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Nursing 323: med surg > Inflammation > Flashcards

Inflammation Flashcards

1
Q

describe the vascular response mechanism of inflammation

A

cell injury/death and brief vasoconstriction –> release of chemical mediators –> vasodilation and increased blood flow –> increased capillary permeability and local edema –> redness, heat, swelling, and pain

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2
Q

describe the cellular response mechanism of inflammation

A

Neutrophils and monocytes move from circulation to the site of injury

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3
Q

define chemotaxis

A

the directional migration of white blood cells (WBCs) to the site of injury, resulting in an accumulation of neutrophils and monocytes at the site.

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4
Q

_______ are the first WBC to arrive at the injury site (usually within 6 to 12 hours)

a. monocytes
b. neutrophils
c. lymphocytes

A

B. neutrophils

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5
Q

monocytes are the second type of phagocytic cells that migrate from circulating blood. they usually arrive at the site within _______ after the onset of inflammation

A

3-7 days

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6
Q

monocytes transform into ______ to help in phagocytosis of the inflammatory debris

A

macrophages

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7
Q

an increased number of band (immature forms of neutrophils) neutrophils in circulation are called a ____

A

shift to the left

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8
Q

_______ are the last to arrive at the site of injury

A

Lymphocytes

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9
Q

the primary role of lymphocytes is related to ________

A

humoral and cell-mediated immunity

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10
Q

the healing process includes 2 major components: _________ and __________

A

regeneration and repair

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11
Q

describe the regeneration component of the healing process

A

Regeneration is the replacement of lost cells and tissues with cells of the same type. The ability of cells to regenerate depends on the cell type

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12
Q

Describe the repair component of the healing process

A

Repair is healing, with connective tissue replacing lost cells. Repair healing occurs by primary, secondary, or tertiary intention

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13
Q

what are the three phases of primary intention in repair

A
  • Initial: 3-5 days
    * Inflammatory
    * Migration of epithelial cells and hemostasis
  • Granulation: 5 days-4 weeks
    * Proliferative
    * Migration of fibroblasts secrete collagen to form scar tissue
    * Abundance of capillary buds
    * Wound is fragile vulnerable for dehiscence
  • Maturation and scar contraction: 7 days to several months
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14
Q

describe secondary intention

A

healing of traumatic wounds, ulcers or infected wound

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15
Q

describe tertiary intention

A

delayed primary intention

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16
Q

infants have a ______ response of WBCs

A

delayed

*low levels of neutrophils
* limited functions of chemotaxis and phagocytosis

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17
Q

older adults have a _______ in inflammatory defenses

A

decline

  • inflammation presents atypically (i.e. mild fever and minimal pain)
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18
Q

older adults have a _______ in pro-inflammatory cytokines

A

increase

  • increase in the prevalence of pro-inflammatory diseases (i.e. atherosclerosis, diabetes and osteoporosis)
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19
Q

risk factors for inflammation

A
  • autoimmune disease
    -genetics
  • compromised immune system
    • infants and older adults
    • disease or medical treatment that compromises immune system
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20
Q

describe primary preventions for inflammation

A
  • prevent injury and infection
    • hand hygiene and proper wound care
    • safe food and water
    • safety equipment
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21
Q

what are the symptoms of inflammation

A
  • local
    • redness
    • heat
    • pain
    • swelling
    • loss of function
      *systemic
    • left shift
      o increased WBC count with elevated band neutrophils
    • leukocytosis
      • malaise
      • nausea
      • anorexia
    • fever, increased pulse, and respiratory rate
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22
Q

inflammation diagnostics

A

WBC with differential
* Cellular response
* Bacterial vs viral
* Acute vs chronic inflammation

Blood tests for generalized inflammatory response
* C-Reactive Protein (CRP)
* Erythrocyte sedimentation rate (ESR)

Imaging
* CT, MRI, X-ray, Colonoscopy, etc.
* Specific to suspected source
* Determine location and extent of inflammation

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23
Q

nursing management for acute inflammation

A
  • Promote adequate nutrition and fluid intake promotes healing
    * Supports increased metabolism during inflammatory response

RICE
* Rest
* Ice
* Compression
* Elevation

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24
Q

how do anti-inflammatory drugs work? name some anti-inflammatory drugs

A
  • Inhibit synthesis of prostaglandin
  • Salicylates (aspirin)
  • Corticosteroids (prednisone)
  • NSAIDs (ibuprofen)
25
Q

define inflammatory bowel disease

A

Inflammatory bowel disease
(IBD)
* Chronic inflammation of the bowel
* Sporadic periods of active disease (flares)
* Ulcerative colitis
* Crohn’s disease
* Peaks at 15-30 years of age

26
Q

chron’s disease affects the ______ to ______

A

mouth to anus
- can affect any portion

27
Q

chrons disease usually affects the _____ and _______

A

colon and ileum

28
Q

define skip lesions and lesion soars

A

○ Lesion soars that start shallow and then get deeper

○ Skip lesions: where you have parts of bowel and parts that are “normal”
§ Cobblestone appearance

