Exam 2 Flashcards
What is inflammation
An adaptive response to injury or illness that brings fluid (plasma), dissolved substances, and blood cells into the interstitial tissues where the invasion or damage has occurred.
What type of response is inflammation and what does it mean?
Is a nonspecific response - same events occur regardless of cause of inflammatory process.
What are the microorganisms that cause inflammation?
- bacteria
- viruses
- fungi
- helminths
- protozoans
What chemical agents can cause inflammation (2)
HCL (internal) or poisons (external)
What physical agents can cause inflammation (2)
Objects that cause trauma to skin, excessive heat or cold and radiation
What is the ACUTE inflammatory process?
- Response occurs within minutes of injury or with infection may be a few hours
- Erythema, heat swelling, pain and impaired function occur
- Continues until trauma or infection is neutralized
What is the CHRONIC inflammatory process?
- Occurs when the acute response is unable to neutralize the harmful stimuli
- Causes damage to healthy tissue – scarring
- Seasonal allergic reactions or autoimmune disease
- Can follow acute but usually does not.
- Diseases of chronic are COPD and SLE
1st Stage: Vascular and Cellular response
- What happens to blood vessels?
- What do injured tissue release?
- What is hyperemia and what is it responsible for?
- Does vascular permeability increase or decrease?
- Blood vessels temporarily constrict the surrounding area
- Injured tissue releases histamines, kinins, and prostaglandins
- Chemical mediators to dilate blood vessels
- Causes an increase in blood flow to injury
- Hyperemia - a marked increase in blood supply
- Responsible for erythema (redness) and heat noted in inflammation
- Vascular permeability increases
- Dilated vessels cause blood flow to slow
What happens when vascular permeability increases?
What does this cause?
- fluids, proteins, and leukocytes (WBCs) leak into interstitial spaces
- causes swelling and pain
What happens when Dilated vessels cause blood flow to slow
- Allows more leukocytes to injured area
- Margination occurs - Leukocytes roll along vessels walls, detach and bind again
- Leukocytosis - Drop in circulating leukocytes stimulates bone marrow to produce and release more into blood stream
- WBC counts can reach 20,000/mm3 (Normal WBC 4,500 to 10,000 per mm3)
What is the 2nd stage of inflammation?
Exudate Production
In the exudate production (2nd stage), what is contained in the fluid that leaks
cytokines, histamines, dead tissue cells, injured tissue cells, and dead phagocytic cells
- Amount is dependent on tissue involved, amount of damage and length and intensity of the initial inflammatory process
for 2nd stage, what types of exudate is there? (3)
What is the name of the 3rd stage of inflammation?
Reparative Phase
What happens in the 3rd stage of inflammation?
- Chemical mediators to assist damaged cells in repairing themselves
- Regeneration occurs - Destroyed cells are replaced with cells identical or similar in structure and are replaced one by one so that the architectural pattern and function of the tissue is restored
- Some tissues regenerate quickly - epithelial tissues of skin, digestive system, respiratory system
Some tissues have limited capacity to regenerate – nervous, muscular and elastic tissues - Scar tissue – fibrous tissue formation occurs when regeneration is not possible
-Early process is granulation tissue
-Does not function as original tissue – can lead to complications
What are macrophages?
secrete factors that remove pathogens by phagocytosis- Secrete Cytokines that attract immune system cells
What are Mast Cells
- Leukocytes found in most tissues of the body
- Principle source of cell-derived mediators of inflammation
- Secrete factors that mediate dilation and constriction of blood vessels
What are the (6) chemical mediators?
- Histamine
- Heparin
- Leukotrienes
- Prostoglandins
- Bradykinin
- Complement
What is a Histamine?
A chemical mediator stored and released by mast cells
- Contributes to early vasodilation, increased permeability and chemically attracts eosinophils (4 types of receptors)
What is Heparin
- Also released and with histamine increase blood flow to the injured site - dec. blood clotting to injury
What are Leukotrienes
Chemically attracts neutrophils and macrophages. Stored and released by mast cells
What are Prostaglandins
Present in most tissue
- Causes vasodilation
- stored and released by mast cells
What are Bradykinin?
Causes dilation of vessels, acts with prostaglandins to cause pain, increase vascular permeability and stimulates histamine release
What is a Compliment (for mediators of inflammation)
Comprises over 20 proteins, activated sequentially and is responsible for dilation, permeability, chemotaxis, phagocytosis and histamine release
What are the 4 types of Histamine receptors?
H1, H2, H3, H4
H1 receptor found primarily on what?
smooth muscle cells, endothelium, and CNS
Stimulation- vasodilation
H4 is located in what?
Peripheral WBCs and mast cells
- involved in immune response
Antihistamine block histamine = ?
decrease allergy symptoms
What occurs when an individual is exposed to the allergen that results in the rapid release of inflammatory mediators
Anaphylaxis
What is an autoimmune disorder?
the body misinterpreting its own tissue as harmful
what involves genes that regulate cytokines pathways
Genetic Consideration and nonmodifiable risk factors
What is the normal ESR levels
0-15 mm/hr, 0-20 mm/hr (women)
What is the cause of leukocytosis
infection, inflammation, leukemia, trauma or stress
What is immunity?
Body’s natural or induced response to infection
3 functions of the immune system
- protect body from foreign antigens
- identify; and destroy potentially harmful cells
- Remove cellular debris
what is immunocompetent
- an effective immune system
- able to identify antigen and effectively destroy or remove them
what is hypersensitivity immunity?
overreaction of the immune system
What is an autoimmune disorder
- immune system attacks own body
what is immunodeficiency
- incompetent immune system
- acquired immunodeficiency syndrome (AIDS)
- system deficit induced by infection with HIV
What is an opportunistic infection?
