Immunity, Inflammation, Infection, skin integrity, Wound Care
Your patient is a 66-year female with MS. She is completely immobile, eats a poor diet, friction is a problem when being moved up in bed. She is bedfast due to immobility and is occasionally moist due to incontinence; and has very limited sensory perception due to the neurological changes related to muscular sclerosis. What is her Braden score? What is her risk for skin breakdown?
* Score of 9 (Immobile-1, diet-1, friction-1, mobility-1, moisture-3, sensory perception-2) * High risk of infection bc it is under 12
ACID mneumonic to reconize hypersentivities
*A*naphylactic and Atopic (type I)(bee sting) *C*ytotoxic (antibody mediated) (type II) *I*mmune complex (type III)(RA, SLE) *D*elayed (cell mediated) (type IV)(poison ivy)
Proliferative phase of full thickness wound repair
*Days 3-24 *Fills with granulation, wound contraction, and wound resurfacing by epithelialization *Vascular bed is reestablished
Conjugate vaccines
--fight a different type of bacteria. These bacteria have antigens with an outer coating of polysaccharides. This type of coating disguises the antigen, making it hard for a young child's immature immune system to recognize it and respond to it. --effectivefor these types of bacteria because they connect (or conjugate) the polysaccharides to antigens that the immune system responds to very well. This linkage helps the immature immune system react to the coating and develop an immune response. --example: Haemophilus influenzae type B (Hib) vaccine.
Microchimerism
-Cells from fetus can remain in womb, pass to future children -Cells can also cross into the mother, Y chromosome cells found in brain, skin, liver, spleen after having sons, found decades later -Can cause autoimmune diseases
Type III hypersensitivity reaction
-Immune-Complex Reaction -Local or systemic -Immediate or delayed -Ex: Systemic lupus erythematosus, acute glomerulonephritis, and rheumatoid arthritis.
MODS (multiple organ dysfunction syndrome)
-caused by severe infection
unstageable pressure ulcer
-obscured by slough and/or eschar -until removed, true depth cannot be determined, either stage 3 or 4
Each category on the Braden scale has a score range of ______
1-4
forms of otitis media
1. Acute (AOM) 2. OM with Effusion (OME) 3. Externa (swimmer's ear)
Problems from Inadequate Antimicrobial Therapy
1. Noncompliance/nonadherence to tx. 2. BSI/septic shock 3. Legal DOT sanctions (ex. TB)
Causes of Bottom-up damage
1. Pressure intensity 2. pressure duration 3. tissue tolerance (negatively affected by age, nutrition, low BP, etc.)
Benefits of a immune response?
1. Protect from invasion 2. Removes damaged tissues/cells 3. Remove cell mutations
Nursing considerations with antipyretic drugs
1. They may cause sweats and DECREASED BP 2. They may actually mask a disease
3 stages of active inflammation
1. acute (minutes-days)(localized or systemic) 2. chronic (formulation of granuloma) 3. repair/restorative
Dark Skin Assessment
1. assess blanching (by comparing sides of the body), as well as: edema, temp. pain, induration 2. Moisten skin to highlight color change
Exotoxin release
1. cholera 2. botulism 3. tetanus 4. gangrene 5. septic shock syndrome
Phases of burn healing
1. emergent/resuscitational phase 2. acute/healing phase 3. rehab/restore
full thickness wound repair
1. hemostasis 2. inflammatory 3. proliferative 4. maturation/remodeling
4 stages of infection
1. incubation: entrance of pathogen --> 1st sx. 2. prodromal stage: nonspecific s/s --> more specific s/s 3. illness stage: specific s/s 4. convalescence: acute signs disappear
Partial-thickness wound repair
1. inflammatory response - serous exudate 1st 24 hrs 2. epithelial proliferation and migration - starts at edges 3. reestablishment of epidermal layers - epidermal cells only migrate across a MOIST surface
Braden scale categories
1. sensory perception 2. moisture 3. activity 4. mobility 5. nutrition 6. friction/shear
Vitamin C recommendations
1000 mg for collagen synthesis and fibroblast function
A score under __ on the Braden scale indicates high risk for PIs
12
Which amount of zinc is recommended for wound healing? 15 to 30 mg 30 to 50 mg 25 to 60 mg 50 to 70 mg
15 to 30 mg
Recommended vitamin A intake for wound healing
1600-2000 retinal Eqs/day
Hydrocolloid dressing are best for stage _
2
The skin of a patient receiving intravenous fluids appears blanched, cool to the touch, and edematous. Upon touch, the patient reports pain. Which complication does this represent? 1 Phlebitis 2 Extravasation 3 Local infection 4 Circulatory overload
2 Extravasation *Extravasation and infiltration: manifested by painful and blanched skin that is cool to the touch and edematous. *Phlebitis is manifested by redness, tenderness, pain, and warmth along the course of the vein starting at the access site. *Redness, heat, and swelling indicate a local infection at the catheter entry site. *Circulatory overload is manifested by crackles in the dependent parts of the lungs, shortness of breath, and dependent edema.
