Chapter 5 Study and Book Questions Flashcards
Explain why a cast placed around a fractured leg in which extensive tissue damage has occurred might be too tight after 24 hours.
Inflammation related to tissue damage causes increasing edema for at least 48 hours under the rigid, non-expandable cast.
b. Explain why such a cast might become loose in 3 weeks.
inflammation has subsided and muscle atrophy has occurred because of immobility.
List specific reasons why the inflammatory response is considered a body defense mechanism.
Pain and visible redness provide warning of tissue injury. Increased fluid at the site dilutes any toxic material. Fibrin mesh and leukocytes localize (wall off) the causative agent. Migration of phagocytic cells, leukocytes, and antibodies (globulins) to the area combat or destroy the agent, and remove debris in preparation for healing.
Explain the rationale for each of the following with acute inflammation: (i) warmth, (ii) fever.
Warmth results from vasodilation and increased blood flow to the area; fever is caused by the release of pyrogens from WBCs.
State three systemic signs of inflammation.
Low-grade fever occurs with increased WBCs, malaise, anorexia, and headache.
Explain why leukocytosis, a differential count, and elevated ESR are useful data but are of limited value.
They confirm the presence of inflammation in the body but do not define the specific cause or location of the problem. In some cases, a differential count is helpful.
. Explain how acute inflammation predisposes to the development of infection.
The increased permeability may permit leakage or penetration of toxins or bacteria (e.g., through the intestinal wall). Any necrosis breaks the barrier, allowing microbes to invade. The edema or increased interstitial fluid may impair arterial flow to an area, leading to ischemia and decreased access of leukocytes to the site. The exudate provides a nutritious medium for organisms to reproduce.
Classify each as inflammation or infection: (i) sunburn, (ii) skin rash under adhesive tape, (iii) common cold, (iv) red, swollen eye with purulent exudate.
b. Inflammation accompanies i and ii; infection is associated with iii and iv.
How does the presence of thick, cloudy, yellowish fluid in the peritoneal cavity differ from the normal state?
Normal fluid should be watery, clear, and colorless.
Thick yellowish fluid often indicates the presence of a bacterial infection (peritonitis).
If a large volume of fluid has shifted from the blood into the peritoneal cavity, how would this affect blood volume and hematocrit?
Blood volume would be low (hypovolemia), and the hematocrit level would be elevated.
Explain how acute inflammation impairs the movement of a joint.
Excessive fluid in the joint cavity and surrounding tissues prevents further stretching of the tissues, such as ligaments, tendons, and skin, as required for movement.
Explain two mechanisms used to increase body temperature as a fever develops.
The body attempts to increase body temperature through shiver-increased skeletal muscle activity, peripheral vasoconstriction, and decreased blood flow and heat loss.
. Why might a client be advised to avoid taking ASA a few days before extensive oral surgery (eg, multiple tooth extractions)?
Aspirin (acetylsalicylic acid [ASA]) interferes with blood clotting (prevents platelet adhesion).
Explain why a young child taking prednisone (glucocorticoid) for chronic kidney inflammation is at high risk for infection and might need prophylactic antibiotics.
Prednisone decreases the immune response, causes atrophy of lymphoid tissue, decreases the number of leukocytes, and suppresses the inflammatory response, thus decreasing resistance to infection.
When part of the heart muscle dies, how does it heal?
Heart muscle heals through scar tissue. Cardiac muscle does not regenerate.
How would the new tissue affect the strength of the heart contraction?
Scar tissue is nonfunctional and therefore cannot contract; thus, heart contractions would be weaker.
Suggest several reasons why healing is slow in the elderly.
Circulation may be impaired, decreasing the supply of oxygen and nutrients to the site. The metabolic rate is decreased, slowing protein synthesis and cell mitosis. Other pathological conditions may interfere with the supply of nutrients or oxygen. The immune response is decreased, predisposing the person to infection and delaying healing.
Explain how scar tissue could affect the function of the following:
a. small intestine
b. brain
c. cornea of the eye
d. mouth
e. lungs (try to find more than one point!)
a. Small intestine—scar tissue may cause obstruction by stenosis as it shrinks, or adhesions may twist or pull on a loop of the intestine.
b. Brain—scar tissue is nonfunctional and can block conduction pathways or interfere with the flow of blood or CSF.
c. Cornea—scar tissue is not transparent and therefore blocks the passage of light rays, impairing vision.
d. Mouth—contractures may develop, preventing normal opening and movement of the mouth, affecting eating, speech, and facial expression.
e. Lungs—the bronchi or bronchioles may be narrowed, reducing airflow, and adhesions may impede movement and expansion of the pleural membranes. Because scar tissue is nonelastic, large amounts of it impair expansion and recoil of the lungs. Scar tissue interferes with blood flow.
Explain the reason for pain and redness accompanying a burn.
Pain—chemical mediators irritate nerves; edema results from increased capillary permeability; erythema occurs because of increased blood in the area.
Explain three reasons why protein levels in the body are low after a major burn.
Over the long term, lower protein levels occur, with protein shifts into tissue and loss in exudates. In addition, protein is in increased demand for repair, but anorexia results in decreased intake, further lowering protein levels.
Explain why immediate neutralization or removal of a chemical spilled on the hand minimizes burn injury
It removes damaging chemicals and prevents penetration into the deeper layers of the skin.
Describe some of the factors that would promote rapid healing of this burn
Good nutrition (including protein and vitamins), promotion of circulation, warmth, and avoidance of secondary infection would promote rapid healing.
Describe three potential complications of a full- thickness burn covering 30% of the body, including the legs and back.
Scar tissue is not elastic and tends to contract over time, leading to reduced range of movement or contractures, decreased coordination of fine movements, and loss of sensory function (e.g., touch, heat).
