Immunity, Infection & Inflammation: Nursing Notes PDF

Week Three Objec ves Immunity/In amma on/Infec on 1. Understand the rela onship between infec on, in amma on, and immunity....

Week Three Objec ves Immunity/In amma on/Infec on 1. Understand the rela onship between infec on, in amma on, and immunity. Infec on, in amma on, and immunity are closely interrelated processes in the body's defense against pathogens. When a pathogen invades the body, it triggers an in ammatory response as part of the innate immune system. In amma on helps contain the infec on and recruit immune cells to the site. The adap ve immune system, consis ng of an body-mediated and cell-mediated responses, then mounts a speci c a ack against the pathogen. In amma on aids this process by increasing blood ow and allowing immune cells to reach the infected area. Successful immunity leads to elimina on of the pathogen and resolu on of in amma on. However, excessive or uncontrolled in amma on can also cause ssue damage. Proper regula on of in amma on and an e ec ve immune response are crucial for overcoming infec ons while minimizing harm to the host. 2. Understand complica ons from impaired Immunity. Severe, life-threatening infec ons from common pathogens Opportunis c infec ons from organisms that rarely cause disease in healthy people Prolonged, recurrent, or disseminated infec ons Increased suscep bility to viral, fungal, and parasi c infec ons Delayed wound healing and poor response to treatments Increased risk of certain cancers like lymphoma Autoimmune disorders due to immune dysregula on 3. Understand causes of immunosuppression. 1. Medica ons: chemotherapy drugs, cor costeroids, immunosuppressants used for autoimmune diseases and transplants 2. Diseases: HIV/AIDS, leukemia, lymphoma, severe combined immunode ciency 3. Malnutri on: de ciencies in protein, vitamins, and minerals impair immune func on 4. Aging: the immune system becomes less e ec ve as people grow older 5. Environmental factors: radia on exposure, extreme stress, lack of sleep 6. Medical treatments; radia on therapy, stem cell/bone marrow transplants 7. Congenital disorders: gene c defects a ec ng immune cell development or func on 4. Iden fy clients at high risk to develop infec on. Newborns and infants with immature immune systems Elderly adults with age-related immune decline Pregnant women due to immunosuppressive e ects Individuals with chronic disease (diabetes, cancer, HIV/AIDS) Those on immunosuppressive medica ons like chemotherapy Individuals with nutri onal de ciencies Pa ents with burns, trauma, or surgical wounds ti ti ti ti ti ti ti ti fl fl fi fi ti ti tt ti ti ti ti ti ti ti ti fl ti ti ti ti fl fi ti ti ti ti ti ti ff ti ff ti ti ti ti fl ti ti ff fl ti ti fl ti ti ti ti ti fl ff ti fi fl ti ti ti ti fl  Week Three Objec ves Smokers and substance abusers with impaired lung defenses Individuals on ven lators or invasive devices like catheters Pa ents with impaired immunity 5. Understand hypersensi vity/allergic reac ons. Occurs when the immune system overreacts to a typical harmless substance (allergen). Can range from mild to severe or life threatening (anaphylaxis with throat swelling, low blood pressure). The reac on involves excessive in amma on triggered by the release of substances like histamine from mast cells and basophils. Symptoms for each organ system can include; skin (hive, rash) respiratory (wheezing, di culty breathing) gastrointes nal (vomi ng, diarrhea) and cardiovascular (hypotension). Epinephrine crucial for anaphylaxis 6. Understand the in ammatory process in the body. The body’s protec ve response to injury or infec on. Involves a complex series of events; 1. Vascular changes- blood vessels dilate and become more permeable, allowing plasma proteins and immune cells to enter the a ected area. Causing redness, swelling, and warmth. 2. Cellular response- white blood cells like neutrophils and macrophages migrate to the site of injury/ infec on. They release in ammatory mediators and enzymes to destroy pathogens and damaged cells 3. Chemical mediators- substances like histamine, prostaglandins, and leukotrienes are released, causing increased blood ow, pain, fever, and further recruitment of immune cells. 4. Phagocytosis- macrophages and neutrophils engulf and digest pathogens and debris through phagocytosis 5. Tissue repair- if the injury persists, the in ammatory response becomes chronic. Fibroblasts proliferate to repair damaged ssue through collagen deposi on and scar forma on. 7. Recognize symptoms of in amma on and causes (Five cardinal signs). 