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Injurious agents Physical mechanical objects causing trauma, excessive heat or cold, radiation
Injurious agents Chemical internal irritants (substances manufactured in body; ex: hydrochloric acid in stomach, as in GERD)
Injurious agents Chemical external irritants strong acids , alkalis, poisons, irritating gases
bacteria Microorganisms
viruses Microorganisms
fungi Microorganisms
parasites Microorganisms
Function of inflammation allows repair of injured area to proceed at faster pace
--Contains injury --Destroys microorganisms Inflammaiton
also can occur in absence of infection. Inflammation
Always present with infection Inflammation
chronic Inflammation Tissue is repeatedly destroyed & repaired, impairing healing.
autoimmune diseases Disproportionate response to the irritating stimulus or against inappropriate target,
IBD—Crohn’s disease or ulcerative colitis autoimmune diseases
Brings fluid, dissolved substances, blood cells to tissues where invasion or damage occurred Adaptive response to injury or illness
Invader neutralized, eliminated, destroyed tissue removed  healing initiated Adaptive response to injury or illness
debrides, allows healing Adaptive response to injury or illness Phagocytosis
same events occur regardless of cause Adaptive response to injury or illness Nonspecific
Pain 1 of the 5 signs of inflammation
Swelling 1 of the 5 signs of inflammation
Redness 1 of the 5 signs of inflammation
Heat 1 of the 5 signs of inflammation
Impaired Function of Part, if injury severe 1 of the 5 signs of inflammation
inflammation sufix "-itis"
Margination leukocytes line up inside vessel walls near injured area
emigration occurs, when they move through the vessel wall into the tissue spaces.
Hyperemia causes redness and heat characteristic of inflammation. Blood flow slows in dilated areas.
leukocytosis leukocyte leakage into tissue
leukocytosis The bone marrow produces more WBC’s in response to
organ function Increased fluid in pleural or pericardial cavity can seriously affect
Inflammation can raise WBC’s from 4500-11,000 to over 20,000 when inflammation occurs.
Joint mobility may be impaired as well.
Pain is from accumulating fluid putting pressure on nerve endings and effects of irritating chemical mediators
histamine irritating chemical mediators
kinins irritating chemical mediators
prostaglandins irritating chemical mediators
1st stage in inflammation Vascular and Cellular Responses
Blood vessels constrict at site of injury Vascular and Cellular Responses step 1
Rapidly followed by vasodilation caused by histamine release from injured tissues, increasing blood flow to area Vascular and Cellular Responses step 2
Vascular permeability increases Vascular and Cellular Responses step 3
Leukocytes leak into interstitial spaces; bone marrow makes more leukocytes and WBC count ↑’s in response to inflammation (leukocytosis— to 20,000 +) Vascular and Cellular Responses step 4
Swelling and pain appear Vascular and Cellular Responses step 5
Hemorrhagic blood from ruptured blood vessels, red and thick
Purulent pus; usually opaque, milky; normally indicates presence of infection, contains large # of cells & necrotic debris
Serous typically accompanies mild inflammation; clear or straw-colored, then watery
2nd stage in inflammation Exudate (“exude” or “ooze”) Production
Made of fluid that escapes from blood vessels, dead phagocytic cells, and dead tissue cells and products they release (serous, purulent, or hemorrhagic Exudate (“exude” or “ooze”) Production step 1
Fibrinogen converts to fibrin in the tissues with thromboplastin and platelets to form interlacing wall to close off the area and prevent spread of injurious agent Exudate (“exude” or “ooze”) Production step 2
Exudate clears away injurious agent by way of lymphatic drainage Exudate (“exude” or “ooze”) Production step 3
nerves Poor regenerative capacity tissues
muscles Poor regenerative capacity tissues
elastic tissues. Poor regenerative capacity tissues
Epithelial tissues of skin good regenerative capacity
GI tract good regenerative capacity
bone good regenerative capacity
lymph good regenerative capacity
bone marrow good regenerative capacity
If regeneration is not possible repair occurs by scar formation
scar formation, mainly made of collagen
