Immunity- Wound Healing Flashcards
Cell injury comes from:
Physical injury
Deficiency of normal substance
Exposure to a toxin
1st defense
Innate
Skin
Mucous membranes
pH, lysozyme, temperature
2nd defense
Innate
Internal
Phagocytes, NK cells, inflammation, fever, anti microbial agents, leukocytes
3rd defense
Adaptive immunity
Humoral immunity- B cells
Cellular immunity- T cells
All leukocyte types
2nd line of defense Neutrophils Lymphocytes (t and b) Monocytes Eosinophils Basophils
Natural killer cells
Non-specific
Non-phagocytic
Secrete chemicals
INF
Interferon
Anti microbial protein
(Complement is another example)
Inflammatory response
Bacteria in blood Mast cell give off histamine Vasodilation Capillary permeability More blood flow and edema (exudate) Red, heat, swelling, pain
Cellular defense
T cells from thymus
Become effector cells (helper and cytotoxic and regulatory) to target intercellular pathogens
Humoral defense
B cells from bone marrow
T cells activate them to secrete antibodies that target extracellular proteins
Lab signs of acute inflammation
High WBC
High CRP
High fibrinogen
Lab signs of chronic inflammation
High CRP
High fibrinogen
High TNF alpha
Non-steroidal anti inflammatory drugs
Stop Cox 1- and -2 Stop prostaglandin made Raise GI acid and less mucus Down regulate renal blood flow and blood clotting Gastric bleeding and ulcers
Cox-2 inhibitors
Specific type of NSAIDS
Help with edema, pain, inflammation, and leukocytosis
Good for musculoskeletal problems
Risk strokes and heart attacks
Glucocorticoids risks
Muscle wasting
Osteoporosis
DM
Edema from vascular permeability
Antibody
Secreted by B cells when antigens present
Tag antigens and mark for destruction
M, A, G, D, E
Pressure Ulcer
“Shear”
Mechanical force caused by gravity and friction like sitting
Necrosis/Eschar
Brown black or tan tissue that sticks to the edges of the wound. Usually needs taken off (called debridement)
Slough
Soft, moist avascular tissue that sticks/clumps to wound
White, yellow, tan, or green
Undermining
Tunneling
Necrosis spreads to create a pocket underneath skin that is bigger than the wound appears on surface
Undermining joins another undermining
Wound Vac using NPWT
Draws wound edges together
Negative pressure wound therapy
Braden Scale (6-23)
Lower score means greater risk of bedsores
Pressure ulcers stage 1
Red skin that doesn’t turn white when pressed
Skin not broken
Temp and hardness may be different
Pressure ulcer Stage 2
Epidermis broken
Drainage and pus present
Dermis can be broken. Usually a shallow cut
Pressure ulcer stage 3
Through dermis and into fatty tissue
Pus, odor, fever, green drainage, and necrosis may start to be visible
Pressure ulcer stage 4
Wound goes into muscle or bone
Dead tissue, drainage, and possible infection
Surgery usually needed
Suspected deep tissue injury characteristics
Purple or maroon local look
Blood blister
Mushy, boggy painful tissue
Pressure ulcer: unstageable
Tissue completely lost but filled in with slough (yellow green brown gray or dark Eschar (necrosis))
It has to be removed to see the bottom of wound but is sometimes left in
Normal wound healing process
Inflammation
Proliferative
Remodeling
Kcal/protein/fluid needs for wound healing
25-30 or 30-35 kcal/kg
1.25-1.5 g/kg
35ml/kg or if over 55 yo, 30 ml/kg
Arginine
Glutamine
Collagen deposition, nitrogen balance, immune function
Fuel for enterocytes, lymphocytes, and macrophages