1. Redness (rubor) - due to increased blood ow from vasodila on of blood vessels. 2. Heat (calor)- caused by increased blood ow and metabolic ac vity in the in amed area 3. Swelling (tumor) results from accumula on of uid and cells from increased vascular permeability 4. Pain (dolor)- caused by release of in ammatory mediators like prostaglandins that s mulate nerve endings 5. Loss of func on (func on laesa)- due to swelling, pain, and ssue damage impairing normal func on ti ti ti ti fl ti ti ti fl fl ti ti ti fl fl ff ti ti ti fl ti fl fl fl ti fl ti ti ti ti ti fl ti ti ffi ti ti  Week Three Objec ves 8. Know the di erence between acute and chronic in amma on. Acute: Chronic: Rapid onset in response to injury of infec on Prolonged and persistent, las ng weeks to Short dura on, typically las ng minutes to days years Usually self limi ng and resolves with removal Results from failure to eliminate the cause of of the s mulus defec ve resolu on Characterized by vascular changes and in ux of Characterized by in ltra on of lymphocytes, neutrophils macrophages, and plasma cells Aims to eliminate the injurious agent and Can lead to ssue damage and destruc on ini ate healing from ongoing in amma on Associated with autoimmune disorders, chronic infec ons, or exposure to irritants May result in forma on of granulomas or brosis to wall o the in amed area 9. Understand how infec on a ects the body. 1. Localized e ects: pathogens like bacteria or viruses can directly damage or invade cells and ssues at the site of infec on, causing in amma on, pain, swelling, and impaired func on. 2. Systemic e ects: if the infec on spreads through the blood stream or lympha c system, it can cause fever, fa gue, muscle aches, and other u-like symptoms as the immune system responds. 3. Toxin release: some pathogens release toxins that can cause widespread e ects like diarrhea, paralysis, ssue damage, and even shock if they enter the blood stream. 4. Immune response complica ons: an excessive or uncontrolled immune response to the infec on can some mes lead to autoimmune reac ons or sepsis, a life-threatening condi on. 5. Organ damage: severe infec ons can impair the func on of vital organs like the lungs (pneumonia), heart (endocardi s), kidneys (pyelonephri s), or brain (meningi s). 6. Chronic e ects: certain infec ons can become chronic or recurrent, leading to long-term complica ons like arthri s, cancer, or organ failure if le untreated. 10. Know the di erence between localized and systemic infec on. Localized infec on: Systemic infec on: A ects a localized area like a wound, skin, or Spreads through the bloodstream of lympha c speci c organ. system Causes local in ammatory signs like redness, Causes body-wide symptoms like fever, chills, swelling, pain, warmth fa gue, muscle aches Examples: celluli s, abscess, UTI Can a ect mul ple organs and systems Examples: sepsis, meningi s, pneumonia fi ff ti ti ti fi ti ti ff ti ti ti ff ti ff ti ff ti ff ff ti ti ti fl ti ti fl ti ff ti ti ti fi ti ti ti ti ti fl ti ti ti ti ti ff ti ti fl ti ti ti fl fl ti ti ti fl ti ft ti ti ti ff ti ti ti ti ti  Week Three Objec ves A localized infec on can become systemic if not treated properly or if immune system cannot contain it. Systemic infec ons are generally more serious and require prompt treatment to prevent complica ons like organ failure or sep c shock. 11. Know the di erent stages of the infec on process. 1. Exposure 2. Entry 3. Coloniza on- begins mul plying and establishing itself within host’s ssues. 4. Invasion- pathogen ac vely penetrates deeper into the host’s cells and ssues, evading immune defenses 5. Mul plica on 6. Tissue damage 7. Dissemina on- pathogen spreads from the ini al site to other areas of the body through the bloodstream or lympha c system 8. Convalescence- the host’s immune system controls or eliminates the pathogen, leading to recovery. 9. Persistance- the pathogen can evade clearance and establish a chronic or latent infec on 12. Know the di erent links in the chain of infec on and how to prevent the spread of infec on. 1. Infec ous agent- the pathogen like bacteria, virus, fungus, or parasite capable of causing disease. 