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Inflammation, Tissue Healing, and Edema

NRS 232 - Pathophysiology I
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Katrina Dielman

on 12 January 2016

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Transcript of Inflammation, Tissue Healing, and Edema

NRS 232 - Pathophysiology I
Inflammation, Tissue Healing, and Edema
5 Cardinal signs of inflammation
Inflammation
Primary and Secondary Intention
Tissue Healing
Edema
Maturation of Human Blood Cells

Basophils
Mature basophils
circulate in vascular system

Can migrate to connective tissue, but don’t reenter bloodstream

Mast cells
Basophils
found in connective tissue
Live for weeks to months
Basophils & Mast Cells
Important in acute bacterial infections
Attracted to areas of inflammation and bacterial products by chemotactic factors
Release toxins, free radicals, defensins, proteolytic enzymes (elastase)
Can damage normal tissue

Neutrophilia
Increase in circulating neutrophils

"Shift to the left"
Immature bands are increased during infection
Neutrophils
Monocytes
Immature macrophages that circulate in bloodstream
Become
macrophages
when entering tissue
Monocytes & Macrophages
Mechanisms of Inflammation
Hemostasis
Vasoconstriction
Formation of a platelet plug (3-7 minutes)
Formation of a fibrin clot (3-10 minutes)
Clot retraction (1 hour)
Vascular Events
Initial vasoconstriction

Norepinephrine & platelets
Vasodilation
-
Hyperemia
Caused by release of chemical mediators from mast cells -
Heat/rubor
Increased capillary permeability

Swelling/edema
Cellular Events in Acute Inflammation
Redness
Heat
Swelling
Pain
Histamine & bradykinin
Prostaglandins
Loss of function
Exudates
Serous
Serosanguinious
Purulent
Fibrinous
Hemorrhagic
Fever
Elevation of hypothalamus set-point by pyrogens
Lethargy
Proinflammatory cytokines from macrophages
Leukocytosis
Muscle catabolism
Loss of appetite
Acute vs. Chronic
Inflammation
Acute
Predominance of
Neutrophils
Macrophages
Chronic
Predominance of
Lymphocytes
Macrophages

Simultaneous
Active inflammation
Tissue damage
Tissue repair by fibrosis
Phases of Tissue Healing
Inflammation
Lasts 3-5 days
Platelets
release
growth factors
Matrix of cells & debris formed -
fibrin mesh
&
platelet plug
Removed by macrophages
Reconstruction/Proliferation
From days 1-10
Granulation
Angiogenesis
- new vessels, very vascular, pink wound
Fibroblasts form collagen structures
Epithelialization
grows from edges to center
Maturation
May continue for months or years
Collagen fiber
remodeling
Contraction of the scar
Disappearance of the capillaries
Factors that
Impair Tissue Healing
Local Factors
Factors causing
excessive or prolonged

inflammation
Factors that interfere with reconstruction & maturation
Systemic Factors
Factors that
suppress
inflammation
Factors that interfere with reconstruction & maturation
References
Copstead, L. & Banasik, J. (2013).
Pathophysiology
(5th ed.). St. Louis, MO: Elsevier.

Felver, L. (2013). Online Materials:
PROP -­‐Pathophysiology online.
Retrieved from https://evolve.elsevier.com/

Giddens, J. (2013).
Concepts for nursing practice
(1st ed.). St. Louis, MO: Elsevier Mosby.
Collaborative Interventions
RICE -
First 24-48 hours after injury
R
est
I
ce
C
ompression
E
levation
Immobilization Devices
Steroidal Agents -
Prednisone
NSAIDs -
Ibuprofen, naproxen
Recombinant DNA & Monoclonal Antibodies
Antipyretics -
Acetaminophen, ASA, NSAIDs
Analgesics -
Acetaminophen, ASA, NSAIDs
Antimicrobials -
Antibiotics, antivirals
Collaborative Interventions
Pharmacotherapy -
Antibiotics, emollients
Wound Care -
Cleansing, dressings
Surgical Treatment -
Excisions, debridement, skin grafts
Nutrition -
Protein, vitamins A & C are required for collagen synthesis

Wound Vac by KCI
Wound Vac Demonstraton
(Also known as polymorphonuclear leukocytes - PMNs)
Contain
histamine
Degranulation
of basophils and mast cells
Begins inflammatory response
associated with allergic reactions
Involved with
wound healing
and
chronic inflammatory conditions
+ LOSS of FUNCTION
(Functio laesa)
Rubor
Fumor
Calsor
Dolor
Leukocytes
Macrophages
Can ingest several times as many microorganisms than neutrophils
Live for months to years
Capable of cell division
May proliferate at site of inflammation
Important secretory function:
Release cytokines
Important in
wound healing
Important in
antigen presentation
Originate from bone marrow stem cells of the myeloid lineage
Injury
Exogenous:
Surgery, trauma, burns, skin injury
Endogenous:
Tissue ischemia
"Hair tourniquet"
Local
Systemic
vs.
Manifestations of Inflammation
Psoriasis
Cellulitis
e.g., ulcerations
e.g., surgical wounds, simple lacerations
Tissue Integrity - Interrelated Concepts
Excess fluid in interstitial compartment:
May be a manifestation of
excess extracellular fluid volume
You are a nurse in a clinic.
Ms. Tokkenlissen
, a 42-year old telephone operator, sprained her ankle last night when she fell down the stairs. "Not only does this hurt so bad I cannot walk on it," she says, "but it looks so swollen and ugly I cannot bear to have people look at me! Can you explain to me why my ankle swelled up?" Answer as if you are speaking directly to Ms. Tokkenlissen.
Max Kneescrape
, age 8, skidded on some gravel and fell off his bicycle. After his various scrapes have been cleaned and all bits of embedded gravel removed, he says to you, his nurse, in a trembling voice, "Why is my knee so red?" His knee is not bleeding. Answer as if you are talking directly to Max.
George Exothermic
, a chemical engineer, has an infected toe. He asks you, "How do the white blood cells know how to get down to my toe to fight the bacteria?" Answer as if you are talking directly to George.
Ms. Dermis
has just returned from the hospital with an open surgical wound. You are a home health nurse, making an initial visit to change the dressing. "I feel too bad to cook," she says, when you ask her how she is eating. What important points does Ms. Dermis need to know about nutrition for wound healing?
Mr. Airtrapping
, age 44, takes a corticosteroid every day for control of his chronic asthma. "That's odd," he says, “When I sliced this finger with a carving knife, the cut didn't get tender and red like I expected. And it is taking a long time to heal. My wife says that's because I am getting old. What do you think?" Respond as if you are speaking directly to Mr. Airtrapping.
Tom Initiative
, age 6, was stung by a bee. "Why does it swell up with a bee sting?" he asks. "Did the bee lay eggs like in that jungle movie? Are they going to hatch out of my arm?" Reply as if you are speaking directly to Tom
Simon Industry
, age 10, sprained his ankle. His mother has venous congestion from a vascular problem. They both have ankle edema. "My ankle is swelling like Mom's," says Simon. "Will I have to wear those support hose too? Will it ever go away?" Answer as if you are speaking directly to Simon.
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