ALTERATION IN INFLAMMATORY AND IMMUNOLOGIC RESPONSE

INFLAMMATION

Is a non specific cellular response to tissue injury or infection

Tissue injury caused by bacteria, trauma, chemical, heat or any other phenomenon released multiple substances that produces dramatic changes in the injured tissue.

STAGES OF INFLAMMATION

STAGES DESCRIPTION RESULT1 Initial injury precipitates

released of chemical; histamine, bradykinin, serotonin, prostaglandin( reaction product of the complement and blood clotting system) and ( hormone substance released by sensitized T cells)

Activates the inflammatory process

2 Increased blood flow to the inflamed area ( erythema)

Produces characteristic sign of redness and increased warmth

3 Increased capillary permeability with leakage of large quantities of plasma out of the capillaries into the damage tissue: tissue spaces and lymphatic blocked by fibrinogen clots.

Initiates the inflammation process; infection is “walled off” and non-pitting edema occurs.

4 Damage tissue infiltrate by leukocytes, which engulf the bacteria and necrotic tissue. After several days , these leukocytes eventually

Produces purulent exudates

die and form a cavity of necrotic tissue and dead leukocytes ( mainly neutrophils and some macrophages)

5 Destroyed tissue cells are replaced with identical or similar and functioning cells and or fibrous tissue

Promotes tissue healing or the formation of fibrous tissue which may reduce the function capacity of the tissue.

CARDINAL SIGNS OF INFLAMMATION

RUBOR REDNESSCALOR INCREASED HEATTUMOR SWELLINGDOLOR PAINLOSS OF FUNCTION

COMMUNICABLE DISEASE

An illness due to an infectious agent or its toxic product which is transmitted directly or indirectly to all person or animal or through an agency of an intermediate animal host, vector of the inanimate environment.

CONTAGIOUS

Applied to disease that are easily spread directly transmitted from person to person

INFECTIOUS

Are those diseases not transmitted by ordinary contact but require a direct inoculation through a break in the previously intact or mucous membrane

EPIDEMIC

A condition in which a disease attack a large number of people in a community at the same time during the same season, and in which the disease tend to spread rapidly to others.

ENDEMIC

(from Greek en- in or within + demos people) in a population when that infection is maintained in the population without the need for external inputs. For example chicken pox is endemic (steady state ) in the UK.

PANDEMIC

(from Greek pan all + demos people ) is an epidemic of infectious disease that spreads through human populations across a large region; for instance a continent, or even worldwide.

SPORADIC

Occurring occasionally here and there not epidemic

CHAIN OF INFECTION

INFECTIOUS AGENT

A microbial organism with the ability to cause disease. The greater the organism’s virulence (ability to grow and multiply), invasiveness ( ability to enter tissue) and pathogenicity (ability to cause disease), the greater the possibility that the organism will cause an infection. Infectious agent are bacteria, virus, fungi and parasites

RESERVOIR

a place within which microorganism can thrive and reproduce. For example the microorganism thrive in human being , animals and inanimate objects such as water, tables tops and doorknobs.

PORTAL OF EXIT

a place of exit providing a way for a microorganism to leave the reservoir. For example, the microorganism may leave the reservoir through the nose or mouth when someone sneezes or cough. Microorganism, carries away from the body by feces, may also leave the reservoir of an infected bowel.

PORTAL OF ENTRY

An opening allowing the microorganism to enter the host. Portals include body orifices, mucus membrane, or break in the skin. Portal also result from tubes placed in body cavities, such as urinary catheter, or from punctures produced by invasive procedures such as intravenous fluid replacement;

SUSCEPTIBLE HOST

a person who cannot resist a microorganism invading the body, multiplying and resulting in infection. The host is susceptible to the disease, lacking immunity or physical resistance to overcome the invasion by the pathogenic microorganism.

HOST CHARACTERISTICSInfluence susceptibility and severity of disease

Age

Socio-economics status

Disease history

Life style

Nutritional status

Immunization

MODE OF TRANSMISSION

Method of transfer by which the organism moves or is carried from one place to another. The hands of the health care worker may carry bacteria from one person to another.

