WEEK 8 Inflammation Flashcards
What is the best definition for inflammation
an immunologic defense against tissue, injury, or allergy.
the body’s reaction to injury, irritation, or infection characterized by redness, swelling, warmth, and/or pain; caused by accumulation of immune cells and substances around the injury or infection, this is known as what ?
inflammation
True or false. Inflammation is protective process initiated to or remove the pathologic agent or stimulus triggering the inflammation, and to promote healing
true
Inflammation is not always with infection , but it can also occur in the absence of infection
false, it’s always present with infection
what are the concepts connected with inflammation
infection
tissue integrity
thermoregulation
gas exchange
clotting
fatigue
stress
immunity
Scope of inflammation
inflammation can be
acute
chronic
repair/restorative
local or systemic
scope of inflammation triggers: Inflammation
mechanical trauma
thermal, electrical or chemical injury
radiation damage
biological assault ( infections )
We know that inflammation can be chronic o acute but what does repair/restorative mean ?
this means they are going to be both chronic and acute
generally if organ is involved it will be what type of inflammation?
it will be systemic
Which is acute and chronic ?
rolling an ankle
bowl disease
first is acute and second is chronic
would this be an example of acute systemic ?
pneumonia and appendicitis
yes both are true
Normal inflammatory response : the goal
the goal is to restore normal function of cells
and fibrous repair when cells can’t be restored
white blood cells and chemicals that serve to protect the body from invaders or cellular/tissue damage are involved
Protective mechanisms, certain cells cannot regenerated ( our cardiac muscle, brain cells )
this is true–> they cannot replace
scar tissue all over and over again when having a heart attack
types of white blood cells Granulocytes and Agranulocytes ( what are the categories under it )
- neutrophil ( helps in phagocytosis )
- eosinophil ( fights against parasitic infection)
- basophil ( produces inflammatory and allergic reactions)
Agranulocytes
4. lymphocyte ( produces specific immune responses)
5. Monocyte `( fights off bacteria viruses and fungi)
what are the 3 type of lymphocytes
- B lymphocytes
- T lymphocytes
- natural killer cell
immature neutrophils are called what ? and what can they not perform?
they are called bands and they canot perfrom endocytosis
how many days does bands turn into segmented ?
12 days
( agranulocytes) this is essentially in immune response, they keep calling for help ( operators) this is activated when there is inflammatory response.
true
mature neutrophils are called what?
segmented neutrophils
When injury has occurred this will occur and call for help, what is this being referred to?
chemotaxis ( realising pro inflammatory response)
a complex process involving more than a dozen different chemicals ( proinfalmamtory hormone)
chemotaxis
Chemotaxis is stimulated by :
bacterial or viral exotoxins
degenerative- by products of inflammation
products of complement system activation
reactive products of plasma clotting
True or false. White blood cells head to an inflammation when chemotaxis occurs
true
what are the 3 hormones linked to proinflammatory hormones ?
prostaglandins
histamines
cytokines
The characteristics of Prostaglandin histamines an cytokines combined together
increase blood flow to the area of injury
increase vascular permeability
activate components of an immune response
attract leukocytes to area of injury
promote angiogenesis ( blood vessel creation making more blood vessels )
stimulate connective tissue growth ( talking about that repair)
cause fever
basophil release ____ that is why we take antihistamine
histamines
give me an example of acute inflamattion
rolling the ankle
what is the stage one acute inflammation?
vascular response
what do you have to think of when thinking about stage one : vascular repsonse?
think of blood focus response
name what undergoes stage one vascular response
injured tissues and local granulocytes and tissue masts secrete pro inflammatory hormones
- small veins constrict and arterioled dilate
- blood flow increases delievering nurtrients, ( oxygen and glucose) to injured tissues
What is a tissue masts ?
this is a type of connective tissue glucose site ( they are involve in throwing off pulmonary hormone to help the response)
what are the clinical manifestations of stage one vascular response?
