Week 12-13 Inflammation and Infection PDF

Week 13 Inflammation Infection COMPETENCIES Define patient-centered, evidenced-based care using the nursing process. Discuss factors that create a culture of safety in caring for patients with select common health alterations. Discuss health promotion, health maintenance, preventi...

Week 13 Inflammation Infection COMPETENCIES Define patient-centered, evidenced-based care using the nursing process. Discuss factors that create a culture of safety in caring for patients with select common health alterations. Discuss health promotion, health maintenance, prevention of illness & injury and facilitation of healing. Competencies Discuss the use of critical thinking to prioritize basic elements of patient care when implementing the nursing process. Discuss critical thinking strategies used when making clinical judgements. Discuss the roles of the interprofessional collaborative practice members. CONCEPT Infection: The invasion of body tissue by microorganisms with potential to cause disease or illness. Inflammation: The physiologic response to reduce the effects of what the body perceives as harmful.  Hyperthermia (FEVER) related to Infection The ability to maintain CONCE normal body temperature. The PT invasion of body tissue by microorganisms with potential to cause disease or illness.  Discuss the events in the inflammatory response. Describe the drug, UNIT nutrition, and nursing OUTCO management of inflammation. MES Fever Describe nursing and collaborative measures used to manage fever Concept: Inflammation Non-specific Complex Response to what the body views as harmful Inflammation Defense Against Infection Inflammation Adaptive response to illness or injury Brings fluid (plasma), dissolved substances and blood cells to the interstitial tissue where invasion or damages has occurred First phase of healing process Nonspecific Inflammation ≠ Infection Pain Swelling Redness Heat Impaired function Inflammatory Response 3 stages: 1. Vascular and Cellular response 2. Exudate response 3. Reparative phase. 1. Vascular and Cellular Response # 1, # 2 and # 3= Vascular and Cellular Response Cell injury Vasoconstriction (transient) then vasodilation Release histamines, prostaglandins, and kinins Start to see redness 1. Vascular Cellular Response Release histamines, prostaglandins, and kinins Blood vessel dilation, increase blood supply to site Hyperemia (redness and heat at site) that accompany inflammation 1. Vascular Cellular Response (continued) Increased vascular permeability Fluid, proteins, leukocytes accumulate Leak into interstitial space causing edema Leukocytes accumulate at site and clotting response Pain is caused by the accumulation of fluid and the release of the chemicals - results in swelling (edema) Types of injuries causing inflammation (Vascular/Cellular Response) Sprained ankle Minor burn Broken bone Inflammatory Response Stage 2 Exudate is produced Fluid that escaped from the blood vessel contains tissue cells, phagocytic cells, and products they release Phagocytosis: removal and destroying of bacteria (ingest) Exudate Serous Purulent Hemorrhagic Inflammatory Response Neutrophils Type of WBC that ingests microorganism and releases enzyme that kills them Purulent drainage (pus) is composed of: Dead neutrophils accumulated at the site of injury Digested bacteria Other cell debris What do you think? 3. Reparative Phase Replacement/repair of injured tissues Granulation: fragile, delicate issue, appears pink or red Damaged cells replaced one by one. When regeneration is not possible, repair occurs by fibrous tissue (scar) Inflammation Acute Chronic Healing in 2 to 3 weeks May last for years No residual damage Injurious agent persists Neutrophils are the May result from changes predominant cell at the in immune system site of inflammation Ex. Autoimmune disease Assessment Cues: Think: Localized Systemic Local Systemic Erythema (red) Temperature (> 38 C) Warmth Pulse >90 bpm Pain Respirations >20/min Edema WBC. 12,000 mm3 Functional impairment Vital signs What questions can you ask as a component of your assessment? Pain? Are you taking medications? Recent procedures/surgeries? Eating habits? Any changes in energy, appetite, headache, urinary? Diagnostics: Tests that direct and determine cause CBC Erythrocyte sedimentation rate (ESR) C-Reactive protein Nursing Care and Collaborative Management Health promotion/teaching Prevention of injury Proper nutrition omega-3 fatty acids, probiotics, antioxidants Decreasing saturated fats, cholesterol, high glycemic index Early recognition of inflammation Prompt treatment Nursing Care Management Concept: Infection Invasion of body tissue by micro- organisms with the potential to cause illness or disease Example/Exemplar: Cellulitis Inflammation of subcutaneous tissues (itis = inflammation) Often following a break in the skin Deep inflammation of the subcutaneous tissue is from enzymes produced by bacteria Common organisms: Staphylococcus aureus Streptococci Cellulitis: Signs and Symptoms Warm or hot to touch Red Swollen Fever/chills Lethargy Discomfort Lymph node enlargement Assessment Recognize Infection Document location, be precise Trace border Assess for symptoms Vital signs Precipitating factors Monitor for signs of sepsis (Septicemia); Gangrene What are some of the patient problems/diagnosis? Planning Set goals Minimizing infection Managing Pain Education Nursing Implementation Rest Encouraging oral hydration Elevation Comfort measures Possible moist heat (need order) Teaching: Hand hygiene; wound care; preventions; symptoms to report; Medication (antibiotics) Antibiotics (collaborative practice) Should see improvement within 3 days Antibiotics should continue in most cases 5 to 14 days Encourage oral hydration Patients always taught to complete the prescription as ordered unless adverse response  Wash hands before touching wound Wash wound daily (soap and water) May see Topical Implementat ion: Antibiotic cream ordered Teaching Monitor for signs to report Increasing infection: Fever, more pain, redness Differential Assessment Skin Assessment Deeper pigmentation Erythema: red hue, hyper or darker pigmentation, Darker Blue hue Important Inflammation is always present with infection, but infection is not always present with inflammation FEVER: Systemic response to an infection Pyrexia  Cellular metabolism increases Increases heat production Oxygen needs Increase Cellular hypoxia (can cause angina; Physiol confusion) Energy stores become depleted ogy of Fatigue Pulse and respirations increase; Fever diaphoresis occurs Dehydration Fever Management Fever Beneficial aspects of fever include increased killing of microorganisms and increased phagocytosis Antipyretic drugs – inhibit prostaglandin synthesis Salicylate Acetaminophen NSAIDS Fever in the Older Adult Older adults are sensitive to temperature extremes Deterioration in vasomotor control of vasoconstriction and vasodilatation Reduced subcutaneous tissue Reduced sweat gland activity Reduced metabolism When body temperature elevation occurs the process of dehydration is a serious problem for the older adult – may result in death