NURS315 Chapter 3 (Unit 2)

Case Study 3.2- Terri is a 42-year-old female. She is married and has four children. Terri lives a very active lifestyle and enjoys gardening and sewing. She recently saw her health care provider because she was having pain in her hands. The pain was limiting the activities that Terri could participate in. Terri also noted that the joints in her fingers were erythematous and that she felt very tired most of the time. Terri was diagnosed with rheumatoid arthritis. She was referred to a rheumatologist for her treatment. 1. Rheumatoid arthritis is an example of chronic inflammation. Compare and contrast the process of acute inflammation and the process of chronic inflammation. 2. Discuss the cellular response and adaptation to the chronic inflammation that is occurring within Terri's joints. 3. Draw a concept map linking the cellular response and adaptation to the long-term alterations Terri will experience with rheumatoid arthritis. Do these alterations have any impact on other tissue / systems within the body? 4. Describe the structural and functional changes that occur as a result of rheumatoid arthritis. 5. How will Terri's body attempt to compensate for these changes? 6. Consider this: How would having rheumatoid arthritis change your current lifestyle?

1. Acute inflammation will resolve within a fairly short period of time. Chronic inflammation occurs over a period of time and may cause alteration of the cells/tissues because of the prolonged stressors placed on those cells. These alterations can result in functional changes within the tissue. 2. Local changes occur within the joints in a symmetrical fashion. Clinical manifestations include erythema, pain, swelling, warmth, and decreased mobility. Over time, changes occur within the joints, causing malalignment or deviation of the joints. 3. Because of the chronic inflammation in the joints, destruction of the tissue will occur. Because of the tissue destruction, Terri will experience an alteration of the normal function in her joints and will not have the flexion and extension capabilities. Systemic response to the chronic inflammation includes fever, fatigue, anemia, anorexia, weight loss, and weakness. Also, consider the fact that chronic pain can also lead to situational depression. 4. Joint destruction over time will cause joint malalignment and deviation. This would make it difficult for Terri to perform even simple activities such as combing her hair, brushing her teeth, or driving her car. 5. In response to the systemic alterations that occur with rheumatoid arthritis such as anemia, compensation will occur because of the low hemoglobin. The body will respond as follows: increased respiration rate and increased heart rate. The body is attempting to maintain homeostasis by increasing the supply of oxygen (increased respiration) and moving it around the body faster (increased heart rate). 6. Pain, decreased ability to care for oneself, and decreased ability to participate fully in activities that you may enjoy.

Case Study 3.1- Brian is an active 13-year-old who lives on a farm. During the spring planting season, he was filling the tractor with fuel. As he was talking the nozzle out of the tank, a spark ignited the fuel. Brian dropped the nozzle and ran to the house. His older sister pushed him to the ground and smothered the flames on his shirt. Brian was taken to the emergency department for treatment of his burns. He had deep partial-thickness burns covering both of his arms. 1. Consider the inflammatory response in relation to Brian's burns. What kinds of local and systemic responses are occurring both at the site of injury and within Brian's body? What is triggering these responses? 2. Would you expect Brian to experience pain with this type of burn? Why or why not? 3. What clinical manifestations would you expect to see with Brian's injury? Why are you seeing these particular manifestations (what processes are occurring within the body that are causing these manifestations)? Draw a map that links the manifestations to the causes. 4. Consider the healing process that takes place with this type of injury. How is new tissue formed? 5. Discuss the different types of treatment options available for Brian. 6. Discuss the potential complications of this type of a burn in relation to the following: a. a widespread inflammatory response b. stress hypermetabolism c. impaired defense mechanisms

1. Vascular response: Occurs immediately after tissue injury. This response involves the release of chemical mediators that control vascular permeability, leading to increased blood flow to the area. The vascular response includes activation of the complement system (source of chemical mediators). Cellular response: Cells required for tissue healing and repair respond to the injury. The steps involved include chemotaxis, cellular adherence, and cellular migration. -The catalyst or trigger for the acute inflammatory response is the tissue injury. 2. Yes. This type of burn will damage the epidermal skin layers. As long as the nerve cells are intact, Brian will feel the sensation of pain. 3. Brian would experience pain, redness, edema, and loss of function of the affected are. These clinical manifestations are attributable to the vascular and cellular responses occurring within his body. Also, depending on the size of the burns, there might be large fluid shifts within the body owing to the increase in the vascular permeability. 4. The wounds will heal by secondary intention. Increased blood supply to the area assists with the formation of granulation tissue within the wound bed. If the burn is superficial, the new tissue will gradually fill in the area. If necrosis of the tissue occurs in the upper epidermal layers, scarring is avoided. However, if tissue necrosis occurs in both epidermal and upper dermal layers, collagen will fill in the wound bed and lead to scarring. 5. Dressing changes with wound debridement and analgesics to manage the pain. Skin grafting would be an option as well, depending on the depth of the burn. 6. Complications include: a. The release of large amounts of chemical mediators can cause fluid shifts because of the vascular permeability. The fluid will shift from the vascular space into the interstitial space. b. To heal wounds, the body requires a large amount of energy and the metabolism will increase drastically. If the body's increased metabolic needs are not met, the following could occur: tissue hypoxia, tissue wasting, and infection. c. The skin is considered as the first line of defense. When the integrity of the skin is impaired, microbes can easily enter the body.

