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med surg


inflammatory response a sequential reaction to cell injury
removes necrotic materials, and establishes an environment suitable for healing and repair inflammatory response
Inflammation is an immediate protective response by the body to any kind of injury to its cells and tissue.
The vascular response results in vasodilation causing hyperemia (increased blood flow in the area) and increased capillary permeability.
vascular response results in increased fluid moving into tissues causing redness, heat, and swelling at the site.
the cellular response neutrophils and monocytes move to the inner surface of the capillaries (margination) and then through the capillary wall (diapedesis) to the site of injury.
Chemotaxis is the migration of WBCs to the site of injury
chemotaxis results in an accumulation of neutrophils and monocytes at the focus of injury
Pus is a creamy substance resulting from dead neutrophils, digested bacteria and other debris
the first leukocytes to arrive at the site of injury (usually 6-12 hours) and have a short life span (24-48 hours) neutrophil
neutrophils phagocytize bacteria, other foreign material and damaged cells
the second type of phagocytic cells that migrate from circulating blood are monocytes
monocytes transform into macrophages
macrophage role is to clean area before healing can occur
lymphocytes are related to humoral and cell-mediated immunity
Complement system (C1-C9) is the major mediator of the inflammatory response
Exudate consists of fluids and leukocytes that move to the site of injury
local response of inflammation includes redness, heat, pain, swelling and loss of function
systemic manifestations of inflammation includes an increase of WBC count with a shift to the left, malaise, nausea an anorexia, increased pulse and respiration rate and fever
inflammation is always present with infection
infection is not always present with inflammation
infection means an invasion of tissues or cells by microorganisms such as bacteria, fungi and viruses
neutropenic means that your WBC is depleted, and you may not be able to manifest an inflammatory response.
a low neutrophil count is called neutropenic
inflammation is based on the severity of the injury and the capacity for the person to respond
vascular response results from capillaries constricting and this releases hit amine which causes vasodilation.
hyperemia is the increased blood flow to an area
fibrinogen leaves the blood and is activated to fibrin
fibrin strengthens a blood clot formed by platelets
in a blood clots platelets release growth factors that start the healing process
bone marrow releases immature neutrophils are called bands
Phagocytosis engulf foreign matter and debris
purulent Pus is a creamy substance resulting from dead neutrophils, digested bacteria and other debris
an increase in WBC can be due to an acute bacterial infection
leukocytosis is the increase in WBC
monocytes arrive at the site of infection in about 3-7 days
Serous fluid results from low cell and protein count, seen in early stages of inflammation (skin blisters)
Catarrhal – mucous – runny nose with URI
histamine is stored in granules of basophils, mast cells, and platelets.
histamine causes vasodilation and increased capillary permeability
serotonin is stored in platelets, mast cells enterochromaffin cells of the GI tract
serotonin stimulates smoother muscle contraction
Purulent fluid is a Combo of WBCs, dead cells, microorganisms – abscess, cellulitis, furuncle
granuloma is when a monocytes clump together to eat a larger particles
prostaglandins are generally considered proinflammatory and prolong the inflammatory response and are potent vasodilators contributing to increased blood flow and edema
prostaglandins have a role as pyrogens in causing febrile (fever)
leukotrienes are more likely to cause anaphylaxis
anaphylaxis cause a vasoconstriction of smooth muscles of the bronchi, which causes a narrowing of the airway
aldosterone is a pro-inflammatory which controls sodium ( hangs with water) and causes BP and HR to go up
Fever above 105.8 F damages regulation by the hypothalamic temperature control center becomes impair, and damage can occur to many cells, including brain cells
cortisol is an anti-inflammatory that inhibits the inflammatory response
sero-sanguineous fluid is found during the midpoint in healing after surgery or tissue injury. composed of RBC and serous fluid
the onset of fever is triggered by the release of cytokines
the shivering response is the body's method of raising the body's temperature until the new set point is attained
exudate fluid are leukocytes that move to the site of injury.