29
Q

symptoms of chron’s disease

A

○ Symptoms: persistent diarrhea, cramping, pain and tenderness
§ Mass in right lower quadrant during palpation –> formation of abscess
§ Systemic: fever, pain, diarrhea, tired, malaise, weight loss

30
Q

ulcerative colitis affects the _______ and _______

A

colon and rectum

31
Q

inflammatory bowel disease pathophysiology and etiology

A

We do not know the exact cause of IBD. IBD is an autoimmune disease involving an immune reaction to a person’s own intestinal tract

think that it results from an overactive, inappropriate, or sustained immune response to environmental and bacterial triggers, probably in a genetically susceptible person. The resulting inflammation causes widespread tissue destruction.

32
Q

what can increase the susceptibility of IBD?

A

Environmental factors, such as diet, smoking, and stress, increase susceptibility by changing the environment of the GI microbial flora.

We think that dietary factors unique to industrialized countries contribute to the development of IBD. High intake of refined sugar, total fats, polyunsaturated fatty acid (PUFA), and omega-6 fatty acids is associated with an increased risk for IBD. Eating fewer raw fruits, vegetables, omega-3−rich foods, and dietary fiber decrease risk. Use of nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and oral contraceptives are associated with increased risk.

33
Q

The inflammation in Crohn’s disease involves _____ layers of the bowel wall

A

all

34
Q

what do typical ulcerations in chron’s disease look like?

A

ulcerations are deep, longitudinal, and penetrate between islands of inflamed edematous mucosa, causing the classic cobblestone appearance

35
Q

Strictures at the areas of inflammation can cause _____________

A

bowel obstruction

36
Q

The inflammation and ulcerations in ulcerative colitis occur in the _________ layer, the _______ layer of the bowel wall.

A

mucosal; innermost

37
Q

fistulas are more common in…

a. chron’s
b. ulcerative colitis

A

a. chron’s

38
Q

In Crohn’s disease, ______ and ________ are common symptoms

a. vomiting; nausea
b. diarrhea; cramping abdominal pain
c. gas; vomiting
d. cramping abdominal pain; gas

A

b

39
Q

in chron’s disease, if the small intestine is involved, weight loss occurs. Why?

A

weight loss occurs from inflammation of the small intestine causing malabsorption

40
Q

In ulcerative colitis, the primary problems are _________ and _______

a. bloody diarrhea; abdominal pain
b. constipation; vomiting
c. abdominal pain; vomiting
d. nausea; gas

A

a

41
Q

symptoms of ulcerative colitis with mild, moderate, and severe disease

A

With mild disease, diarrhea may consist of no more than 4 semiformed stools daily that contain small amounts of blood. The patient may have no other manifestations.

In moderate disease, the patient has increased stool output (up to 10 stools/day), increased bleeding, and systemic symptoms (fever, malaise, mild anemia, anorexia).

In severe disease, diarrhea is bloody, contains mucus, and occurs 10 to 20 times a day.

  • In addition, fever, rapid weight loss greater than 10% of total body weight, anemia, tachycardia, and dehydration are present.
42
Q

IBD complications

A

IBD have both local (confined to the GI tract) and systemic (extraintestinal) complications

*GI tract complications include hemorrhage, strictures, perforation (with possible peritonitis), abscesses, fistulas, CDI, and colonic dilation (toxic megacolon- more common with UC)

*systemic complications, such as multiple sclerosis and ankylosing spondylitis

*Other complications: malabsorption, liver disease (primary sclerosing cholangitis), and osteoporosis

43
Q

those with Crohn’s disease are at increased risk for _________ cancer

a. large intestine
b. stomach
c. gallbladder
d. small intestine

A

small intestine

44
Q

IBD labs

A

A CBC typically shows iron-deficiency anemia from blood loss.

A high WBC count may be a sign of toxic megacolon or perforation.

Decreased serum sodium, potassium, chloride, bicarbonate, and magnesium levels occur due to fluid and electrolyte losses from diarrhea and vomiting.

Hypoalbuminemia is present with severe disease because of poor nutrition or protein loss.

Increased erythrocyte sedimentation rate, C-reactive protein, and WBCs reflect inflammation.

The stool is examined for blood, pus, and mucus. Stool cultures can determine if infection is present.

45
Q

IBD imaging

A

double-contrast barium enema, small bowel series (small bowel follow-through), transabdominal ultrasound, CT, and MRI, are useful for diagnosing IBD.

