Transcript Document 7174967

INFLAMMATION,
INFECTION AND
IMMUNITY
Objectives
• Describe how inflammatory changes act as
bodily defense mechanisms
• Identify signs and symptoms of
inflammation
• Discuss the process of repair and healing
• Discuss the actions of commonly found
infectious agents
• Compare community acquired and health
care associated infections
Objectives
• Describe the centers of disease control
isolation guidelines for
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Airborne
Droplet
Contact
Transmission based precautions
Objectives
• Discuss the nursing care of patients with
infections
• Describe the CDC standard precautions
guidelines for infection control
• Describe the immune response
• Describe the nursing care of patients with
HIV and those with allergies
• Describe the process of autoimmunity
INFLAMMATORY
CHANGES
HOW DO THEY PROTECT THE BODY?
Series of bodily actions that defend the body:
1. Hemodynamic:
a. Capillary bed dilation
b. Increased blood flow to the area (WBC’s)
c. Evidence:
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Warmth (calor)
Redness (Rubor)
Inflammatory Changes
2. Increased Permeability:
a. pavementing:
- WBC’s line small blood vessel walls
- passing thru the walls and invade area
- Europhiles, monocytes
- phagocytosis
b. protein rich fluid:
- also permeates thru the walls
- leads to swelling/pain (tumor/dolor)
Inflammatory Changes
3. Chemical Mediators found in body tissues
and : cause the hemodynamic changes and
vascular permeability:
a. cytokines and eicosanoids
- bradykinin
– blood vessel dilation
- blood vessel permeability
- pain and s/s of inflammation
Inflammatory Changes
3. Chemical Mediators: cause the
hemodynamic changes and vascular
permeability:
b. complement system:
- immunological reactions
- involving antigen-antibody reactions
- leads to a massive release of histamine
- leads to the S/S of anaphylactic shock:
Inflammatory Changes
The S/S of anaphylactic shock:
1. Massive vasodilation
2. Vascular permeability
3. Smooth muscle contraction
Leads to signs and symptoms of anaphylaxis:
- hypotension
- swelling
- bronchoconstriction
Inflammatory Changes
4. anti-inflammation:
a. release of cortisol:
- hormone produced by the adrenals
- slows release of histamine,
- stabilizes lysosomal membranes
- prevents the influx of leukocytes
b. slows down or stops the inflammatory process
c. protects the body from excess inflammation
patients with chronic or inborn inflammatory diseases
- benefit from corticosteroid injections
Identifying S/s of
inflammation
1. Local S/s of inflammation:
a. Heat
b. Swelling
c. Redness
d. Pain
- Leading to loss of function
Identifying S/s of
inflammation
Systemic S/s of inflammation:
1. Fever related to;
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b.
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d.
e.
Pyrogens
Phagocytosis
Bacterial endotoxins
Antigen-antibody complexes
Certain viruses
Identifying S/s of inflammation
Systemic S/s of inflammation:
2. Other S/s’s:
a. headaches
b. muscle aches
c. chills
d. sweating
e. leukocytosis :
- seen without an infxn
- related to inflammation only
- disappears within hours
Venous Access Devices
Wound Healing
1. Starts from the onset of inflammation:
2. Speed of healing:
- Depends on the type of tissue, and health
3. Macrophages:
- Clean up inflammatory debris
4. Fibroblasts:
a. Lay down elastin and collagen at Wd edges
b. Gradually migrate to the base of the Wd
c. Forms granulation tissue
Wound Healing
5. Epithelial cells:
- migrate over the wound and form a scab
6. Regeneration:
- scab falls off
- damaged cells are replaced by new cells
- AKA – regeneration
- some tissue does not regenerate well
- leads to scar formation
Wound Healing
Age and general health:
- affect speed of tissue regeneration
- delayed in older person due to:
* decreased tissue elasticity
* decreased blood supply
Nutritional deficiencies:
- regeneration may also be impaired by
- vitamin – C, Zinc, other minerals
deficiencies
Wound Healing
Infection and or ulceration of a wound:
- May lead to tissue loss
- Granulation tissue forms around Wd
- It may eventually fill the wd if it is small
- If the Wd is large:
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The wound is cleaned and debridement is
used
It helps regeneration and healing
Wet to dry dressings are used
Wound Healing
Primary intention:
- clean wound that is sutured
- heals from outside in
Secondary intention :
- infected wound
- allowed to heal from inside out
Delayed primary closure:
- a sutured wound that was once infected
Actions of infectious agents
• Bacteria:
• One celled, Multiplies rapidly within the
infected person
• Classified by:
– shape:
• Round (cocci)
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classified how they group together
Diplococi (groups o two)
Clusters ( staphylococci)
Chains ( streptococci)
Actions of infectious agents
• Bacteria:
– shape
• Rod shaped
– Bacilli further subdivided into
» Fusiform
» Spirochetes
– whether they require oxygen to survive:
• Aerobes
• Anaerobes
– ability to take up and or retain stains.