2. Reservoir- the place where the infec ous agent resides and mul plies such as humans, animals, soil, or objects 3. Portal of exit- the path by which the agent leaves the reservoir, such as respiratory secre ons, blood, or feces 4. Mode of transmission- the way the agent is spread, such as contact, droplet, airborne, vehicle, or vector 5. Portal of entry- the route by which the agent enters a new host, such as mucous membranes, broken skin, or respiratory tract. Measure to stop the chain of infec on include: Proper hand hygiene and disinfec on to eliminate infec ous agents Covering coughs/sneezes and using PPE to contain portals of exit Prac cing safe injec on prac ces and proper handling of sharps to avoid direct inocula on Ensuring adequate ven la on and air handling to minimize airborne transmission Maintaining cleanliness and sterilizing equipment/surfaces to reduce environmental reservoirs Promo ng healthy lifestyles and immuniza ons to increase host resistance 13. Know the di erent types of isola on precau ons. Standard precau ons: basic infec on control measures used for all pa ent encounters. Includes hand hygiene, use of PPE ti ti ti ti ti ti ti ff ff ff ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti ti  Week Three Objec ves Contact precau ons: used for infec ons spread by direct or indirect contact with the pa ent or environment. Requires gown and gloves upon entry to pa ent room Droplet precau ons: Used when respiratory droplets are the main mode of transmission, like in uenza. Requires a mask within 6 feet of the pa ent. Airborne precau ons: for infec ons spread over long distances by small airborne par cles like tuberculosis. Requires an N95 respirator or PAPR when entering airborne isola on room. 14. Know C-Di : Causes, signs and symptoms, treatment and nursing precau ons C. Di is a bacteria that can cause serious intes nal infec ons, o en a er an bio c disrupts the normal gut ora. Causes: overgrowth of c. Di commonly due to recent an bio c therapy that kills bene cial gut bacteria. Signs and symptoms: watery diarrhea, abdominal pain, fever, nausea, loss of appe te Treatment: stopping the an bio c that caused the disrup on, uid/electrolyte replacement, an bio cs like oral metronidazole for mild cases or oral vancomycin for severe cases. Nursing precau ons: -contact precau ons (gown, gloves) -strict hand hygiene - disinfect pa ent room surfaces and equipment with sporicidal agents. -isolate posi ve cases and implement contact precau ons -educate family/pa ent on preven ng transmission 15. Know In uenza: Causes, signs and symptoms, treatment and nursing precau ons In uenza is a highly contagious viral respiratory infec on caused by in uenza viruses. Signs and symptoms: abrupt onset of fever, body aches, headache, fa gue, sore throat, cough, and runny nose. Treatment: relieving symptoms with rest, uids, and over the counter meds like acetaminophen. An viral drugs may be prescribed for high risk groups. Nursing precau ons: -respiratory hygiene, cough e que e. -droplet precau ons (mask within 6 ) -annual u vaccine - proper handwashing and avoiding touching face -stay home un l fever-free for 24 hours -disinfect surfaces and equipment -monitor for complica ons like pneumonia 16. Know pa ent educa on regarding an bio c usage. Take full prescribed course of an bio cs Do not skip doses. Take the right amount at right intervals Should be taken alone w/o dairy products, antacids, or supplements that can interfere with absorp on Be aware of side e ects like rash, diarrhea, nausea, and report any concerning symptoms promptly. Do not share an bio cs or save for later use Prac ce good hand hygiene Finish all doses to ensure infec on is fully cleared. Nutri on: 17. Understand the causes of malnutri on (Under and over nourishment). Insu cient nutrient intake- lack of access to enough food, poverty, famine, or an unbalanced diet lacking essen al nutrients fl fl ffi ti ff ti ti ti fl fl ti ff ti ti ti ti ti ti ff ti ti ti ti ff ti ti ti ti ti ti ti ti ti ti ti fl ti ti ti ti ti tt ti ti ti ti ti ti fl ti ft ti fl ft ti ti ti ti ti ti ti ti ti fi ti ti fl ti ft ti ti ti  Week Three Objec ves Impaired absorp on- condi ons like Crohn’s disease, celiac disease, or short bowel syndrome that prevent proper nutrient absorp on Increased nutrient losses- severe burns, wounds, diarrhea, or kidney disease leading to excessive nutrient losses Increased nutrient requirements- condi ons like cancer, HIV/AIDS, or hyperthyroidism that increase metabolic demands Inability to ingest food- disorders a ec ng swallowing or the GI tract like stroke, Parkinsons disease, or esophageal cancer Psychiatric illnesses- ea ng disorders like anorexia nervosa or bulimia nervosa causing inten onal food restric on Socioeconomic factors- food insecurity, lack of educa on about nutri on, cultural prac ces, or neglect in vulnerable popula ons 18. Understand the e ects of malnutri on. Muscle was ng and weakness from lack of protein Impaired immune func on, increasing infec on risk Nutrient de ciencies causing condi ons like anemia, osteoporosis, night