Inflammation & InfectionAcute Inflammatory ResponseFeatures of InflammationInflamed Surgical IncisionSlide 5Slide 6Types of LeukocytesPolymorphonuclear NeutrophilsMonocyteLymphocytesManifestations of InflammationLocal Manifestations of InflammationSystemic Manifestations of InflammationGranulomatous InflammationWound HealingInflammatory ResponseSlide 17Resolution & RepairAging & Mechanism of Self-DefenseFactors Affecting InflammationInflammationINFECTION: A cause of inflammationNature of InfectionChain of InfectionInfectious AgentReservoirMode of TransmissionSusceptible HostThe Infectious ProcessThe Infectious Process (cont’d)Defense against infectionSlide 32Health-Care Associated InfectionsThe Nursing Process - Assessment:The Nursing Process Planning and OutcomesInterventionsSlide 37Slide 38Slide 39Slide 40Slide 41Slide 42Slide 43Slide 44Slide 45Emerging InfectionsK. A. Ennen, PhD, RN, CNEInflammation & InfectionResponse of Body to Injury2Acute Inflammatory Response•Inflammation – rapid protective response to cellular injury•Can occur ONLY in vascularized tissue•Macroscopic: see redness, swelling, heat, pain, & loss of function of inflamed tissues•Microscopic: accumulation of fluid and cells at inflammatory site3Features of Inflammation•Rubor (Redness)•Calor (Heat)•Dolor (Pain)•Tumor (Swelling•Functio Laesa (Altered Function)4Inflamed Surgical Incision•7Types of Leukocytes•8Polymorphonuclear Neutrophils•PMNs or Polys•1st in exudate•2 weeks to make; half-life 6 hours•Suitcase of enzyme-loaded & antimicrobial substances•Phagocytosis9Monocyte•Form of leukocyte•Agranular•Originates within bone marrow•Smaller #s and pace inflammatory response•Called a Macrophage when in exudate10Lymphocytes•Present in small #s in exudate•Larger #s in chronic reactions11Manifestations of Inflammation•Local–Involves same hallmarks of inflammation; types of exudate & necrosis vary with the injury and tissue or organ affected•Systemic–Effects of inflammation are fever & increases levels of circulating leukocytes and plasma proteins•Chronic–Lasts 2 weeks or more–Can occur as a distinct process w/o much acute inflammation–Characterized by dense infiltration of lymphocytes and macrophages–Body walls off & isolates host from tissue damage, forming a granuloma12Local Manifestations of Inflammation•Redness-hyperemia from vasodilation•HEAT- metabolism due to hyperemia•Pain- from edema, pressure, nerve stimulation by mediators, pH change• - Fluid shift to interstitial spaces and fluid exudate accumulation•Loss of function- Swelling and pain13Systemic Manifestations of Inflammation•Leukocytosis- WBC increase•Malaise, nausea, anorexia- probably due to chemical mediator release•Fever & chills- Triggered by the release of cytokines they cause fever by their ability to initiate metabolic changes in the temperature regulating center14Granulomatous Inflammation•Unique & distinctive•Large #s of macrophages•Aggregation into nodular clumps•Mycobacterium Tuberculosis15Wound Healing•Scar formation & regeneration•Primary healing – fibrin glue, bridge of granulation tissue•Healing by secondary intention16Inflammatory Response•18Resolution & Repair•Inflammatory lesions resolve if little tissue lost or injured tissue capable of regeneration–Healing by Primary Intention•Inflammatory lesions that involve extensive damage or tissues incapable of regeneration heal by repair–Healing by Secondary Intention19Aging & Mechanism of Self-Defense•Elderly at risk for impaired wound healing–Chronic illnesses–Medications•Elderly at risk for sustaining various wounds–Mobility–Physiologic changes in skin–Loss of subcutaneous fat layer of protection–Collagen fibers thicker and less elastic•Diminished immune function•Atrophy of epidermis underlying capillaries–Consequent decreased perfusion – hypoxia of wound bed20Factors Affecting Inflammation•Intact circulation to affected area needed•Liberal supply of leukocytes•Functional leukocytes•Nourishment•Presence of foreign material in wound•Wound infection•Dehiscence21Inflammation•22INFECTION: A cause of inflammation23Nature of Infection•Pathogen: a disease causing microorganism–Bacteria–Viruses–Fungi•Communicable or contagious24Chain of Infection25Infectious Agent•The potential for microorganisms to cause infection depends on various factors:1. Number of organisms2. Virulence of an organism or its ability to cause disease3. Competence of the person’s immune system4. Length and intimacy of contact between the person and the microorganism26Reservoir•The natural habitat of the organism- this is where the microorganisms grow and multiply and include the human body, animals, soil, food, water, and inanimate objects27Mode of Transmission•Direct•Indirect•Airborne/Droplet28Susceptible Host•Susceptibility to infection depends on:–Intact skin and mucous membranes–Normal pH levels of the GI and GU tracts and the skin–White blood cells–Age, sex, race, and heredity–Immunization status–Fatigue, climate, nutritional and general health status, presence of preexisting illness, treatments and medications.–Stress–Invasive or indwelling medical devices29The Infectious Process•Severity of illness depends on the extent of the infection, the pathogenicity of the microorganisms and the susceptibility of the host.30The Infectious Process (cont’d)•Local vs. Systemic Infection•Course of infection–Incubation–Prodromal–Illness–Convalescence31Defense against infection•Normal flora•Body system defenses: cilia in the airway•Inflammatory response•Immune system3233Health-Care Associated Infections•Health-Care Associated Infections [HAIs]–Nosocomial infection–An infection resulting from the delivery of health care services in a health care facility.–Healthcare workforce shortages•Endogenous or exogenous•Iatrogenic34The Nursing Process - Assessment:•Status of body defenses•Client susceptibility–Age–Nutritional status–Stress–Disease process–Medical therapy35The Nursing Process Planning and Outcomes•The idea here is to plan outcomes that prevent infection or interfere with the infection cycle.•Examples include demonstrate effective hand hygiene and good personal hygiene practices, identify the signs of an infection, demonstrate stress-reduction