Inflammation, Infection, & Immune Response

• Inflammation


  Does not necessarily mean infection
• Acute inflammation


  • Injury, Flare up
• Chronic inflammation


  • Rheumatoid arthritis
• Local responses of inflammation


  • Redness
  • Heat
  • Swelling
  • Loss of Function
  • Pain
• Systemic responses of inflammation

  • Increased WBC (Neutrophils 11,000+)
  • Malaise
  • Nausea & Anorexia
  • Increased HR, RR, & Temp.
• NANDAs of Inflammation


  • Risk of Infection
  • Pain
  • Impaired Tissue Integrity
  • Hyperthermia
  • Imbalanced Nutrition
  • Risk for Fluid Volume Deficit
• NANDAs influenced by fever


  • Imbalanced Nutrition
  • Risk for Fluid Volume Deficit
• To help cease fever, fluid intake needs to increase
• RICE


  • Rest: conserves nutrients & oxygen for healing
  • Ice: Promotes vasoconstriction to reduce swelling and pain
  • Compression: Reduces development of edema
  • Elevation: Reduces swelling by increasing venous return & reduces pain
• Drugs that can aid with fever and inflammation


  • Antipyretics: aspirin, acetaminophen, NSAIDs (no steroids)
  • Anti-inflammatory: aspirin, corticosteroids, NSAIDs, Ibuprofen
  • Vitamins: A, B, C, D, E
• Infection


  Occurs when an organism can colonize & multiply within a host
• Phases of infection


  • Incubation Period
  • Prodromal Stage
  • Clinical Stage
  • Convalescent Period
• Symptoms of prodromal phase


  • Vague
  • General Malaise
  • Fever
  • Myalgia
  • Headache
  • Fatigue
• Symptoms of acute stage


  • Fever
  • Chills
  • Tachycardia
  • Tachypnea
  • Redness, swelling, pain, impaired function
• Infection graph


  Shifts to the left
• Types of exudates


  • Serous: Clear
  • Serosanguineous: clear pink & red streaks; healing from surgery
  • Hemorrhagic: blood; common after surgery
  • Purulent: White & yellow- pus (Can indicate infection & have an odor)
• Physiologic changes that occur with aging


  • Decreased perfusion, inflammatory and immune response (may need higher dose)
  • Decreased cough reflex & cilia movement
  • Retention of urine; decreased contractility of bladder and increased prostate hypertrophy in men (damage to bladder)
  • Decreased gastric acid & emptying
  • Thinning of skin & decreased sensation
• Additional factors of infection


  • Decreased activity, poor nutrition & fluid status, chronic illness
  • Diabetes
• Infection manifestations in older adults


  • Changes in behavior
  • Mental Status Changes/ Disorientation; UTI
  • Restlessness
  • Tachypnea
• Classic manifestations of infection


  • Redness
  • Heat
  • Swelling
  • Fever
  • Chills
• Factors that can impair healing


  • Drug therapy: Chemo, steroids, transplants
  • Poor blood supply: poor blood circulation
  • Oxygenation
  • Malnutrition: Vitamins, minerals, proteins
  • Chronic Disease
  • Aging (immune system declines with age)
  • Impaired inflammatory, immune, and tissue responses
• Inflammation can evolve into an infection
• Inflammation does not necessarily indicate infection
• Pain management for infection


  • Non-analgesics
  • Pillows
  • Positions
• Ice is used for pain management of inflammation (e.g. sprained ankle)
• Managing fever


  • Acetaminophen/ Motrin
  • Antipyretics
  • Fans/ cool & wet washrag (Cool > ice)
• The body naturally relieves fever through sweating
• Organs that aid in processing antibiotics


  • Liver: Metabolism
  • Kidneys: Excretions
• For an elderly patient on antibiotics, a smaller dose should be considered as it can be difficult on the liver and kidneys
• Antibiotics are used to treat bacteria
• Peak


  30 minutes after administration (highest point in the body)
• Trough


  Right before administration (the lowest point in the body)
• Bacteriostatic


  Inhibits growth & leaves the destruction to the host's immune system (Tetracyclines, erythromycin)
• Bactericidal


  Kills the organism (penicillins, cephalosporins)
• If someone is allergic to penicillin with an aggressive disease, a bacteriostatic antibiotic would be used
• Culture


  Shows what specific organism is growing
• It takes 24-48 hours for a culture to develop
• The patient's symptoms will typically worsen before the culture comes back
• When infection occurs, the neutrophil white blood cell increases
• Wet to dry treatment

  Can reduce & remove growth of infection