Concept of Inflammation and Immunology

and Disruptive Inflammatory Responses

NCM 112 | MEDICAL SURGERY | THEORY | 11A-F
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DIFFERENCE BETWEEN CONCEPTS OF

INFECTION AND INFLAMMATION AND
INFLAMMATION DISRUPTIVE
INFLAMMATORY
Infection RESPONSES
● Refers to invasion and
multiplication of bacteria The chemical mediators of
or virus within the body inflammation
● Path = external to internal
Histamine
Inflammation ● Vasodilation
● Refers to the body’s ● Changes in vascular
protective response permeability
against the infection ○ Acute
● Path = internal to external ● Most common

5 Cardinal signs of Inflammation Kinins

● Heat ; calor ● Increase vasodilation and
● Redness ; rubor vascular permeability
● Swelling ; tumor ● Attract neutrophils to
● Pain ; dolor affected area
● Loss of function ; functio
laesa Both promote vasodilation ;
manage widen the blood vessels
to allow more blood to flow

Bradykinin
● Suspected of causing pain

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Serotonin function ;
● Vasodilation debilitatin
● Changes in vascular g
permeability Cause Foreign Persistent
○ Acute substanc foreign
● Same with histamine es that agents ;
enters the autoimmu
body ; ne
Prostaglandins physical disease
● Increase vascular harm
permeability
Outcome Return to Scarring ;
● Draw leukocytes to the normal ; permanen
affected area near t tissue
● Vasoconstrict normal damage
structure
○ Causes changes in
and
the blood vessels function
● Pain and fever inducer

Other causes of Inflammation

The classifications of
inflammation as to cause,
duration, type of exudates
produced, location and type
of tissue involves
Types of Inflammation
Criteria Acute Chronic
Endogenous
● Immunopathological
reactions
● Neurological disorders
● Genetic disorders
○ Pre existing disease

Onset Immediat Gradual ; Exogenous

e insidious
● Mechanical
Duration Days ; Months ; ● Physical
less than years ● Chemical
2 weeks
● Nutritive
Purpose Protective Non ● Biological
function protective ○ All external factors

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Duration of Time Types of Exudate

Acute Serous
● Short duration ● Characterized = results
● Mins to hours or days from outpouring of fluid
that has low cell and
Subacute protein content
● 2-6 weeks ● Early stage of inflammation
● Found in
Chronic ○ Cellulitis
● Months to years ○ Skin blisters
○ Pleural effusion
● Appearance
Degree of Tissue Damage
○ Clear
○ Thin
Superficial
○ Watery
● Just the skin surface or
below
Fibrinous
● Characterized = presence
Profound
of large fibrins to adhesions
● Impale deeper tissue
● Found in
○ Pericarditis
○ Peritonitis

Membranous
● Characterized = loose
white r gray substance
lining the mucous
membrane

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 ● Found in ○ Runny nose
○ Gut
○ Tracheobronchial
THE CONCEPT OF
tree
INFLAMMATION WITH THE
■ Catarrhal
FOLLOWING CONDITIONS
■ Diphtheria
○ Also common in
infections of the Rheumatic Fever
respiratory system
● Inflammatory disease
Purulent ● Develop after group A beta
● Characterized = pus hemolytic streptococcal
formation pharyngitis
● Found in ● May develop to =
○ Suppurative rheumatic heart disease ;
infection as evidenced by
■ Consists of ○ Heart murmur
plasma, active ○ Cardiomegaly
and dead cells ○ Pericarditis
○ Boils ○ Heart failure
○ Abscess formation
Signs and Symptoms
Hemorrhagic or Serosanguinous ● Jones criteria/ major
● Characterized = as a result criteria
from rupture or necrosis of ○ If px develop at least
blood vessels ; hematoma 2 of the following
● Carditis
Mucinous ○ Inflammation of the
● Characterized = presence heart
of mucus and epithelial ○ Affects 3 layers of
cells the heart
● Found in ● Polyarthritis
○ Allergic rhinitis