For people with skin issues, ensure _____ to ____ mL of fluids/day
2000 / 3000
The risk of hemorrhage is greatest during the first ___ hours after surgery.
24-48
Full-thickness wound repair applies to stage _ & _ wound
3 & 4
Requirements for CDI
3+ liquid stools in 24 hrs
For people with PI's, don't keep HOB elevated about _ degrees
30
SSIs occur within __ days of surgery
30
Trough level is drawn ___ mins before med. dose
30
The peak level is drawn ____ minutes after med. dose
30-60
acute/healing phase of burn healing
36-48 hrs. after burn until wound closes
A construction worker sustains a puncture wound from a rusty nail and the last immunization for tetanus is unknown. The primary health care provider prescribes tetanus immune globulin. Which type of protection does this immunization offer? 1 Lifelong passive immunity 2 Long-lasting active protection 3 Stimulation of antibody production 4 Immediate passive short-term immunity
4 Immediate passive short-term immunity *Only active immunity is lifelong
Normal WBC count
5,000-10,000 or 11,000 /mm3
braden scale range
6-23
chronic infection
> 12 weeks
What age group is the pneumococcal vaccine recommended for?
> 65 years
vascular compensation in inflammatory response
> permeability leads to hypovolemia & hypotension
What level of ESR indicates inflammation?
>20 mm/hr.
Examples of antipyretics
Acetaminophen, aspirin, NSAIDS
Macrophages
Aid in debridement
MHC class I
All cells
Which reaction is an example of a type I hypersensitivity reaction?Anaphylaxis Serum sickness Contact dermatitis Blood transfusion reaction
Anaphylaxis
dendritic cells
Antigen-presenting cells, located mainly in lymphatic tissues and skin, that is particularly efficient in presenting antigens to naive helper T cells, thereby initiating a primary immune response.
Bactericidal agents vs. bacteriostatic agents
Bactericidal agents directly kill bacteria, while bacteriostatic agents interfere with replication
CA-MRSA treatment
Bactrim, Doxycycline, Minocycline, and Clindamycin
When caring for a patient with sepsis, the nurse expects that which component of the differential white blood cell count will be elevated? Band neutrophils Mature neutrophils Segmented neutrophils Polymorphonuclear cells
Band neutrophils (Immature)
Which cells are elevated with parasitic infection?
Basophils, eosinophils
lymphoid progenitor cells
Become B cells - T cells and natural killer cells
_______ and _________ tend to dry up wounds & aren't good on healthy tissue
Betadine / H+ peroxide
Are whites or blacks more like to have SLE?
Blacks
Vitamin A sources
Broccoli, Oranges, Carrots, Milk, Sweet Potatoes, Spinach, pumpkin, liver
CDI
C. diff infection
Helper T cells
CD4 Activate other T cells ,B cells, macrophages, and NK cells. *These are the cells targeted by HIV*
How is MRSA spread?
CONTACT: catheters, VADs, endotracheal tubes
Which tests are used to detect general infection?
