Inflammation/Infection/UTI/Sepsis/HIV/AIDS Flashcards
1
Q
What can cause inflammation?
A
Broken bones, sprains, cuts, asthma
2
Q
When we have inflammation , does that mean there is an infection too?
A
No
3
Q
When we have an infection, does that mean there is inflammation ?
A
Yes, when there is an infection there is also inflammation
4
Q
Inflammatory pathophysiologic response involves ……
A
vascular response
cellular response
cell mediators
5
Q
What is the cellular response in the inflammatory process?
A
When the monocytes, neutrophils and macrophages come into the injured area
6
Q
Cell mediators include the
A
complement protein cascade systems, prostaglandins, leukotrienes
7
Q
Inflammatory response depends on the ________ __________ of the individual
A
reactive capacity
How well does a person respond to injury - think what factors enable a stronger response
8
Q
A patient who is ________________ would be lacking in white blood cells and would have trouble initiating an effective _____________________.
A
immunocompromised; inflammatory response
9
Q
The inflammatory response depends on the ____________ of the injury -
A
nature; there is a difference between being pricked by a pin and being stabbed by a knife
10
Q
Three basic types of inflammation
A
Acute
Subacute
Chronic
11
Q
Acute Inflammation
Who are the prominent cell types present at this inflammation ?
A
healing occurs within 2-3 weeks
neutrophils are prominent cell type at area of inflammation
12
Q
Subacute inflammation
A
persists a little longer than acute inflammation
endocarditis for example
13
Q
Chronic Inflammation
A
anything greater than 3-6 months
prominent cell types involved are the lymphocytes and the macrophages
may result from changes to the immune system (rheumatoid arthritis)
asthma and arthritis are examples
14
Q
Chronic inflammation can lead to _____________
A
deterioration, depending on the severity
15
Q
Older patients may have less response to _________
A
temperature. If they have an infection, we could see a slower than normal rise in temperature
16
Q
3 things that will help us address inflammation
A
Vital signs, labs and assessment
17
Q
Clinical Manifestations
A
Color (erythema ) temperature, swelling, function, drainage (color, amount, odor)
18
Q
Questions you would ask the patient
A
how did the injury happen?
what medications are you taking ? (pregnisone can decrease the inflammatory process)
medical history - any diabetes (slow healing time) history of arthritis
19
Q
lab findings
A
CBC - any increase in WBC, or neutrophils or BANS
20
Q
Local Inflammation
A
Redness, heat, pain, swelling, loss of function
21
Q
Systemic inflammation
A
increase in WBC with a shift to the left (increased number of immature WBC) malaise, nausea, anorexia, increased temp, pulse and respiratory rate
These symptoms would point to more of a systemic infection that is throughout the body
22
Q
Vital signs
A
temperature, respirations, pulse, BP, pulse ox, pain
23
Q
How can we minimize inflammation and infection ?
A
Immunizations (Tetanus, pneumonia and flu)
Good hand hygiene
nutrition helps to regenerate tissue
24
Q
What is one way to assess patients nutritional level?
A
Albumin levels
25
What might we first see in the older adult when there is an infection?
Confusion
26
Manifestations of systemic infection
increase in temperature, pulse, respiration, decrease in pulse ox and decrease inBP
27
What can happen with too elevated fever levels ?
seizures
28
Drug therapy to decrease the inflammatory response
aspirin (blocks prostaglandin synthesis in the hypothalamus)
Tylenol (acts on the temperature regulatory center in the hypothalamus)
NSAIDS (motrin, advil have antipyretic effects)
corticosteroids
antipyretics should be give around the clock
29
Benefits of fever
increase destruction of microbes
increased proliferation of T cells
increased phagocytosis
higher body temp may enhance activity of interferons
30
RICE
Rest, Ice, Compression, Elevation
31
Heat can help promote healing by increasing
circulation to inflamed site, done 24-48 hours after injury
32
What can ice do to the vessels ?
Vasoconstriction
33
Can local infection be contained ?
