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.