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5 Cardinal manifestations of inflammation:
- warmth
- redness
- edema (swelling)
- pain
- decreased function
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3 Stages of the Inflammatory Process
- Vascular Response
- Cellular Response
- Tissue Repair
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Describe vascular response:
- initial response to injury causing vasoconstriction to contain the bleeding
- secretion of chemical mediators signaling WBC's of problem
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Describe Cellular Response:
Exudate stage when leukocytes move in to the area.
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Acute cellular response what WBC arrives?
Chronic?
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Describe Tissue Repair:
It is the replacement stage that BEGINS at the time of injury. Fibroblasts arrive to stimulate revascularization, secrete collage and form scar tissue.
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Difference between and acute and chronic inflammatory response.
Acute is short term and is associated with all types of injury. Leukocytes storm the site, but stop migrating after awhile
Chronic is a response that lasts longer than 2 weeks. Leukocytes are always there causing constant inflammation
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5 common causes of inflammation:
- trauma
- surgery
- infection
- Extremes of heat and cold
- Ischemic damage
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Describe vascular response to inflammation:
It is the first response to injury leading to vasoconstriction of venules and vasodilation of arterioles.
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Describe cellular response to inflammation:
It is when WBC's move in to the area to fight any foreign bodies.
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Tissue macrophages
Engulf and digest cellular debris and pathogens
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microphages
small phagocytes
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Band is the same as
Stab....both are neutrophils
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neutrophils
most abundant WBC
consists of Basophils and Eosinophils
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Bands
immature neutrophils (or any WBC) that should be in the marrow maturing
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Eosinophils
fights parasites
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basophils
inflammatory rxn
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mast cells
- fights allergies/anaphalyxis
- WOUND HEALING
- FIGHTS PATHOGENS
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monocytes
When inflammation occurs these go to the site and divide in to macrophages and dendrites
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What is meant by a shift to the left?
When bands or stabs run at a higher % than normal causing a shift to the left.
It means the infection is starting to run a muck!!!
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phagocytosis
when a cell ingests and disposes of cellular debris and pathogens
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Leukocytosis occurs when? What is it?
Acute Inflammation
Elevated white blood cell count
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Leukopenia
decrease in WBC to below normal value
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Pancytopenia
- decrease in all blood cells...
- WBC
- RBC
- Platelets
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Serous
clear water plasma....blister like
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Fibrinous
thick, sticky mesh.
Has fibrinogen in it....blood clot
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Menbranous
Develops on the surface of the mucous membrane ....thrush
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Purulent
- pus made of :
- WBC
- Proteins
- Debris
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Catarrhal
cells that produce mucus. Found in a UTI
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Sanguineous Hemorrhage
Bright RED!!!
Severe tissue injury where blood vessels and RBC's are damaged
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Serosanguenous
Serous fluid + Hemorrhagic together....
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What is fever?
an abnormal elevation of core body temperature.
It is a universal response to inflammation and infection
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What part of the brain regulates temperature?
Hypothalamus
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What's the set point?
our body temperature level which is needed for survival
Fights infection
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Pyrogens (Exogenous and Endogenous)
It is what causes the hypothalamus to raise body temperature and readjust set point
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What affects the hypothalamus to change our body temp?
- breakdown of bacterial and their products
- breakdown of WBC's
- chemical mediators (histamines & prostaglandins)
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4 Stages of a fever
- Prodromal
- Generalized Shaking/chill
- Flush
- De-effervescence
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Prodromal
- Earliest stage
- Headache, fatigue, malaise, aches and pains
Feel cold, but hot to touch
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Describe generalized shaking/chill stage of a fever
Occurs as the fever rises in response to the increased set point.
Shivering to increase heat production as the metabolism and set pt continue to adjust upward.
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When do convulsions occur from a fever?
104 and 40 celsius
cells are damaged and the hypothalamus can no longer maintain the responses that increase heat loss
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How do you intervene during a temperature?
ice packs on groin and under arm
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Describe Flush stage of a fever
cutaneous vasodilation occurs after shivering has caused the body temp to reach a new set pt at the control center.
Skin is now warm and flush
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De-effervescence
Fever is breaking.
maked by initiation of sweating and the fever now diminishes or disappears
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Subjective Symptoms of a fever
Person complains of feeling hot, chilled, headache, malaise, decrease in appetite
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Objective signs of a fever
- flushed
- chills
- tachycardia
- tachypnea
- drowsy/confused/disoriented
- Lab data
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Lab Data from Fever
- Increased WBC and ESR
- Changes in serum electrolytes
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Expected outcome after interventions for fever
Temp will decrease to a safe level within 1-2 hours
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Interventions for Fever:
- DONT LET PT GET DEHYDRATED...
- Antipyretics for temps above 38.2 or 100.8
- Cooling measures
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Chemical mediators
- Histamine
- Seratonin
- Prostaglandins
- Kinins
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Histamine
Capillary dilation and enhances capillary permeability.
Causes redness and warmth
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Seratonin
Vasoconstrictor
Provides protection against further insult, loss of blood or infection
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Prostaglandins
Promotes capillary dilation and enhances capillary permeability
Causes redness, warmth, fever, pain....contributes to menstural pain
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Kinins
Increases capillary permeability allowing for fluid, fibrin and proteins to escape in to tissues and interstitial spaces.
Clots and encapsulates area!!!
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Margination and pavementing
provides a route for cells to get to site
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diapedesis
escaping of RBC to injured area
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Chemotaxis
leukocytes moving to area
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What is the life span of the neutrophil and why is this important in the inflammatory process?
12-18 hours.....
Neutrophils are good for one process only, so we count them and know where we are in an infection/inflammation. Is it getting away from us? Or is our body fighting it well?
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Left shift occurs with....
BACTERIAL INFECTIONS ONLY!!!
Never viral!!!!
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With a left shift with important?
The % of bands....not the # of them.
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Amount of functional loss from an injury is determined by....
amount of scar tissue
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B Cells
form plasma cells and are concerned with antibody formation
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T Cells
concerned with cell mediated immunity
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What does it mean when there is a decrease in Bands?
You are getting better, antibiotics are working?
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Leukocytosis....how does this vary in acute versus chronic inflammation?
Leukocytes are there in abundance when there is an acute injury. But then it goes down.
In a chronic situation....leukocytes are always present.
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What condition can the ESR diagnose?
(Erythrocyte Sedimentation Rate) Explain....
It is seen in chronic inflammation diseases like arthritis.
It tells how much inflammation is in the body. The more sediment there is and the longer it takes to settle.....means more inflammation.
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What do dendritic cells do?
present antigens....allowing a connection between innate and adaptive immunity
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