- hyperemia/redness, warmth
True or false. Stage one vascular response causes capillary to leak/permeability?
this is true
true or false in stage one vascular response it Causes our capillaries to leak our plasma fluid out ( our plasma is now leaking in the vascular intersial space)
true
True or false. Define if this is true in terms of the characteristics amongst stage one vascular repsonse. Tons of blood flow going constricting that blood return, the blood flow is going to increase ( this is going to heal)-> we use oxygen for atp, glucose for energy replace for those that needs it.
true
Does macrophages not secrete pro-inflammatory hormones ? in stage one vascular repsonse
false, it does secrete it
Mature WBC’s are quicker and promote neutrophil invasion. 12 days of maturing will be 12 hours instead, because it’s quick.
true
When inflammation is occurring, how can we simplify that explanation
?
increased blood flow–> leakage of plsma proteins= edema –> neutrophil emigration
What is occurring in stage two cellular response?
granulocytes and tissue mast cells become activated ) neutrophils occurs)
12 hrs after injury
-phagocytosis
what promotes continuous inflammatory response in stage two cellular response?
eosinophils,basophils, and mast cells
True or false. Stage two : cellular response does not exudate forms ?
false, it does
What are the clinical manifestations of stage two : cellular response
dead WBCs, necrotic tissue, leaked cell fluid
This is telling neutrophils to mature and head out ( they are going to cause phagocytosis) , where does this occur?
stage two: cellular response
Macrophages increase and stimulate monocyte production in stage two cellular response, is that true or false?
that is true
What type of cascade occurs in stage 2 cellular response? and what does it increase ?
arachidonic acid cascade, it increases inflammation
Fill in the blanks : Stage two : cellular response
Fatty acids in memebranes of injured cells turn into arachidonic acid which is then converted by ______ enzyme into subtances histamine ______, prostaglandins, ____ , _____ that promote inflammation
COX , leukotrines, serotonin, kinins ( protein in the blood that cause inflammation and affect bp).
TRUE OR FALSE. ibuprofen stops COX from getting worse?
this is true
This occurs stimulaneously with stage one vascular response and stage two cellular response ( scar tissue is no longer functional, there is a ‘bandaid’)
this is stage three : tissue repair and replacement
Characteristics of stage 3 : tissue repair and replacement
- all white blood cells invovled start the replacement of lost/damaged tissues by stimulating healthy cells to divide
- White blood cells trigger blood vessel growth and scar tissue formation for those cells that cannot divide
- function of these cells are lost
true or false: healing can only occur if inflammation occurs
true!!!
this starts as an acute inflammation
chronic inflammation
this is diffuclt to detect, may feel run down, tired, achy, and no symptoms ( asymptomatic)
this is a chronic inflammation
true or flase. Chronic inflmmation is a pronlonged inflmmation and the star here is neutrophils!
false, although it is a prolonged inflmmation, macrophages are the star!
what is a type of phagocyte?
macrophage
What does macrophages release in chronic inflmmation?
release tissue thromboplastin–facilitates hemostasis, promotes fibroblasts
- removes necrotic tissue and pathogens ( debridement ) continous release
Select all that is true in terms of chronic inflammation
Thickening and scarring of connective tissue
may also be subclinical
- no overt symptoms - more systemic manifestations
- investigate through blood tests: CPR and ESR
-may need a WBC scan to identify areas of inflammation
all is true
what does hemostais and fibroblasts do in chronic inflmmation?
hemostasis= stop bleeding
fibroblasts = making more scar tissue
when investigating an inflmmation for acute and chronic which blood tests are we giving for the apteint for acute and chronic ?
acute CPR c - reactive protein
chronic ESR euthrocyte sedementation rate
Outcomes of acute inflammation
Select all that is true
vascular changes
neutrophil recruitment
mediators
Injury that can occur
Infraction
bacterial infections
toxins
trauma
they are all true
what is the resolution for acute inflammation?
clearance of injurious stimuli
clearance of mediators and aucte inflmmatory cells
replacement of injured cells
normal function
Define if these charcateristics are true in terms of chronic inflammation
angiogenesis
mononuclear cell infiltraete
fibrosis ( scar)
injury :
- viral infections
chronic infections
persistent injury
autoimmune diseases
they are all true
name the clinical manifestations for local response vs systemic repeponse ( how do we determine if it’s localize or systemic)
- extensiveness
2.location
3.dependent on pateint’s immune response - dependent on acute vs chronic
True or false. Location matters when determining sytsemic or local as we would need a good neutrophils system to help rejevunate healing.
true
Proinflmamtory hormone explains the clinical maifestations of local response ?
yes it does
If it’s not open , you can see exudate. True or false?
false, if its not open you cannot see exudate, since exudate means you can see leakge ( pus ) etc.