Yes
34
Symptoms of local infection
change in vital signs (fever, tachycardia, tachpynea)
pain, redness, swelling, temperature, motion
later signs would be hypotension and decreased pulse ox
35
Symptoms of systemic infection
change in vital signs (fever, tachycardia, tachpynea)
pain, redness, swelling, temperature, motion
malaise, anorexia,lymph node enlargement, altered Mental status (blood cells in brain not getting oxygen they need because of hypoxemia (decreased oxygen flow) , changes in renal function and/or cardiac output , hypotension, hypoxemia
36
What is sepsis ?
Sepsis is SIRS + infection
37
normal WBC count
4500-11,000
38
Infections can be ......
localized, disseminated, or systemic
39
For infection, clinical manifestations are the result of the ........................ response
inflammation and immune response
40
Systemic affects only one body part.... true or false .....
obviously False. ..... Systemic affects the whole body at once
41
Leukocytosis
increased in white blood cells
42
Immature neutrophils can not fight infections. true or false
true
43
For a patient exhibiting symptoms of an infection, what kind of antibiotics would we start them out on
broad spectrum antibiotics
44
SIRS
Systemic inflammatory response syndrome - inflammatory response is going on throughout the body - can be indicative of infection, ischemia, infarction , asthma - SIRS does not necessarily mean there is an infection
45
Sepsis
SIRS + possible infection - a body's response to infection
Sepsis can cause life threatening organ dysfunction
46
Risk factors for sepsis
Age - very old and very young
co-morbidities
medical devices - foley catheter is a risk for sepsis
immunocompromised patients - transplant patients
47
sepsis spectrum
can be from mild to severe
48
criteria for SIRS
increased pulse, increased respiration, inc/dec in WBC, inc/dec in temperature
2 of these 4 lead to SIRS
49
severe sepsis
sepsis + end organ damage
altered mental status, edema, renal impairment - with hypoxemia, renal cells will not be getting oxygen they need to make urine
we have to work quickly on getting cultures and fluids and antibiotics for them
50
septic shock worry
death
51
septic shock =
severe sepsis and prolonged hypotension
there is vasodilation, maldistribution blood flow and myocardial depression
52
leukopenia
decreased number of white blood cells
53
If a patient comes in with elevated temp, elevated pulse, productive cough, decreased pulse ox, confusion - we need to monitor them and give them
IV fluids, quick boluses-
we could give boluses but their blood pressure might still be hypotensive - indicating septic shock
54
severe sepsis , lactic acid levels are
lactic acid > 2
55
septic shock , lactic acid levels are
lactic acid > 4
56
multiorgan dysfunction syndrome
failure of two or more organs as the result of severe sepsis
57
sepsis diagnostics
no specific diagnostic test but an array are looked at
58
sepsis diagnostics
CBC
CBC - leukocytosis/leukopenia/increase in BANS
59
sepsis diagnostics
electrolytes
increased glucose, Na+ , decreased K+ (shock)
60
when we are doing the bloodwork, we are looking to see if our patient is in _____________, _____________ , ___________.
sepsis, severe sepsis, or septic shock
61
Procalcitonin levels are present when
there is bacteria. it is released from every type of organ/tissue when bacterial infection is present
62
C reactive protein is produced by the _________ when there is inflammation
liver.
we look at C reactive protein together with WBC count
63
severe sepsis
lactic acid > 2
64
septic shock lactic acid levels
lactic acid > 4
65
we always do blood cultures before we get the specific
antibiotic
66
Culture sources
blood, urine, sputum
67
It is ideal to get _______________ before giving antibiotics so we can identify the _______________
blood cultures; pathogen
68
creatinine, ABG's , radiography- indicative of
MODS - we look at these labs for indications of organ function
69
MODS
multiple organ dysfunction syndrome
70
prevention of sepsis
aseptic care, prophylaxis , patient teaching
71
prophylaxis
action taken to prevent disease, especially by specified means or against a specified disease
72
management of sepsis - early stages - uncomplicated
oxygen therapy
ABCs
optimize fluid status IV therapy (1000 ml of fluid within 5-10 minutes b/c body needs that fluid)
broad spectrum antimicrobial therapy - within 1 hour of sepsis - Get culture first ideally
temp & pain management
emotional support
ongoing monitor for change in condition
73
for sepsis patients, what is one thing we will always give .....
fluids are always something we can give....