- infections that would not affect people with intact immune system
How does active immunity work?
it occurs through:
- exposure to disease
- vaccination
- long-lasting, often lifelong
- takes several weeks to develop
How does passive immunity work?
it occurs through:
- Receiving antibodies from another person
- ex: mother to newborn
- provides immediate protection
- lasts only weeks/months
Leukocytes overview description
- WBC
- the primary cells in both nonspecific and specific immune responses
- derived from stem cells in bone marrow
- attacks, and destroys anything “foreign” (damaged tissue and infection)
–> Respond to released chemicals from other leukocytes and damaged tissue
Can leukocytes move through tissue spaces?
yes
What are the normal levels of leukocytes?
4500-10,000 cells/mm3
what cell adheres to vascular epithelial cells in vessel walls, and other tissue spaces within the lymphatic system
leukocytes
what level of leukocytes is leukocytosis
more than 10,000/mm3
what is leukocytosis
when there is a release of WBCs by bone marrow to respond to a threat
what is leukopenia
a decrease in the number of circulating leukocytes
- when bone marrow activity is suppressed
- when leukocyte destruction increases
What are the 3 major groups of leukocytes?
- Granulocytes
- Monocytes
- Lymphocytes
Where are granulocytes derived from?
- from myeloid stem cells in bone marrow
- instrumental in inflammatory response
- 3 types: neutrophil, eosinophil and basophil
Where are monocytes derived from?
- from myeloid stem cells in bone marrow instrumental in bone marrow
- inflammatory response
Where are lymphocytes derived from?
derived from lymphoid stem cells in bone marrow
- Primary cells involved in the specific immune response
what is the name of the largest leukocytes?
monocytes
what consists of 60-80% of leukocytes
granulocytes
which leukocyte has a short lifespan
granulocytes
what is 2-3% of circulating leukocytes?
monocytes
what leukocyte states for months/years until it is activated
monocytes
what leukocyte is a memory cell
lymphocytes
Which Granulocyte is the most plentiful and consists of 55-75% of granulocytes?
Neutrophil
Neutrophil desc.
Phagocytic: Engulf, destroy foreign agents
—> first arrive at site of invasion
Which granulocyte is involved in hypersensitivity response —> inactivate some inflammatory chemicals released during inflammatory process
Eosinophils
- less efficient than neutrophils as phagocytes
What granulocyte is found in large #’s in the respiratory and GI tracts
Eosinophils
Which granulocyte is not phagocytic?
Basophils
Which granulocyte contains proteins and chemicals like heparin, histamine, bradykinserotonin, and leukotrienes
Basophils
Which granulocyte has an acute hypersensitivity or stress response?
Basophils
What type of monocytes differ by which tissue they reside?
Macrophages
Which monocyte activates the immune response against chronic infections
Macrophages
Which monocyte originates in the myeloid, lymphoid cell lines
- antigen-presenting cells
- operate in most organs?
Dendritic cells
What are Langerhans cells?
Specialized dendritic cells in the skin
Which monocyte relates to the recognition of antigens?
Langerhans cells
Which type of lymphocytes mature in the thymus?
T cells
Which type of lymphocyte, when in contact with APCs, matures into active helper T cells, cytotoxic T cells, or memory T cells
T cells
Which type of Lymphocyte mature in the bone marrow
B cells
Which type of lymphocyte, when on contact with antigen, activated and mature into plasma cells or memory cells
B cells
Are Natural killer cells from B cells or T cells?
B cells
Polysaccharides, polypeptides, and nucleic acids also may be what?
Antigenic
white blood cell known as the memory cell
lymphocytes
Antigen description
- Provoke specific immune response when introduced into the body
- Typically, large protein molecules are found on cell membranes/walls of microorganisms or tissues incompatible with blood cells, vaccines, pollen, egg whites, animal dander, and insect or snake venom.
- Antigenic determinant site (epitope) – part of the antigen that causes a specific immune response
- Characteristics of complete antigens (immunogens)
- Large molecules with multiple determinant sites
- Have two characteristics: Immunogenicity – the ability to stimulate a specific immune response
- Specific reactivity – ability to stimulate specific immune system components
- Small molecules (e.g., dust) that cannot evoke an antigenic response alone may link to proteins (haptens) to form complete antigens
When antigens are encountered in the body –> two major groups of cells generate effective immune responses which are…
- Lymphocytes
- Antigen-presenting cells (APC’s)
What is the primary immune response for antigens?
- B cells produce antibodies to eliminate extracellular antigens
- Antibodies react specifically to that antigen
- Takes approximately 3 days
What is the secondary immune response for antigens?
Subsequent encounters with an antigen trigger memory cells
IgM desc.
Responsible for primary immunity
- Produced 48-72 hrs after an antigen enters body
- Does not pass through placenta
IgG desc
Major immunoglobin
- Results from secondary exposure to a foreign antigen
- Responsible for antiviral and antibacterial activity
- Passes through the placenta barrier
IgA desc
Protects mucous membranes
- Does not pass through the placenta
- Congenital deficiency are prone to autoimmune disease
IgD desc
Role unknown
- Short half-life (3 days)
- Assist in the regulation of mucosal homeostasis
IgE desc
Increases during allergic reactions, anaphylaxis
- important defense against parasitic disease
Intracellular pathogens —> activate ___ lymphocytes
T
Cell-mediated immunity
- acts at the cellular level by attacking antigens and B cells directly
- T lymphocytes subdivide into helper T cells or suppressor T cells
- Helper T cells –> initiate immune response
- Suppressor T cells limit immune response
Complement System desc
- consists of 20 plasma proteins (complement proteins)
- component of blood serum in an inactive form
- Activates general inflammatory reaction increases vascular permeability, enhances phagocytosis, and promotes vasodilation
Cytotoxic T lymphocytes
- Attack malignant cells
- Responsible for rejection of transplants, tissue grafts
Immune cells secrete cytokines
-this is crucial for controlling what?
- Cytokines carry what? and for what?
- crucial in controlling the growth and activity of other immune system cells and blood cells
- Cytokines carry messages for immune system function
The Lymphoid System consists of…..
lymph nodes, spleen, thymus, bone marrow, and lymphoid tissue
Why do lymphoid systems exist?
