INFLAMMATION Overview

Goals for This Concept Presentation Define and describe the concept. Notice the risk factors for inflammation. Recognize when an individual has inflammation. Provide appropriate nursing and collaborative interventions to eliminate inflammation.

Define and Describe the Concept of Inflammation

Definition Inflammation is an immunologic defense against tissue injury, infection, or allergy. Inflammation is a normal and expected physiologic response to cellular injury. The response is protective in that it provides an opportunity for the body to heal and repair the injury. This biophysical concept is foundational to patient care across the lifespan. (Giddens 216) Giddens, Jean. Concepts for Nursing Practice. Mosby, 2013. <vbk:978-0-323-08376-8#outline(21)>. Although inflammation is always present with infection, inflammation often occurs in the absence of infection. Inflammation is the body's physiologic response to injury—not the agent causing the injury as is seen with infection. Giddens, Jean. Concepts for Nursing Practice. Mosby, 2013. <vbk:978-0-323-08376-8#outline(21.1)>.

Categories of Inflammation Concept: Perfusion Categories of Inflammation Acute Inflammation Chronic Inflammation Repair/Restorative Define: Acute: Immediate and serves as a protective function. Can last from minutes to days (usually less than 2 weeks). Chronic: Inflammation that continues for weeks to years after initial injury is termed chronic; tissue is repeatedly being destroyed and repaired, thus impairing healing. Local chronic inflammation. Systemic chronic inflammation may result from many diseases or may be the consequence of disease processes, including autoimmune diseases such as the inflammatory bowel diseases ulcerative colitis (UC) and Crohn's disease. Repair/Restorative: Acute inflammatory response is to eradicate the harmful stimuli from the body and initiate the repair. Whereas, chronic inflammatory response may be a complication of acute inflammation, not allowing for repair or it may be the consequence of systemic disease. Giddens, Jean. Concepts for Nursing Practice. Mosby, 2013. <vbk:978-0-323-08376-8#outline(21.2.2)>.

Concept: Perfusion ACUTE INFLAMMATION ACUTE INFLAMMATORY RESPONSE

Function of the Inflammatory Response Concept: Perfusion Function of the Inflammatory Response Immune & Inflammatory Restitution of normal, functioning cells after injury (seen in acute response) Fibrous repair when restitution of functioning cells is impossible (seen in chronic response) Review A&P, Micro, and Pathophysiology for cellular regeneration and replacement. An inflammatory response is often directly linked to the activities of the immune system, demonstrating an overlap and interplay of physiologic processes between the two systems (immune and inflammatory) providing protection to the host. It has also been noted that an inflammatory process has two primary functions directed at a positive outcome for the individual: (1) restitution of normal functioning cells following injury or (2) fibrous repair when functional cells cannot be restored. This may include an overly severe immune response to stimuli resulting in additional tissue damage or an inadequate response leading to infection or chronic inflammation and illness. Giddens, Jean. Concepts for Nursing Practice. Mosby, 2013. <vbk:978-0-323-08376-8#outline(21.4)>. Damaged functional cells can regenerate when damaged or destroyed (kidney, liver, pancreas). Other cells, such as the brain DO NOT REGENERATE. Fibrous repair may be seen as scarring (local and systemic) or calcifications.

RECOGNIZE THE Risk factors for Inflammation

Risk Factors: Populations at Greatest Risk Inflammation can affect all individuals, regardless of age, gender, race, and socioeconomic status. The populations at risk for a severe or ineffective inflammatory response are the: Very young Very old Uninsured

Recognize when an Individual has an Inflammation

ASSESSMENT Assessment of an individual for the presence of inflammation includes asking appropriate questions to elicit a history and conducting a physical examination. In addition, laboratory and diagnostic testing aids in the diagnosis.

History The history should be focused on determining the nature of the inflammatory trigger (e.g., recent injury, exposure to allergens, exposure to infectious agents) and the patient's physiologic ability to respond, or more specifically the risk for an ineffective inflammatory response. The nurse should also inquire about the presence of symptoms commonly associated with inflammation including swelling, pain, and fatigue. It is also important to determine the duration of the inflammatory process and the treatment measures, if any, that have already been initiated.