4 Mode of Transmission

1. CONTACT TRANSMISSION

DIRECT CONTACT ( PERSON TO PERSON)

INDIRECT CONTACT (USUALLY INANIMATE OBJECT)

2. AIRBORNE TRANSMISSION

DROPLET NUCLEI ( RESIDUE OF EVAPORATED DROPLETS THAT REMAIN SUSPENDED IN AIRBORNE DUST PARTICLES OR VAPOR)

3. VECTOR BORNE TRANSMISSION

OCCURS WHEN AN INTERMEDIATE CARRIER ( VECTOR) SUCH AS A FLIES, MOSQUITOES, TICK AND OTHERS.

4. ENTERIC TRANSMISSION

(VEHICLE ROUTE –THROUGH CONTAMINATED ITEMS)THE ORGANISM ARE FOUND IN FECES AND ARE INGESTED BY SUSCEPTIBLE VICTIM OFTEN THROUGH FECALLY CONTAMINATED FOOD AND WATER.

BACTERIAL INFECTION

SCARLET FEVER

Other name “Scarlatina” Usually follows streptococcal pharyngitis Most common in children ages 3 to 15 years old

Mode transmission Droplet

Incubation period Last from 2 to 4 days

Causes Group A beta – hemolytic streptococci

Signs and Symptoms Sore throat Headache Chills Anorexia Abdominal pain Malaise Fever 37.8 to 39.4 Inflamed and heavily coated tongue Strawberry-like tongue Beefy red tongue Oro pharynx appeared red, edematous with muco-purulent exudates.\ Fine erythematous rash on upper chest, back ,neck abdomen ,legs and

arms( - soles of foot and palm of the hand)

Nursing Diagnosis Activity intolerance Altered oral mucous membrane Hyperthermia Impaired skin integrity Pain Risk for infection

Diagnostic Test Pharyngeal swab Culture CBC (granulocytosis, decreased RBC)

Treatment and Nursing Intervention

Antibiotic therapy( Penicillin/ Erythromycin) fro 10 days Implement respiratory secretion precaution for 24 hours after starting

antibiotic therapy Keep the patient on complete bed rest while he’s febrile to prevent

complications, promotes recovery and help conserve his energy. Offer frequent oral fluid and oral hygiene and administration of

antipyretic as ordered. Apply topical anaesthetics on patients tongue and throat to relieved

pain Provide skin care to relieve discomfort from the rash.

DIPTHERIA

Is an acute highly contagious disease Usually infect the respiratory tract primarily involved the tonsil,naso

pharynx and larynx Most strike in area where crowding and poor hygienic conditions

prevail.

Incubation Period 2 to 6 days

Causes Corynebacterium diphthreriae

Mode of transmission Indirect contact Airborne respiratory droplet

Signs and Symptoms Sorethroat Dysphagia Nausea and vomiting Chills A rasping cough Hoarseness fever 37.8 to 38.9℃ Thick patchy greyish-green membrane over mucous membrane

pharynx ,larynx, tonsils, soft palate and nose Stridor Sbsternal retraction Cyanosis Restlessness Tachypnea Skin lesion resembles impetigo

Diagnostic Test Culture throat swab Electrocardiogram

Nursing Diagnosis Altered nutrition: less than body requirements Impaired skin integrity Ineffective airway clearance Ineffective breathing pattern Risk for fluid volume deficit imbalance Risk for infection Risk for injury

Treatment & Nursing Intervention

Treatment include penicillin or erythromycin Assess respiratory effort and status, level of consciousness Elevate the head of the bed Keep an emergency tracheostomy set

Offer frequent small feeding of liquid and soft foods Maintained strict isolation precaution until 2 consecutive negative

throat culture Stress the need for childhood immunization Teach proper disposal of nasopharyngeal secretion.

Pertussis

Also called “whooping Cough” A highly contagious infection Cough that becomes in a high pitched inspiratory whoop

Incubation period 6 t0 8 weeks

Cause Bordetella pertussis

Mode of transmission Direct inhalation of contaminated droplets from a patient in the acute

stage Indirect through soiled linen and other articles contaminated by

respiratory secretions

Signs and Symptoms Hacking, nocturnal cough Anorexia

Sneezing Lacrimation Rhinorrhea Vomiting Loud crowing inspiratory whooping cough Epistaxis Cyanosis Wheezes

Diagnostic Test Naso-pharyngeal swab Sputum culture

Nursing Diagnosis Activity intolerance Anxiety Fluid volume deficit Impaired gas exchange Ineffective breathing pattern Pain Risk for infection Risk for injury

Treatment & Nursing Intervention Administration of antitussive and antibiotic (erythromycin) Respiratory isolation ( masks only) for 5 – 7 days after initiation of

antibiotic therapy To decreased exposure to infective organism, change soiled linen,

empty the suction bottle and change the trash bag at least once each shift.

