Inflammation Rids the body of harmful

microorganisms

Help stimulate both antibody- mediated and cell-mediated actions

Causes of Inflammation–Mechanical injuries

–Physical damage

–Chemical injury

–Microorganisms

–Extreme heat or cold

–Hypersensitivity response

–Ischemic damage or trauma2

Copyright © 2007 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 3

Inflammatory Process• Leukocytes (WBCs)

>Neutrophils – 1st internal line of defense

>Monocytes/Macrophages - phagocytocis

>Eosinophils – degrade vasoactive chemicals;

increases in allergic response

>Basophils – cause obvious signs of

inflammation; contain many

chemicals acting on BV

• Virtually any injury to the vascularized tissue (having a blood supply) will activate inflammation

• Immediate but short-term protection against effects of tissue injury and foreign proteins

• Non-specific body defense to invasion or injury started by any event 4

Inflammatory Response

• Sets off histamine activation released by leukocytes

• Basophils and mast cells

5

3 STAGES OF INFLAMMATION

• STAGE 1 – VASCULAR

• STAGE 2 – CELLULAR EXUDATE

• STAGE 3 – TISSUE REPAIR

AND REPLACEMENT6

7

Sequence of Inflammatory Responses

• Stage 1 VASCULARPHASE 1

Immediate constriction of arterioles and

venules resulting from trauma to vascular

smooth musclePHASE 2

Increased blood flow to area (hyperemia)

and swelling (edema formation)

8

Inflammatory Responses• STAGE 2 CELLULAR EXUDATECharacterized by neutrophilia,

secretion of many factors into interstitial fluid, formation of exudate (pus)

Nuetrophils attack and destroy foreign materials & remove dead tissue thru phagocytosis

Inflammatory Responses• STAGE III TISSUE REPAIR AND

REPLACEMENTLeukocytes stimulate new blood

vessel growth and scar tissue formation

Loss of function occurs where damaged tissues are replaced with scar tissue

9

FIVE CARDINAL SIGNS

10

Redness

11

vasodilation and increased blood flow to injured site

Heat12

Swelling

13

occurs as exudates (fluids and cell) accumulates in tissues; accompanied by pain

PAIN

14

caused by pressure exerted by exudates accumulation as well as presence of soluble biochemical mediators as prostaglandin and bradykinin

Damaged tissues are replaced with scar tissues

15

Loss of function

INFLAMMATION• H

• I

• P

• E

• R

16

= Heat

= Induration

= Pain

= Edema

= Redness

• Learning Tip

A normally functioning immune system is required to trigger inflammatory responses that

produces the sign of inflammation or infection

18

19

Infectious Disease Control

• Transmission routes–Contact–Droplet–Airborne–Common vehicle transmission

20

Infectious Disease Control

• Handwashing recommendations (CDC)–Soap and water

–Alcohol-based hand cleanser

• Vector-borne transmission

21

Guidelines for Infection Control

• Nurse’s role–Wash hands

–Wear gloves

–Wear masks, eye protection, and face shield

–Wear gown

Infection Control in the Community and in Health-care Agencies

22

• World Health Organization (WHO)

• Centers for Disease Control and Prevention (CDC)

> Teach standards to prevent

and control diseases and

monitor disease outbreaks23

Community-Acquired Infection

If on admission to a hospital or health-care agency a patient already has an infection

24

Nosocomial Infection

An infection that develops as a result of the stay in the hospital or health-care agency

25

Host

-His condition plays a major role in whether or not an infection is acquired

26

Areas at High Risk

Intensive careNeonatal care unitDialysisOncologyBurn unit

27

Pathogens commonly responsible

• Escherichia coli (E. coli)

-UTI• Staphylococcus aureus (staph)

- Nosocomial surgical wound infections

and septicemia• Pseudomonas aeruginosa

- nosocomial pneumonia

found in sinks, water, nebulizer28

Antibiotic Therapy• Multiple therapy increases

susceptibility to other types of infection

• Promotes resistance of pathogens to antibiotics

29

Antibiotic-resistant Infections

30

• 2 most common:

