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NURS2500 Patho/Pharma > WEEK 8 Inflammation > Flashcards

WEEK 8 Inflammation Flashcards

1
Q

What is the best definition for inflammation

A

an immunologic defense against tissue, injury, or allergy.

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2
Q

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 ?

A

inflammation

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3
Q

True or false. Inflammation is protective process initiated to or remove the pathologic agent or stimulus triggering the inflammation, and to promote healing

A

true

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4
Q

Inflammation is not always with infection , but it can also occur in the absence of infection

A

false, it’s always present with infection

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5
Q

what are the concepts connected with inflammation

A

infection
tissue integrity
thermoregulation
gas exchange
clotting
fatigue
stress
immunity

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6
Q

Scope of inflammation
inflammation can be

A

acute
chronic
repair/restorative

local or systemic

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7
Q

scope of inflammation triggers: Inflammation

A

mechanical trauma
thermal, electrical or chemical injury
radiation damage
biological assault ( infections )

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8
Q

We know that inflammation can be chronic o acute but what does repair/restorative mean ?

A

this means they are going to be both chronic and acute

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9
Q

generally if organ is involved it will be what type of inflammation?

A

it will be systemic

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10
Q

Which is acute and chronic ?

rolling an ankle
bowl disease

A

first is acute and second is chronic

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11
Q

would this be an example of acute systemic ?

pneumonia and appendicitis

A

yes both are true

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12
Q

Normal inflammatory response : the goal

A

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

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13
Q

Protective mechanisms, certain cells cannot regenerated ( our cardiac muscle, brain cells )

A

this is true–> they cannot replace

scar tissue all over and over again when having a heart attack

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14
Q

types of white blood cells Granulocytes and Agranulocytes ( what are the categories under it )

A
  1. neutrophil ( helps in phagocytosis )
  2. eosinophil ( fights against parasitic infection)
  3. basophil ( produces inflammatory and allergic reactions)

Agranulocytes
4. lymphocyte ( produces specific immune responses)
5. Monocyte `( fights off bacteria viruses and fungi)

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15
Q

what are the 3 type of lymphocytes

A
  1. B lymphocytes
  2. T lymphocytes
  3. natural killer cell
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16
Q

immature neutrophils are called what ? and what can they not perform?

A

they are called bands and they canot perfrom endocytosis

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17
Q

how many days does bands turn into segmented ?

A

12 days

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18
Q

( agranulocytes) this is essentially in immune response, they keep calling for help ( operators) this is activated when there is inflammatory response.

A

true

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19
Q

mature neutrophils are called what?

A

segmented neutrophils

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20
Q

When injury has occurred this will occur and call for help, what is this being referred to?

A

chemotaxis ( realising pro inflammatory response)

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21
Q

a complex process involving more than a dozen different chemicals ( proinfalmamtory hormone)

A

chemotaxis

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22
Q

Chemotaxis is stimulated by :

A

bacterial or viral exotoxins

degenerative- by products of inflammation

products of complement system activation

reactive products of plasma clotting

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23
Q

True or false. White blood cells head to an inflammation when chemotaxis occurs

A

true

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24
Q

what are the 3 hormones linked to proinflammatory hormones ?

A

prostaglandins
histamines
cytokines

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25
Q

The characteristics of Prostaglandin histamines an cytokines combined together

A

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

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26
Q

basophil release ____ that is why we take antihistamine

A

histamines

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27
Q

give me an example of acute inflamattion

A

rolling the ankle

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28
Q

what is the stage one acute inflammation?

A

vascular response

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29
Q

what do you have to think of when thinking about stage one : vascular repsonse?

A

think of blood focus response

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30
Q

name what undergoes stage one vascular response

A

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

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31
Q

What is a tissue masts ?

A

this is a type of connective tissue glucose site ( they are involve in throwing off pulmonary hormone to help the response)

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31
Q

what are the clinical manifestations of stage one vascular response?

A
  • hyperemia/redness, warmth
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32
Q

True or false. Stage one vascular response causes capillary to leak/permeability?

A

this is true

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33
Q

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)

A

true

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34
Q

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.

A

true

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35
Q

Does macrophages not secrete pro-inflammatory hormones ? in stage one vascular repsonse

A

false, it does secrete it

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36
Q

Mature WBC’s are quicker and promote neutrophil invasion. 12 days of maturing will be 12 hours instead, because it’s quick.

A

true

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37
Q

When inflammation is occurring, how can we simplify that explanation
?

A

increased blood flow–> leakage of plsma proteins= edema –> neutrophil emigration

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38
Q

What is occurring in stage two cellular response?

