NR 324 Week 6 EDAPT_Altered Inflammation and Immunity

Since the primary inflammation occurs in the respiratory system, the exudate that collects in the lungs fills the alveoli, decreasing the amount of gas exchange that can occur. Even if the inflammation remains within the lungs, the alteration in gas exchange can be life-threatening. Clinical Manifestations of Inflammation Whether occurring deep in the body (e.g., pyelonephritis) or on the surface (e.g., the palm of hands scraped during a fall), the clinical manifestations of inflammation are the same: • heat (localized warmth or systemic fever) • redness • swelling • pain • eventual loss of function Some of these responses can be beneficial in wound healing and infection control or pathological, as in many chronic disease states. Diseases in which inflammation plays a dominant pathological role have the suffix "-itis," such as appendicitis. Inflammation Biomarkers When inflammation is present in the body, there will be higher levels of substances known as biomarkers, which can be measured when assessing a client with suspected inflammation-related health alterations. C-reactive protein (CRP) is a biomarker that increases during acute inflammation. Additional Measurable Mediators and Biomarkers of Inflammation • acute-phase proteins (e.g., C-reactive protein or CRP) • cyclooxygenase (COX)-related metabolites • cytokines (e.g., IL-6 and TNF-alpha) and chemokines • formation of DNA adducts • inflammation-related growth factors and transcription factors (e.g., NF-kappaB) • major immune cell types • prostaglandins • reactive oxygen and reactive nitrogen oxide species (ROS and RNOS) Inflammation is “a local response to cellular injury that is marked by capillary dilatation, leukocytic infiltration (local swelling), redness, warmth, and pain and that serves as a mechanism initiating the elimination of noxious agents and of damaged Healing Primary Intention Healing If an individual goes to the emergency department and has sutures placed, the injury will heal and result in a fine scar. This is primary intention healing. Secondary Intention Healing If an individual leaves the injury alone and decides not to seek treatment, the body will create a blood clot to help heal itself. Granulation tissue will form on the bottom of the wound bed and heal itself from the inside out until the wound is filled in. The client may have a larger scar from this healing process. This is secondary intention healing. Dehiscence is the separation and disruption of previously joined wound edges. In this example, the suture line from the client’s injury has separated. This is commonly paired with the concept of evisceration, or when the wound edges separate so much that organs actually protrude through the wound itself. Emotional Response to Wounds Several factors related to wounds can affect the client's emotional response, including: • scarring or deformity • strong or offensive odor of wound drainage • amount of wound drainage and frequency of dressing changes • fear of how others will react to the wound, odor, drainage, or scarring While caring for a client with an extensive or non-healing wound, it is important for the nurse to remain calm and keep nonverbal behaviors consistent with professional standards. Facial expressions, like