there is a decrease in mobility due to pain and swelling
acute inflammation the healing occurs in 2-3 weeks and usually leaves no residual damage and neutrophils are the predominant cell type at the site of inflammation
subacute inflammation has the same features of acute inflammation but last longer
chronic inflammation lasts for weeks, months or even years, with predominate cell types being lymphocytes and macrophages
the best management of inflammation is the prevention of infection, trauma, surgery, and contact with potentially harmful agents
older people have a blunted febrile response to infection
antipyretic drugs are used to reduce fever
to prevent acute swings in temperature antipyretic drugs are given around the clock
key concept in treating soft tissue injuries and related inflammation RICE
R in rice stands for rest and it helps the body use its nutrients and oxygen for the healing process. lets fibrin and collagen to form across the wound edges with little disruption
I in rice stands for ICE, and cold application is usually appropriate at the time of initial trauma to cause vasoconstriction and decrease swelling and pain
when can heat be added to inflammation? 24-48 hours after and promotes healing by increasing the circulation to the inflamed site
E in rice stands for Elevation, reduces edema at the site of inflammation by promoting venus and lymphatic return
C in rice stands for Compression, serves to counter the vasodilation effects and development
regeneration is the replacement of lost cells and tissues with cells of the same type
repair is the healing as a result of lost cells being replaced by connective tissue
most common type of healing that result in a scar forming repair
epithelial cells readily divide and regenerate
skin and lining of the blood vessels are epithelial cells
connective tissue are bone, cartilage, tendons and ligaments and blood
smooth muscle regeneration usually possible, particularly in the GI tract
cardiac muscle damage is replaced by connective tissue
skeletal muscle connective tissue replaces severely damaged muscle
primary intention healing takes place when a wound margins are neatly approximated, as in a surgical incision or a paper cut
the initial inflammatory phase lasts for 3-5 days, approximation of incision edges, fibrin clot forms meshwork for starting capillary growth
the granulation (fibroblastic, reconstructive) phase is the second step and last from 5 days to 3 weeks.
during the granulation phase the wound is pink and vascular ( good blood flow)
fibroblasts are immature connective tissue cells that migrate into the healing site and secrete collagen
collagen is organized and restructured to strengthen the healing site, at this stage it is termed scar tissue or fibrous
during the maturation phase it begins 7 days after the injury and continue for several months or years
secondary intention are wounds that occur from trauma, ulceration, and infection have large amounts of exudate and wide, irregular wound margins with extensive tissue loss
secondary intention wound edges cannot be approximated or brought together
healing and granulation take place from the edges inward and from the bottom of the wound upward until the defect is filled
tertiary intention healing occurs with the delayed suturing of a wound in which two layers of granulation tissue are sutured together
a contaminated wound is left open and sutured closed after the infection is controlled tertiary intention
wounds are classified by their cause (surgical or non surgical; acute or chronic) or depth of tissue affected (superficial, partial thickness, or full thickness
superficial wound involves only the dermis
partial thickness wounds extend into the dermis
full thickness wounds have the deepest later of tissue destruction because they involve the subcutaneous tissue and sometimes extend into the fascia and underlying structures such as the muscle, tendon or bone
another system used to classify open wounds is based on the color of the wound (red, yellow, black)
adhesions are bands of scar tissue that form between or around organs, may occur in the abdominal cavity or between the lungs and pleura and may cause intestinal obstruction
evisceration occurs when wound edges separate to the extent that intestines protrude through wound
dehiscence is the separation and disruption of previously joined wound edges
dehiscence may be caused by infection caused by inflammation, granulation tissue not strong enough to withstand forces imposed on wound, obese people are at higher risk because adipose tissue has less blood supply
fistula formation is an abnormal passage between organs or a hollow organ and skin
keloid formation is a great protrusion of scar tissue that extends beyond wound edges and may form tumor like masses of scar tissue. occurs more in african americans
