Inflammation

Question 1

Define Inflammation

Answer 1

• Inflammation is an immunologic defense against tissue injury, infection, or allergy.

Question 2

Examples of Injury Causing Inflammation

Answer 2

• Mechanical injury: Bone fractures, sprains, and dislocations from tripping and falling, sports, recreational activities such as hiking and mountain climbing
• Thermal injury: Sunburn, spilling hot fluids on self, setting clothing on fire by getting too close to fireplace or stove, injury from fireworks
• Electrical injury: Child sticking wet finger in a power outlet; adult using electric appliance near water without a grounded outlet
• Chemical injury: Ingestion of chemicals such as bleach or lye by children, contact of household cleaners with the eye
• Radiation injury: Skin burns at the portal of entry of radiation therapy such as that used in the treatment of breast cancer or for pain control of bone metastases associated with prostate cancer
• Biological assault: Bacterial, viral, or fungal infections such as cellulitis, coryza, or athlete’s foot

Question 3

Scope of Inflammation

Answer 3

• Ranges from no inflammation to active inflammation
• May be localized or systemic
• Active inflammation may be: acute, chronic, or repair/restorative
• Injured arm is local because it is in one area
• Autoimmune disease would be systemic because it is throughout the whole body, unsure of where it is coming from and we have to do a little more digging
• Acute: new, onset
• Chronic: over a long period of time (i.e. 3 mo, 6 mo)

Question 4

Acute Inflammation

Answer 4

• Allergic Reaction
• Chemical Irritants
• Infection
• Trauma Injury
• Burns
• Laceration, cuts, wounds
• Frostbite

Question 5

Chronic Inflammation

Answer 5

• Cardiovascular Disease
• Neurological Disease
• Autoimmune Disease
• Rheumatoid Arthritis
• Cancer
• Lupus
• Fibromyalgia
• Chronic Fatigue Syndrome

Question 6

Steps of Inflammation

Answer 6

1. breaks the skin and pin has bacteria or virus, histamines are released, causing dilation and increased permeability of the vessels (causes swelling), if swelling gets to be too much it can cause a loss of circulation and impair mobility
2. dilation and increased leakiness of local blood vessels; migration of phagocytes to the area
3. phagocytes (macrophages and neutrophils) consume bacteria and cell debris; tissue heals

Question 7

Consequences of an Excessive or Ineffective Inflammatory Response

Answer 7

• Local tissue damage from compression
• Development of chronic inflammation
• Systemic pathology: atherosclerosis, chronic renal disease, neurological disorders
• Inflammation sticks around and does not go away
• Chronic inflammation in blood vessels can lead to atherosclerosis as the arteries may develop more plaque and become less elastic

Question 8

Risk Factors: Populations at Greatest Risk

Answer 8

• Very young: inability to understand what is and what is not safe, low self awareness and injury awareness
• Very old: do not want to ask for help, reduced immunity, fall risk
• Uninsured: less access to healthcare, wait until limb is very infected when they may die and it becomes too late

Question 9

5 signs of inflammation

Answer 9

• pain
• swelling
• redness
• heat
• loss of function
• When tissue injury occurs, proinflammatory hormones (e.g., prostaglandins, cytokines, histamines) increase blood flow to the injured area. Because blood is warmed by the interior of the body and provides color to the overlying tissue, increased blood flow results in both redness and heat. Swelling is the result of a combination of increased blood flow and extravasation of WBCs, fluids, and other substances out of the vascular system into the injured area. Pain results from the pressure of swollen tissues that stimulate pain receptors. Loss of function occurs as a result of swelling. For example, swelling can impede muscle and joint movement. Pain can also cause guarding and avoidance of painful voluntary movement, which also contributes to loss of function.

Question 10

Diagnostic Tests

Answer 10

• Blood tests: CBC (Complete Blood Count), WBC with differential, CRP (C-Reactive Protein), ESR (Estimated Sedimentation Rate), Serological tests to detect specific antibodies or viruses
• Radiographic studies: MRI (Magnetic Resonance Imaging), CT (Computerized Tomography), PET scans (Positron Emission Tomography)
• Different types of WBC for differential, can look at it and figure out which way the shift is going and what the bacteria is causing
• If elevated, we are looking at some kind of inflammation
• WBCs when high are infection and inflammation
• CRP and ESR are two nonspecific inflammatory markers; if I draw blood on someone complaining of aching and muscle weakness and the markers are high, there is something going on but cannot say what exactly
• Serological tests are like titers
• MRIs to check for fractures
• CT scans
• PET scans

Question 11

Primary Prevention - before the problem happens

Answer 11

• Reducing risk for injury and infection
• Maintaining good hygiene
• Properly using safety equipment
• Properly storing and preparing food

Question 12

Define RICE

Answer 12

Rest
Ice
Compression
Elevate

Question 13

Nursing Interventions

Answer 13

• Rest, ice, compression, elevation (RICE): Most helpful after sprain, strain, or trauma; helps minimize swelling; most beneficial for the first 24 to 48 hours after injury
• Monitor circulation and pulses of extremity
• Compressing reduces swelling and immobilizes the extremity
• Putting a wrap on an injury too tight can further injure the area
• Ice 15-20 minutes, take it off, then reapply
• Ice should not be directly on the skin as it can cause frostbite and cut off circulation
• Elevate above level of heart