74
management of sepsis - complicated - SEPTIC SHOCK
same care as prevention and early sepsis - oxygen may require mechanical ventilation
75
management of sepsis - complicated - SEPTIC SHOCK
- IV considerations
large IVS, at least 2 so we can get crystalloids 30 ml/kg into them.....
76
when we give IVs, we evaluate effectiveness by paying attention to
urine output, pulse Ox , vital signs
77
If IV's are not raising certain vital signs, what can we administer
vasopressins
78
HAI's
health care associated infections - infections that occur within the hospital through delivery of care
79
endogenous infections
from client themselves
80
exogenous infection
from the hospital/personnel
81
iatrogenic infection
occurs from the interventional procedure themselves
82
Preventing HAI's
hand washing, asepsis, environmental controls
83
about how many deaths occur a year because of HAI's
about 75,000
84
Tier One Standard Precautions
applies to all patients
85
tier two transmission precautions
when person has a known disease - airborne, droplet, contact precautions
86
airborne particle size
less than 5 microns
87
droplet particle size
greater than 5 microns
88
Important factors when it comes to preventing transmission and infections
hand washing, immunizations, nutrition, stress management, hydration, rest and sleep
89
ARO
antimicrobial resistant organisms - can be bacterial, viral, fungal, parasitic
organism changes in such a way that it becomes resistant to antibiotic. changes happen that decrease ability of drug to destroy it
90
Etiologic factors for ARO development
administration of antibiotics for viral infections
submitting to pressure from patients for Rx
using inadequate drug regimes
using broad therapy in place of first line therapy
patients - incomplete therapy
91
VRE
a common ARO
vancomycin Resistant Enterococci
92
VRSA
Vancomycin Resistant Staph Aureus
93
MRSA
Methicillin Resistant Staph Aureus
94
Patient teaching to prevent development of ARO's
```
only take prescribed medication
finish all prescriptions
do not request antibiotics for colds and flu
do not take "left over" medications
following directions
```
95
Chain of Infection
```
A microbe
a reservoir
path from reservoir
mode of transmission
path of entry
susceptible hosts
```
96
What is the number one cause of UTI's ?
Escherichia coli (E. Coli)
normally found in the intestinal tracts
women might not be wiping from front to back
older adults might be incontinent of stool and not cleaning themselves as well
97
Classification of UTI
Upper vs Lower
98
Lower UTI
usually no systemic manifestations
99
Who gets more UTI's: women or men ?
Women
100
Cystitis
inflammation of the bladder
101
Urethritis
Inflammation of the urethra
102
Urosepsis
characterized by bacteriuria and bacteremia
| this is a UTI that has spread systemically
103
bacteriuria
bacteria in the urine
104
signs of symptoms of urosepsis
```
incr/decr temp
increase pulse
incres RR
incres/decres WBC
2/4 of these lead to SIRS
```
frequency of urination
confusion
pain
105
Urosepsis treatment
fluids, fluids, fluids
| Broad spectrum antibiotic after we get cultures
106
Do not hesitate to ask the doctor for an order for an __________ to get a urine sample
in and out catheter so we can obtain a sensitivity test to get a more specific antibiotic
107
Why do we choose isotonic fluids with patients when we are talking about giving fluids for Severe Sepsis and septic shock and sepsis ?
Because we want to keep that fluid within the vascular system. isotonic fluid stays within a vascular system
108
Why do we give colloids
IV solutions that increase osmotic pressure. Pull for volume expansion- will keep fluid within the vascular space
109
When we are giving fluids for sepsis, what do we want to do?
Increase the amount of fluid within the intravascular space
110
Isotonic fluid stays within the ________________
vascular system
111
How does rest help during inflammation process?
rest helps body to use nutrients
112
Cold is applied when during the inflammatory process?
at times of initial trauma to induce vasoconstriction and reduce swelling
113
What does compression do ?
compression serves to counter effects of vasodilation
114
Clinical manifestations of infection are the result of which two responses ?