If the face receives a full-thickness burn, describe three ways function could be impaired after healing.
Function could be impaired because of possible distortion of the mouth and eyelids, interfering with function (speaking, eating) and facial expressions, such as a smile. There may be restricted mobility related to contractures or loss of elasticity, reduced sensitivity to touch or other sensory stimuli, and less strength.
What is the body’s first line of defense?
mechanical barrier such as intact skin and mucous membrane
identify the body’s second and third line of defense
second-processed of phagocytosis and inflammation
thirds- the immune system response
Which of the three lines of defense are specific?Explain what is meant by specific defense mechanism
The immune system is the specific defense mechanism of the body. It provides protection by stimulating a unique response following exposure to foreign substances
Define phagocytosis. Identify the type of cells that are phagocytic.
the process by which neutrophils, monocytes, macrophages engulf and destroy bacteria,cellular debris or foreign substances
What is inflammation, and what is its basic function?
Identify some causes of inflammation
Inflammation is the body’s nonspecific response to injury that involves increase blood flow to the area to localize and remove an injurious agent. Inflammation can cause redness, swelling, warmth, and pain; loss of function is also possible. If may be caused by direct physical damage such as cuts or sprains, caustic chemicals such as acids or drain cleaners, ischemia, or infarction, allergy, extreme heat or cold, foreign bodies such as splinters or glass and infection
Identify the two main events of the vascular response that occur during an inflammatory response. Explain their function as part of the response and the direct effects of each event.
The two main events are vasodilation and increased capillary permeability in response to a chemical mediator ( histamine, serotonin) released at the site of injury. This allows for the accumulation in the area of fluid (to dilute any toxic substance) and specific plasma proteins such as globulins or antibodies (to react with specific antigens) and fibrinogen (to form a fibrin mesh to localize the problem)
involved in cell mediated immunity
t lymphocytes
elevated during allergic responses
eosinophils
secrete histamine
basophils and mast cells
the first cells to migrate to an injured area
neutrophils
involve in antibody production
T lymphocytes and B lymphocytes
elevated during chronic inflammation
monocytes
sources of macrophages
monocytes
phagocytize microorganisms
neutrophils, macrophages, monocytes
list the systemic effects of inflammation, and identify the reason that each of these manifestation occurs
fever d/t release of pyrogens by leukocytes and macrophages, malaise, HA and anorexia
list some potential complications that may develop as a result of inflammation
infection in inflamed tissue, deep ulcers (from severe or prolonged inflammation
Skeletal muscle spasms or strong muscle contractions
local complications such as tissue destruction and scarring
Pain or edema (edema compresses the organs such as blood vessels and airways)
Causative agent: direct damage (trauma) chemicals ischemia cell necrosis or infarction allergic rxn physical agent ( burns) foreign bodies (splinters or dirt) infection
acute inflammation
causative agent
when the cause persists and is not removed or eradicated
chronic inflammation
s/sx
immediate or occurring within a few hours (ex. sunburn)
severity varies with the situation or cause
acute inflammation
s/sx
delayed and prolonged over a significant period of time.
Maybe intermittent
severity varies depending on the cause and pathophysiology & duration
chronic inflammation
cells involved
neutrophils, and macrophages
lymphocytes if an immune response is involved
acute inflammation
cells involved
lymphocytes
macrophages
fibroblasts
chronic inflammation
treatment
acetaminophen, glucocorticoids and NSAIDS, RICE
acute inflammation
treatment
acetaminophen, NSAIDS, ACTH, exercise, physiotherapy, pain and modification
chronic inflammation
results
healing unless it becomes chronic d/t persistence of causative agent; regeneration or resolution
acute inflammation
reslts
scarring and or granuloma
tissue breakdown may occur with bleeding and loss of function
chronic inflammation
What is the four letter acronym that list the approach to first aid for injury related inflammation
RICE
R-rest
I-early application of ice for vasoconstriction decreasing pain and edema
C-compresion reduces edema and pain by activating alternate sensory pathways
E-elevation improves fluid flow away from the damaged area
Identify the differences between NSAIDS and glucocortcoids or steroidals and antiinflammatory drugs
NSAIDS are analgesis and antipyretic
they may cause allergic rxn, slow blood clotting and may cause nausea or stomach ulceration
Steroids-decreased immune response and increase risk for infection, HTN, and edema. May also cause osteoporosis and skeletal muscle wasting
identify the differences between NSAID and acetaminophen
NSAIDs are antiinflammatory, they may cause allergic rxn and slow blood clotting
Acetaminophen has no anti-inflammatory action. overuse at higher dosages than recommended may cause kidney and liver damage
identify additional nonpharmcologic therapies/tx that could be used to treat inflammation, particularly conditions that are chronic such as arthritis.
heat, physiotherapy,adequate nutrition and hydration, mild to moderate exercise, elastic stocking to reduce fluid accumulation
Differentiate between the process of resolution and regeneration
resolution occurs when there is minimal tissue damage, the damage is repeated and cells recovers & resume normal function in a short time
regeneration is the healing process that occurs in tissues whose cells are capable of mitosis (e.g. epithelial cells of the skin, GI tract)
The damaged cells are replaced by proliferation of nearby undamaged cells
Describe the classification of burns based on
depth of tissue damage
the partial thickness of burns involve the epidermis and part of the dermis
deep partial-thickness burns involve the destruction of the epidermis and part of the dermis
full-thickness burns result in the destruction of all skin layers and often underlying subcutaneous tissue as well
Describe the classification of burns based on body surface area involved
the percentage of body surface area (BSA) burned uses the “rules of nines” or for calculation to determine extent of injury and fluid replacement needs