19. A patient is diagnosed with Achilles tendonitis. What would you expect to be the clinical manifestations of this condition given what you know about acute inflammation? a. heel pain, swelling, limited range of motion b. fever, anorexia, weakness c. redness, inability to walk, ankylosis d. fibrosis, degeneration, scarring

a. heel pain, swelling, limited range of motion

10. Which of the following best describes the inflammatory process in relation to an acute injury? a. increased vascular permeability, dilation of vessels, and leukocyte attraction to the site of the injury b. release of chemical mediators and vessel constriction c. vessels dilate, causing the release of chemical mediators d. none of the above

a. increased vascular permeability, dilation of vessels, and leukocyte attraction to the site of the injury

16. Ulcerative colitis is found in the: a. large intestine b. small intestine c. stomach d. anywhere in the GI tract from the mouth to anus

a. large intestine

3. The preferred outcome from the inflammation process is: a. tissue repair or regeneration b. cellular alteration with scar tissue formation c. metaplasia d. cellular hypertrophy

a. tissue repair or regeneration

12. During the inflammation process, a fever would be an example of: a. a local response to the inflammation process b. a systemic response to the inflammation process c. an indirect action d. a holistic response

b. a systemic response to the inflammation process

18. A patient is diagnosed with ulcerative colitis. She has more than four bowel movements per day but no fever, weakness, fatigue, or other systemic manifestations. Her disease would be classified as: a. mild b. moderate c. severe d. in remission

b. moderate

20. A major aspect of treatment for inflammatory conditions is: a. ice, rest, elevation, compression b. removal of the source of injury when possible c. acetaminophen (Tylenol) d. use of steroids

b. removal of the source of injury when possible

13. Katelynn, a 13-year-old female, is accompanied to the emergency department by her mother. Katelynn hit a tree with their 4-wheeler and has large abrasions on her right knee and forehead. Her mother asks if Katelynn will need "stitches". You know that this type of wound will most likely heal by: a. primary intention b. secondary intention c. leukocyte adherence d. third intention

b. secondary intention

1. Acute inflammation occurs in response to: a. cellular repair b. tissue injury c. scar formation d. cellular reproduction

b. tissue injury

5. You know the most important roles for chemical mediators are to: a. release histamine b. constrict vessels to control potential bacterial invasion in the area c. induce vasodilation and increase capillary permeability d. cause pain to decrease mobility

c. induce vasodilation and increase capillary permeability

8. The inflammation process must prepare the site of injury for healing. This includes cleaning up the debris (dead and impaired tissue) at the site. This process of engulfing and digesting impaired tissue is called: a. chemotaxis b. diapedesis c. phagocytosis d. degranulation

c. phagocytosis

17. A major difference between Crohn disese and ulcerative colitis is the presence of ______ in Crohn disease. a. a chronic inflammatory response b. ulcers c. skip lesions d. histamine

c. skip lesions

6. During the inflammation process, the vascular response triggers the following changes at the site of the injury except: a. vasodilation b. increased permeability of vessels c. vasoconstriction d. increased blood flow

c. vasoconstriction

9. Cells that play a role in phagocytosis include: a. neutrophils b. monocytes c. macrophages d. all of the above

d. all of the above

14. Katelynn asks what she can do to help the abrasions heal faster. All of the following are important factors in wound healing except: a. integrity of the vascular and cellular inflammatory responses b. reformation of the extracellular matrix c. regeneration of those cells capable of mitosis d. decreased protein synthesis

d. decreased protein synthesis

4. You are caring for Andrew, a 5-year-old boy, in the emergency department. He has a sliver in his right index finger that has been present for 2 days. Andrew refused to let his mother remove the sliver and now the tissue around the sliver is red, warm, and swollen. What is the most likely cause of the warmth and swelling? a. the release of prostaglandins b. cytokines c. vasoconstriction in the microcirculation d. increased blood flow to the area due to vasodilation

d. increased blood flow to the area due to vasodilation

15. Chronic inflammation differs from acute inflammation because it: a. triggers the cellular response before the vascular response b. occurs for a period of 1 week after the acute stage of inflammation c. involves different cells d. represents a persistent or recurrent state of inflammation lasting several weeks or longer

d. represents a persistent or recurrent state of inflammation lasting several weeks or longer

2. Inflammation is a process that includes the following: a. vascular and cellular responses b. the formation of exudates c. preparation for tissue repair d. a and c e. a, b, and c

e. a, b, and c

7. In order for the cellular response to occur, which of the following processes needs to take place? a. cellular migration b. cellular adherence c. chemotaxis d. a and b e. a, b, and c

e. a, b, and c

11. The primary signs and symptoms of acute inflammation include all of the following except: a. redness and heat b. swelling c. pain and loss of function d. a and c e. all of the above

e. all of the above