A

granulocytes and tissue mast cells become activated ) neutrophils occurs)
12 hrs after injury
-phagocytosis

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39
Q

what promotes continuous inflammatory response in stage two cellular response?

A

eosinophils,basophils, and mast cells

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40
Q

True or false. Stage two : cellular response does not exudate forms ?

A

false, it does

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41
Q

What are the clinical manifestations of stage two : cellular response

A

dead WBCs, necrotic tissue, leaked cell fluid

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42
Q

This is telling neutrophils to mature and head out ( they are going to cause phagocytosis) , where does this occur?

A

stage two: cellular response

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43
Q

Macrophages increase and stimulate monocyte production in stage two cellular response, is that true or false?

A

that is true

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44
Q

What type of cascade occurs in stage 2 cellular response? and what does it increase ?

A

arachidonic acid cascade, it increases inflammation

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45
Q

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

A

COX , leukotrines, serotonin, kinins ( protein in the blood that cause inflammation and affect bp).

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46
Q

TRUE OR FALSE. ibuprofen stops COX from getting worse?

A

this is true

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47
Q

This occurs stimulaneously with stage one vascular response and stage two cellular response ( scar tissue is no longer functional, there is a ‘bandaid’)

A

this is stage three : tissue repair and replacement

48
Q

Characteristics of stage 3 : tissue repair and replacement

A
  1. all white blood cells invovled start the replacement of lost/damaged tissues by stimulating healthy cells to divide
  2. White blood cells trigger blood vessel growth and scar tissue formation for those cells that cannot divide
    - function of these cells are lost
49
Q

true or false: healing can only occur if inflammation occurs

A

true!!!

50
Q

this starts as an acute inflammation

A

chronic inflammation

51
Q

this is diffuclt to detect, may feel run down, tired, achy, and no symptoms ( asymptomatic)

A

this is a chronic inflammation

52
Q

true or flase. Chronic inflmmation is a pronlonged inflmmation and the star here is neutrophils!

A

false, although it is a prolonged inflmmation, macrophages are the star!

53
Q

what is a type of phagocyte?

A

macrophage

54
Q

What does macrophages release in chronic inflmmation?

A

release tissue thromboplastin–facilitates hemostasis, promotes fibroblasts
- removes necrotic tissue and pathogens ( debridement ) continous release

55
Q

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

A

all is true

56
Q

what does hemostais and fibroblasts do in chronic inflmmation?

A

hemostasis= stop bleeding
fibroblasts = making more scar tissue

57
Q

when investigating an inflmmation for acute and chronic which blood tests are we giving for the apteint for acute and chronic ?

A

acute CPR c - reactive protein
chronic ESR euthrocyte sedementation rate

58
Q

Outcomes of acute inflammation
Select all that is true
vascular changes
neutrophil recruitment
mediators

Injury that can occur
Infraction
bacterial infections
toxins
trauma

A

they are all true

59
Q

what is the resolution for acute inflammation?

A

clearance of injurious stimuli
clearance of mediators and aucte inflmmatory cells
replacement of injured cells
normal function

60
Q

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

A

they are all true

61
Q

name the clinical manifestations for local response vs systemic repeponse ( how do we determine if it’s localize or systemic)

A
  1. extensiveness
    2.location
    3.dependent on pateint’s immune response
  2. dependent on acute vs chronic
62
Q

True or false. Location matters when determining sytsemic or local as we would need a good neutrophils system to help rejevunate healing.

A

true

63
Q

Proinflmamtory hormone explains the clinical maifestations of local response ?

A

yes it does

64
Q

If it’s not open , you can see exudate. True or false?

A

false, if its not open you cannot see exudate, since exudate means you can see leakge ( pus ) etc.

65
Q

You have to visualize this on the outside

A

this is a local response

66
Q

Local response :
what are the charcateristics

A

swelling
pain
heat
redness
exudate/impaireed function serous/fibrinous/purulent/hemorrhagic

67
Q

This is typically seen witch chronic inflammation pateints

A

systemic response

68
Q

what are the characteristics of systemic response?

A

neutrophilia ( abnormally high nuetrophils in the body)
fever
malaise
loss of apetite
muscle catabolism

69
Q

why do you have a fever when having a chronic inflammation pateint in systemic repsonse?

A

because this is your pro inflammatory response

70
Q

What occurs when you loss petite in systemic response ?

A

we are gonna ahve muscle loss

71
Q

Whata are the assessment ( nursing process) in terms of inflammation

A

history
physical assessment
diagnostics

72
Q

go more in depth of physical assesment when assesing a patient with inflammation

A

look for trauma
check for colour
temeprature
pain
swelling
look for any drainage ( what you see, smell)?

73
Q

WHat undergoes diagnosis when assessing a patient with inflmmation?