Inflammatory and immune response
115
Different types of infection
local, disseminated, systemic
116
Local infection
limited to specific body part like an organ or area of body
117
Systemic infection
infection that affects the entire body at once - it is in the bloodstream
118
Disseminated infection
spread of organisms beyond initial site
119
Local infection manifestations
pain, redness, swelling, warmth, decreased motion -
| change in vital signs: fever, tachycardia, tachypnea
120
Systemic infection manifestations
pain, redness, swelling, warmth, decreased motion,
change in vital signs: fever, tachycardia, tachypnea
malaise
121
With UTI's think of ........
cystitis
122
symptoms of cystitis
```
frequency
urgency
dysuria
hematuria
fever
confusion in older adults
suprapubic pain
```
123
Diagnostics for UTI
dipstick for leukocyte estrace
nitrates
Urinary Analysis/ Culture and Sensitivity
124
dipstick for leukocyte estrace - what does it indicate ?
pyuria - pus from bacteria
125
When nitrates are present, this shows that .....
bacteria are present
126
Treatment for UTI's
antimicrobials
increased fluid intake
prevention
127
Teaching and Prevention for UTI prevention
```
showers better than baths
perineal cleaning "from front to back"
voiding after intercourse
anti-microbial therapy
no scented toilet paper
no perfumes to perineal area
empty bladder regularly
```
128
Urinary tract above urethra is normally ______________
sterile
129
What defense mechanisms exist to maintain sterility/prevent UTI's?
Complete emptying of bladder, ureterovesical junction competence, ureteral peristaltic activity
130
ureterovesical junction competence
the ureter connects to the bladder
131
ureteral peristaltic activity
forward movement of urine- urine should not be backing up in system, but moving forward
132
Foley catheter should never go past the level of
the bladder, in order to prevent UTI's
133
The pH of our urine is
less than 6.0 pH - it is acidic. this is an antibacterial defense
134
High urea concentration and abundant glycoproteins interfere with
the development of UTI's
135
CAUTI
catheter associated UTI's - most common HAI's
136
often Causes of UTI- bacterial wise
E. Coli is often UTI cause
| less frequently: Pseudomonas species
137
Most UTI's are under ______ and under_______
underrecognized and undertreated
138
Clinical Manifestations of UTI
```
urinary frequency
urgency
incontinence
nocturia
nocturnal enuresis
weak stream
hesitancy
intermittency
post void dribbling
urinary retention
dysuria
```
139
in older adults symptoms for UTI are often
absent
140
In older adults, what are some signs of UTI?
nonlocalized abdominal discomfort rather than dysuria (more of suprapubic pain)
cognitive impairment possible
fever less likely
141
IF we have an older adult that is confused think....
UTI, infection, pneumonia, maybe diabetes too -- the point is just to start thinking about different possibilities when symptoms arise
142
Diagnostic Studies for UTIs
first we do history and physical - think of risk factors (age, gender)
do they have urinary catheter in place, or use in/out catheters, are they/have they been on antibiotics, previous UTI's, immunocompromised, BPH, tumors, renal calculi
dipstick urinalysis
- identify presence of nitrites, WBC and leukocyte esterase
- urine for culture and sensitivity
143
in a patient suspected of having UTI's, we will conduct __________________
dipstick urinalysis
| culture and sensitivity tests
144
regarding a dipstick urinalysis test, elevated/ decreased WBC indicates we may have an
infection
145
regarding a dipstick urinalysis test, nitrites would indicate the presence of
bacteria
146
Antibiotic worries/ education
It is important to educate patients about antibiotic regime for UTI treatment
medications themselves - some we have to worry about when to give them (with food/without food)
and avoidance of sunlight
147
Antibiotics to keep in mind for UTI's (will not be tested on )
Trimethoprim/sulfamethoxazole
Nitrofurantoin (Macrodantin)
Fluoroquinolones
Ampicillin, Amoxicillin, Cephalosporins
148
Antifungals for fungal infections
Amphotericin or Fluconazole
149
UTI's can be very painful so we will be giving
urinary analgesics
150
Phenazopyridine
used in combination with antibiotics
provides soothing effect on urinary tract mucosa
stains urine reddish orange color
can be mistaken for blood and stain underclothing
151
Which analgesic medication can stain a patients urine a reddish/orange color ?