- Recover proteins from the vascular system
- Protects bloodstream from invading organism
The function of lymph nodes
- Filter foreign products or antigens –> immune surveillance
- Houses and supports the proliferation of lymphocytes and macrophages
Spleen description
- Largest lymphoid organ
- Filters blood – only lymph organ that can filter blood
- Two kinds of tissue
- White pulp: lymphoid proliferation, immune surveillance, B-cells
- Red pulp: blood filtration, removes debris, and foreign matter from blood
- Stores blood and breakdown products of RBCs for future use
Thymus gland description
- Considered a central lymphoid organs
- Located superior anterior mediastinal cavity beneath the sternum.
- During fetal life and childhood, site for maturation and differentiation of thymic lymphoid cells ( after puberty begins to atrophy
- Thymosin stimulates lymphopoiesis – formation of lymphocytes or lymphoid tissue
What does the bone marrow produce and store?
hematopoietic stem cells
- all cellular components of blood are derived from this
related to the spleen, what is the red pulp
Phagocytic cells dispose of damaged or aged RBC’s and platelets
What is considered the central lymphoid organs
Bone Marrow
What type of tissue is located at key sites of potential invasion by microorganisms such as the skin, submucosa of GI, Resp, and GU tracts
Lymphoid tissues
Tonsils and adenoids protect the body from what?
from inhaled and ingested foreign agents
What is lymph? (part of lymphatic system)
watery fluid within the lymphatic system
What are the 4 first lines of defense against infection
- Skin
- Mucous - line cells of body - trap microorganisms or foreign substances
- Ciliary movements
- Bactericidal substances in body fluids
A barrier breach in the skin would result in what?
Inflammation
What are the 3 reactions to inflammation; how the body processes invader?
- Invader neutralized and eliminated
- Destroyed tissue removed
- Healing and repair initiated
Are children and older adults more prone to infection and why?
B/c older adults have declining immune function while children have an immature immune system
More immunity genetic considerations happen in which gender?
Females
Type 1: IgE- mediated hypersensitivity
- Rapid development of symptoms after exposure to antigens 15 – 30 minutes (usually)
- May involve skin, eyes, nasopharnyx, bronchopulmonary tissue, and GI tract
- Can sometimes have delayed onset 10 – 12 hours
- Most severe anaphylaxis
Type II: Cytotoxic hypersensitivity description
- Response is rupture of cells that are targeted by the immune response
- Mediated by IgM or IgG antibodies
- Examples: transfusion reactions, Rh incompatibility, Hashimoto thyroiditis
Type III: Immune complex-mediated hypersensitivity Description
- Inflammatory response in the targeted tissues — tissue damage
- May occur 3- 10 hours after antigen exposure
- Autoimmune disorders such as SLE, RA
Type IV: Delayed-type hypersensitivity description
- Characterized by tissue damage at the site of antigen contact
- Damage occurs 24 – 48 hours after exposure
- Examples: TB test (Mantoux test) allergic contact dermatitis
- Occurs when the immune system attacks components of its own body
- The immune system fails to distinguish itself from others.
autoimmune disease
Rheumatoid arthritis (RA), Psoriasis, Chron’s disease, Lupus (SL), scleroderma etc.
- these are all examples of what type of disease
Autoimmune disease
What are the 3 types of transplant reactions
- Hyperacute Rejection
- Acute rejection
- Chronic Rejection
What is a hyperacute rejection
- Occurs in minutes or hours after transplantation
- Characterized by organ swelling, clot formation and hemorrhage
What is an acute rejection
- Occurs in weeks after transplantation 1week to 3 months
- Failure in function of organ and pai
What is a Chronic rejection
- occurs months to years after transplantation
- Slow, insidious failure occurs as a result of immune-mediated damage
which type or immune deficiency (primary or secondary)
Congenital
May affect T cells and/or B cells
May result from defects in WBCs
primary
which type or immune deficiency (primary or secondary)
- Acquired later in life
- Lead to a decrease immune function and increased susceptibility to infection and malignancies
- Typically result from trauma and stress
- May result from cancer therapies
- AIDS results from HIV attacks and depletes helper T-cells causing immune dysfunction.
secondary
what impairs immune response when related to nutrition
Protein-energy malnutrition and lipid, vitamin and mineral deficiencies
modifiable risk factors for immunity
- Weight
- Stress
- Alcohol, drug, cigarette use
- IV drug use
- Risky sexual behaviors
What type of vaccine is a killed virus
- contained killed version of microorganism
- induces body to produce antibodies not as strong as live virus
- Example: inactivated poliovirus vaccine
What type of vaccine is a toxoid vaccine
- toxin from a microorganism is treated (to weaken its effects) and given to individual.
-Boosters are needed to maintain ongoing protection
- Example: tetanus toxoid
What type of vaccine is a live virus
- contains an attenuated (weakened) form of the microorganism that causes
a disease. - Examples: measles and varicella
What type of vaccine is a recombinant vaccine
- DNA from two or more sources is combined to genetically alter an organism
- Examples: Hepatitis B, HPV, and Acellular Pertussis
- Boosters are typically required
What type of vaccine is a conjugated virus
- A combination of a weak antigen joined with a strong antigen as the carrier to increase the immune response to the weaker antigen
What reaction is rare when getting a vaccine?
