
First, __ and later __ and __ collect along the capillary wall and then migrate out through wide separations of the wall into the interstitial area.

stimuli; leukocytes

neutrophils; monocytes and macrophages

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the movement of cells from the capillary wall to the interstitial area is called ____

Diapedesis

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When phagocytic cells die at the site, __ __ are released and __ nearby cells, prolonging ____. If an __ __ or __ __ occurs, this also enhances the __ response.

lysosomal enzymes; damages; inflammation

immune response; blood clotting; inflammatory

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Cardinal signs of inflammation:

``` redness heat swelling pain loss of function ```

If we go back to a wound, like a pressure ulcer that gets infected, the body can respond by developing (6):

``` a fever fatigue malaise headache anorexia (lack of appetite, lower appetite) weight loss ```

Pyrogens =

fever inducing substances

Pyrogens circulate in the blood and trigger the __ to __ to a __ level or __ ___. So the temperature level that the body must meet now is __. Therefore you have __ mechanisms like __, ___, and increases in the __ __ __. Once that gets __ __ __, that's what causes fever.

hypothalamus; reset; higher; higher temperature; higher compensatory; shivering; vasoconstriction; basal metabolic rate out of control

When inflammation occurs, __ can form. Think about an __ as any fluid that filters from the circulatory system into the __, or areas of inflammation. It can be __ __ or __ fluid.

exudate; exudate; lesion pus like, clear

When an injury occurs, the skin is left exposed, fluids leaks out of the __ __ and into the nearby __. The fluid is composed of __, __, and ___.

blood vessels; tissues serum, fibrin, WBCs

Inflammatory exudates transport __ and __ to the body so __ can occur. They also transport __ to the area in order to allow for tissue repair.

leukocytes; antibodies; phagocytosis nutrients

Name the 5 different types of inflammatory exudates:

1. Serous exudates 2. Sanguinous exudates 3. Serosanguinous exudates 4. Fibrinous exudates 5. Purulent exudates

Serous exudates are

watery, consist of primarily fluid, some proteins, and WBCs

Sanguinous exudates are

bloody

Serosanguinous exudates are

mostly serous with RBCs present, but may be pinkish; still watery

Fibrinous exudates are

thick, sticky, high cell and fibrin content

Purulent exudates are

thick, yellow green, contain more leukocytes, cel debris, and microorganisms (ex: pus)

Leukocytosis is : | This is important b/c it allows __ to go the __ area and phagocytose any invading bacteria

an increase in WBCs; neutrophils; injured

During inflammation, there is an increase in __ __ __ in the blood. This is not normally found in the blood and we use it as an inflammatory __ b/c it appears with acute inflammation and ___ within ___-__ hours.

C reactive protein marker; necrosis ; 24-48

During inflammation, there can also be an elevated __ __ called __ in blood. Elevated __ __ increase the rate at which ___ settle in a sample. This is why we use __ as an inflammatory __.

sediment rate; ESR plasma proteins; RBCs ESR; marker

An increase in __ __ and __ __ occurs in the blood when undergoing inflammation.

plasma proteins; cell enzymes

When assessing for a infection or inflammation, we are looking for a WBC greater than

11,000

Neutrophils are responsible for

phagocytosis

Basophils release

histamine leading to inflammation

Eosinophils increase an __ __. They also consume substances related to __ with a __.

allergic response; infection; parasite

When we are looking at lymphocytes, another type of WBC, we are talking about our __ cells and __ cells.

T; B

T cells are active in _-__ __ ___ and B cells produce __. Other lymphocytes include __ and __.

cell-mediated responses; antibodies | macrophages; monocytes

In looking at our WBC differential, a patient with leukocytosis also known as elevated white count often has an increase in ___ __, or __. An elevated band level indicates a __ __.

immature neutrophils; bands left shift

Acute inflammation is short in duration, usually lasting less than __ __. It involves a __ set of events, and there is __ __.