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 ○ At least 5 joints are ● Fever
affected ● Laboratory findings
○ Joints affected for ○ Increased
up to 4 weeks erythrocyte
● Subcutaneous nodules sedimentation rate
○ Deep seated ○ Increased C-reactive
nodules on the skin protein
○ Round, firm, painless ○ Prolonged PR interval
and free moving
○ Develop over bony Diagnostic Tests
prominences and ● No specific DT to
tendons determine RF but only
○ Disappear after 1-2 supports
weeks ● Throat culture
● Erythema marginatum ● Rapid antigen detection
○ Rare skin rash tests
○ Macular or papular, ● ECG
non itchy rash on ○ Sinus tachycardia
the trunk and ○ Sinus bradycardia
proximal extremities ○ Sinus dysthymia
● Chorea ○ 1st degree heart
○ Rapid, purposeless, block
erratic, jerky, ○ Atrial fibrillation
uncoordinated ○ Atrial flutter
involuntary ○ Prolonged PR interval
movement of face ● Elevated erythrocyte
and extremities sedimentation ; ESR =
○ Resolves within 6 minor criteria
months ● Elevated serum C-reactive
protein
● Jones criteria/ minor
criteria
● Arthralgia

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Medical Management ○ Preventive steps
● 1 time IM injection of needed to minimize
penicillin recurrence and
● 10 day course of oral complications
penicillin ○ Cardiac
● Erythromycin reevaluations
○ Alternative to ○ To report any signs
penicillin of thromboembolism
● Cephalosporin or heart failure
● Azithromycin
Trichinosis
● Prophylactic antibiotics
after initial antibiotic
● Cause = eating raw meat
treatment
● Causative agent =
○ IM penicillin
Trichinella spiralis
○ Every 3-4 weeks
● After an adequate
○ For 5 years if px did
inflammatory response
not have carditis
develops in the intestine ;
○ For 10 years if with
the female adult larvae is
carditis
eventually expelled in the
● Antiinflammatory
feces
medications
● In tissues other than
○ Salicylates ; aspirin
skeletal muscle, such as
○ Corticosteroids ;
○ Myocardium
prednisone
○ Brain
● Diazepam ; valium |
● The parasites soon
Phenobarbital = chorea
disintegrate ; causing
intense inflammation and
Nursing Management
are then reabsorbed
● Teach px about ; primary
focus
Signs and Symptoms
○ The disease
● Abdominal discomfort
○ Treatment
● Cramping

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 ● Diarrhea Medical Management
● Facial swelling around eyes ● Mebendazole
● Fever ● Albendazole
● Muscle pain ● Pain killers
● Muscle weakness ○ For muscle soreness

Diagnostic tests Nursing Management

● Muscle biopsy ● Educate px
○ Supplement blood ● Adequate rest
exam ● Administer medications as
○ Removing of small ordered
parts of muscle ● Emphasize prevention
● CBC
● Creatinine kinase and
Herpes Zoster
Lactate Dehydrogenase
○ Increase in the blood
● Aka = shingles
when muscle cells
● Causative agent =
are damaged or
varicella- zoster virus ; VZV
destroyed
● After chickenpox, the virus
● Increased eosinophils
lie dormant inside nerve
○ When new larvae
cells, spinal cord, brain
invades the tissues
● Due to = reactivated due to
● Indirect
declining of cellular
immunofluorescence,
immunity
latex agglutination,
● Travel by way of the
enzyme linked
peripheral nerves to the
immunosorbent assays
skin
○ Detect antibodies
● Creation of red rash of
developed by the
small, fluid filled blisters
infected person’s
immune response to
the parasites

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Assessment for Shingles
● Painful vesicular eruption
○ Along the sensory
nerves from one or
more posterior
ganglia
● Early vesicles contain
serum
○ Later becomes
purulent, rupture,
then form crusts
○ Confine din face or
trunk
● Itching Nursing Management
● Tenderness
● Malain and GI disturbances
precede eruption
● Inflammation is unilateral
○ Thoracic
○ Cervical
○ Cranial nerves in
band like
configuration
Medical Management
● Acyclovir ; zovirax
● Valacyclovir ; valtrex
● Famciclovir ; famvir
● Analgesics ; aspirin,
meperidine
● Corticosteroids
○ Symptomatic
● Triamcinolone ; aristocort,
kenacort, kenalog
○ Subcutaneous
injection under
painful areas as an
anti inflammatory
agent
● Zostavax
○ Vaccine for
prevention in adults
above 60 who had
chicken pox
● Educate about the
importance of medication
compliance and follow up
appointments
● Teach application of wet
dressing
● Proper hand hygiene
● Relaxation techniques
● Diversionary activities
● Loose clothing
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Herpes Simplex Psoriasis