3rd stage of inflammation Reparative Phase
Granulation tissue appears early in this phase; fragile, gelatinous, pink or red tissue (from newly formed capillaries)
Repair of injured tissues by regeneration or replacement with scar tissue; damaged tissues replaced with connective tissue Reparative Phase step 1
Regeneration replaces destroyed tissue cells by cells that are identical or similar in structure and function Reparative Phase step 2
Cells are organized so patterns of cells and function of tissue are restored Reparative Phase step 3
Granulation tissue—appears early in this phase; fragile, gelatinous, pink or red tissue (from newly formed capillaries) Reparative Phase step 4
Histamine is Key chemical mediator of inflammation
Stored in mast cells in skin, bronchial tree, GI tract, blood vessels Histamine
Directly stimulates pain receptors, ↑ capillary permeability Histamine
Dilates nearby blood vessels Histamine
Anaphylaxis (life-threatening allergic reaction)— Histamine
Anaphylaxis (life-threatening allergic reaction)—rapid, large scale, widespread release of chemical mediators of inflammation throughout body
H1 receptors vascular system, bronchial tree
H2 receptors primarily in stomach
Histamine receptors H1 receptors: vascular system, bronchial tree H2 receptors: primarily in stomach
Benadryl (diphenhydramine), block H1 receptors
Vistaril (hydroxyzine) block H1 receptors
Zantac (ranitidine), block H2 receptors
Tagamet (cimetidine) block H2 receptors
Common diseases Appendicitis Crohn’s disease Arthritis—most common inflammatory disorder and leading cause of disability in U.S. Nephritis Peptic ulcers SLE (lupus) RA (rheumatoid arthritis) Inflammatory bowel disease
Erythrocyte sedimentation rate normal male 0–15 mm/h
Erythrocyte sedimentation rate normal female 0–25 mm/h
WBC with differential WBC 4,500-11,000
C-reactive protein (CRP) people with high levels may have ↑ risk for heart disease from inflammatory arterial damage
ESR measures how fast erythrocytes (RBCS) settle in tube over given period of time
ESR Erythrocyte sedimentation rate
RICE Rest Ice Compression Elevation
Ice 20 min q 2-3 hrs
Compression i.e. ace wrap--√ color, sensation, temp, extremity ROM, pulses
preventing further injury minimize mobility & wt-bearing: splints, slings, wheelchairs, walkers, crutches
Especially during 1st 24-48 hrs after injury: RICE
flaxseed oil anti-inflammatory
fish oil anti-inflammatory
walnut oil anti-inflammatory
omega 3’s flaxseed oil, fish oil, and walnut oil
vitamin C for cellular repair nutrients to support healing
protein nutrients to support healing
carbs nutrients to support healing
NSAIDS--Nonsteroidal Anti-Inflammatory Drugs Inhibit synthesis of prostaglandins, lipids in all tissues that promote inflammation
Analgesics pain NSAIDS
antipyretics fever NSAIDS
Ibuprofen (Motrin), ↓’s pain & fever-NSAIDS
Naproxen (Aleve), ↓’s pain & fever-NSAIDS
aspirin ↓’s pain & fever-NSAIDS
Indomethacin (Indocin), ↓’s pain & fever-NSAIDS
Celecoxib ↓’s pain & fever-NSAIDS
Celebrex Cox 2 inhibitor-↓’s pain & fever-
peptic ulcers Avoid NSAIDS or use with caution in client
anticoagulants Avoid NSAIDS or use with caution in client
↓ liver or kidney function Avoid NSAIDS or use with caution in client
Corticosteroids (Glucocorticoids) Comes from the adrenal gland
Natural hormones, released by adrenal cortex--↓ swelling & pain Corticosteroids (Glucocorticoids)
Potent anti-inflammatory agents Corticosteroids (Glucocorticoids)
Generally for short-term treatment due to potentially serious side effects Corticosteroids (Glucocorticoids)
Cortisone, Prednisone, Dexamethasone, Methylprednisolone Corticosteroids (Glucocorticoids)
↓Immune response, ↑blood glucose, ↑WBC, mood swings, fluid retention, GI ulcers Corticosteroids (Glucocorticoids) Adverse effects
To treat pain associated with inflammation if NSAIDS alone insufficient Analgesics
Morphine, Oxycodone (opioids) Analgesics
Monitor respiratory rate Analgesics
Monitor pain status Analgesics
Sedation, ↓ LOC, CNS depression, nausea, vomiting, constipation Analgesics
EPA and DHA Fish Oils
Also lower triglycerides Fish Oils
May interact with NSAIDS to increase susceptibility to bruising, nosebleeds, or other sources of bleeding Fish Oils
Created by: ED.
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