2 weeks | discrete; minimal scarring

With chronic inflammation is a __ swelling and exudate. There is a presence of more __, __, and __. There is usually continued __ __ and more __ __ __. Also, __ may develop around the foreign object.

less lymphocytes, macrophages, and fibroblasts tissue destruction; fibrous scar tissue granulomas

Complications that occur b/c of inflammation include: (4)

1. ) infection b/c microorganisms can more easily penetrate edematous tissue. 2. ) cell necrosis and lack of cell regeneration cause erosion of tissue ; This results in a severe, prolonged inflammation. 3. ) skeletal muscle spasms can occur to protect in response to pain. 4. ) Local complications depend on the site of inflammation but can include obstruction, loss of sensation and decreased cell function

"RICE" therapy

Rest Ice Compression Elevation

Ice and compression cause __ __ in an effort to reduce __.

local vasoconstriction; swelling

Elevation allows for decreased __ due to gravity.

swelling

Pharmacologic treatment for inflammation: 3 categories

1. ) Anti-inflammatory meds 2. ) Analgesia medications 3. ) Antipyretic meds

Examples of anti-inflammatory meds (reduce swelling):

1. ASA 2. NSAIDs like Aleve and Ibuprofen 3. Steroids like Prednisone

Examples of Analgesics: (pain relievers)

1. ASA 2. Tylenol 3. Ibuprofen 4. Aleve

What are antipyretics:

fever reducers

The other things that is very essential to understand are medications such as __ and __. These can __ __ in our patients. WE have to look out for bleeding such as __, __-, __ __.

ASA; NSAIDs increase bleeding bruising, nosebleeds, GI bleeds

Complement activation includes (5): these are accomplished through __ __ __.

1. ) cell lysis which is destruction of the cell 2. ) mass cell degranulation with the release of histamine 3. ) chemotaxis which involves release of chemical mediators like bradykinin 4. ) an attraction of leukocytes 5. ) opsonization which involves coding of foreign cells to make it easier for phagocytic cells to find plasma derived mediators

Long term use of synthetic steroids like Prednisone affects the normal feedback mechanism of the body leading to a __ or normal secretion of the natural hormones and __ of the __ __ where steroids are produced. __ of __ tissues reduce the number of ___ leading to an increased risk of __ and decreased __ __. Catabolic effects include __ __, which can lead to __, __ __, and tendency of thinning of __ or __.Therefore, sudden sensation of the presence of increased __ may cause an adrenal crisis similar to __ b/c insufficient glucocorticoids are available in the body.

reduction; atrophy; adrenal glands; Atrophy; lymphoid; WBCs; infection; immune response; bone demineralization; osteoporosis; muscle wasting; skin; mucosa; stress; shock

What are the 3 types of healing?

1: Resolution 2: Regeneration 3. Replacement

Resolution is a process that occurs when there is __ __ _. The damaged cells recover and the tissue return to normal in a short period of time. EX: __ __

minimal tissue damage; mild sunburn

Regeneration occurs in damaged tissue in which the cell is capable of __. Some types of cells such as __ cells are always replicating while there are cells like __ in the liver that undergo mitosis when necessary.

mitosis epithelial hepatocytes

Replacement by __ __ or __ __ __ takes place when there is extensive tissue damage or the cells are incapable of __. EX: __, ___.

connective tissue; scar fibrous tissue; mitosis | brain; myocardia

Healing by Primary intention: Example:

a paper cut or surgical incision

With a surgical incision, sutures are applied in order to approximate the __ __. This means that the __ __ are kept __ __ so they can __. All areas are able to heal simultaneously.

wound edges; wound edges ; close together; heal

Healing by Secondary Intention: When there is a large break in tissue with more inflammation such as with a __ ___ or __ __, the wound heals from __ __. Meaning that the wound heals from __ ___. With this, there is a longer healing period and more __ __ develops.

pressure ulcer; compound fracture; bottom up; inside out; scar tissue

During the proliferative phase, foreign material and cell debris have been removed by phagocytes, monocytes, and macrophages. Then, __ __ which is highly __ and is __ and __ or even __, grows in the gaps.

granulation tissue; vascular; pink; red

The onset of the remodeling phase can range from around __ __ to __ __. The remodeling phase as a whole can last for a __ or __. As the phase progresses, the __ __ of the wound increases. With scar tissue, it becomes __% as strong as normal tissue. Since activity at the wound site is reduced, the scar loses its __ appearance as blood vessels that are no longer needed are removed by __. Usually, phases of wound healing progress in a predictable manner. If they don't, healing may progress to a __ __, such as a __ __, or a __ __ such as a __.