Actions of infectious agents
• Bacteria:
– ability to take up and or retain stains:
• Gram positive:
– Have a thick covering that retains the stain
• Gram negative:
– Have a thin wall and do not retain the stain
• Acid fast stain:
– Used to detect mycobacterium tuberculosis
• Immunoflourescent stains:
– Reveal different organisms and antibodies when exposed to
ultraviolet light
• Each classification gives the details of how to kill it
or its design (via O2 or cell wall )
Actions of infectious agents
• Viruses:
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Visible thru the electron microscope
May be RNA or DNA viruses
Have a protein capsule but no cell wall
Replication is dependent on a host
Live within the host’s cells (killing them is
hard)
– DNA viruses Cause:
• Colds, measles, chickenpox, hepatitis
– RNA viruses cause:
• HIV
• Few antivirals meds (prevention is KEY)
Actions of infectious agents
• Fungi:
– Vegetable-like organisms
– Feed on organic matter
– Few produce diseases in humans
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Tinea corporis (ring worm)
Tinea pedis (athletes foot)
Tinea capitis ( scalp fungal infection)
Tinea cruris (jock itch) crural fold)
Majocchi’s Granuloma: (epidermal fungal infxn)
– Many are superficial skin infections
Actions of infectious agents
• Fungi: (cont’d)
– Fungal infections may be life threatening i.e.:
• Cryptococcus
• Aspergillus
– Immunocompromised individuals
• Chemo
• HIV
• Transplant patients
– Fungal infections “
• Called mycoses
• Spore forming (resistant to antiseptics/disinfectants)
– Pts, may be treated with topical & systemic
antimycotics
Actions of Infectious Agents
• Protozoa:
– Once celled organism
– Plamsodium species produces disease in
humans
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Malaria
Amoebic dysentery
Giardiasis
Trypanosoma gambiense (sleeping sickness)
– Spread by fecal contamination of food or
water
Actions of Infectious Agents
• Protozoa: (Cont’d)
– Pneumocystis jiroveci:
• Common in patients with HIV
• Low immunity leads to pneumocystic pneumonia
Actions of Infectious Agents
• Rickettsiae:
– Are between bacteria and viruses in size
– Appear as rods, cocci, or varied shapes
– Multiply in the cells of animals
• Rats, squirrels
– Transmitted to humans thru flea and tick bites
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Rocky mountain spotted fever
Typhus
These diseases are found in areas of poor sanitation
Where rodent and insects are not controlled
Actions of Infectious Agents
• Helminths:
– Worms
– Hand to mouth transmission
– Commonly found in GI tract
• Abd pain and bloating or asymptomatic
– Children:
• Pin worm: (Rectal irritation)
• Tape worms (GI tract) (wt loss, Abd pain, bloating)
• Hook worms: via soles of the feet and may migrate
to lungs, or GI tract ( liver, intestine etc)
– Producing abd pain, diarrhea, anemia
Actions of Infectious Agents
• Mycoplasmas:
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Gram negative, multi-shaped organism
No cell walls
Called pleuropneumonia-like organisms
Cause:
• Atypical pneumonia in humans
• Reiter syndrome : (multi-system inflammatory
disease in humans)
• Usually responsible for respiratory tract infections
in children and adult
• Respond well to erythromycin
Actions of Infectious Agents
• Prions:
– Do not have a nucleus
– Transmittable and leads to:
• Have a long incubation period and very resistant to
ABX
• brain damage
– Brain develops holes or becomes spongiform
• Progressive degenerative diseases of nervous system
• Creutzfeldt-Jakob disease
• Bovine spongiform encephalopathy (mad cow’s
Disease )
Community acquired
infections
• Transmitted in daily contact with people
– Flu viruses (predictable times of the year)
– Child hood diseases ; September (school)
• Related to
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Poverty
Low immunization rates
overcrowded environments
Resistant strains of pathogens (TB, MRSA)
Infected immigrants
Community acquired infections
• Food borne illnesses:
– More common in the summer
– Food poisoning (picnics, hot weather : mayo)
• Staphylococcus
• Salmonella
– Hepatitis outbreaks
• Poor hygiene by food handlers
– Sexually transmitted infections :