CRP & ESR
Infection- Dx tests
CT & MRI
CRE
Carbapenem-resistant Enterobacteriaceae
Which term describes the practice of placing clients with the same infection in a semi-private room? Isolating Cohorting Colonizing Cross-referencing
Cohorting
Which information regarding varicella is correct? Communicable until all vesicles are dry Still communicable even when dry scabs remain No longer communicable after the fever has subsided Not communicable while vesicles are surrounded by red areolas
Communicable until all vesicles are dry
Dermis
Contains CT, collagen, and fibroblasts
Which function does black polyurethane foam serve in wound healing? Select all that apply. One, some, or all responses may be correct. Contracts the wound Absorbs fluids from the wound Restricts the growth of granulation tissue Helps determine depth of the wound Protects the periwound tissue from pressure
Contracts the wound Absorbs fluids from the wound
Culture vs. Sensitivity
Culture IDs microbes, while sensitivity determines which antibodies will work!
3 types of T cells
Cytotoxic T cells Helper T cells Suppressor T cells
A surgical wound requires a Hydrogel dressing. The primary advantage of this type of dressing is that it provides: A. an absorbent surface to collect wound drainage. B. decreased incidence of skin maceration. C. potection from the external environment. D. moisture needed for wound healing.
D. moisture needed for wound healing (this helps in AUTOLYTIC DEBRIDEMENT)
Which condition does nonblanchable erythema indicate about the skin tissue? Infection Damage Hypoxia Pressure
Damage
DTPI (deep tissue pressure injury)
Deep red, maroon, or purple
Which type of cell modulates the immune response?
Dendritic cells (AKA Antigen-presenting cells)
enzyme-linked immunosorbent assay (ELISA)
Diagnoses IgG deficiency
Do/don't use donut-shaped pillows for pressure relief
Don't!
Which characteristic would be indicative of abnormal healing of a primary wound? Slough tissue in the wound base A fruity, earthy, or putrid odor A dry or moist granulation tissue bed Drainage for more than 3 days after closure
Drainage for more than 3 days after closure
Examples of Hydrocolloids
Duoderm
Most causative HAI agents?
E. coli & S. aureus
Elderly fever
Elderly have a lower body temp., so fever can be classified as 99F and above
_____toxins are produced in bacterial cell walls and related via lysis
Endo
___toxins are produced & released by bacteria into the environment
Exo
Treatment for c. diff
FMT, metronidazole, vancomycin, teicoplanin, fidaxomicin
IgM antibodies
First antibody produced in response to infection Remember: IgM = iMMediate
How often should you ice a sprain/strain?
For 10 minutes, q. 2 or 3 hours
mucosal membrane pressure injury
Found on mucous membranes with a history of a medical device in use at the location of the injury. Due to the anatomy of the tissue these ulcers cannot be staged.
______ causes a superficial injury, while ______ causes a deeper injury
Friction / shear
rehab/restore phase of wound healing
From time of wound closure -> achieving highest level of functioning
fungi imperfecti
Fungi causing disease
GIP-PCR
GI pathogen panel-polymerase chain rx. Diagnoses C. Diff
What should you do when performing a wet-to-dry dressing and the packing touches the outside of the wound?
Get a new piece and start over; it is contaminated
Which intention healing involves the greatest risk of infection?
Healing by secondary intention
How would you classify a stage 3 wound that is healing dramatically? A. Stage 1 wound B. Healing stage 3 wound
Healing stage 3 wound
Healing by primary intention
Healing without wound contraction that occurs when wounds are rapidly closed with sutures with minimal loss of tissue and minimal bacterial contamination; edges are APPROXIMATED
Which cells does HIV attack?
Helper/CD4 cells
When is a fibrin mesh formed in full-thickness would repair?
Hemostasis
Examples of nursing dx. r/t infection
Impaired tissue integrity, risk for infection, imbalanced nutrition
What is the role of estrogen in the immune response?
It promotes the immune response and > risk for autoimmune disease
Which body parts would be dressed in a figure-eight manner? Joints Thighs Upper arms Lower arms
Joints - To provide a snug fit and immobilization. Cylindrical body parts such as the thighs, upper arms, and lower arms should be dressed in a spiral manner.