3 days; 3 weeks year; longer tensile strength 80% red apoptosis chronic wound; venous ulcer pathological scarring; keloid

Acute wounds involve a breach in the integrity of the __ and __ __. These lesions go through the four stages of healing:

skin; underlying tissue 1. ) Hemostasis 2. ) Inflammatory stage 3. ) Proliferative stage 4. ) Maturation stage

``` Chronic wounds fail to complete cycle of healing within __ to __ __ despite interventions. Reasons for this include: 1.) 2.) 3.) It is estimated that over __ ___ individuals worldwide suffer from long term lesions. Some of the most common types: 1.) 2.) 3.) 4.) ```

2 to 4 weeks; 1. ) patient comorbidities 2. ) lifestyle choices 3. ) characteristics of the wound itself 67 million 1. ) Pressure ulcers 2. ) Venous wounds 3. ) Arterial wounds 4. ) Lesions associated with diabetes

Pressure Ulcers: According to the __ __ __ __ __, a pressure ulcer is a __ injury to the __ and/or __ __ usually over a __ __ as a result of __, or pressure in combination with __ and/or __.

National Pressure Ulcer Advisory Panel; localized; skin; underlying tissue; bony prominence; pressure; shear; friction

Factors that promote healing (6):

1.) Youth 2.) good nutrition 3.) adequate hemoglobin 4.) effective circulation (Both 3 and 4 allow for nutrients and oxygen to reach the affected area) 5.) Area remains clean and undisturbed 6.) no infection or trauma to the site

``` Scar tissue replaces normal skin, which results in the __ of __ and __ of normal cells and __ __. Specialized structures include: 1.) 2.) 3.) Is scar tissue elastic? ``` ``` Scar tissue can cause: 1.) 2.) 3.) Common examples of adhesions are between __ __ __ or __ __ after a surgical procedure. Adhesions prevent __ __ or structures and may eventually cause __ or __ of the tissue. Adhesions are __ of __ __ joining __ __ that are normally separated. Scar formation can restrict __ __ __. ```

loss; function; loss; specialized structures 1. ) hair follicles 2. ) nerves 3. ) receptors NO. 1. ) contractures 2. ) obstructions 3. ) adhesions loops of intestines; pleural membranes; normal movement; distortion; twisting bands; scar tissue; two surfaces; range of movement

Hypertrophic scar tissue is __ __ consisting of __ __ __. Overgrowth of __ __ leads to __ __ ( __ __ of __ tissue_. This can be very disfiguring and cause severe __.

fibrous tissue; excessive collagen deposits; fibrous tissue; keloid formation (hard ridges of scar tissue); contractures?

Ulceration results in further __ __ and also more __ at a future time. __ ___ may be impaired around scar.

tissue breakdown; ulceration; blood supply

Dehiscence is a surgical complication in which a wound __ in a surgical site. Risk factors: (5) Sx include: (A-D)

ruptures 1. age 2. diabetes 3. obesity 4. grabbing of the sutures 5. trauma to the wound after injury A. bleeding B. pain C. inflammation D. fever

Prevention of Dehiscences:

1. adequate undermining to reduce stress on wound's edges such as when it's being sutured 2. Avoid heavy lifting to reduce bedding or hematomas (bleeding underneath the skin) 3. speeding healing through adequate nutrition 4. controlling diabetes and avoiding meds like steroids 5. steroid strips may be used to cover the sutures for up to a week 6. antibiotics and cleaning the wound may help

Hemostasis:

vasoconstriction occurs which minimizes bleeding and prevents microorganisms to enter. A special protein known as fibrin forms crosslinks on top of the skin to secure the barrier.

Macrophages devour __ and __ __ and produce __ __ to spur healing. About __ to __ days after the wound, the proliferative stage occurs when __ __ begin to enter the wound.

bacteria; damaged tissue; growth factors 2-3 , fibroblast cells

Fibroblast cells produce a fibrous protein called __ during __ __ forming __ tissue to replace the __ tissue from before. As epidermal cells divide to reform the outer layer of skin, the dermis __ to close the wound.

collagen; collagen deposition; connective; fibrin contracts

Finally, in the fourth stage of remodeling, the wound matures as the newly deposited collagen is __ and __ into __ types. Through this process, which can take over a year, the __ __ of the new skin is improved and blood vessels and other connections are __. With time the new tissue can reach from __to __ % of its original tissue.

rearranged; converted; specific; tensile strength; strengthened ; 50-80%