INFLAMMATION
Signs of Inflammation
- Heat (calor) – increased metabolism on site produces heat
- Redness (rubor) – hyperemia (increased blood flow) from vasodilation
- Swelling (tumor) – fluid shift to interstitial space
- Pain (dolor) – release of vasoactive amines (such as histamines & prostaglandins which transmit pain signals to the brain)
- Loss of Function (functio laesa) – due to swelling and pain
Stages of Inflammation
- Vascular Stage
- Phase 1 – local temporary vasodilation
- Phase 2 – release of vasoactive amines resulting in hyperemia
- results in an increase of capillary permeability, swelling and pain occurs; macrophages arrive releasing cytokines
- Cellular Stage
- neutrophils then leukocytes arrive
- pus formation from dead WBC and bacteria
- arachidonic acid cascade occurs releasing histamine, leukotriene, prostaglandin, serotonin (mediators of inflammation)
Cell Reproduction
- Labile Cells
- Undergo complete regeneration via proliferation
- e.g. skin cells, hair follicles, bone marrow
- Stable Cells
- Regenerate only if stimulated
- e.g. liver cells, lymphocytes
- Permanent Cells
- Incapable of reproduction
- e.g. brain cells, cardiac muscle, bone
Cellular Defenses
- Neutrophil / Polymorphonuclear Cells
- 55-70%
- lifespan: hours to days
- segmented cells: mature neutrophils
- band cells: immature neutrophils
- fight bacteria
- first responders during inflammation
- Basophil
- < 1%
- appear during allergic and parasitic reaction
- Eosinophil
- 1-2%
- appear during parasitic, viral, and allergic reactions
- Macrophage
- monocytes: immature macrophages
- lifespan: months to years
- stimulate other immune cells to fight by releasing cytokines
- phagocytize (eat) debris and pathogens
Macrophages of the Different Organs
- Lungs – Alveolar Macrophages
- Connective Tissue – Histiocytes
- Liver – Kupffer Cells
- Brain – Microglia
- Bone – Osteoclasts
- Kidney – Mesangial Cells
Rheumatic Fever
- Remnants of the dead Streptococcus from the sore throat bind to the heart and joints and are detected by the body as an invader causing inflammation (Type II hypersensitivity)
- Cause: Group A Beta-Hemolytic Streptococcus (GABHS)
- Signs and Symptoms (Major / Jones Criteria)
- Migratory Polyarthritis
- SQ Nodules / Aschoff Bodies
- Erythema Marginatum
- Carditis
- Sydenham’s Chorea / St Vitus’ Dance
- Treatment of Choice
- Nursing Management
- small frequent feeding
- increased protein diet
- increase oral fluids
- respiratory precaution
- health teaching:
- get treated for sore throat (“ayaw sige inom Biogesic, di na siya cure-all”)
Herpes Zoster
- Cause: reinfection of Varicella zoster
- Signs and Symptoms
- neuralgia
- painful unilateral vesicular (serous fluid filled) skin eruptions usually starting on the trunk
- Drug of Choice
- ACYCLOVIR - will only stop reproduction of virus and reduce severity but will not totally cure the disease
- Nursing Management
- avoid contact with skin eruptions
- apply wet dressing to soothe pain
- administer analgesics as ordered
- assist patient with ADLs as pain may be unbearable at times
Herpes Simplex
- Cause: Herpes Simplex Virus Type 1 & 2
- Types
- Type 1 Virus: causes orolabial lesions (on the lips)
- Type 2 Virus: causes genital lesions (on the genitalia)
- Signs and Symptoms
- clustered small vesicles, when ruptured forms a shallow ulcer (COLD SORES)
- itching and pain
- flu-like symptoms
- lymphandenopathy
- Treatment of Choice
- ACYCLOVIR - will only stop reproduction of virus and reduce severity but will not totally cure the disease
Malaria
- Malarial parasites digest hemoglobin for energy and produce HAEMOZOIN, a waste hemoglobin pigmentation, which is deposited in tissue, causing inflammation
- Cause: Plasmodium spp.
- Species
- P. falciparum – tertian (fever ever 3rd day)
- P. ovale – tertian (fever ever 3rd day)
- P. malariae – quartan (fever ever 4th day)
- P. vivax – tertian (fever ever 3rd day)
- Signs and Symptoms
- paroxysmal chills
- fever
- fatigue
- muscle pain
- headache
- dizziness
- Diagnostic Test of Choice
- Treatment of Choice
- CHLOROQUINE (given to travelers entering a malaria-infested area)
- QUININE & FANSIDAR
Psoriasis
- chronic non-inflammatory skin disorder characterized by an 8-9x faster rate of production of epidermal cells; hereditary
- Cause: autoimmune response; T cells migrate to the skin releasing cytokines (which signal inflammation) and causes rapid multiplication of skin cells
- Types
- Plaque - raised areas of inflamed skin covered with silvery white scaly patches
- Guttate - small, scaly, red or pink, teardrop-shaped lesions appearing primarily at the trunk
- Pustular - red, tender, raised bumps filled with pus usually found at the hands and feet
- Inverse - smooth inflamed patches appearing at skin folds especially at armpits, genitals, and under the breasts
- Erythodermic - widespread inflammation and exfoliation of the skin accompanied by itching, swelling, and pain
- Signs and Symptoms
- raised areas of inflamed skin covered with silvery white skin (plaques) (80-90% of patients)
- bilateral symmetry
- Treatment of Choise
- Medications
- steroids
- triamcinolone
- retinoids
- chemotherapeutics
- Nursing Management
- stress management
- promote understanding of disease
- improve self concept & body image
- prevent dryness
- avoid scratching
- avoid staring at patient
- use warm water
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