Phenazopyridine
152
It is important to recognize those individuals more at risk of a UTI - who are they ?
debilitated persons
older adults
underlying diseases (HIV/diabetes)
those taking immunosuppressive drug or corticosteroids
153
Health promotion for UTI's
wipe perineal area from front to back
emptying bladder regularly and completely
evacuating bowel regularly
drinking adequate fluids (persons weight x 2)
cranberry juice or cranberry tablets may reduce # of UTI's
avoid unnecessary catheterization and early removal of indwelling catheters
aseptic technique must be followed during instrumentation procedures
routine and thorough perineal care for all hospitalized patients
answer call lights and offer bedpan or urinal at frequent intervals
154
prevention of CAUTI
wash your hands ! before and after patient contact
avoidance of unnecessary catheterization
early removing of indwelling catheters
follow aseptic technique for procedures
wear gloves for care of urinary catheters
155
In teaching our patients, what are some potential bladder irritants ?
caffeine, alcohol, citrus juices, chocolate, highly spiced foods
156
we should emphasize to our patients the importance of taking the full course of _______ despite the disappearance of _______
antibiotics; symptoms
157
What else to teach patients about UTI prevention and treatment ?
maintain adequate fluids
void after intercourse
regular voiding
158
Renal colic
a type of pain someone gets when urinary stones block part of your urinary tract
159
common source of UTI is
HAI's and CAUTI's are the most often source
160
How can you get HIV?
sex without a condom
passed from mother to baby
sharing injecting equipment
contaminated blood transfusions & organ transplants
161
Thrombocytopenia
a deficiency of platelets, which increases the risk for bleeding
162
What is the only way to know for sure that you have HIV ?
To get tested
163
If left untreated HIV can lead to ......
AIDS
164
HIV is a __________ acid virus
ribonucleic
165
Why is HIV called a retrovirus ?
Because it replicates in a "backward" manner going from RNA to DNA
166
What is the target cell for HIV ?
CD4+ T cell - a type of lymphocyte
167
How does HIV bind to its target cells?
Through fusion
168
HIV cannot replicate unless it is inside what ?
A living cell..... this is the case for all viruses
169
HIV disease progression - important points to remember
highly individualized progression of disease
treatment can alter the disease pattern
individual prognosis is unpredictable
170
When does the HIV antibody test become positive ?
From 3 week to 3 months
171
Acute Infection for HIV occurs from
1-3 weeks. This is the time when the person does not know they have HIV but are experiencing some flu-like symptoms
172
Asymptomatic period of HIV infection lasts for about how long in those untreated ?
10 years
173
Acute HIV infection Clinical Manifestations
- when does this start occuring
occurs about 2-4 weeks after infection- it is highly infectious at this point
Flu like symptoms- fever, swollen lymph nodes, joint pain, diarrhea, sore throat, headache, nausea, malaise, muscle/joint pain, diffuse rash
may have 1-2 or 3 or these symptoms - very similar to flu symptoms
potential for neurological complications such as aseptic meningitis, peripheral neuropathy, facial palsy
174
HIV advances to a more active stage as the ______ cell count declines closer to ________ cells/uL and the viral load increases.
What is this stage called ?
CD4 T cell count; 200
This stage is the symptomatic infection progression of HIV
175
HIV Symptomatic infection symptoms
persistent fever, chronic diarrhea, recurrent headaches, frequent night sweats, severe fatigue
Also it is more common to have certain infections like thrush, shingles, bacterial infections, persistent vaginal candida infections, outbreaks of oral or genital herpes, and Kaposi Sarcoma
176
Oropharyngeal Candidiasis
as known as "Thrush"
177
HIV/AIDS patient teaching
immune system support - can help delay HIV progression, whether patient chooses to take ART or not
178
What is the goal of HIV treatment ?
To decrease the viral load and to increase CD4 T cells
179
The lower the viral load of HIV, the ________ active the disease.
less
180
Two things to pay attention to when monitoring HIV
CD4 T cell count
Viral Load
181
What does the CD4 T cell count provide ?