Anaphylaxis
Vaccine hesitancy description
- Concerns about overloading immune system at young age, vaccine safety, religious beliefs and personal experiences
- Belief in “herd immunity” will protect their child so no need to vaccinate
- Belief that natural healing methods are better than vaccines
- Doubts about the effectiveness of vaccines
-Perceived associations between vaccines and development of chronic disease
What should healthcare provider offer to a patient that has vaccine hesitancy
- Provide balanced information about risks and benefits
-Legislation requiring informed consent varies from state to state
What is the nurse’s responsibility to a patient with vaccine hesitancy
Informing parents/guardian
Supplying literature
Obtaining written consent
12 diagnostic tests related to immunity
Enzyme immunoassay (EIA)
Enzyme-linked immunosorbent assay (ELISA)
Antinuclear antibody (ANA)
Autoantibody
Immunoglobulins
Polymerase chain reaction (PCR)
Rapid HIV tests
Radioallergosorbent test (RAST)
Skin reactions
Western blot test
Complete blood count (CBC)
Complement
Independent interventions related to immunity
Proper nutrition
Adequate exercise
Sleep
Stress reduction
Stress management
lifespan considerations for Infants and Children related to immunity
- Immune system development influenced by early in utero experiences, environmental exposures after birth, other factors
- IgG: only immunoglobulin crosses placenta
Maternal IgG disappears by 6–8 months - Child’s IgG increases gradually until 7–8 years Cell-mediated immunity achieves full function early in life
- Premature newborns most prone to infection
lifespan considerations for Adolescents related to immunity
- Immune system still maturing
- Long-term damage from marijuana use chronic inflammatory, autoimmune response
lifespan considerations for Pregnant Women related to immunity
- Brief decline in maternal cell-mediated immunity during pregnancy
- Prevents rejection of fetus
- Mother at greater risk of developing viral, bacterial infections
- Be up-to-date on immunizations before pregnancy
- May get immunizations during pregnancy if needed except live viruses*
lifespan considerations for Older Adults related to immunity
- Normal changes associated with aging
- Decrease in immune response
- Lower resistance to infection
- Poor response to immunizations
- Immune system changes may bring on insulin resistance
- Hypersensitivity response reduced or delayed
- Autoantibodies more common
What is the cause of neutrophilia?
- Acute infection or stress response, myelocytic leukemia, inflammatory or metabolic disorders, tissue necrosis
What is the cause of eosinophilia?
parasitic infections, allergic reactions, autoimmune disorders
What is the cause of Basophilia
– hypersensitivity responses, leukemia, splenectomy, hypothyroidism
What is the cause of monocytosis?
– chronic inflammatory disorders, infections, leukemia, Hodgkin disease
What is the cause of lymphocytosis?
– infections, viral infections, lymphocytic leukemia
Related to inflammation, what is pharmacological therapy aiming to do?
- Aimed at reducing inflammatory response and the symptoms of pain and fever associated with inflammation
- Salicylates - ASA
- Nonopioid Analgesics – Acetaminophen
- NSAIDS -
- Corticosteroids – treat autoimmune disease
- Can increase glucose, cause electrolyte imbalance, weight gain, nausea, impair wound healing
Chronic inflammatory state is associated with ___ and ______
age and obesity
Most anti-inflammatory drugs act to decrease prostaglandins which promotes ________.
permeability
What is hepatitis
inflammation of the liver
What does hepatitis do to liver
prevents the liver from functioning
the liver is responsible for the production and processing of what?
- Production of bile to aid in breakdown and absorption of fats
- Processes nutrients that are carried from the small intestines via blood
Why younger children at risk with inflammation?
their structure is smaller such as short epiglottis, shorter and narrower trachea
lifespan considerations for pregnant women related to inflammation
- Immune system is diminished as protection for the fetus
- Pre-eclampsia – thought to be an inflammatory mediated hypertensive disorder of pregnancy
- Changes in immune system can lead to hypersensitivity to nonpathogenic stimuli and can lead to development of chronic inflammatory disease.
Lifespan considerations for older adults related to inflammation?
- Inflammatory markers – C reactive protein etc. may be increased in older and obese individuals
- Increase markers are seen in increased fragility of the individual
- Increase in markers is also associated with increased morbidity, comorbid conditions and more frequent hospitalization
- Can reduce inflammation through diet and resistance training
pathophysiology of hepatitis
- inflammation damages hepatic cells and disrupts liver function
1a. cell-mediated immune responses damage hepatocytes and Kupffer cells (Hyperplasia, necrosis and cellular regeneration) - Biliary flow of bile ducts may be obstructed by the inflammatory process (causing jaundice)
Mild: (Hep A)
- liver parenchyma is not significantly damaged
Severe: (Hep A &/or Hep C)
- severe liver damage
- Infiltration by lymphocytes, macrophages and other WBC’s causes inflammation that block drainage
- Structural changes occur in parenchymal cells – altered liver function
- Impaired bile secretion
- Elevated ALT and alkaline phosphatase levels
- Decrease albumin systhesis
- There is a disruption of metabolism of nutrients, drugs, alcohol and toxins and bile elimination
How is Hepatitis A transmitted?
fecal-oral, rare complications, vaccine
How is Hepatitis B transmitted?
blood and body fluids, perinatal, complications: chronic hepatitis, cirrhosis, liver cancer, vaccine
How is Hepatitis C transmitted?
blood and body fluids, perinatal, complications: chronic hepatitis, cirrhosis, liver cancer
How is Hepatitis D transmitted?
blood and body fluids, perinatal, rare, complications chronic hepatitis, liver cancer, fulminant hepatitis
How is Hepatitis E transmitted?
– fecal-oral, complications: chronic hepatitis, fulminant hepatitis, may be severe in pregnant women
- Effects may be local within the liver or systemic
what are 2 nonviral forms of hepatitis?
Alcoholic and drug induced hepatitis
What are the disease states of Hepatitis?