Which organ releases acute phase proteins to > fibrinogen to > hemostasis?
Liver
Clonal selection
Lymphocytes specify to a specific antigen
Examples of live, attenuated vaccines
MMR & chickenpox
Which cells release tissue thromboplastin?
Macrophages
Which is more effective: macrophages or neutrophils?
Macrophages
For which side effect would the nurse monitor the patient who is prescribed prednisone? 1 Hyperkalemia 2 Metabolic acidosis 3 Metabolic alkalosis 4 Hypermagnesemia
Metabolic alkalosis Corticosteroids such as prednisone may cause metabolic alkalosis as a result of decreased levels of metabolic acids. Drugs such as captopril and losartan can cause hyperkalemia. Diuretics such as spironolactone can cause metabolic acidosis because of increased levels of metabolic acids. Magnesium levels can increase in patients taking magnesium hydroxide.
When do B cells mature in liver?
Mid-fetal stage
MDRO
Multidrug-resistant organism
Two stem cells of immune cells
Myeloid progenitor and lymphoid progenitor cells
Hepatitis S/S
N&V, fever, malaise, dark urine, jaundice
Which cells are elevated in the presence of bacteria?
Neutrophils
_______ are directly involved in phagocytosis
Neutrophils
18+ score on Braden scale
No risk of pressure injuries
Do hospitals get reimbursed for problems related to skin breakdown?
No; it is a nursing-sensitive outcome
Which solution would be used to clean a wound before obtaining a culture? Povidone-iodine Hydrogen peroxide Sodium hypochlorite Nonbacteriostatic saline
Nonbacteriostatic saline
endogenous infection
Normal flora multiply and cause infection as a result of treatment (streptococcus, enterococcus, yeast overgrowth)
2nd line of defense
Phagocytes, NK cells, macrophages, granulocytes
Treatment for evisceration until surgery
Place sterile gauze soaked in sterile saline
PAPR
Powered Air Purifying Respirator
______ is the best indicator of current nutritional status
Pre-albumin
Toxoid vaccines
Prevent diseases caused by bacteria that produce toxins (poisons) in the body. Weakened toxins are called toxoids. When the immune system receives a vaccine containing a toxoid, it learns how to fight off the natural toxin. The DTaP vaccine contains diphtheria and tetanus toxoids.
Which function of regulator T-cells (Tregs) needs to be included when providing education about cell-mediated immunity? Recognize self cells versus non-self cells and secrete lymphokines Prevent hypersensitivity on exposure to non-self cells or proteins Destroy cells that contain a processed antigen's human leukocyte antigen Destroy unhealthy or abnormal self cells, cancer cells, and virally infected body cells
Prevent hypersensitivity on exposure to non-self cells or proteins
In which phase of full thickness wound repair do fibroblasts make collagen?
Proliferative phase
Which role does vitamin A play in wound healing? 1 Quickens fibroplasia 2 Acts as an antioxidant 3 Promotes wound closure 4 Acts as immune function
Promotes wound closure --> Vitamin A promotes epithelialization, wound closure, inflammatory response, angiogenesis, and collagen formation.
Natural chemical debridement
Promotion of self-digestion (autolysis) of dead tissues by naturally occurring bacterial enzymes
Hydrogel
Put in wound for debridement / place dry, sterile dressing over it / provides MOISTURE for healing
What does spectrum mean in terms of antibiotics?
Refers to the # of organisms affected by antibiotics
resurfacing
Regrowth of new skin cells across the open area of a wound as it heals.