● 2 causative agents ● Chronic, noninfectious,

○ Herpes simplex inflammatory disease that
type 1 causes overproduction of
■ Mouth keratin
○ Herpes simplex ● Hereditary defect
type 2 ● More common = 15-35
■ Genitals years old
■ Lower ● Tend to improve then recur
prevalence periodically throughout life
■ Appears at ● Aggravated by
onset of ○ Emotional stress
sexual activity ○ Anxiety
○ Either agents can ○ Trauma
occur in both areas ○ Infections
○ Seasonal changes
Diagnostic Tests ○ Hormonal changes
● Viral cultures
○ Older Assessment for Psoriasis
○ Crusted patches ● Lesions
● Rapid assays ○ Red
○ Acute lesions ○ Raised patches
○ Vesicular lesions ○ Covered with silvery
scales
Medical Management ● Nails
● Use of sunscreen ○ Pitting
● Suppressive therapy ○ Discoloration
○ Acyclovir ; zovirax ○ Crumbling beneath
○ Valacyclovir ; valtrex the free edges
○ Famciclovir ; famvir ○ Separation of nail
plate

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 ● Palms and soles ■ Calcipotriene ;
○ Pustular lesions ; dovonex
palmar pustular ■ Tazarotene ;
psoriasis tazorac
● Complications ● Prevents development of
○ Arthritis of multiple epidermal cells
joints ● Systemic agents
○ Erythrodermic ○ Systemic cytotoxic
psoriasis preparations
■ Involves total ○ Methotrexate
body surface ○ Hydroxyurea ; hydrea
area ○ Cyclosporine A
○ Oral retinoids ;
Medical Management synthetic derivatives
● No known cure of vitamin A and its
● Gentle removal of scales metabolite, vitamin
with baths A acid
○ Oils ○ Etretinate
■ Olive
■ Mineral Nursing Management
● Emollient creams ● Explain psoriasis, control,
○ Alpha- hydroxy medications
acids ● Do not pick or scratch skin
○ Salicylic acids ● Use of warm water
● Regular skin care ● Pat dry
● Stress management ● Use of emollients with
occlusive dressings
Pharmacologic Therapy ● Oil bath
● Topical agents ● Psychological support
○ Corticosteroids with ● Arthritis
occlusive dressings ○ Rest
○ Non- steroidal ○ Heat application
agents ○ Salicylates

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 Diagnostic Tests
Malaria
● CBC
● Electrolyte panel
● Causative agents
● Renal function tests
○ Plasmodium vivax
● Urine and blood cultures
■ Most
● Thick and thin blood
threatening
smears
○ Plasmodium
● Chest radiography
falciparum
● CT scan
○ Plasmodium ovale
● Peripheral blood smear
○ Plasmodium
● Antigen detection methods
malariae
○ Under development
● Mode of transmission =
bite of female anopheles
Medical Management
species mosquito
● Antimalarial drugs
● Incubation period = 12-30
○ Artemether = 20 mg/
days
lumefantrine ; 120
mg/ coartem
Clinical Symptoms
○ Mefloquine ; lariam
● Cough
● Antipyretics
● Fatigue
● Antiprotozoal
● Malaise
○ Chloroquine
● Shaking chills
phosphate ; aralen
● Arthralgia
○ Clindamycin ;
● Myalgia
cleocin
● Paroxysm of fever
○ Doxycycline ;
○ Malarial rigor
vibramycin,
○ Shaking chills and
vibra-tabs, doryx
sweats
○ Primaquine
○ Every 48-72 hours
○ Quinine sulfate ;
depending on the
formula Q
species