Colonoscopy allows for examination of the entire large intestine lumen and sometimes the most distal ileum.

colonoscope may be needed to diagnose disease in the small intestine

46
Q

define tenesmus

A

doesn’t feel like you defecated after going

47
Q

Ulcerative colitis GI symptoms and systemic symptoms

A
  • GI symptoms
    ○ Diarrhea (predominant symptom)
    § Stool contains blood & mucus
    □ Mild: up to 4 stools a day
    □ Moderate: greater than 4 and up to 10 stools a day
    □ Severe: greater than 10 or greater than 20
    □ Think about dehydration, electrolyte imbalance
    □ How do patients function? /
    ○ Urgency, frequency, tenesmus
    § Tenesmus: doesn’t feel like you defecated after going
    ○ LLQ cramping relieved by defecation
  • Systemic symptoms
    ○ Fatigue
    ○ Rapid weight loss
    ○ Anemia if there is blood in the stool
    ○ Dehydration
    ○ Tachycardia
48
Q

complications of chron’s disease

A
  • Crohn’s disease
    ○ Intestinal obstruction, abscess & fistulas
    § Because it involves all layers
    ○ Hemorrhage
    ○ Perforation of the bowel
    ○ Malnutrition and nutritional deficiencies
    ○ ↑Risk small intestine cancer
49
Q

ulcerative colitis complications

A
  • Ulcerative colitis
    ○ Hemorrhage
    ○ Colon perforation
    ○ Toxic megacolon: dilated and inflamed colon
    § Perforation –> sepsis and hemorrhage
    ○ Paralysis or perforation → sepsis or hemorrhage
    ○ Tx: Decompression or colectomy
    ○ ↑risk colon cancer - After 10 years of disease
50
Q

chron’s disease diagnostic test and lab tests

A
  • Diagnostic tests:
    ○ Imaging studies
    § Sigmoidoscopy, colonoscopy, barium upper/lower x-ray series
    § Biopsy: diagnosis
  • Laboratory tests
    ○ CBC, ESR, CRP, serum levels of electrolytes
    § Anemia, infection, inflammatory markers
    § C reactive protein - general inflammation marker
    § Electrolytes: diarrhea
    ○ Stool tests
    § C-diff
51
Q

when using pharmacological therapy to treat IBD, the ultimate goal is to…..

A

terminate acute attacks quickly & reduce incidence of relapse

52
Q

what kind of meds would you use for a patient presenting with mild to moderate disease?

A

locally acting & systemic anti-inflammatory drugs

53
Q

give examples of medications used to treat mind to moderate IBD

A

○ 5-aminosalicylic acid (5-ASA) – ex: mesalamine (Asacol)
§ Anti-inflammatory medications
§ Sulfasalazine and Aminosalicylates
□ Help put people in remission
□ Can be used to keep people in remission
□ More effective in ulcerative colitis but can be used for both
○ Corticosteroids for acute exacerbations
§ Help systemically with inflammation
§ Get the person back to baseline

54
Q

when a patient presents with severe IBD you expect them to be on _______

A

immunosuppressants

55
Q

give examples of severe IBD medications

A

○ Mercaptopurine, azathioprine (Imuran)
○ Immune response modifiers
§ Ex: Infliximab (Remicade)
§ Block proteins that cause inflammation
○ More toxic and more side effects
○ Used when patient is not responding to meds
○ Worried about infections

56
Q

what other medications can be given to patients with IBD

A

antimicrobial and antidiarrheals

57
Q

describe the step-up and step-down approach

A
  • Step-up approach: start lower
    ○ Mild diseases
    ○ Mild treatment and then step up if not work
    ○ Ste up to more aggressive treatment: immunosuppressant, modifiers
  • Step down approach: start with more aggressive and then step down once they are starting to do better
58
Q

what are some non-pharmacologic therapies for IBD

A
  • Antigens in diet may stimulate exacerbation
  • Individualize dietary management
  • Increased dietary fiber may reduce diarrhea
  • Acute exacerbation of IBD
    ○ NPO
    ○ Enteral or TPN
    ○ Elemental diet (Ensure)
    ○ Parenteral (IV)
  • Adequate nutrition without making the symptoms worse
  • Surgery
    ○Only when necessitated by complications
    ○ Resection of affected portion
59
Q

IBD nursing implementation and evaluation

A

Implementation
* Monitor fluid volume
○ Use stool chart to record frequency, amount & characteristics
○ Monitor vital signs every 4 hours
§ Tachycardia
§ Loosing a lot of electrolytes- blood pressure
○ Daily weights
○ Maintain bowel rest PRN – limit oral intake (NPO)
○ Maintain fluid intake by mouth or IV
○ Provide good skin care
§ Rectal area
○ Assess for other indications of fluid deficit

Implementation and Evaluation
* Promote adequate nutritional intake
○ Monitor laboratory results
○ Provide prescribed diet, enteral/parenteral nutrition as necessary
○ Arrange for dietary consultation
○ Food diary to identify trigger foods
○ Teach home care to client and family
* Promote healthy body image
○ Major concern for children & adolescents
○ May experience frustration at lack of control
○ Accept client’s feelings & perceptions of self
○ Encourage discussion of physical changes
○ Listen openly to patient’s concerns
○ Encourage patient to make choices & decisions

Nursing 323: med surg (6 decks)

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