Acute appendicitis develops in an older client with a history of chronic constipation. Before arrival at the hospital, the client attempted self-care at home. Which self-care measure could potentially lead to rupture of the appendix? Avoiding food and liquids because of nausea Applying an ice pack to the abdomen Self-administering a small-volume enema Taking acetaminophen for pain
Self-administering a small-volume enema
When a patient who was exposed to invaders recovers rapidly without damage to healthy body cells, the nurse identifies that which immune response protected the patient? Self-tolerance Antibody-antigen interaction Intact skin and mucous membranes Inflammatory response against invading foreign proteins
Self-tolerance
Shearing vs Friction
Shearing occurs when the skin is stationary and the underlying tissue shifts with gravity; while friction occurs when the patient moves in bed
Which immune preparation contains antibodies that provide passive immunity? Toxoid Killed vaccine Live attenuated vaccine Specific immune globulin
Specific immune globulin
Systemic Inflammatory Response Syndrome (SIRS)
Stage 1: > in cytokines, leukocyte migration, vasodilation Stage 2: > in macrophages & platelets Stage 3: systemic rx., organ failure
Which stage of pressure injury involves blistering?
Stage 2
Which stage can you see fat tissue, granulation, epibole, and possibly slough and eschar?
Stage 3
Which stage do slough/eschar first appear?
Stage 3
Which stage of pressure injury may involve a sinus tract?
Stage 4
_ cells secrete lymphokines that stimulate macrophages
T
generation of clonal diversity
T cell maturation
Type IV immune reaction
T-cell mediated (delayed hypersensitivity) - Contact dermatitis
Types of airborne transmission
TB, varicella, rubeola
emergent/resuscitational phase of burn healing
Time of onset -> 24 hrs
iceberg concept of infection
Tip: people with classic s/s Middle of iceberg: less severe s/s Larger, bottom part of iceberg: largest group (ASYMPTOMATIC CARRIERS)
What is botulism?
Toxin heads to neuromuscular nerve synapses and blocks AcH receptors on muscle cells. S/sx: descending symmetric paralysis. A potential bioterrorism agent.
TORCH panel
Toxoplasmosis Rubella Cytomegalovirus Herpes
Fecal Microbiota Transplant (FMT)
Transplantation of healthy colonic bacteria into a person with dysbiosis of colonic bacteria for resolution of symptoms (ex. C. diff.)
Which type of hypersensitivity reaction occurs when the client's sensitized T cytotoxic cells are involved as the mediators of injury? Type I Type II Type III Type IV
Type IV Remember: ACID (Allergy - Cytotoxic - Immune complex-mediated - Delayed Hypersensitivity) *Type IV hypersensitivity reaction occurs when the sensitized T cytotoxic cells are involved as the mediators of injury, such as a tuberculin test (Mantoux skin test) or contact dermatitis. Type I IgE-mediated reaction will occur when histamine is involved as the mediator of injury. (Allergic) Type II cytotoxic reaction will occur when complement lysis is the mediator of injury. (Cytotoxic) Type III immune complex reaction will occur when neutrophils are involved as the mediators of injury (Immune complex-mediated)
VRE complications
UTI, endocarditis, bacteriemia
Most common HAI?
UTIs
Venous stasis ulcer vs arterial ulcer
Venous stasis - Shallow, irregular shape, pain r/t edema, minimum hair growth, Arterial - full thickness; cool, pale, shiny, taut skin *See pics below
Which vitamins best help support immune response?
Vitamins A & D
Increase in specific ___ types (differential) indicates infection
WBC
Why are tertiary wounds left open?
Wound is extremely contaminated and needs to be treated/debrieded before closure
____ is a vitamin essential for epithelialization
Zinc
____ may impair copper metabolism & impair immunity
Zinc
skin care bundle
a tool used to provide consistency in the assessment and planning of care for patients who are at risk for pressure injuries
Neutrophils are involve in _______ inflammation
acute
Convalescence stage of infection
acute sx. disappear
A DTPI extends into _____ tissue
adipose
______ organisms cause more infection than ________
aerobic / anaerobic
You should put sterile gloves on before/after irrigating a wound
after
immune senescence
age-related declines in immune system functioning
______ is the best indicator of protein intake over the last 6 months
albumin
Bacteria thrive in urine with an _______ pH
alkaline
Type 1 immune response
allergic (bee sting)
Arterial ulcer
an open wound on the lower legs or feet caused by poor arterial blood flow
iatrogenic illness
an unfavorable response due to prescribed medical treatment (has the same word root as "pedIATRic and gerIATRic)
Tx for swimmers ear
antibiotics
Use caution with NPWT and __________ medications
anticoagulant
Biofilm
bacterial glycocalyces like to adhere to catheters, medical devices, tubes, and wounds
Which cells release histamine?