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 ○ Quinidine gluconate ○ Use of penicillamine
■ Cardioquin and captopril
■ Quinalan ■ Severe
■ Quinidex reaction
■ Quinoa towards integ
○ Tetracycline ; system
achromycin, sumycin ● Types
○ Pemphigus vulgaris
Nursing Management ■ Most common
● Prevention ○ Pemphigus foliaceus
● Assess and monitor for ○ Pemphigus
bleeding erythematosus
● Administer medications as
prescribed
Pemphigus Vulgaris

Bullous diseases ● Also affects the oral

● Definition = chronic
disorder that results in the
development of blisters ;
bullae
○ Blisters = fluid filled
● Increased incidence
○ Jewish and
mediterranean
people
○ Middle and older
adults
● Associated with
○ Other autoimmune
disorders
mucous membrane
● Caused by
○ Immunoglobulin G
antibodies
○ HLA-A10 antigen
● Acantholysis
○ The separation of
epidermal cells from
one another
● Common cause of death =
septicemia ; S.aureus
○ Infection of the
blood stream

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Appearance of the blisters ○ Test fluid of blister to
● Appear first in the mouth identify acantholytic
and scalp then the face, cells
back, chest, umbilicus,
groin Goals of Treatment
● Form in the epidermis ● Control the severity of the
● Cause the epidermal cells disease
to separate above the ● Prevent infection
basal layer ● Prevent loss of fluids
● Rupture, leaving denuded ● Promote healing
skin and crusting
● Oozing fluids have musty
Immunodeficiency (HIV/AIDS)
odor
● Lesions are painful
HIV
● Nikolsky’s sign
● Retrovirus = RNA to DNA
○ Pressure on a blister
○ Back to front way
causes it to spread
○ Need RNA to make
to adjacent skin
DNA
● Transmitted through
Diagnostic Tests
○ Sexual intercourse
● Immunofluorescence
with infected person
microscopy
○ Exposure to HIV
○ To identify lgG
infected blood or
antibodies in the
blood products
epidermis and
○ Perinatal
serum
transmission ; upon
● Skin biopsy
delivery
○ To determine the
○ Breastfeeding
presence of
● Infects cells with CD4
acantholysis
receptors
● Tzanck test
○ Lymphocytes
○ Monocytes

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 ○ Macrophages ○ AIDS
■ CDC category
● Primarily cause damage to C
and destruction of CD4+ T
cells Clinical Manifestations
○ More CD4 receptors ● Chills
● CD4 + T cells ● Fever
○ Plays a key role in ● Night sweats
the ability of the ● Dry cough
immune system to ● Dyspnea
recognize and ● Lethargy
defend against ● Confusion
pathogens ● Stiff neck
● Viral load ● Seizures
○ Blood test ● Headache
○ Very high during the ● Malaise
first 6 months of ● Fatigue
infection and during ● Oral lesions
the late stages ● Skin rash
● Stages ● Abdominal discomfort
○ Primary infection ● Diarrhea
■ Acute HIV ● Weight loss
infection ● Lymphadenopathy
■ Acute HIV ● Progressive
syndrome ● Generalized edema
○ HIV asymptomatic
■ CDC category Diagnostic Tests
A ● EIA = enzyme
○ HIV symptomatic immunoassay
■ CDC category ● ELISA = enzyme-linked
B immunosorbent assay
○ Both = detect HIV

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 ● Western blot Nursing Management
○ Separates blood
proteins and detects
HIV antibodies
○ Confirmatory for
ELISA
● Viral load test
○ Detect level of HIV in
the blood
● CD4/CD8 ratio
○ Used to monitor the
immune system if
HIV is present
● Client education
○ Prevent to go on the
latter stage
● Prevent infection
● Controlling fatigue
○ Conserve energy
● Supporting individual
coping
● Promote effective
therapeutic management

Pharmacologic Management
● Nucleoside Analog
Reverse Transcriptase
Inhibitors ; NRTI’s
○ Becomes part of the
HIV DNA and derail
its building process
○ Zidovudine
■ Retrovir
■ AZT
● Non- Nucleoside Reverse
Transcriptase Inhibitors ;
NNRTI’s
○ Attach to reverse
transcriptase
○ Prevents conversion
of HIV RNA to DNA
○ Etravirine 200 mg

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