Pages 186-191: Med Surg

Question 1

why is the inflammatory response necessary?

Answer 1

neutralizes and dilutes the inflammatory agent, removes necrotic materials, and establishes an environment suitable for healing and repair

Question 2

inflammation and infection

Answer 2

inflammation is always present with infection, but infection is not always present with inflammation (can be caused purely by heat, radiation, trauma, chemicals, rather than just infection)

Question 3

vascular response step one

Answer 3

after cell injury, artioles briefly vasoconstrict

Question 4

vascular response step two

Answer 4

histamine is released, vessels dialate, which causes hyperemia (increased blood flow to injured site)

Question 5

vascular response step three

Answer 5

increased capillary permeability causes fluid to move from capillaries to tissue

Question 6

vascular response step four

Answer 6

exudate is initially composed of serous fluid and plasma proteins, which exert oncotic pressure and further draw fluid from blood vessels causing edema

Question 7

vascular response step five

Answer 7

when protein fibronogen leaves the blood, fibrin is activated, which strengthens clots

Question 8

why are clots important to tissue?

Answer 8

traps bacteria, prevents their spread, framework of healing process

Question 9

chemotaxis

Answer 9

directional migreation of WBCs to site of injury

Question 10

cellular response via neutrophils

Answer 10

arrive to injury site within 6-12 hours and phagocytize bacteria; only live 24-48 hours

Question 11

what do dead neutrophils produce?

Answer 11

pus

Question 12

bands

Answer 12

immature neutrophils released due to bone marrow relasing more neutrophils into circulation and infection getting worse

Question 13

shift to the left

Answer 13

when band neutrophils are increasing due to acute bacterial infections or progressive infections in general

Question 14

cellular response via monocytes

Answer 14

arrive 3-7 days after onset of inflammation and transform into macrophages, which clean the area before healing can occur; long life span

Question 15

multinucleated giant cell

Answer 15

particles are too large for a single macrophage and they accumulate, then encapsulate in collagen, causing formation of granuloma (small area of inflammation)

Question 16

prostaglandins

Answer 16

produced from arachidonic acid and cause vasodilation (producing increased blood flow and edema PROINFLAMMATORY); can also act as pyrogen

Question 17

complement system

Answer 17

enzyme cascade c1-c9 mediate inflammation and destroy invading pathogens through phagocytosis, increased vascular permeability, chemotaxis, and cellular lysis

Question 18

c8 & c9

Answer 18

final components of complement system that pierce the cell and lyse

Question 19

thromboxane

Answer 19

causes brief vasoconstriction and skin pallor at the injury site and promotes clot formation- short half life and gives way to prostaglandins and histamines vasodilation

Question 20

leukotrienes

Answer 20

slow reacting anaphylaxis, which constricts smooth muscule of bronchi and stimulates chemotaxis

Question 21

local response

Answer 21

redness, heat, pain, swelling, loss of fx

Question 22

systemic response

Answer 22

increased WBC with shift to left, malaise, nausea, increased pulse and respirations, fever

Question 23

systemic response possibly caused by

Answer 23

complement activation and cytokines

Question 24

fever

Answer 24

onset is due to cytokines, hypothalamus stimulates ANS to promote shivering, and epinephrine released from the adrenal medulla increases the metabolic rate

Question 25

benefits of fever

Answer 25

increased killing of microorganisms, increased phagocytosis from neutrophils, increased proliferation of T cells

Question 26

acute inflammation

Answer 26

healing occurs in 2-3 weeks usually with no damage, neutrophils are predominant

Question 27

subacute inflammation

Answer 27

same as acute, but inflammation lasts longer

Question 28

chronic inflammation

Answer 28

may last for years, injurious agent persists or repeats injury to site, lymphocytes and macrophages dominant

Question 29

when should fever be treated rapidly?

Answer 29

if 104+ or immunosuppressed patient

Question 30

Aspirin

Answer 30

Salicylates lower the temperature, interfere with prostaglandins, and reduce capillary permeability; selectively depress CNS

Question 31

Tylenol

Answer 31

acetominophen lower the temperature

Question 32

NSAIDs

Answer 32

ibuprofen, motrin, advil inhibit synthesis of prostaglandins and reduce fever

Question 33

corticosteroids

Answer 33

interfere with granulation tissue and induce immunosuppressive effects and reduce fever

Question 34

Rest (RICE)

Answer 34

repair process is facilitated by allowing fibrin and collagen to form across the wound edges with little disruption

Question 35

Ice (RICE)

Answer 35

ice used initially and heat used later around 24-48 hours

Question 36

Compression (RICE)

Answer 36

counters the vasodilation effects and development of edema, asses distal pules and capillary refill before and after devices are placed

Question 37

Immobilization

Answer 37

promotes healing by decreasing metabolic needs of the tissues

Question 38

Elevation (RICE)

Answer 38

elevate above the level of the heart to reduce edema by increasing venous and lymphatic return; contraindicated in patients with reduced arterial circulation