You have to visualize this on the outside
this is a local response
Local response :
what are the charcateristics
swelling
pain
heat
redness
exudate/impaireed function serous/fibrinous/purulent/hemorrhagic
This is typically seen witch chronic inflammation pateints
systemic response
what are the characteristics of systemic response?
neutrophilia ( abnormally high nuetrophils in the body)
fever
malaise
loss of apetite
muscle catabolism
why do you have a fever when having a chronic inflammation pateint in systemic repsonse?
because this is your pro inflammatory response
What occurs when you loss petite in systemic response ?
we are gonna ahve muscle loss
Whata are the assessment ( nursing process) in terms of inflammation
history
physical assessment
diagnostics
go more in depth of physical assesment when assesing a patient with inflammation
look for trauma
check for colour
temeprature
pain
swelling
look for any drainage ( what you see, smell)?
WHat undergoes diagnosis when assessing a patient with inflmmation?
radiographic blood
Why are these important when assessing?
Vital signs
Blood work
vital signs can detect that fever tieing to that inflammation
blood work if they have neutrophil change
Trueor false. Anemia causes you to have loss of apetite and not having a good diet, which causes to be more prone to chronic inflammation?
true
who’s more prone to getting inflammation in terms of population?
older adults and babies ( have no antiboodies yet) and they are a bit more fragile
Name the the different inflammation blood work values we look at
WBC total
segmented
bands
monocytes
lymphocytes
eosinophils
basophils
hemoglobin
How can we stop inflammation from stoping to the first place ( select all that is true)
a. eat well
b. take care of yourself
c.hand hygiene
d. safety
these are all true
what are the clinical management for inflammation
primary prevention
( eat well, hand hygiene, safety, etc)
Secondary prevention- screening ( there is no screening )
collaborative approaches
What undergoes collaborative interventions in clinical management ( inflammation)
goals : mediate inflammatory process and promote healing and repair
treat underlying cause
Define all that when treating the underlying cause of inflammation
Infection-eliminate cause
hypersensitivity response - only manage inflammation
Sprain/Strain: Rice and NSAIDS
Chronic-monitor to prevent further tissue damage, treat cause, support ongoing tissue function, medications
( type 1 diabetes, provide insulin)
2nd one is wrong, yes u have to manage the inflammation, however you also have to manage the pathologic issue ( e.g DM, RA, MS)
What does rice stands for ?
Rest on ice compression on elevation
Characteristics of RICE
first 24-48 hours after injury
Rest to prevent further reinjury and trigger inflmmation
ce for 10 minutes at a time every 2-3. hours
True or false. Using the Rice methods, we use comprehension to reduce swelling
true
Why do we elevate above level when using the RICE method?
we elevate above level of heart to minimize swelling
What are the Pharmacology therapy we use to reduce inflammation, manage fever, and pain relief when dealing
Reduce inflammation
- steroidal agents
- glucocorticoids- prednisone
Non-steroidal anti- inflammatory drugs (NSAIDS)
- ibuprofen
Manage fever
- antipyretics
1) acetaminophen
2) aspirin
3) NSAIDs
Pain Relief
-analgesics
1) acetaminophen
2)aspirin
3) NSAIDS
4) OPIOIDS ( if pain is severe)
This is given but side effects is bleeding, this is at the bottom of managing fever ( as a lot of side effects)
aspirin
What stops the COX enxyme?
Ibuprofen
What is the difference in the MOA of presidone vs. NSAIDS
steroids is either life or death
ibuprofen has side effects ( renal, and liver)
Define if these characteristics are true or false within the Prednisone
You want to use this long term to avoid the inflammation coming back
When administering the medication, we follow up frequently to make sure the effects are controlled as possible
the first one is wrong, we use this for a short term but in a high dose
What are we monitoring when taking Prednisone
fluid retention
blood pressure
( making sure weights , sodium ) and if they have fluid or no fluid in the body
DRUG CARD : Corticosteroids : Prednisone
MOA: Decrease inflammation through suppressing immune responses ( inhibit macrophage accumulation, reduce capillary permeability )
Administration
Do not stop abruptly, must be tapered slowly
Give with or after meals to prevent GI upset
Indiciations :
Severe allergic conditions
endocrine disorders
respiratory disorders
Contraindication:
active untreated infections
Drug to drug:
use with caution with NSAIDS/ASA (GI side effects increased )
what are the side effects of Prednisone
CVS: fluid retention- HTN
Endo: adrenal insufficient
Gi: peptic ulder
Psych: mood disturbances, depression, psychosis, insomnia
Labs: hyperglycaemia
long term : cushings
What type of prednisone do we use if it’s systemic and localize?