A

radiographic blood

74
Q

Why are these important when assessing?
Vital signs
Blood work

A

vital signs can detect that fever tieing to that inflammation

blood work if they have neutrophil change

75
Q

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?

A

true

76
Q

who’s more prone to getting inflammation in terms of population?

A

older adults and babies ( have no antiboodies yet) and they are a bit more fragile

77
Q

Name the the different inflammation blood work values we look at

A

WBC total
segmented
bands
monocytes
lymphocytes
eosinophils
basophils
hemoglobin

78
Q

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

A

these are all true

79
Q

what are the clinical management for inflammation

A

primary prevention
( eat well, hand hygiene, safety, etc)
Secondary prevention- screening ( there is no screening )
collaborative approaches

80
Q

What undergoes collaborative interventions in clinical management ( inflammation)

A

goals : mediate inflammatory process and promote healing and repair

treat underlying cause

81
Q

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)

A

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)

82
Q

What does rice stands for ?

A

Rest on ice compression on elevation

83
Q

Characteristics of RICE

A

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

84
Q

True or false. Using the Rice methods, we use comprehension to reduce swelling

A

true

85
Q

Why do we elevate above level when using the RICE method?

A

we elevate above level of heart to minimize swelling

86
Q

What are the Pharmacology therapy we use to reduce inflammation, manage fever, and pain relief when dealing

A

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)

87
Q

This is given but side effects is bleeding, this is at the bottom of managing fever ( as a lot of side effects)

A

aspirin

88
Q

What stops the COX enxyme?

A

Ibuprofen

89
Q

What is the difference in the MOA of presidone vs. NSAIDS

A

steroids is either life or death
ibuprofen has side effects ( renal, and liver)

90
Q

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

A

the first one is wrong, we use this for a short term but in a high dose

91
Q

What are we monitoring when taking Prednisone

A

fluid retention
blood pressure
( making sure weights , sodium ) and if they have fluid or no fluid in the body

92
Q

DRUG CARD : Corticosteroids : Prednisone

A

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 )

93
Q

what are the side effects of Prednisone

A

CVS: fluid retention- HTN
Endo: adrenal insufficient
Gi: peptic ulder
Psych: mood disturbances, depression, psychosis, insomnia
Labs: hyperglycaemia
long term : cushings

94
Q

What type of prednisone do we use if it’s systemic and localize?

A

pill for systemic
and lotion for localized

95
Q

true or false. Prednisone can be taken oral and iv as well

A

true, iv causes more side effects tho

96
Q

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 )

A

both are true

97
Q

Sudden withdrawal and adrenal crisis : corcotocoids is not important in our body?

A

false, it is

98
Q

What is controlled by the release of ACTH (Adrenocorticotropic hormone)from pituitary glad through negative feedback ?

A

adrenal galnds

99
Q

Sudden withdrawal and adrenal crisis
define the characteristics

A

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

100
Q

Where does adrenal crisis results from ?

A

results from sudden withdrawal such as hypotenesion, flu symptoms, seizures, shock

101
Q

is inflammation the agent causing the injury as seen with infection?

A

no it is a protective factor

102
Q

what kind of inflammation is this? Inflammation that continues for weeks to years after the initial injury

A

chronic

103
Q

what are the four categories of chemotaxis?

A

(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.

104
Q

what is the source and inflammatory response for bradykinin?

A

Source: plasma protein and kinins
inflammatory response: Increase vascular permeability and vasodilation
responsible for pain production

105
Q

what is the inflammatory response prostaglandins do?

A

mediate late stages of acute inflammatory response
increase vasodilation
increase vascular permeability
active in anaphylactic hypersensitivity reactions

106
Q

where is the source and inflammatory response to histamine?

A

mast cells
mediates early acute inflammatory response

107
Q

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”

A

chemotaxis

108
Q

what does Arachidonic acid cascade do? what stage does it fall under?

A

this is responsible for anti and pro inflammatory process, falls under stage 2: cellular response

109
Q

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

A

stage 2: cellular response

110
Q

what does the scope of inflammation range from?

A

from no inflammation to active inflammation
localized or systemic

111
Q

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.

A

true

112
Q

what are prostaglandins, cytokines and histamines known for?

A

they are the three major hormone groups (pro inflammatory)

113
Q

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.

A

false it attracts leukocytes

114
Q

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

A

the last step

115
Q

true or false: Neutrophils are of significant importance in an acute inflammatory response.

A

true

116
Q

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.

A

true

117
Q

true or false: macrophages are critical in a chronic inflammatory response.

A

true

118
Q

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.

A

true

NURS2500 Patho/Pharma (16 decks)

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