ALTERATION IN INFLAMMATORY AND IMMUNOLOGIC RESPONSE INFLAMMATION y
Is a non specific cellular response to tissue injury or infection
y
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 INFLAMMATION STAGES
1
DESCRIPTION RESULT Initial injury precipitates Activates the released of chemical; inflammatory process histamine, bradykinin, serotonin, prostaglandin ( reaction product of the complement and blood clotting system) and ( hormone substance released by sensitized T cells)
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 ³walled off´ and non-pitting edema occurs.
4
Damage tissue infiltrate by leukocytes, which engulf the bacteria and necrotic tissue. After
Produces purulent exudates
several days , these leukocytes eventually 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 INFLAMMATION
RUBOR CALOR TUMOR DOLOR LOSS OF FUNCTION
REDNESS INCREASED HEAT SWELLING PAIN
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. y
CONTAGIOUS
Applied to disease that are easily spread directly transmitted from person to person y
INFECTIOUS
Are those diseases not transmitted by ordinary contact but require a direct inoculation through a break in the previously intact or mucous membrane
y
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. y
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. y
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. y
SPORADIC
Occurring occasionally here and there not epidemic
CHAIN OF INFECTION y
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 y
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. y
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. y
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; y
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 CHARACTERISTICS Influence susceptibility and severity of disease y
Age
y
Socio-economics status
y
Disease history
y
Life style
y
Nutritional status
y
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 y y y
Other name ³Scarlatina´ Usually follows streptococcal pharyngitis Most common in children ages 3 to 15 years old
Mode transmission Droplet y
Incubation period Last from 2 to 4 days y
Causes Group A beta ± hemolytic stre ptococci y
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) y y y y y y y y y y y y
Nursing Diagnosis Activity intolerance Altered oral mucous membrane Hyperthermia Impaired skin integrity Pain Risk for infection y y y y y y
Diagnostic Test Pharyngeal swab y
y
Culture CBC (granulocytosis, decreased RBC)
Treatment and Nursing Intervention y y
y
y
y
y
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 y y
y
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 y
Causes Corynebacterium diphthreriae y
Mode of transmission Indirect contact Airborne respiratory droplet y y
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 y y y y y y y y
y y y y y y
Diagnostic Test Culture throat swab Electrocardiogram y y
Nursing Diagnosis Altered nutrition: less than body requirements Impaired skin integrity Ineffective airway clearance Ineffective breathing pattern y y y y
y y y
Risk for fluid volume deficit imbalance Risk for infection Risk for injury
Treatment & Nursing Intervention y y y
y
y y
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 y y y
Also called ³whooping Cough´ A highly contagious infection Cough that becomes in a high pitched inspiratory whoop
Incubation period 6 t0 8 weeks y
Cause Bordetella pertussis y
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 y
y
Signs and Symptoms Hacking, nocturnal cough Anorexia Sneezing Lacrimation Rhinorrhea Vomiting Loud crowing inspiratory whooping cough Epistaxis Cyanosis Wheezes y y y y y y y y y y
Diagnostic Test Naso-pharyngeal swab Sputum culture y y
Nursing Diagnosis Activity intolerance Anxiety Fluid volume deficit Impaired gas exchange Ineffective breathing pattern Pain Risk for infection Risk for injury y y y y y y y y
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 y y
y
y y y
y y y
Tetanus y
Also known as Lockjaw
Incubation Period 3 days to 3 weeks average 10 days y
Cause
y
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 y
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 y y y y y y y y y y
Diagnostic Test Blood culture Wound culture Cerebrospinal fluid pressure y y y
Nursing Diagnosis Altered nutrition: less than body requirements Altered tissue perfusion Impaired physical mobility Ineffective airway clearance Ineffective breathing pattern Pain Risk for injury y y y y y y
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 y
y
y y y y y
Ophisthotonus
LOCKJAW LYME DISEASE y
y y y y
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 y
Incubation Period 3 to 32 y
Mode of transmission Tick bite Vector borne y
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 y y y y y y y y y y y y y y
Diagnostic Procedure Blood test Elevated erythrocyte sedimentation rate Lumbar puncture y y y
Nursing Diagnosis
y y y y y y y
Altered tissue perfusion Fatigue Hyperthermia Impaired physical mobility Knowledge deficit Pain Risk for infection
Treatment and nursing Management y
y y y y
Give antibiotic Doxycycline (Vibramycin), Ceftriaxone R ocephin) 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 flulike 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 y
Also known as ³salmonella infection´
Incubation period 1 to 4 weeks y
Cause Salmonella y
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 y
y
Signs and Symptoms Malaise Anorexia Myalgia Headache y y y y
y y y y y y y y y y y
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 y y
Nursing Diagnosis Activity in tolerance Altered nutrition : less than body requirements Diarrhea Fluid volume deficit Hyperthermia Pain Risk for infection y y y y y y y
Treatment and Nursing Intervention y
y y y y y y
Chloramphenicol, ampicillin, amoxicillin, ciprofloxacin, cefotaxime Increased fluid intake Bed rest Follow contact precaution,handwashing Record intake and output TSB Observed patient s/sxs of bowel perforation
ceftriaxone,