basophils and mast cells
myeloid progenitor cells
become neutrophils, mast cells, basophils, eosinophils
IgE antibodies
bind to mast cells and basophils and are involved in allergic reactions
Dakin's solution
bleach solution that debrides tissue PROTECT SURROUNDING TISSUE BY APPLYING VASELIN
BSI
blood stream infection
electrical stimulation
can promote vessel growth/granulation
Hantavirus
caused by exposure to rodent-infected areas
CVC
central venous catheter
Macrophages are involved in _______ inflammation
chronic
Inflammatory phase of full thickness wound repair
collagen appears in 2+ days and forms scar tissue; establishes a clean wound bed
Maturation phase of full thickness wound repair
collagen scar continues to reorganize and strength; up to one year
Example of a primary immunodeficiency
common variable immunodeficiency
ESR
confirms the nonspecific presence of inflammation
Type II Immune Response
cytotoxic hypersensitivity (tissue rejection)
antimicrobial sensitivity testing
determine effects of a drug on that microbe
CRP test
determines inflammation
active acquired immunity
develops following direct exposure to the pathogenic agent
continuous wet gauze
dilutes exudate & softens eschar
DOt
directly observed therapy (Ex. TB -- pts MUST complete all of the tx.)
Colonization involves microbes that do/do not cause disease
do not
primary immunodeficiency
entire immune defense system is inadequate and the individual is missing some if not all of the components necessary for a complete immune response
natural active acquired immunity
exposure to infectious agent
S/S of Non-Hodgkin's Lymphoma
fatigue, abdominal pain, fever, chills, wt. loss, night sweats
symptoms of systemic infection
fever, > HR and RR, malaise, anorexia, N&V
IgA
found in secretions Remember: A looks a little bit like a drop
A ____-thickness wound heals by forming new tissue
full
stage 4 PI
full thickness skin AND TISSUE loss w/ exposed bone, ligament, tendon or muscle, slough and eschar may be present, undermining, tunneling, and epibole
PI stage 3
full thickness skin loss
Alginate
furry gauze that absorbs exudate
Colonization
growth of microbes, but NO TISSUE INVASION
granulation tissue
healthy scar tissue, but not as strong as collagen
Tunneling
hidden wounds that extend into surrounding tissue
Risks for VRE
hospital stays, severe illness, enteral nutrition
______ and ______ are dressings used to provide autolytic debridmenet
hydrogel / hydrocolloid
Risk factors for SSIs
hyperglycemia, smoking, PVD, obesity
S/S of MODS (multiple organ dysfunction syndrome)
hypotension, tachycardia/tachypnea, oliguria, hypoxia, seizures, coma
Band cells
immature neutrophils
Subunit vaccines
include only parts of the virus or bacteria, or subunits, instead of the entire germ. contain only the essential antigens and not all the other molecules that make up the germ, side effects are less common. The pertussis (whooping cough) component of the DTaP vaccine is an example of a subunit vaccine.
Healing by secondary intention
infected wound, leave it open, and myofibroblasts will play a key role in repair
passive artificial immunity
injection of antibodies
prodromal stage
interval from nonspecific s/s to specific
Infection causes a _____ shift of WBCs, bc there is an increased number of immature neutrophils
left
types of contact transmission
lice, scabies, RSV
IgD antibodies
located on B cell membranes where they act as antigen receptors Remember: Think of "D" for "Deer", and their Y-shaped antlers. Antigen receptors are Y-shaped.
secondary immunodeficiency
loss of immune functioning as a result of an illness or treatment
A lower/higher score on the Braden scale indicates increased risk of pressure injuries
lower
Primary phagocytic cells
macrophages and neutrophils
resident microbes
microbes that become established
MASD
moisture associated skin damage
ESR test
monitor cancers, RA, and TB
Non-Hodgkin's Lymphoma
more common type, from B/T cells
When you irrigate a wound, you...
