Inflammation
An immunologic defense against tissue injury, infection, or allergy
Acute Inflammation
The initial response to tissue injury and is short in duration (minutes-days). The goal is to eradicate the harmful stimuli from the body and initiate repair
Chronic Inflammation
Continues for weeks to years after initial injury
Scope of Inflammation
Inflammation ranges from no inflammation to active inflammation is classified as acute, chronic, or repair/restorative and either localized or systemic.
Normal Physiological Process of Inflammation
An overlap and interplay between two systems (immune and inflammatory) providing protection to the host.
Inflammatory Process
- Restitution of normal functioning cells following injury.
- Fibrous repair when functional cells cannot be restored.
WBCs are attracted to an area of inflammation by _____.
Chemotaxis
Chemotaxis
Is a complex process involving more than a dozen chemicals whose release is initiated by stimuli.
Four Categories of Chemotaxis
- Bacterial or viral exotoxins
- Degenerative by-products of inflammation
- Products of complement system activation
- Reactive products of plasma clotting in the inflamed area.
Three Major Hormone Groups
- Prostaglandins
- Cytokines
- Histamines
Neutrophils
Are of significant importance in an inflammatory response. Movement of these is mediated by several chemotaxis factors that arise from the area of tissue damage.
Reactive oxygen species (ROS)
Are created by the neutrophils and macrophages that bind with the lysosomes to help kill the invading pathogen.
Band cells
Immature neutrophils, may be present in the blood to achieve the increased numbers of neutrophils required of the response.
Lymphocytes
Are the most prominent in inflammatory responses to viral antigens.
_____ are also important in combination with monocytes and macrophages in situations of chronic inflammation.
Lymphocytes
Macrophages
Are critical in a chronic inflammatory response.
Tissue Thromboplastin
Facilitate hemostasis and to promote fibroblast activity.
Macrophages and Lymphocytes
Will comprise the majority of WBCs found in the exudate during a chronic inflammatory response.
What are the local manifestations of inflammation?
Redness, Heat, Pain, Swelling, Loss of Function
Variations in Inflammation
May occur in individuals across the lifespan, with a range of symptoms.
Excessive Stimulation Consequence
Hypersensitivity reactions to the immune system; allergies, asthma, arthritis, multiple scllerosis, and lupus erythematosus.
Systemic Pathology Consequence
Inflammatory response of metabolic effects of obesity and potential role of inflammation within fat cells.
Multisystem Organ Failure Consequence
Associated with sepsis or septic shock invokes strong immune and inflammatory responses.
Chronic Inflammation Consequence
Has been linked to a number of systemic diseases.
Populations at Risk
- All Ages
- Genders
- Ethnic Groups
- Socioeconomic Groups
Individual Risk Factors
- Autoimmune Diseases
- Compromised Immune Systems
- Genetics
- Chronic Diseases
- Poor Hygiene
- Poor Nutrition
- Poor Living Conditions
- Smokers
Assessment
Asking appropriate questions, examination of the patient, lab tests. and diagnostic tests.
Assessment - History
Focused on the determining the nature of the inflammatory trigger.
Assessment - Examination Findings
Obvious trauma, swelling, drainage or pus, pain, fever, decreased function.
Assessment - Diagnostic Tests
Collection of data or blood to determine what is causing the inflammation/infection.
Primary Prevention
Using good hygiene, safety equipment, food, and water safety issues.
Collaborative Interventions
- RICE
- Immobilization Devices
- Pharmacologic Agents
RICE
- Rest
- Ice
- Compression
- Elevation
Immobilization Devices
- Splints
- Slings
- Wheelchairs, Walkers, or Crutches
- Bed Rest
Pharmacologic Agents
- Steroid Agents
- Nonsteroidal Anti-Inflammatory Drugs (NSAID)
- Recombinant DNA and Monoclonal Antibodies
- Antipyretics
- Analgesics
- Antimicrobials
Inflammation Causes
- Infection
- Immunity
Inflammation Effects
- Tissue Integrity
- Thermoregulation
- Gas Exchange
- Clotting
- ]Fatigue
- Stress
Clinical Exemplars of Inflammation
- Acute Inflammation
• Acute infection (bacterial, viral, fungal, parasitic)
• Bronchitis • Burn • Bursitis • Foreign body injury
• Insect bite or sting • Joint sprain or strain • Nephritis
• Rheumatic fever • Tendonitis • Traumatic injury - Chronic Inflammation
• Atherosclerosis • Chronic infection
• Chronic obstructive pulmonary disease • Cirrhosis
• Diverticulitis • Fibromyalgia • Gingivitis
• Inflammatory bowel disease • Myocarditis • Osteoarthritis
• Psoriasis • Vasculitis - Autoimmune-Based Inflammation
• Asthma • Crohn's disease • Goodpasture's syndrome
• Grave's disease • Multiple sclerosis • Myasthenia gravis
• Rheumatoid arthritis • Systemic lupus erythematosus
Bronchitis
Inflammation of the bronchial tubes and may begin as an acute irritation and progress into a chronic infection.
Gastroenteritis
Inflammation of the stomach and intestines, may be caused by a variety of viruses, contaminated water or food, as a side effect of medications, and in infants it may present with the introduction of allergens within new foods.
Atherosclerosis
Is a disease characterized by the buildup of plaque on the intimal layer of arteries and represents a chronic inflammatory process.
Cirrhosis
Is a disease state that results from the destruction of healthy liver tissue and replacement with scar tissue.
Asthma
An autoimmune-based inflammation, a common chronic disorder of the airways that is complex and characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation.
Rheumatoid Arthritis
Is an autoimmune disease causing inflammation to the joints and is characterized by periods of “flares” and “remission.”
The nurse is completing an admission assessment of a new patient to the unit. The nurse notes a long, thin, fading scar on the patient’s abdomen in the right lower quadrant. What is the best explanation for the scar’s appearance?
Fibrous tissue replacing damaged tissue when injury is extensive
Which of the following patients is at higher risk for inflammatory reactions?
79-year-old man with diabetes
A patient admitted to an acute care floor has rubor of an area of injury on the left lower extremity. The nurse understands that this redness is caused by
Vasodilation
A patient comes to a clinic with a chief complaint of, “My left arm is red and swollen. It hurts badly enough that I couldn’t go to work today.” The physician orders computer-assisted tomography (CT) scanning of the left upper extremity. The nurse knows the patient understands the reason for the procedure when he states
“This test will help to better determine where the injury actually is and how severe it is.”
The nurse is reviewing the erythrocyte sedimentation rate (ESR) of a patient to determine which significant finding?
Confirms the nonspecific presence of inflammation.