pill for systemic
and lotion for localized
true or false. Prednisone can be taken oral and iv as well
true, iv causes more side effects tho
Define if this these statements are true in the therapeutic effects of prednisone
less likely to see results however for active inflammation it can reduced inflammation ( if lungs-reduced brochical inflammation revealing improved work of breath, reduced wheezing and reduces mucus production
for treatment for endocrine disroder : reduced active disease ( addisons’s )
both are true
Sudden withdrawal and adrenal crisis : corcotocoids is not important in our body?
false, it is
What is controlled by the release of ACTH (Adrenocorticotropic hormone)from pituitary glad through negative feedback ?
adrenal galnds
Sudden withdrawal and adrenal crisis
define the characteristics
negative feedback :
exogenous control suppresses pituitary release of ACTH and suppresses production of natural cortisol by adrenal glands
Adrenal crisis - hypotension seizure shock flu symptoms
- therapy is kept short term ( less than 10 days)
if long term, may give eod: requires dose to be tapered as it is discontinued so adrenals resume production
Where does adrenal crisis results from ?
results from sudden withdrawal such as hypotenesion, flu symptoms, seizures, shock
is inflammation the agent causing the injury as seen with infection?
no it is a protective factor
what kind of inflammation is this? Inflammation that continues for weeks to years after the initial injury
chronic
what are the four categories of chemotaxis?
(1) bacterial or viral exotoxins,
(2) degenerative by-products of inflammation,
(3) products of complement system activation, and
(4) reactive products of plasma clo ing in the inflamed area.
what is the source and inflammatory response for bradykinin?
Source: plasma protein and kinins
inflammatory response: Increase vascular permeability and vasodilation
responsible for pain production
what is the inflammatory response prostaglandins do?
mediate late stages of acute inflammatory response
increase vasodilation
increase vascular permeability
active in anaphylactic hypersensitivity reactions
where is the source and inflammatory response to histamine?
mast cells
mediates early acute inflammatory response
what term is this describing? this is essentially when an alarm goes off when the White blood cells are notified, singing “clean up clean up everything do your share”
chemotaxis
what does Arachidonic acid cascade do? what stage does it fall under?
this is responsible for anti and pro inflammatory process, falls under stage 2: cellular response
what stage of inflammation does this fall under?
■ Fatty acids in membranes of injured cells turn into arachidonic acid which is then converted (by COX enzyme) into substances (histamine, leukotrienes, prostaglandins, serotonin, kinins) that promote more inflammation
stage 2: cellular response
what does the scope of inflammation range from?
from no inflammation to active inflammation
localized or systemic
true or false: Inflammation is a process involving white blood cells (WBCs) and a number of different chemicals that serve to protect the body against invading pathogens or cellular/tissue trauma.
true
what are prostaglandins, cytokines and histamines known for?
they are the three major hormone groups (pro inflammatory)
true or false: the proinflammatory hormones increase blood flow to the injured area, increase vascular membrane permeability, activate various components of an immune response, removes leukocytes to the area of injury, promote
angiogenesis, stimulate growth of connective tissue, and cause fever.
false it attracts leukocytes
when does this occur in acute inflammation
Release of nitric oxide and prostacyclin, endothelin, thromboxane A2, angiotensin II, growth factor, and chemokines from activated
endothelial cells
the last step
true or false: Neutrophils are of significant importance in an acute inflammatory response.
true
true or false:
The chemotaxic factors bind to the surface of the neutrophils and cause them to release additional factors, resulting in pathogen breakdown from lysosomal cytoplasmic enzymes. The neutrophils are also directly involved in phagocytosis after they bind to antibodies already connected to the antigen.
true
true or false: macrophages are critical in a chronic inflammatory response.
true
true or false: The liver will respond by releasing a number of proteins, called acute phase proteins, that include complement system proteins, clo ing factors, and protease inhibitors.
true