move from top to bottom
innate immunity
natural; nonspecific
you cannot stage a _______ wound
necrotic
wet to damp dressing
necrotic debris removed with little trauma
NPWT
negative pressure wound therapy (wound vac)
OME
no sx. of infection / no tx. / caused by URIs/allergies
PI stage 1
non-blanchable erythema; intact skin
carbapenem
normally treats peritonitis and bacterial meningitis
exogenous infection
not present in our normal flora (salmonella)
top down damage
o Superficial / Stage 1 o Caused by superficial shear or friction o Presents as red skin
_______ is a possible complication of pressure injuries
osteomyelitis
Symptoms of localized infection
pain, redness, swelling, pus, drainage, heat
Eosinophils
parasites and allergies
A _____-thickness wound heals by regeneration
partial
Dehiscence
partial or total separation of wound layers Cause: sudden strain s/s: serosanguineous drainage first few days post-op
PI stage 2
partial thickness skin loss with EXPOSED DERMIS
PME
particulate matter exposure (smoke, dust, mold)
nervous compensation in inflammatory response
peripheral vascular constriction
Neutrophils and monocytes are types of _________
phagocytes
signs of a healing wound
pink-beefy red, granulation, CLEAR drainage
Inactivated vaccine
polio
examples of antifungal drugs
polyenes, imidazoles, triazoles, thiazoles, allylamines, echinocandins
Cohorting
practice of grouping patients who are colonized or infected with the same pathogen
Suppressor T cells
prevent hyperimmune rx.
Botulism
prevention of nerve impulse transmission
B cells
produce plasma cells and memory cells
cholera
profuse diarrhea
Proinflammatory hormones
prostaglandins, cytokines, histamines
evisceration
protrusion of visceral organs through a wound opening / emergency, requires surgery
Assay
rapid culture
MHC proteins
recognition of "self" and "nonself" cells by the immune system
Gram-negative bacteria
release endotoxins (Negative-eNdotoxins)
Gram-positive bacteria
release exotoxins
irrigation
removes exudates -Use 35-ml syringe / 19-gauge
COX inhibitor drugs
required for severe inflammation
Koplik spots are present with rubeola/rubella.
rubeola How to remember? rebeOla is Ordinary measles (not German) and presents with kOplik spots.
#1 cause of hospitalized pt. deaths
sepsis
septic shock is AKA
sepsis-induced distributive shock
3 types of exudate
serous, purulent, sanguineous
Granuloma
small area of healing tissue; made of macrophages, fibroblasts, and collagen
Maceration
softening or dissolution of tissue after lengthy exposure to fluid
MHC class II
specialized cells
Moisture retentive dressings
spontaneous separation of necrotic tissue is promoted by autolysis
Blood and urine are normally ________
sterile
Layers of the epidermis (superficial to deep)
stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, stratum basale *Corns Lovers Grow Several Bales
_______ is a bacterial infection, that, when untreated, can lead to heart valve and renal damage
strep
Broad-spectrum antibiotics can cause _________, bc normal flora is destroyed
suprainfection
SSI
surgical site infection
Chlorohexidine swabs are good for _______ care
suture
Vitamin C sources
tomatoes, potatoes, fortified juice
topical chemical debridement
topical enzyme preparations to loosen necrotic tissue
passive natural immunity
transfer of antibodies from a mother to her fetus or baby
transient microbiota
transferred from other person/object
examples of endotoxin diseases
typhoid, meningococcal
venous stasis ulcer
ulcer caused by venous insufficiency and stasis of venous blood; usually forms near the ankle
sharp/surgical debridement
used for a draining, necrotic injury
artificial active immunity
vaccination
MRSA treatment
vancomycin, delafoxacin, linezolid, ceftaroline
renal compensation in inflammatory response
vasodilator glomeruli
Healing by tertiary intention
wounds left open for 3-5 days to allow edema or infection to resolve or to permit exudate to drain and then are closed with sutures, staples, or adhesive skin closures.