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Gonorrhea
Syphilis
HIV
All require reporting to the public authorities (laws vary)
Prevention and control
• Child hood immunizations
– Ignoring or indifference is leading to reemergence of child hood diseases R/T:
• Fees
• Unable to meet schedules for immunizations etc
– Repeat vaccinations for older children
– State laws require certain immunizations
• Before a child starts school
Prevention and control Cont’d
• Blocking the chain of transmission:
– Education in :
• Food handling
• Refrigeration
• TB screening
– Early Isolation of the exposed patient (positive TB
test)from the public
• Control of Vectors (mosquito spraying)
• ABX to children exposed to :
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communicable diseases
Streptococcal infections
Sanitation of water supplies,
Cooking meat, eggs, poultry well done
Prevention and control (Cont’d)
• Personal measures to control the spread of
communicable disease:
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Proper hygiene
Hand washing
Personal barriers (condoms)
Staying home when s/s of an infectious
disease appear breaks the chain of infection
Health Care Associated infections
• HAI’s :
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AKA- Nosocomial infections
Carry a higher morbidity (danger to in house pt)
Occur within the health care facility
May affect the patient and the health care worker
More serious than community acquired infxn
Vancomycin Resistant enterococcus (VRE)
• May be related to overuse or misuse of ABX
• ABX alter the normal flora replacing good microbes
with bad ones that are more difficult to get rid off
– Thru mutations
HAI’s
• MDRO’s: (multidrug-resistant organisms)
– Microorganisms that are resistant to one or
more classes of antimicrobials
– Such as:
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MRSA
VRE
E- Coli
Klebsiella Pneumonia and others
– General measures that help impede resistant
strains of microbes :
• Vaccinations
• Appropriate use of ABX (C&S specific) )
HAI’s
• Health care worker is at high risk of contracting
HAI:
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Hepatitis B
Legionnaires disease
Staph
Pseudomonas
• Iatrogenic infections: caused by treatments
given to patients
– Immunosuppressant drugs for transplants
– Super infections ( clostridium Dificile)
• Normally lives within us and kept in check by normal
flora
Nursing Care of patients with
infections
• Key to preventing the spread of infections
in the hospital is thru medical and surgical
asepsis:
– Medical asepsis:
• Often called clean technique
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Changing bed linen
Sanitizing bedpans
Individual med cups for each pt
Frequent hand washing
Medical Asepsis
• Hand hygiene:
– Dirty hands are the primary mode of infectious
transmissions
– Need to remind yourself to :
• frequently wash your hands (friction, running
water, soap)
• Alcohol based waterless antiseptic
• Surgical scrub
Surgical Asepsis
• Sterile technique
– Technique that Prevents unsterile surfaces to come in
contact with the patient
• Standard precautions:
– Used for the care of all patients
• Transmission based precautions
– Disease specific isolation techniques
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Reduce the risk of airborne infections
Airborne,
contact
droplet,
protective
Surgical Asepsis
• Some standard precautions may be used in
specific situations
• ie:
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Respiratory hygiene
Cough etiquette
Safe injection practices
Masks for insertion of catheters/ LP’s
Make sure you read box 13-3
CDC Standard Precautions for
infection control
The immune response
• Two types:
– Antibody mediated is a response to an antigen
• B lymphocytes
• Antibodies
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Antigen binds to a receptor on the lymphocyte
Results in production of antibodies
Which will look for the antigen and stick to it
Neutrophils and macrophages will recognize
them and clean up
Antibodies
• 5 classes:
– IgG : most abundant crosses placental barrier
• Provides passive newborn immunity
– IgM
– IgA
– IgE : is vital for allergic reactions and parasitic
infections
– IgD