- Autoimmune hepatitis
- Metabolic-disorder hepatitis
- Nonalcoholic fatty liver disease (occurs in pts w/diabetes or obesity)
Non-viral risk factors for hepatitis
- Autoimmune disorders such as systemic lupus erythematous
- Alcoholism
- Obesity
- Diabetes
- Medication such as high doses of Tylenol
- Toxins including poisonous mushrooms and vinyl chloride
tips for prevention of Hepatitis
- Healthy lifestyle choices
- Avoid toxins, chemicals and medications causing hepatitis
Risk factors for getting Hepatitis A
- Contaminate food and water (most common cause)
- Travel in areas with high rates
- HIV-positive status
- Living with an individual who has
- Illicit drug use (any form)
- Male to male sexual contact
How to prevent Hepatitis A
- Vaccination – 2 available
- Practice good hand hygiene
- Boil water or use bottle water, cook foods thoroughly and peel raw vegetables – when traveling in developing countries
Risk factors for Hepatitis B
- Sexual contact with contaminated blood or body fluids (most common cause)
- Multiple sexual partner
- Male to male sexual contact
- Sharing of IV needles
- EXPOSURE TO BLOOD ***
- Living with someone infected
- Hemodialysis
- Traveling to areas with high rates
How to prevent Hepatitis B
- Vaccination
- Practice safe sex
- Avoid sharing personal items (razors, toothbrush, needles)
Risk factors for Hepatitis C
- Contact with infected blood (sharing of needles most common causes)
- Healthcare worker exposure to infected blood
- Illicit drug use (injections)
- History of HIV
- Boy piercing or tattoo with infected equipment
- Having received blood products before 1987
Prevention for Hepatitis C
- Practice safe sex
- Avoid sharing personal items (razors, toothbrush, needles
Risk factors for Hepatitis D
- Illicit drug use (injections)
- Having HBV
- Male to male sexual contact
- Multiple blood transfusion
- Get the HBV vaccine
Risk factors for Hepatitis E
Drinking contaminated water
Prevention of Hepatitis E
- Practice good hand hygiene
- When traveling in developing countries, boil water or use bottle water, cook food thoroughly and peel raw fruits and vegetables.
What are the clinical manifestations (S&S) of acute hepatitis
Acute hepatitis – asymptomatic during incubation period
- No symptoms if mild
- Fever
- Malaise and fatigue
- Jaundice
- Pruritus
- Abdominal pain in RUQ or epigastric area
- Anorexia
- N/V
- Myalgia and arthralgia
What are clinical therapies
- Supportive therapy including rest, nutrition, vitamin supplements and avoidance of alcohol
what is myalgia
pain in muscles
what is arthralgia
pain in joints
What are the clinical manifestations (S&S) of chronic hepatitis
- No symptoms if mild
- Malaise and fatigue
- Arthralgia
- RUQ abdominal pain or pressure from the enlarged liver
- Jaundice
What are the clinical therapies to help resolve chronic hepatitis
- Supportive therapy for lifelong management
- Interferons and antiviral medications
- Liver transplantation if liver failure occurs
What is the prodromal phase?
- occurs between exposure to virus and appearance of clinical manifestations
- jaundice - d/t inc. bilirubin in blood
- starts about 2 weeks after exposure can be insidious or rapid in onset
- symptoms:
- Frequent episodes of myalgia and arthralgia
- Anorexia
- Mild but chronic abdominal pain in RUQ or epigastrium
- Low-grade fever
What is the Icteric Phase?
- Begins with onset of jaundice (some patients may not experience)
- Approximately 5 – 10 days after initial symptoms
- Dark colored urine – d/t increased levels of conjugated bilirubin (results from breakdown of hemoglobin conjugated by hepatocytes and excreted in the bile.
What is the Convalescent Phase (recovery)?
- Increase sense of well-being usually following 2-3 weeks of acute illness
- Disappearance of abdominal pain and jauncie
- Increase levels of energy
- Improved appetite
- HAV - resolves in < 2 months but can last as long as 6 months
- HBV – may take up to 6 months
What does ALT stand for
alanine aminotransferase
What does ALP stand for
alkaline phosphatase
What deos LDH stand for
lactic dehydrogenase
What does AST stand for?
aspartate aminotransferase
What are the 7 types of diagnostic tests for Hepatitis
ALT, ALP, LDH, AST, GGT, serum bilirubin and liver biopsy
lifespan considerations in Infants and Children related to hepatitis
- Hep A most common spread at daycare centers where children are in diapers and being potty trained
- Hep B spread by infected mothers to children – dependent on viral load
- Young asymptomatic - adolescents may have more severe symptoms
- Hep C – spread through vertical transmission to children (or exposure blood and fluids)
- Hep D and E less common – HDV only occurs In presence of HBV – rarely seen in children born in US d/t vaccination in infancy
- Acute hepatitis onset usually rapid – fever, N/V, decrease appetite, sore muscles stool may appear clay-colored and urine dark. Jaundice at later stages
lifespan considerations in Pregnant women related to hepatitis
- Flulike symptoms with jaundice more severe during pregnancy
- Lab tests to differentiate pregnancy complications – preeclampsia
- Hep B and C can pass to babies during birth
- Hep B vaccination after birth can decrease likelihood of HBV infection
- Women with hep B – babies should receive HBV immune globin within 12 hours after birth followed up with 2-3 additional vaccinations over 15 months
- Can breastfeed an infant who has been vaccinated
- All pregnant women are tested for HBV in pregnancy to prevent vertical transmission
lifespan considerations in older adults related to hepatitis
- Complications are higher in older adults
- Morbidity higher d/t diminished immune response, nutritional deficiencies and cumulative toxin exposure
- Acute HAV clinically severe and more likely to experience complications
- Acute HBV tends to be asymptomatic and there is a higher progression rate to chronic HBV
- HCV most frequent cause of acute hepatitis in age group
- experience more complications of cirrhosis
- scar tissue formation is more rapid - Hep D and E may occur but less prevalent
- Antiviral therapy contraindicated in many older adults with HCV d/t age and other medical conditions
- Direct Acting Antiviral Agents have been effective in treating adults > 65 years old
- Encourage vaccination
What is an infection?
An invasion of body tissue by microorganisms with the potential to cause illness or disease
What is the major defense mechanism of the body related to infection?
the immune system
what is a disease without recognizable findings? (Microorganism is detected but little to no symptoms seen) – can cause considerable damage example CMV infection in women can lead to significant disease in unborn children.
subclinical disease
an illness that directly passes from one individual/animal to another by contact with bodily fluids or indirectly by contact with contaminated objects, airborne particles, or vectors.
a communicable disease
any communicable disease caused by microorganisms that are commonly transmitted from one individual or animal to another or from an animal to an individual.
an infectious disease
what is a pathogen?
microorganism that causes disease
a type of pathogen that causes disease only in susceptible individual
Examples: individuals with Cancer or HIV
opportunistic pathogen
what are mycoplasma bacteria?
small, no cell wall, resistant to antibiotics that inhibit cell wall synthesis (penicillin)
What is colonization?