hypertrophic scar occurs when an overabundance of collagen is produced during healing, raised red and hard scar that is non life threatening
wound measurements are made in centimeters
tunneling of a wound is when cotton tip is placed in a wound and there is movement
underminin of a wounds is when there is a lip under the wound
tunneling and undermining are charted in respect to a clock
sutures and fibrin sealant are used to facilitate wound closure and create an optimal setting for wound healing
fibrin sealant can be used with sutures or can used independently to seal wound sites where sutures cannot control bleeding
primary intention wounds is common to cover wound with a dry sterile dressing that is removed as soon as drainage stops, or 2-3 days
topical antimicobials shouldn't be used in a clean granulating wound because they may damage the new epithelium and delay the healing process
red wound the purpose of treatment is to protection of the wound and gentle cleansing
for a red wound the dressing material should keep the wound surface clean and slightly moist is optimal to promote epithelialization
transparent films are semipermeable dressing that permits gaseous exchange between wound and environment, use
used for dry noninfected wounds or wounds with minimal drainage transparent films (tegaderm, transeal, OpSite, BlisterFilm)
yellow wound dressing materials should absorb the exudate and cleanse the wound surface. number of dressing changes is determined by the amount of wound secretions
black wound treatment calls for immediate debridement of the nonviable, eschar tissue
hydrocolloid dressings are used to treat yellow wounds
the inner part of hydrocolloid dressings interact with exudate, forming a hydrated gel over the wound. doesn't allow O2 to diffuse from the atmosphere to the wound
type of therapy that uses suction to remove drainage and speed wound healing negative pressure wound therapy (wound vac)
for negative pressure therapy you should monitor the patients serum protein levels and fluid and electrolyte balance due to losses from the wound
gauzes and nonwovens provides absorption of exudates, supports debridement if applied and kept moist. can be used for cleaning or packing of a wound ( kerlix, kling)
nonadherent dressings are woven or non woven dressings, with either saline, petrolatum or antimicrobials in them. used on minor wounds or as a second dressing
foam dressings are sheets or other shapes of foamed polymer solution with small, open cells capable of holding fluids. used for partial or full thickness wounds or infected wounds ( allevyn, curafoam)
absorptive dressings are for large volumes of exudates that need to be absorbed. for partial or full thickness wounds (ABD pads, Covaderm, Abdominal pads)
hydrogel dressing is available as a sheet, gel or gauze designed to donate moisture to a dry wound and maintain a moist healing environment, serves to rehydrate the wound tissue. provides limited absorption of exudate, partial of full thickness wounds (AquaSite, Tegagel,)
angiogenesis is the production of new blood vessels
surgical debridement is the quick method of debridement to prevent, control, or remove infection
mechanical debridement is when a wet to dry dressing in which open mesh gauze is moistened with normal saline, packed on or into wound surface and allowed to dry
a diet high in protein, carbs, and vitamins with moderate fat intake is necessary to promote healing.
a pressure ulcer is a localized injury to the skin and/or underlying tissue (usually over a bony prominence)
pressure ulcers fall under the category of healing by secondary intention
most common site for pressure ulcers is the sacrum and then the heels
shearing force is the pressure exerted on the skin when it adheres to the bed and the skin layers slide in the direction of body movement
risk factors the pressure ulcers include advanced age, anemia, diabetes, immobility, incontinence, low diastolic BP <60 mmHg, obesity, vascular disease
unstageable pressure ulcer is when (full thickness)the actual depth of the tissue loss is obscured by slough (yellow, tan, gray, green or brown) and/ or eschar (tan, brown, or black) in the wound bed
stage 1 pressure ulcer is a nonblanchable redness of a localized area usually over a bony prominence
stage 2 pressure ulcer is partial thickness loss of dermis manifesting as a shallow open ulcer with red pink wound bed, with out slough
stage 3 pressure ulcer is full thickness tissue loss with subcutaneous fat may be visible but not bone
stage 4 pressure ulcer is full thickness tissue loss with exposed bone, tendon or muscle. slough or eschar may be present on some parts of the wound bed
risk assessment should be done using the braden scale to assess for risks of pressure ulcer
document a pressure ulcer based on stage, size, location, amount of exudate, type of wound, presence of infection or pain
Created by: 691650210
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