A marker of immune function
182
HIV/AIDS Monitoring for Complications (opportunistic diseases/therapy complications)
decreased WBC counts
low platelet counts
Anemia is associated with ART (antiretroviral therapy)
altered liver function
183
Opportunistic infections such as pneumocystosis or malignancies such as Kaposi's sarcoma can signal the final stage of HIV, infection, which is
AIDS
184
Resistance tests can help determine what ?
If the person's HIV is resistant to the medications being used
185
What helps health care providers know which medications may be effective in HIV therapy?
assays
186
HIV/AIDS interprofessional care
monitor disease progression, immune function, and manage symptoms
initiate and monitor Antiretroviral therapy
prevent, detect, and/or treat opportunistic infections
prevent or decrease complications of therapies
prevent further transmission of HIV
187
To prevent the emergence of ARO, patients need to take the entire course of antibiotics, even when _________ have resolved
symptoms
188
ART
antiretroviral therapy
189
ART can significantly slow HIV progression but it
is complex
has side effects
does not work for everyone
is expensive
190
lipodystrophy
changes in body shape caused by a redistribution in fat in the abdomen, upper back, and breasts along with fat loss in the arms, legs, and face
191
some HIV infected patients, especially those who have been infected and on ART for a ling time, may develop a set of _____________
metabolic disorders
192
What are some of the metabolic disorders some HIV infected patients may eventually develop ?
```
lipodystrophy
hyperlipidemia
insulin resistance
hyperglycemia
bone disease (osteoporosis, osteopenia, avascular necrosis)
lactic acid acidosis
renal disease
cardiovascular disease
```
193
For HIV patients, goals for care are aimed at
```
compliance with drug regimens
adopting a healthy lifestyle
beneficial relationships
spiritual well being in regard to life and death
coping with disease and treatment
```
194
Early recognition and treatment of HIV can
slow down the disease progression itself
195
What is the normal range of CD4 T cell count ?
800-1200 cell/uL
196
Oral Thrush
a common opportunistic infection associated with those in symptomatic stage of HIV
uncommon in the healthy person
197
Kaposi Sarcoma
a common infection for those who have HIV
malignant vascular lesions that appear anywhere on the skin surface or on internal organs
lesions vary in size from pinpoint to large and may appear in a variety of shades
198
PJP
Pneumocystis Jiroveci Pneumonia
- see this as common infection in those with HIV
can be deadly for those with HIV
not normally seen in those with regular immune system
199
Signs and Symptoms HIV infected patients need to Report
altered level of consciousness, nausea, vomiting, seizures, dehydration
200
patients with HIV must take at least one _____ a day for how long?
One pill a day for the rest of their lives
201
Most common methods of transmission of HIV
unprotected sex with an infected partner
| sharing needles with infected person
202
The "almost eliminated as risk factors for HIV transmission" are
transmission from mother to fetus
| infection from blood products
203
What is the final stage of HIV infection ?
AIDS
204
Opportunistic infections such as pneumocystosis or malignancies such as Kaposi's sarcoma can signal the final stage of HIV, infection, which is
AIDS
205
many HIV patients, despite the treatments, experience
disease progression and death
206
persons with undetectable HIV viruses must take what on a daily basis to continue to suppress their HIV virus ?
their HIV medications
207
What are prophylactic antibiotics ?
Antibiotics to prevent a certain infection like pneumonia - we don't like prophylactic antibiotics
208
To prevent the emergence of ARO, patients need to take the entire course of antibiotics, even when _________ have resolved
symptoms
209
What is the final phase of the inflammatory response ?
Healing
210
Healing includes what two major components ?
Regeneration and Repair
211
Regeneration consists of
replacing the lost cells and tissues with cells of the same type
212
Repair consists of
healing and usually results in scar formation
213
Repair healing occurs by ________, ________ , or _______ __________
primary, secondary, tertiary intention
214
What is primary intention ?
Primary intention healing takes place when wound margins are neatly approximated, as in a surgical incision or a paper cut.
215
Primary intention healing includes what 3 phases ?