The process by which microorganisms become resident flora
They grow and multiply but do not cause disease
What is a local infection?
Limited to a specific area of the body
Example: Otitis media, UTI
What is a systemic infection
Infection spreads and affect different parts of the body
Example: cellulitis or sepsis
what is bacteremia (systemic infection)
when a culture of blood reveals a bacteria
What is septicemia (systemic infection)
when bacteremia results in a systemic infection
what is asepsis
absence of disease-causing microorganism
What is the aseptic technique?
decrease possibility of transferring microorganisms
medical vs surgical asepsis
Medical asepsis – practices that intend to confine specific microorganisms to specific areas – limiting the number, growth, and transmission of
- Referred to as “clean” – almost all microorganisms are absent
- “Dirty” or soiled, contaminated - microorganisms are likely to be present
Surgical asepsis (aka sterile technique) - practices that keep an area or object free of all microorganisms.
- Includes practices that not only destroy microorganisms but also spores
What is an etiologic agent (infectious agent)
Dependent on number of microorganisms present, virulence, and pathogenicity, ability to enter body, susceptibility of host and the ability to live in host body
What is a reservoir
Source of microorganism – can be from another part of body, other humans, plants, animals and environment. Also food, water and feces can be a reservoir
What is the portal of exit?
Respiratory tract, GI tract, Urinary tract, Reproductive tract, Blood and Tissue
What is the Method (Or means) of transmission
- Direct transmission – touching, biting, kissing, or sexual intercourse. Droplet is considered direct but within 3 feet of each other (sneezing, coughing, spitting, singing, or talking)
- Indirect transmission - (vehicle-borne or vector-borne)
- Airborne transmission – transmission of droplets or dust, transmitted by air currents (TB, C-diff spores)
what is a Portal of entry
Where enters body - respiratory, break in skin barrier, genitalia , urethral meatus
What is a susceptible host?
Anyone at risk for infection (those individuals who do not have antibodies, a compromised host – very young, very old, immunosuppressive treatment for Cancer or chronic illnesses)
how are nasal passages barriers to infection
they trap microorganisms, dust, and foreign materials in the cilia and moist mucous membranes
How are lung barriers to infection
they are equipped with alveolar macrophages that ingest microorganisms, other cells, and foreign particles
How is the vagina a barrier to infection
they have a low pH which inhibits the growth of disease-producing organisms
does saliva help with preventing infection?
yes, it is a barrier
related to infection, what is a specific defense?
- Immune system when an antigen induces a state of sensitivity and antibodies respond to contain or destroy the antigen
what lack of help to facilitate transmission of disease; very common in children
Poor hand hygiene
What are the factors that facilitate transmission of infection?
- organism’s resistance to drying and variations in environmental temperature
- the ability to alter/destroy the normal function of the host cell and promote colonization, proliferation, and invasion by the pathogen
- adhesion factors produced by or incorporated into the cell wall to improve its ability to attach to or colonize the host
- toxin production
- endotoxin
- blocking specific immune responses
what is an endotoxin?
found in the cell wall of gram-negative bacteria and are released only when the cell is disrupted
- can activate many regulatory systems and cause fever, inflammation, clotting, bleeding or hypotension when released in large quantities
what is an exotoxin?
- soluble proteins that the microorganism secrete into surrounding tissue
- Highly poisonous and can cause cell death or dysfunction
a therapy we can give to help with infection, and/or inflammation would be to give….
fluids
if patient has breathing difficulties, a therapeutic intervention that would be recommended is giving what??
Fluid, fluid, fluid
what are the 4 stages of the infectious process?
- incubation period
- prodromal stage
- illness stage
- convalescent stage
what is the incubation period?
- Pathogen begins active replication but does not cause symptoms
- May last from hours to years (salmonella – HIV)
what is the prodromal stage?
- Symptoms begin to appear
- Usually nonspecific symptoms - general malaise, fever, myalgias, headache, and fatigue.
What is the illness stage?
- Pathogen proliferates and disseminates rapidly
- Toxic by-products of microorganism metabolism and cell lysis occur
- Immune response
- Above Produces tissue damage and inflammation
- Fever chills may be significant * elderly and patients with ETOH abuse may have hypothermia
- Tachycardia and Tachypnea d/t increase metabolic demand
- Localized manifestations: erythema, heat, swelling, pain, and impaired function (if internal organs, may experience tenderness to palpation over the site or show signs of impaired function (example: renal infection - -hematuria and proteinuria)
What is the convalescent stage?
- The infection is contained, and the pathogen is eliminated
- Affected tissue is repaired and manifestations are resolved.
What is an Iatrogenic infection
(Healthcare-associated infection [HAI])
- result of a diagnostic or therapeutic procedure
what is a compromised host
(Healthcare-associated infection [HAI])
body defenses have been lowered d/t surgery or illness
what is a “immunological responses decreased”
(Healthcare-associated infection [HAI]) patient is more prone to HAI d/t Cancer, chronic disease, pressure ulcers or organ transplants
what is the result of antibiotic therapty
(Healthcare-associated infection [HAI])
alteration of body’s natural flora
What invasive procedures can result in an HAI?
Catherization: Urinary, cardiac, insertion of IV
- Organisms infected this way may be resistant to drugs and not respond to antibiotics
What is the most simple mistake that can cause an HAI?
poor hand hygiene
is urinary catheterization the #1 cause of HAI?
Yes
How does a patient get healthcare-associated pneumonia
When patient is put on a ventilator, tracheostomies, endotracheal intubation
- put on a VAP
What is the most common HAI (the most common infection?)