Provide oxygen and moist air Suction secretion as necessary. Elevate the head of the bed Encouraged the patient to breath deeply after giving antitussive to

enhance ventilation Create a quite environment to decreased coughing stimulation Provide small frequent feeding Monitor acid base fluid and electrolytes balance

Tetanus

Also known as Lockjaw

Incubation Period 3 days to 3 weeks average 10 days

Cause Clostridium tetani

Mode of transmission Indirect contact: occurs through a puncture wound that is

contaminated by soil, dust or animal excreta containing C. tetani or by way of burns or minor wounds

Signs and Sypmtoms Pain or paresthesia at the site of injury Difficulty chewing or swallowing food Irregular heart beat Tachycardia profuse sweating Low grade fever Painful involuntary muscle contraction Opisthotonus ( arched back rigidity) Board like abdominal rigidity Intermittent tonic seizure Cyanosis

Diagnostic Test Blood culture Wound culture Cerebrospinal fluid pressure

Nursing Diagnosis Altered nutrition: less than body requirements Altered tissue perfusion Impaired physical mobility Ineffective airway clearance Ineffective breathing pattern Pain Risk for injury

Treatment and Nursing Intervention Within 72 hours after puncture wound give the patient tetanus immune

globulin or tetanus antitoxin and tetanus toxoid. Administered high dose antibiotic ( penicillin, tetracycline)Clean the

injured site using hydrogen peroxide Maintain adequate airway and ventilation suction standby. Have Endotrachealtube and tracheostony set at bedside Monitor intake and output of the patient Keep patient room dark and quite Perform range of motion exercise

Ophisthotonus

LOCKJAW

LYME DISEASE

Typically begin with the classic skin lesion called erythema chronicum migrans.

Infected white- tailed deer or white footed mice Common during summer Lyme Connecticut Target parts of the body are heart, bones and brain

Causes Spirochete Borrelia Burgdorferi

Incubation Period 3 to 32

Mode of transmission Tick bite Vector borne

Signs and Symptoms Sore throat dry cough Bulls eyes appearance rashes (papule that become red and warm and painful) Ringlike rash on axilla thigh and groin Conjunctivitis Urticaria Fever 40℃ chills Malaise fatigue Head ache stiff neck Tachycardia Joint swelling Lymphadenopathy

Diagnostic Procedure Blood test Elevated erythrocyte sedimentation rate Lumbar puncture

Nursing Diagnosis Altered tissue perfusion Fatigue Hyperthermia Impaired physical mobility Knowledge deficit Pain

Risk for infection

Treatment and nursing Management

Give antibiotic Doxycycline (Vibramycin), Ceftriaxone ( Rocephin) and Azithromycin ,amoxicillin for 3 to 4 weeks

Plan care to provide Analgesic and antipyretic Assist the patient with range of motion Protect the patient from sensory overload

Lyme disease is an acute inflammatory disease characterized by skin changes, joint inflammation and flu-like symptoms caused by the bacterium Borrelia burgdorferi transmitted by the bite of a deer tick. Symptoms resolve in 3 to 4 weeks even without treatment, but secondary or tertiary disease may develop if initial infection is not treated.

TYPHOID FEVER

Also known as “salmonella infection”

Incubation period 1 to 4 weeks

Cause Salmonella Typhi

Mode of transmission Direct contact with infected people or animal and ingestion of

contaminated Indirect contact drinking water contaminated by excretion of a carrier

Signs and Symptoms Malaise Anorexia Myalgia Headache chills Weakness Cough Increasing abdominal pain Diarrhea Delirium

Confusion Hypoactive bowel sound Increased temperature 40℃ in the evening Crackles Distended abdomen and tenderness

Diagnostic Test Blood culture Stool culture

Nursing Diagnosis Activity in tolerance Altered nutrition : less than body requirements Diarrhea Fluid volume deficit Hyperthermia Pain Risk for infection

Treatment and Nursing Intervention

Chloramphenicol, ampicillin, amoxicillin, ciprofloxacin, ceftriaxone, cefotaxime

Increased fluid intake Bed rest Follow contact precaution,handwashing Record intake and output TSB Observed patient s/sxs of bowel perforation