Initial phase, Granulation Phase and Maturation Phase and Scar Contraction
216
What happens in the initial phase of healing ?
Acute Inflammatory response brings neutrophils and macrophages to the area. Blood clots form and macrophages digest debris. The fibrin clots serve as an inviting ground for future capillary growth and epithelial cell migration
217
What happens during the granulation phase of healing ?
Fibroblasts migrate to the healing site and secrete collagen. Capillary sprouts proliferate and begin to mature. A thin layer of epithelium migrates across the wound surface ikn a one cell thick layer until it contacts cells from the opposite direction . The epithelium begins to thicken and mature and wound now closely resembles adjacent skin
218
What happens during the maturation phase of healing ?
Collagen fibers are further organized and a mature scar is formed. This is the remodeling stage
219
What is secondary intention?
A type of repair healing for wounds which are not approximated and that have large amounts of exudate , and wide, irregular margins. The inflammatory reaction may be greater than in primary healing.
220
Healing and granulation take place from the edges _______ and from the _________ of the wound upward until the defect is filled.
inward; bottom
221
What are the components of granulation tissue ?
Proliferating fibroblasts, proliferating capillary sprouts (angioblasts) various types of WBC, exudate and loose semi fluid ground substance
222
Tertiary intention
healing occurs with delayed suturing of a wound in which two layers of granulation tissue are sutured together. This occurs when a contaminated wound is left open and sutured closed after the infection is controlled.
It also occurs when a primary wound becomes infected, is opened, is allowed to granulate and is then sutured.
223
___________ _______ usually results in a longer and deeper scar than primary or secondary intention.
Tertiary intention
224
Purulent exudate contains
WBCs, live and dead microbes, liquefied dead cells, and other debris
225
If the demand for neutrophils during the acute inflammatory response increases, what happens?
A shift to the left....
| the bone marrow releases immature forms of neutrophils (bands) into circulation
226
What does it mean to debride a wound ?
Cleaning the debris from a wound before healing can take place
227
RICE - it is important for treating .......
soft tissue injuries
228
Why does rest help with soft tissue injury ?
it helps the body use its nutrients and O2 for the healing process, The repair process is facilitated by allowing fibrin and collagen to form across the wound edges with little disruption
229
What does compression do ?
Counters the effects of vasodilation and edema by occluding blood vessels and stopping bleeding
230
Important assessment point when applying compression bandages
check distal pulses and capillary refill to make sure circulation is not cut off (paleness and loss of feeling)
231
Immobilization - how does it help the healing process ?
Promotes healing by decreasing the tissues metabolic needs
232
Elevation - how does it help the healing process?
elevating extremity above level of the heart decreases edema by increasing venous and lymphatic return
it also helps reduce pain associated with blood engorgement at the injury site
233
Cold therapy applied to a site of inflammation reduces
swelling, pain and congestion from increased metabolism in the area
234
In wound healing, what three vitamins have essential roles ?
Vitamin C, vitamin B and Vitamin A
235
Wound healing - Vitamin C is needed for
capillary synthesis and collagen production by fibroblasts
236
Wound healing - Vitamin B is needed for
it is necessary as coenzymes for many metabolic reactions
237
If a vitamin B deficiency develops, a disruption of what will occur?
Protein, fat, carbohydrate metabolism
238
Why is vitamin A needed in healing ?
To aid in the process of epithelialization
239
What are factors that can interfere with wound healing ?
Factors that can interfere with wound healing include malnutrition, obesity, decreased blood supply, tissue trauma, smoking, drugs (e.g., corticosteroids, chemotherapy), wound debris such as necrotic tissue, advancing age, diabetes mellitus, poor health, anemia, and infection
240
Those with a Braden score of 16 or less are considered to be .....
at risk for pressure ulcers
241
Patients with acute bacterial infections have elevated WBC counts with a shift to the left. True or false.
True
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When it comes to wound healing, what is adhesion ?
This is the band of scar tissue that forms between organs that can occur in the abdominal cavity and cause intestinal obstruction.
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what is fistula formation ?
An abnormal passageway between organs or between a hollow organ and the skin that will leak fluid or pus until it is healed
