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49 notecards = 13 pages (4 cards per page)

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Concept 24: Inflammation

front 1

Inflammation

back 1

An immunologic defense against tissue injury, infection, or allergy

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Acute Inflammation

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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

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Chronic Inflammation

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Continues for weeks to years after initial injury

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Scope of Inflammation

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Inflammation ranges from no inflammation to active inflammation is classified as acute, chronic, or repair/restorative and either localized or systemic.

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Normal Physiological Process of Inflammation

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An overlap and interplay between two systems (immune and inflammatory) providing protection to the host.

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Inflammatory Process

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  1. Restitution of normal functioning cells following injury.
  2. Fibrous repair when functional cells cannot be restored.

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WBCs are attracted to an area of inflammation by _____.

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Chemotaxis

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Chemotaxis

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Is a complex process involving more than a dozen chemicals whose release is initiated by stimuli.

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Four Categories of Chemotaxis

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  • Bacterial or viral exotoxins
  • Degenerative by-products of inflammation
  • Products of complement system activation
  • Reactive products of plasma clotting in the inflamed area.

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Three Major Hormone Groups

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  • Prostaglandins
  • Cytokines
  • Histamines

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Neutrophils

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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.

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Reactive oxygen species (ROS)

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Are created by the neutrophils and macrophages that bind with the lysosomes to help kill the invading pathogen.

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Band cells

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Immature neutrophils, may be present in the blood to achieve the increased numbers of neutrophils required of the response.

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Lymphocytes

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Are the most prominent in inflammatory responses to viral antigens.

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_____ are also important in combination with monocytes and macrophages in situations of chronic inflammation.

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Lymphocytes

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Macrophages

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Are critical in a chronic inflammatory response.

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Tissue Thromboplastin

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Facilitate hemostasis and to promote fibroblast activity.

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Macrophages and Lymphocytes

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Will comprise the majority of WBCs found in the exudate during a chronic inflammatory response.

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What are the local manifestations of inflammation?

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Redness, Heat, Pain, Swelling, Loss of Function

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Variations in Inflammation

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May occur in individuals across the lifespan, with a range of symptoms.

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Excessive Stimulation Consequence

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Hypersensitivity reactions to the immune system; allergies, asthma, arthritis, multiple scllerosis, and lupus erythematosus.

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Systemic Pathology Consequence

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Inflammatory response of metabolic effects of obesity and potential role of inflammation within fat cells.

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Multisystem Organ Failure Consequence

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Associated with sepsis or septic shock invokes strong immune and inflammatory responses.

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Chronic Inflammation Consequence

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Has been linked to a number of systemic diseases.

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Populations at Risk

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  • All Ages
  • Genders
  • Ethnic Groups
  • Socioeconomic Groups

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Individual Risk Factors

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  • Autoimmune Diseases
  • Compromised Immune Systems
  • Genetics
  • Chronic Diseases
  • Poor Hygiene
  • Poor Nutrition
  • Poor Living Conditions
  • Smokers

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Assessment

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Asking appropriate questions, examination of the patient, lab tests. and diagnostic tests.

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Assessment - History

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Focused on the determining the nature of the inflammatory trigger.

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Assessment - Examination Findings

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Obvious trauma, swelling, drainage or pus, pain, fever, decreased function.

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Assessment - Diagnostic Tests

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Collection of data or blood to determine what is causing the inflammation/infection.

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Primary Prevention

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Using good hygiene, safety equipment, food, and water safety issues.

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Collaborative Interventions

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  • RICE
  • Immobilization Devices
  • Pharmacologic Agents

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RICE

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  • Rest
  • Ice
  • Compression
  • Elevation

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Immobilization Devices

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  • Splints
  • Slings
  • Wheelchairs, Walkers, or Crutches
  • Bed Rest

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Pharmacologic Agents

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  • Steroid Agents
  • Nonsteroidal Anti-Inflammatory Drugs (NSAID)
  • Recombinant DNA and Monoclonal Antibodies
  • Antipyretics
  • Analgesics
  • Antimicrobials

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Inflammation Causes

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  • Infection
  • Immunity

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Inflammation Effects

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  • Tissue Integrity
  • Thermoregulation
  • Gas Exchange
  • Clotting
  • ]Fatigue
  • Stress

front 38

Clinical Exemplars of Inflammation

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  • 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

front 39

Bronchitis

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Inflammation of the bronchial tubes and may begin as an acute irritation and progress into a chronic infection.

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Gastroenteritis

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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.

front 41

Atherosclerosis

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Is a disease characterized by the buildup of plaque on the intimal layer of arteries and represents a chronic inflammatory process.

front 42

Cirrhosis

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Is a disease state that results from the destruction of healthy liver tissue and replacement with scar tissue.

front 43

Asthma

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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.

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Rheumatoid Arthritis

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Is an autoimmune disease causing inflammation to the joints and is characterized by periods of “flares” and “remission.”

front 45

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?

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Fibrous tissue replacing damaged tissue when injury is extensive

front 46

Which of the following patients is at higher risk for inflammatory reactions?

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79-year-old man with diabetes

front 47

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

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Vasodilation

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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

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“This test will help to better determine where the injury actually is and how severe it is.”

front 49

The nurse is reviewing the erythrocyte sedimentation rate (ESR) of a patient to determine which significant finding?

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Confirms the nonspecific presence of inflammation.