1. Methicillin-Resistant Staphylococcus Aureus (MRSA)

2. Vancomycin-resistant Enterococci

(VRE)

31

Methicillin-Resistant Staphylococcus Aureus (MRSA)

• Difficult to treat

• High mortality rate

• Affects mainly the elderly and chronically ill

• Vancomycin HCl

= a potent and very expensive antibiotic, administered IV as treatment 32

Vancomycin-resistant Enterococci

(VRE)• Enterococci- normal flora in the GI and

female genital tracts

• VRE- new pathogenic strain

• Transmitted via direct or indirect contact

• Susceptible: those with indwelling cath. Or CV cath., immunocompromised, surgical patients, multiple antibiotics, extended hospital stays

33

NURSING CARE TIP

Antibiotics are not effective against viral infections such as colds or flu. Antibiotics do not work on viral infections. Misuse is creating antibiotic-resistant “superbugs”.

Antibacterial soaps may also contribute to the superbug problem.

34

Antibiotic-Resistant Organism Precautions

1. Private room required

2. Gloves worn by all hospital personnel entering the room

3. Wash hands on entering and leaving the room

4. Gowns required if contamination of clothing is likely

5. Decontaminate all equipment used in the room

35

• M-onitor superinfections

• E -valuate renal/liver function

• D -iarrhea – take yogurt

• I -nform provider prior to taking other

meds

• C -ultures prior to initial dose

• A -lcohol is out, ask about allergy

• T -ake full course of drug

• E -valuate cultures, WBC,

temperature 36

CRITICAL THINKING

ACTIVITY B

37

1. Mrs. Sampson has neutropenia from chemotherapy treatments.

A. Why is hand hygiene the most important intervention you can do to help prevent infection for Mrs. Sampson? 2 pts.

B. What would be a priority nursing diagnosis for Mrs. Sampson? 2 pts.

C. What type of isolation could be beneficial to her? 1 pt.

38

2. Which of the following patients is at greatest risk for infection and why? 2 pts.

a. Mr. Ashland, age 55, is hospitalized for a hernia repair. He is overweight and has adult-onset diabetes

b. Mrs. Scotland, age 72, is hospitalized for a broken hip. She is thin, frail, has dementia, and has undergone placement of a urinary catheter

c. Jackson Dunn, age 2, is hospitalized for minor surgery. He is thin and small for his age

39

3.Which of the following is the most important nursing action to use to prevent hospital-acquired urinary tract infection in a patient with an indwelling urinary catheter?

a. ensure an adequate intake of IV and oral

fluids

b. use clean technique for catheter insertion

c. position drainage bag higher than bladder

level

d. maintain a closed urinary drainage

system40

a.“I’ll take this until I start feeling better”

b. “I have pills left over from the last time I had this infection”

c. “I’ll take all of this as it says to on the medication label”

d. “I take only half of a pill to reduce the cost of the pills”

• 4. Which of the following statements indicates to the nurse that the patient understands the general principles of appropriate antibiotic use?

41

5. Which of the following patient temperature readings would be priority for the LPN/LVN to report to the registered nurse?

a. temperature 97 F (36.1 C) for older

patient with hypertension

b. temperature 98.9 (37 C) for first day

postoperative patient

c. temperature 99.6 F (37.5 C) for patient

with neutropenia

d. temperature 100 F (37.7) for patient

with appendicitis 42

MEDICATIONS FOR INFECTIOUS DISEASES

43

Types

• Penicillins

• Cephalosporins

- First generation drugs

- Second, third gen.

• Aminoglycosides

• Fluoroquinolones

• Tetracyclines

• Erythromycin

• Sulfonamides

• Amphotericin B

• Fluconazole

44

THOUGHTS TO LIVE BYA life is not measured

By the games that are won,

But that you lived in the moment

And learned to have fun.

Michael Dooley45