Inflammatory And Immunologic Disturbances Flashcards
Three Lines of Defense
• Anatomical Barriers
• Acute Inflammatory Response
• Immune System
What are the layers of the skin?
Stratum Corneum
S.lucidum
S.Granulosum
S.Germinativum
3 Lines of Defense
First Line of Defense
Second line of Defense
Third Line of Defense
Mechanical Barriers and Chemical Barriers
First Line of Defense
Inflammation response and phagocytosis
Second line of defense
Specific immune response, Natural Killer cells (NK cells)
Third line of defense
Anatomical Barriers: First line of defense
Skin, Mucous Membrane, Normal Bacterial flora
1st line defense - Normal Bacterial flora are:
Clostridium difficile
Yeast Infections
multilayer barrier, shed outer layer, contains fatty acids that kills some bacteria
Skin
contain cilia in upper respiratory tract, macrophages
Lungs
flush action of urine washes away bacteria
Urinary Tract
Occurs in response to injury
• Localized
• Immediate
• Beneficial
• Appropriate level of
response
• Non Specific
Inflammatory Respons
Causes of Inflammation
Physical
Trauma, Lacerations, Burns
Causes of Inflammation
Chemical
BItes, Allergic response
Causes of Inflammation
Microorganisms
Bacteria.
Inflammatory Response (5 stages of response)
-REDNESS
• SWELLING
• PAIN
• HEAT
• LOSS OF FUNCTION
Purpose of inflammation (NRPA)
-Neutralizes and Dilutes Toxins
• Removes necrotic materials
• Provides an environment for healing
• Add “itis” to affected body part
4 Phases of Inflammation
Vascular
Cellular
Formation of Exudate
Healing
Think Blood Vessels
Vascular
Think WBC’s
Cellular
Fluid and neutrophils
Formation of Exudate
regeneration or repair of tissue
Healing
Injury occurs
• Mediators intervene
• Vasodilation occurs
• Capillaries become more permeable
• Swelling and movement of fluid occurs
Vascular Phase: Blood Vessels
Injury occurs
Chemotaxis begins
White blood cells rush in to help
Neutrophils Monocytes Macrophages
Cellular Phase – Think WBC’s
Chemical Mediators
Coordinators of the inflammatory response
• Histamine
• Prostagladins
• Cytokines
(ESR or sed rate)
<20 mm/hr
Erythrocyte sedimentation rate
non specific test identifying the presence of inflammation <1.0 mg/dl
CRP – C reactive protein
special long wave ultraviolet light produced by a Wood’s lamp that induvisible flourescence in certain skin lesions . Best seen in darkened room.
Wood’s Light examination- a special long wave ultraviolet light produced by
obtain tissues for examination
Skin biopsy
use to document contact sensitivity or allergy
– suspected allergens are placed on normal skin beneath patches of tape
– patches are removed and the skin under the patches is examined at specified intervals
Patch Test
scales from a lesion are scraped with a scalpel and placed on a glass slides covered with potassium hydroxide and examined
Fungal Scraping
for cytologic exam of blisterng diseases of the skin
Tzanck smear
for suspected vesicle or pustule is opened and contents applied to a glass of slide.and scanning after
Tzanck smear
reveal nature and extent of nature and show progress or improvement from treatment
clinical photograps
Systemic Manifestations of Acute Inflammation
Fever/chills
Cytokines
Benefits
- Increased killing of microorganisms
- Increased phagocytosis by neutrophils
- Increased activity of interferon
Leukocytosis Neutrophils
- “left shift”…band cells
Inhibits prostaglandin synthesis
NSAID’s ( Ibuprofen, Toradol)
NSAID’s nursing implications
- Give w/food
- Elderly-high risk GI bleed
- Prolongs bleeding times 1 day
- Assess renal function-creatinine w/chronic use
Inhibits production of prostaglandins Decreases platelet aggregation
NSAID’S (Salicylates – Aspirin)
ASPIRIN Nursing implications
Give w/food
Prolongs bleeding times 4-7 days
Block histamine at the receptor site
Decreases gastric acid secretion
ANTI-HISTAMINES
Benadryl, Ranitidine (Zantec), Famotidine (Pepcid)
NURSING IMPLICATIONS OF ANTIHISTAMINE
With meals
Drowsiness/dizziness
- Decrease inflammation by stabilizing neutrophils and lysosomes Inhibit prostaglandin synthesis
- Inhibits chemotactic cytokines
- Decreases mast cell stimulation
Prednisone (Corticosteroids)
Prednisone (Nursing Implications)
Meals
Prednisone (Chronic Use complications)
Risk of infection
Hyperglycemia
SE
Occurs when first line of defense is broken by cellular injury
Acute Inflammatory Response
Injury can be caused by:
-trauma or surgery
• chemical agents
• temperature extremes
• invasion of micro-organisms
• oxygen/nutrient deprivation (ischemic damage)
• genetic/immune defects (e.g. autoimmune)
A biochemical and cellular process that occurs in vascular tissues due to cellular injury
Acute Inflammatory Response
- Inflammation may precede an immune response
or be caused by one - Occurs physiologically in the same manner
whether initial or second exposure to antigen
Non- specific elimination of micro-organisms
Momentary constriction followed by prolonged vasodilation of arterioles and venules
Vascular permeability increases d/t histamine release
VASCULAR RESPONSE
Hemodynamic changes in microcirculation:
