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Inflammation 102
LU Lewis and Lecture notes
| Question | Answer |
|---|---|
| Epidermis | top layer, 0.05-1.5 mm layer, langerhan and dendritic cells first level of defense |
| dermis | collagen and elastic fibers, 0.3-3.0mm glands and hair follicles |
| subcutaneous | fat, varies from person to person, regulates body temperature |
| Assessing wounds | size, location, redness, edema, ecchymosis, drainage, approximation |
| vascular response | vasoconstriction (limit bleeding), followed by vasodilation (bring WBC to area, allows fluid to leak out of vascular) fibrin forms |
| cellular response | neutrophils, monocytes, |
| neutrophils | arrive first at injury (phagocytes). Eat, digest and produce waste products (pus), comes from the bone marrow |
| Shift to the left | infection in body so great depeletes mature WBC and the bone marrow sends out immature neutrophils (called bands) to help the fight. Check CBC for bands |
| monocytes | arrive 3-5 days after injury, get rid of waste produced by phagocytes, macrophages release fibrenogin and starts to heal and knit together |
| Chemical Response to injury | Complement system, 1-9 types. Complement deficiency means one is missing. |
| Kines, histamines, prostaglandins, serotonin | chemical response, all irritate skin and cause pain and swelling, part of healing |
| prostaglandins | activate pathways that cause production of leukotrines (which cause anaphylactic reaction) |
| arterial problem | not much swelling, but can't get stuff to the area of damage |
| venous problem | swollen, can't get the bad stuff back out |
| Cillins (PCN) | cidal, GI issues and rash, no toxicity, watch for anaphylaxisis, Gram + |
| cephlosporins (Keflex, ceclor) | cidal, GI issues, no toxicity, cross reacts with PCN, Gram + and -. Most common antibiotics |
| Tetra (cycline) | NO CHILDREN, static, GI Issues and yeast, renal toxic, Adverse coumadin, milk, sunlight and stains teeth, Gram + and - |
| macrolides (myicin) | static, GI and hepatic toxicity, OTO toxic and renal, take with water, no grapefruit juice, Gram + |
| aminoglycosides (genatmycin, vancomycin) | cidal, rash, GI, fatigue, irreversible Ototoxic, nephro toxic, Measure peaks and troughs, can affect coumadin. Gram - and some + |
| fluroquinolins (cipro No PG, oxins No Kids) | static, GI, dysrhythmias, hepatotoxicity, tendon ruptures, anaphylactic, BS elevation, Gram + and pseudomonus |
| Sulfa (bactrim) | static, rash (up to 6 weeks), aplastic anemia, fatal blood abnormality, Gram + and - |
| Fever | thermostat in hypothalmus, prostoglandins act on it to increase them, causes shiver, sweating etc to lower temp. Epi released increases metabolism, treet 100.1 and above |
| NSAIDS | antiprostaglandin meds. antipyretic, antiinflammatory, analgesic. mild to moderate GI effects |
| ASA | lasts for a couple of days, renal toxic. Reye's syndrome in children |
| Tylenol | analagesic, high rate of death (in multiple meds patients OD without meaning to). liver toxic. Max dose 4000mg QD. Antidote is mucomist |
| Cox 2 | celebrex, block receptors. NOT antipyretic, no GI effects but possible cardiac effects |
| nosocomial infections | hospital acquired |
| Factors impede healing | smoking, immobility, nutrition, chronic diseases, meds, skin breakdown, environment |
| Phases of Wound Healing | Inflammatory phase, proliferative phase, remodeling phase |
| Inflammatory phase | immediate to 2-5 days, hemostasis (vasoconstriction, platelets, clotting). Inflammation (vasodilation, phagocytosis) |
| Proliferative phase | 2 days to 3 weeks. Granulation (fibroblasts lay new collagen, fills defects and makes caps). Contraction (wound edges pull together). Epitheliazation (crosses moist surfaces 3 cm from good cell in all directions) |
| remodeling phase | 3 weeks to 2 years. New collagen forms (for strength) and scare tissue grows |
| suprainfections | yeast, black tongue, caused by antibiotic use |
| antifungal meds | diflucan, lamasil. Live toxic, use with caution in Liver patients |
| antivirals | valtrex, treat virus. Liver toxic |
| tamiflu | to shorten the length of flu, and to prevent it after exposure |
| RYB wounds | Red (trauma or surgical wound: protect and clean) Yellow (prescence of slough and exudate: cleaning and removal of non viable tissue) Black (necrotic tissue: debridement) |
| Types of Dressings | gauze, nonadherent dressings, transparent films, hydrocolloids, foams, absorptive dressings, hydrogel, alginates, antimicrobials |
| Reduce risk of pressure sore in Wheelchair | shift weight every 20 min |
| vasoconstriction | initial inflammatory response |
| arachidionic pathway | leukotrienes and prostoglandins |
| liver function decreases | decrease dosage |
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