Clinical Manifestations Concept: Perfusion Clinical Manifestations

Common Diagnostic Tests Laboratory tests CBC WBC with differential CRP ESR Serologic tests to detect specific antibodies or viruses Radiographic studies MRI CAT PET scans Colonoscopy Ultrasound -Blood testing for white blood cell counts with differential is helpful in determining if neutrophil, lymphocyte, or macrophage cell counts are elevated, indicating bacterial or viral infection and acute or chronic inflammation. -C-Reactive protein (CRP) and erythrocyte sedimentation rate (ESR) blood testing are nonspecific tests that will confirm the presence of inflammation, though not the location or cause. -Various serologic tests for viruses or antibodies against pathogens, such as hepatitis, human immunodeficiency virus (HIV), Epstein-Barr, severe acute respiratory syndrome (SARS), herpes simplex, syphilis, methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C. diff.), and Helicobacter pylori, among many others, will be helpful in determining the cause of inflammation and guide treatment regimens to eradicate or control infection and minimize damage from inflammation. -Computer-assisted tomography (CT), magnetic resonance imaging (MRI), proton emission tomography (PET) scans, Ultrasounds, or a colonoscopy is useful in determining the location and extent of inflammation within the body. Giddens, Jean. Concepts for Nursing Practice. Mosby, 2013. <vbk:978-0-323-08376-8#outline(21.5.3.2)>.

Collaborate Management Reducing risk for local and systemic injury and/or infection Management is directed at mediating the inflammatory response to promote repair and healing and avoid an excessive inflammatory response that may lead to further tissue injury and/or death. General guidelines are made depending on the cause of the inflammation. AIM: is to mediate the inflammatory process to prevent additional tissue damage or death. General Guidelines: -If inflammation is due to infection, the underlying cause of the infection must be eradicated. -If inflammation is due to a hypersensitivity type immune response, such as allergies, asthma, or autoimmune diseases, management of inflammation must be combined with management of the immune response and the pathologic consequence of immune dysfunction (e.g., diabetes mellitus, inflammatory bowel syndrome, rheumatoid arthritis, or muscular sclerosis). -inflammation is due to an uncomplicated strain or sprain, the standard treatment regimen of rest, ice, compression, and elevation (RICE) combined with nonsteroidal antiinflammatory drugs (NSAIDs) will help with both management of pain and moderation of the inflammatory response. -Chronic inflammatory responses to disease require careful monitoring to prevent or slow the process of tissue damage that may result in organ failure. Treatment of the underlying cause of the disease, support for ongoing tissue function, and prevention of organ or limb dysfunction or deformity are all important areas of clinical management. Giddens, Jean. Concepts for Nursing Practice. Mosby, 2013. <vbk:978-0-323-08376-8#outline(21.6.3)>.

Clinical Management: Collaborative Interventions (cont’d) Collaborative Learning In your learning groups, discuss the role various pharmacologic agents have in the treatment of inflammation. Think about at least one specific example of each drug category. Drug Category Role in Treatment Examples of Drugs Steroids NSAIDs Recombinant DNA and monoclonal antibodies Antipyretics Analgesics Antimicrobials

Exemplars for Inflammation Concept: Perfusion Exemplars for Inflammation Our exemplars for this course: Acute: Appendicitis and Cholecystitis (not listed in table). Cholecystitis can also be chronic. Chronic: Ulcerative Colitis & Peptic Ulcer Disease Auto-immune: Crohn’s Disease

Interrelated Concepts What other interrelated Concepts can you think of from past and this HCC courses can you think of? -Mobility (Dengerative Joint Disease) -Oxygenation (Asthma and COPD)…basically like gas exchange -Perfusion? -Comfort -Homeostasis (current) -Intracranial Regulation (current) -Metabolism -Reproduction (inflammatory responses: labor/del/post/new)