blindness Fluid and electrolyte imbalances Delayed wound healing Fa gue and lethargy from lack of calories Growth stun ng in children Organ failure in SEVERE cases 19. Know the di erence between fat soluble vitamins and water soluble. Fat-Soluble vitamins (A,D,E,K) are absorbed through the intes nal tract with the help of fats. They can be stored in the body’s fa y ssues and liver. Excess intake can lead to toxicity. Water-soluble vitamins (B-complex, C) dissolve easily in water and are readily excreted from the body through urine. They need to be replenished regularly in the diet as they cannot be stored in signi cant amounts. Fat-soluble vitamins are be er absorbed when consumed with some dietary fat. Water-soluble vitamins are not a ected by fat intake. De ciencies of fat-soluble vitamins take longer to develop due to storage in the body. Water-soluble de ciencies occur more rapidly. 20. Know lab values that are important to nutri on. Albumin- low levels may indicate protein malnutri on. Half life is 21 days Prealbumin- preferred for assessing short-term protein status changes. Half-life is 2 days Transferrin- an iron-binding protein that decreases with protein de ciency. Half-life is 8 days Total lymphocyte count- cell-mediated immunity is impaired with protein-calorie malnutri on Hemoglobin/Hematocrit- low levels suggest anemia from de ciencies in iron, folate, or vitamin B12 Electrolytes- imbalances can occur with severe malnutri on a ec ng uid regula on Nitrogen balance studies- calculate protein intake vs losses to determine anabolic or catabolic state ti ti ff fi ti ff ti ti ff ti ti tt ti ti ti tt ti fi ti fi ff ti ti ti ti ti ti ti ti ti fi ti ff ti fi ti fl ti ti ti ti fi  Week Three Objec ves 21. Review BMI ranges. Underweight: BMI < 18.5 Normal wight: bMI 18.5-24.9 Overweight: BMI 25-29.9 Obesity Class 1: BMI 30-34.9 Obesity Class 2: BMI 35-39.9 Obesity Class 3: BMI > 40 In children: bmi at or above 85% is overweight, and over 95% is obese 22. Know the di erent types of modi ed diets (P&P Box 45.10). Clear liquid diet- broth, gela n, juice Full liquid diet- strained soup, milk, pudding So diet- so , moist and east to chew. Mashed potatoes, yogurt, cooked veggies Low ber diet- Low residue diet- low ber with low fat and lactose restric ons Renal diet- Limits protein, sodium, potassium, phosphorus, and uids for kidney disease Diabe c diet- controls carbohydrate intake and promotes foods low on glycemic index 23. Know the di erence between parental and enteral feedings. Parenteral nutri on: Enteral Nutri on: Nutrients delivered directly into the Nutrients delivered through GI tract bloodstream Preserves gut integrity and func on Used when the GI tract is non-func onal or Lower infec on risk compared to parenteral inaccessible Cannot meet full nutri onal requirements in Can provide complete nutri on requirements some cases Higher risk of complica ons like infec ons, May be used as a supplement or transi on metabolic issues from parenteral nutri on 24. Know nursing interven ons for a client on enteral feeding. -Verify tube placement before ini a ng feedings or administering medica ons through the tube to prevent complica ons like aspira on -monitor gastric residual volumes regularly and hold feedings if excessive residuals are present. -ensure proper ushing of the feeding tube before and a er to prevent clogging -assess for signs of intolerance like abdominal disten on, nausea, vomi ng, diarrhea, and report concerns promptly ft fi ti ti ft ff ff ti fl ti ti ti ti fi ti ti ti ti ti ti ti ti fi ti ti ti ti ti ft ti fl ti ti  Week Three Objec ves -provide oral care assess for tube dislodgment/proper tube posi on -monitor intake and output, weight, and lab values to evaluate hydra on status and nutri on adequacy 25. Understand roles of the UAP, LPN and RN in nutri on care, enteral feeding, etc. Unlicensed Assis ve Personnel (UAP)- under nurse supervision, UAPs can assist with basic feeding tasks like posi oning the pa ent, opening containers, documen ng intake, and providing oral care before/ a er meals LPN- LPN’s can monitor tube feeding rates, ush feeding tubes, check gastric residuals, and document intake/output. They work under the direc on of the RN RN- RN’s are responsible for the comprehensive assessment of nutri onal status, developing the nutri on care plan, verifying tube placement, administering tube feedings/medica ons, monitoring for complica ons, and evalua ng the e ec veness of nutri on interven ons. RN’s also educate pa ents/ families and supervise UAPs and LPNs ft ti ti ti ti ti ti ti ff ti ti fl ti ti ti ti ti ti ti ti ti ti