Exam 3 Flashcards by Scarlet Guzman

Inflammation

an immunologic defense against tissue injury, infection, or allergy

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First outcome

Involves acute inflammation and restitution
Best possible outcome
(ex-sprained ankle)

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Acute inflammation

initial response to injury

Focus is to eradicate dead tissue and protect against infection

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Restitution

damaged tissue is replaced by identical tissue

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Second outcome

fibrous repair of the damaged tissue and formation of scar tissue
Substantial tissue damage (ex-burn)

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Third outcome

development of chronic inflammation;
pathologic agent remains active;
tissue destruction continues;
high outcome of morbidity and mortality

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Fourth outcome

death of tissue and death of host

worst possible outcome

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What are the outward signs of acute inflammation?

5 cardinal signs:

redness, swelling, heat, pain, loss of function

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Physiologic changes of acute inflammation

increased blood flow;
migration of leukocytes from the blood to the tissues;
proteins, fluids, lymphocytes, monocytes, macrophages, granulocytes

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Chronic inflammation

continues for weeks to years, never really goes away;

a granuloma is formed

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Granuloma

at the site of an injury: an accumulation of macrophages, fibroblasts and collagen

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Important history to assess for inflammation?

What was the trigger?
-exposure to allergens
-exposure to infectious agents
-recent injury
Risk factors: very young, very old, immunocompromised
Physiological ability to respond
Symptoms and duration
Treatment up to the point of diagnosis

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Internal signs of inflammation

fever, increased WBC, slowing/absence of tissue/organ function

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Labs for inflammation

WBC with differential
C-reactive protein (CRP)
Erythrocyte sedimentation rate (ESR)

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C-reactive protein (CRP)

elevation tells us that there is presence of inflammation;

marker for cardiac disease

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Erythrocyte sedimentation rate (ESR)

refereed to as esedrate;

elevation indicates presence of inflammation

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Epstein-Barr

virus that causes mononutriosis

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C-diff

3 loose stools confirm presence;

needs protective isolation

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H.pylori

microorganism;

antibiotic 7-10 days and ulcer is gone

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Primary prevention of inflammation

hand hygiene, clean wounds, safety equipment in sports (helmets, padding), food and water safety standards

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What does RICE stand for? (used for sprains)

Rest
Ice
Compression
Elevation

Steroid usage in inflammation

effective in reducing swelling and pain

NSAIDs in inflammation

good for pain, fever, and inflammation

Antipyretics in inflammation

for fever (103 or higher, get blood culture)

Analgesics in inflammation

for pain

Antimicrobials in inflammation

for actual microorganisms or prophylaxis

Evidence definition

an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities that are served

Primary literature involves

quantitative research, qualitative research, and mixed design research (original research)

Quantitative research includes:

objective observation and validation; | random controlled double blind studies

objective observation and validation

forms hypothesis of what the researcher is trying to prove

random controlled double blind studies

least amount of bias; two groups: controlled and experimental; both patients and researchers are blind to interventions

Qualitative research includes:

a person'ts experiences, interviews, surveys, questionaires

Mixed design research

a combination of both qualitative and quantitative research; | provides a holistic approach to research questions

Secondary literature involves

evidence summaries, and systematic reviews/meta-analysis

Evidence summaries

summarizes original research studies

Systematic reviews/meta-analysis

synthesis of the evidence and conclusion on effectiveness; | summarizes evidence from multiple studies

Attributes of evidence

has to have: - replicability - reliability - validity

GRADE system

Grades of recommendation assessment, development, and evaluation

Grade A

Strongly recommends: high certainty that net benefit is substancial

Grade B

Recommends: high certainty that the net benefit is moderate to substancial

Grade C

Neutral: moderate certainty that the net benefit is small

Grade D

Recommends against: moderate to high certainty that there is no net benefit OR that the harm to the patient outweighs the benefit

Grade E or I

Insufficient evidence to recommend for or against

Randomized controlled trial

test group and controlled group

Cohort study

research following one group of people

Case-controlled study

study of two groups that have two different outcomes

Case study/reports

detailed analysis of members o f a group and making inferences

Longitudinal study

study over time

Ethnography

study of people and cultures

Phenomenology

study of experiences and consciousness as experienced from a 1st person point of view

Grounded theory

discovery of theory through analysis of data