UTI
Why are antibiotic-resistant bacteria increasing?
bc of inappropriate or prolonged use of antibiotics
Where does MRSA colonize?
In nares and skin
How is MRSA transmitted?
Transmitted primarily by direct physical contact not through respiratory droplets
Integumentary system includes what 4 things
- Skin
- hair
nails - Sebaceous sweat, and mammary glands
Functions of the skin
- protects underlying tissues
- nerves in skin enable perception
This includes: - touch
- pain
- pressure
- heat
- cold
- body temp regulation
What helps protect skin from UV damage
Melanin
What are internal factors of the appearance of the skin
- Genetics
- Age
- Individual’s underlying health
What are the external factors of the appearance of the skin?
- Activity
For skin disorders, what is the most diverse collection of disorders
Infectious disorders
What is contact dermatitis
inflammatory disorder of the skin
What is an irritant for contact dermatitis?
Contact with chemicals, soaps, dyes, detergents, metals, perfumes
What are the symptoms for a characterized by damage to dermis, epidermis?
- Red, pruritic rash where skin came into contact with allergen or irritant
What causes inflammatory skin disorders?
- Exposure to environmental stressors
- Injury to skin
What is an observable changes form normal skin structure
Lesions
For skin disorders, what is the primary inflammatory skin disorder response?
- Arise from previously healthy skin
- Macules, patches, papules, nodules, tumors, vesicles, pustules, bullae, wheals
For skin disorders, what is the secondary inflammatory skin disorder response?
- Results from a change in primary lesions
- Crusts, scales, lichenification, scars, keloids, excoriation, fissure, erosion, ulcers
What is an intentional wound
Occurs during therapy such as operation or venipuncture
What is an unintentional wound?
- What is a closed wound?
- what is an open wound?
- Accidental such as fracture
- Closed: tissues traumatized without break in skin
- Open: Skin or mucous membrane surface is broken
What are the degrees of contamination for wounds?
- Celan wounds
- Clean contaminated wounds
- Contaminated wounds
- Dirty, infected wounds
What is a partial thickness wounds
- Confined to skin
- Heal by regeneration
What is a full-thickness wound?
- Involve dermis, epidermis, subq tissue, possibly muscle and bone
- Require connective tissue repair
What are the most common skin disorders
- acne
- dermatitis
- Inflammatory reactions to topical drugs
- Infectious diseases of skin
What is the most common form of cancer
skin
inheritable skin disorders
- epidermolysis bullosa
- ichthyosis
- albinism
are men more affected by infection skin disorders
yes
are men more affected by pigmentary, autoimmune disorders?
no, women are
When ou age, what hapens to your skin
- change in skin thickness
- Surface pH
- quality of wound healing
Is lighter skin more prevalent in individuals for some conditions
no, some conditions are more prevalent in individuals with darker skin as some more prevalent in lighter skin
What are modifiable risk factors for the skin
- proper skin care
- avoid irritants or allergens
- avoid excessive cleansing of the skin
- what medications that cause thinning fot he skin
- watch nutrition
What types of screenings should be done for the skin
- regular self-examination
- develop familiarities with one’s skin
– professional examinations
How to prevent skin disorders
- bathing/grooming/cleansing
- use lubricants/lotion
- promote hydration
- avoid alcohol
The oral activity is susceptible to injury to what?
to injury of the lips, soft tissues, buccal cavity, and/or oropharynx, which may compromise health and create wounds
What are the goals of treatment of independent interventions for patient?
- Control severity
- Prevent infection
- Promote healing
inter-professional teams improve patient outcomes such as who?
- Nurses
- nurse care managers
- attending healthcare provider
- oncologists
- yada yada….
When do we use OTC medications for skin issues
For less serious conditions such as:
- sunburn
- acne
- most are topical
Examples of extensive or long-term prescription therapy
- Eczema, dermatitis, psoriasis
- can be oral or topical
- under doctors supervision
what situations puts you at risk for skin breakdown?
- poor blood circulation
- fluid deficit/excess
- impaired mobility
- impaired sensation
- malnutrition
- overweight
- skin diseases
Lifespan consideration for newborns on tissue integrity
- Skin covered by vernix caseosa in utero
Skin conditions that may be present at birth:
- Milia
- mild acne
- erythema toxicum
- “stork bites”
Lifespan consideration for Children on tissue integrity
- Larger Body surface area + thinner skin
More commonly affected by viral infections
Lifespan consideration for Adolescence on tissue integrity
- skin goes under hormonal changes
- in females, can cause premenstrual exacerbation of preexisting skin disorders
skin disorders that tend to appear in adolescence:
- acne
- seborrheic dermatitis
- psoriasis
- tinea versicolor
Lifespan consideration for Pregnant women on tissue integrity
- skin changes related to hormonal increases in pregnancy such as:
- hyperpigmentation
- stretch marks (striae distensae)
- Pruritis gravidum
- possible atopic eruption of pregnancy (in roughly 50% of pregnancies
Lifespan consideration for Older adults on tissue integrity
Normal skin changes in the aging process
- occurs slowly
- glands decrease oil production
What is primary intention healing?
- tissue surfaces have been approx. (closed) with little or no loss
- Formation of minimal granulation tissue, scarring
What is secondary intention healing
- Extensive wound with tissue loss and edges that cannot or should not be approx.
