Inflammation

1
Inflammation

• Susan Fowler sfowler_at_tricountycc.edu

2
Objectives p. 4

• Inflammation and Infection objectives are
  intertwined.
• Inflammation is the concept and appendicitis is
  the exemplar (best example) of inflammation.

3
Inflammation What it is and What it isnt.

• The bodys cellular response to injury,
  infection, or irritation.
• Mechanism is the same regardless of injuring
  agent.
• Always present with infection.
• It is not infection. Infection is not always
  present with inflammation.

4
Inflammatory Response

• Intensity depends on extent and severity of
  injury bodys ability to react
• Sequential
• Neutralizes dilutes inflammatory agent
• Removes necrotic materials
• Establishes an environment suitable for healing
  and repair

5
Causes of Inflammatory Response

• Heatburn injury
• Radiationsunburn, radiation tx
• Trauma
• Allergenssinuses anaphylactic shock
• Infection

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Steps of Inflammatory Response

• Vascular response
• Cellular response
• Formation of exudate
• Healing

7
Vascular Response

• Cell injury
• ?local vasoconstriction
• ?release of kinins, antihistamines,
  prostaglandins
• ?local vasodilation and hyperemia
• ?increased capillary pressure and permeability
• ?fluid exudate from capillaries to tissue spaces
  leading to edema

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Vascular Response contd

• Fluid exudate contains fibrinogen
• Fibrinogen changes to fibrin
• Fibrin and platelets make clot
• Clot traps bacteria to prevent spread

9
Cellular Response

• WBCsspecifically neutrophils and
  monocytesmigrate thru capillary walls to site of
  injury. This migration is called chemotaxis.
• Neutrophils and monocytes (which change to
  macrophages) perform phagocytosis, cleaning up
  bacteria and dead cells.

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Cellular Response contd

• Other cells that may be released
• Eosinophilsallergic responses
• Lymphocyteshelp develop immunity
• Basophilscarry histamine and heparin

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Cellular Response Chemical Mediators

• Mediators released that play a role in
  inflammatory response and cell lysis
• Histamine
• Serotonin
• Complement system
• Prostaglandins
• Serotonin
• Kinins

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Formation of Exudate

• Formed when fluid leaks from capillaries into
  tissue spaces
• Made up of serous fluid, cells, chemical
  mediators
• Sometimes confused with infection in an open
  wound because it may look milky white, yellowish,
  or pale green, but it has no odor if infection is
  not present.

13
Manifestations of Inflammation

• Localized response (redness, pain, swelling, etc)
  and systemic response (increased TPR, malaise,
  nausea, anorexia, etc) are the same as in the
  infectious process (see Infection Concept
  Lecture)
• With a high degree of inflammation, and when
  infection is present, WBCs rise

14
Types of Inflammation

• Acutehealing occurs 2-3 weeks primarily
  neutrophils involved
• Subacutehealing occurs same way, but takes
  longer
• Chronicmay last for years injurious agent
  persists or repeats injury to site primarily
  lymphocytes and macrophages (monocytes) involved.

15
Healing Process

• Regenerationreplacement of lost cells and
  tissues with cells of same type
• Repairreplacement of lost cells with connective
  tissue (scar)

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Healing Process contd

• Regenerative cells
• Skin
• Bone and bone marrow
• Mucous membranes
• Spleen
• Liver
• Kidney
• Pancreas

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Healing Process contd

• Non-regenerative cells
• Neuronsreplaced by glial cells, new neurons may
  be produced by stem cells
• Skeletal and cardiacrepaired with scar tissue

18
Appendicitis

• Inflammation and infection of appendix located
  immediately past the ileocecal valve on the side
  of the ascending colon.
• Causes kinking, fecalith, tumor, or foreign
  body with pus formation

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Plan of CareAssessment

• Periumbilical pain moving to McBurneys point
• Rovsings, Blumbergs, Obturator, Ileopsoas
• Guarding
• Pain with DRE
• Low grade fever
• Anorexia
• NVD or constipation
• Elevated WBC, abd x-ray

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Plan of Care Expected Outcomes

• Patient will receive proper management of
  appendicitis
• Patients pain will be controlled
• Infectious and inflammatory processes will
  subside
• Patient will experience full recovery without
  complications (wound infection, DVT, respiratory
  infection, etc.)
• Patient will receive and understand all
  instructions

21
Plan of Care Interventions

• Appendectomy
• -Open or laparoscopic
• -Usually 24h stay but if perforated, several
  days with NG, IV, drains, possible open wound, IV
  meds
• -Pre and postop antibiotics

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Plan of Care Nursing Mgmt

• Depends on whether OP or inpatient
• Preoperatively, pt is assessed, site is marked,
  laxatives enemas are contraindicated
• Postop VS per protocol
• Pain controlIV to po
• IVF and meds
• Wound assessment and changes (if inpatient)
• Advance DAT and activity
• Pt education re wound care, SS infection, pain
  mgmt, activity restrictions, RTC time, when to
  call MD.

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Plan of Care Evaluation

• Appendicitis has been resolved
• Appendectomy performed successfully
• Infection and inflammation has subsided as
  evidenced by VS and WBC returned to normal levels
• Patients pain is controlled
• Patient had no complications
• Patient received and understood all instructions