- Differs from primary intention healing
- Repair time longer
- Scarring greater
- Susceptibility to infection greater
What is tertiary healing
- Wound left open for 3-5 days, then closed
- Allows edema of infection to resolve, wound to drain
What is the inflammatory phase
- first 3-6 days after injury
Hemostasis results from
* Vasoconstriction
* Retraction of injured blood vessels
* Deposition of fibrin
* Formation of blood clots
* Formation of scab on surface of wound
Inflammatory phase: what are Phagocytosis
- Macrophages
- Engulf microorganisms and cellular debris
- Secrete angiogenesis factor: stimulates formation of epithelial buds at end of injured blood vessels
- This microcirculatory system sustains healing process
What is the Proliferative phase
Proliferative phase — day 3- 4 to about day 21
* Fibroblasts begin to synthesize collagen
* If wound is sutured, a raised “healing ridge”
appears under suture line
* Capillaries grow across the wound,
increasing blood supply
* Fibroblasts deposit fibrin in the wound
Granulation tissue
* Translucent red tissue, fragile, bleeds
easily
* When edges of wound not sutured, area
must be filled with granulation tissue
* When tissue matures, marginal epithelial
cells migrate to it, proliferating to fill
wound
* If wound does not close by epithelialization,
scab forms
* Later, if wounds not covered by epithelial
What is the maturation phase
Day 21 to 1-2 years
- Fibroblasts continue to synthesize
collagen - Collagen fibers reorganize into more
orderly structure - Wound site is remodeled, contracted
- Scar becomes stronger
- Repaired area never as strong as
original tissue - Keloid: hypertrophic scar caused by
abnormal amount of collagen - Particularly in dark-skinned
individuals
Risk factors for complications
Hemorrhage
* Massive bleeding
* Hematoma: internal hemorrhage
* Risk greatest during first 48 hours after surgery
* Emergency
Infection
* Contamination of wound surface with microorganisms is
inevitable
* Presence can impair wound healing, lead to infection
* Immunocompromised patients especially susceptible
* Wound can be infected
* At time of injury
* During surgery
* Postoperatively: becomes apparent 2–11 days
postoperatively
What is dehiscence
Partial or total rupture of a sutured wound
What is evisceration
Protrusion of internal viscera through incision
What are risk factors for wound healing
- Obesity
- Poor nutrition
- Multiple trauma
- Failure of suturing
- Excessive coughing
- Vomiting
- Dehydration
- Sudden straining may precede dehiscence
- Wound should be supported quickly by large sterile
saline-soaked dressings
What is the health promotion or wound healing?
- Nutrition
- Lifestyle
- Medications
What areas some clinical manifestations of wounds?
Exudate
- Material that has escaped from blood vessels during inflammatory
process
* Deposited in tissue or on tissue surfaces
What are the 3 types of exudate?
- Serous – mild inflammation (clear or straw color)
thin and watery - Purulent – thicker composed of cells and necrotic
tissue (opaque or milky, color blue, green, yellow) - Sanguineous – large number of RBC’s indicates damage to
capillaries – frequently seen in open wounds
What is mixed exudate?
clear and blood-tinged drainage
* Serosanguineous: commonly seen in surgical incisions
* Purosanguineous – pus and blood – seen in a new wound that is
infected
what are the 7 principles of wound healing to remember
❖ Intact skin-first line of defense against microorganisms.
❖ Careful hand hygiene is used in caring for a wound.
❖ Reposition every 2 hours to prevent skin breakdown.
❖ Adequate blood supply is essential for normal body
response to injury.
❖ Normal healing is promoted when the wound is free of
foreign material.
❖ The extent of damage and the person’s state of health
affect wound healing.
❖ Response to wound is more effective if proper nutrition is
maintained.
Systemic factors that may affect
wound healing to remember
❖ Age: children and healthy adults heal more rapidly
❖ Circulation and oxygenation: adequate blood flow is essential
❖ Nutritional status: healing requires adequate nutrition
❖ Wound etiology: specific condition of the wound affects healing-necrotic
tissue or slough
❖ Health status: corticosteroid drugs and postoperative radiation therapy
delay healing, comorbidities
❖ Immunosuppression
❖ Medication use
❖ Adherence to treatment plan
❖ The more factors affecting healing increases complexity
Local Factors that may affect
wound healing to remember
Pressure-lack of blood flow
Desiccation-too dry, cells dry up
Maceration-too moist, promotes bacterial growth
Trauma
Edema-limits blood supple to the area
Infection-leaves body is busy fighting infection, can’t heal
Excessive bleeding-breeding ground for infection, interferes
with oxygen perfusion
Necrosis-dead tissue
Biofilm-thick, protective slimy barrier of sugars and proteins
What are the 2 priorities when it comes to wound healing?
- Promotion of healing
- Prevention of Infection
What is escharotomy done?
For full-thickness wounds that encircle or near encircle a body part and have formed eschar
What pharmacologic therapy do we use for normal wound healing?
- Antibacterial ointments
- Prophylactic antibiotics
- Analgesics
- Complementary therapies: products containing aloe vera
What pharmacologic therapy do we use for impaired wound healing?
- Antibiotics specific to causative organism
- In some cases, growth factors
- Opioids, nonsteroidal anti-inflammatory drugs (NSAIDs) for
pain management
For non-pharmacologic therapy, what do we use for wounds with impaired healing?
Vacuum-assisted closure
- do not use on wounds with eschar, necrotic tissue, or malignancy present
- wounds with anything exposed
What are 2 cellular therapies for wound healing?
- Stem cell therapies
- Skin or tissue grafts
What does biosurgery use
sterile maggots
Lifespan considerations for Newborns, infants, and children
- skin more fragile and thin
- susceptible to infection
- major infections: Staph, Fungi
When cleaning wounds: clean w/warm soapy water; cover with sterile bandage
Lifespan considerations for Older Adults
- Skin is more fragile
- Hold wrinkled skin taut
- check routinely for skin breakdown every 2 hours
Description of an arterial ulcer
Toes and feet, shin
Deep ulcer, pale
Shiny skin
Loss of hair
Pallor upon elevation
Cool to touch
Little to no edema
Intermittent, severe, resting pain
Decreased, absent pulses
Description of a Venous Ulcer
Usually around ankle
Superficial, pink, beefy, irregular edges
Skin looks leathery, brown, purple, dermatitis
present
Edema present
Aching, mild pain
Normal pedal pulse
Risk factors for a Diabetic Ulcer
Dx of DM
DM not well controlled
Overweight
Neuropathy
Poor circulation
Wearing poor fitting shoes
Walking barefoot
ETOH/smoking
High cholesterol
Aging
*Often results in amputation (toe, foot
