©skubala 1. 2 the dust mite quietly lurking under our beds, inside sofas and carpet are creatures...
TRANSCRIPT
©SKUBALA1
©SKUBALA2
The Dust Mite
Quietly lurking under our beds, inside sofas and carpet are creatures too small to see without a microscope or strong magnifying glass.
OH, see how they itch!
©SKUBALA3
Antigen
The dust mite deposits antigens on our skin surface and are immune system system reacts
©SKUBALA4
Inflammatory Response
Antigens stick to the mast cell IgE antibodies, causing granules in the mast cell to fire their contents into the surrounding tissue.
©SKUBALA5
Response to Injury
ADAPTIVEHypertrophy – increased size
Hyperplasia – increased number
Atrophy – decreased size
Metaplasia – change in type of cell; reversible
MALADAPTIVEDysplasia – reversible if stimulus is removed
Anaplasia – often characteristic of malignant tumors
©SKUBALA6
©SKUBALA7
Inflammation vs. Infection
Inflammation can be caused by non-living agentsInflammation is always present with infectionA superimposed infection can occur with inflammation
Infection is caused by the invasion of cells by microorganismsInfection is not always present with inflammation
©SKUBALA8
Iatrogenic vs Nosocomial
Iatrogenic: Caused by the treatment of a physician, resulting in an adverse condition
Nosocomial: Caused by exposure to an organism in the hospital setting
©SKUBALA9
Clinical ManifestationsLocalized
RednessHeatPainSwellingLoss of Function
©SKUBALA10
Clinical ManifestationsSystemic
LeukocytosisMalaiseNauseaAnorexiaIncreased pulseIncreased respiratory rateFever
©SKUBALA11
Primary Defense Mechanisms
Skin and mucous membranesMononuclear phagocyte systemInflammatory responseImmune system
©SKUBALA12
Mononuclear Phagocyte System
MPS is made up of monocytes, macrophages and their precursor cells.Located in various tissues and organsOriginate in bone marrowFunction: Phagocytosis and participation in the immune response
©SKUBALA13
Inflammatory ResponseVascular
VasoconstrictionRelease of histamine/chemicalsVasodilation Increased capillary permeabilityFluid exudate
©SKUBALA14
Inflammatory ResponseCellular
Margination and diapedesisChemotaxis to attract leukocytes NeutrophilsPus formation WBC’s (bands)MonocytesLymphocytesEosinophils and basophils
©SKUBALA16
©SKUBALA15
Mediators in Inflammatory Response
HistamineSerotoninKininsComplement componentsFibrinopeptidesProstaglandins and leukotrienesLympokines
©SKUBALA16
Stages of Febrile Response
ProdromalChillFlushDefervescence
©SKUBALA17
The Healing Process
Regeneration – replacement of lost cells and tissue with cells of the same typeRepair – healing as a result of lost cells being replaced by connective tissue
Primary intentionSecondary intentionTertiary intention
©SKUBALA18
Primary Intention
Wound margins well approximated
Surgical incisionsPaper cuts
Phases:InitialGranulationScar contraction and maturation-
©SKUBALA19
Secondary Intention
Wide, irregular wound marginsTraumaUlcerationInfection
Wound classification RedYellowBlack
©SKUBALA20
Tertiary Intention
Delayed primary intentionDelayed suturingInfection
Larger deeper scar
©SKUBALA21
©SKUBALA22
Complications of Healing
Keloid formationContractureDehiscenceAdhesions
©SKUBALA23
Factors that Delay Wound Healing
Nutritional deficienciesInadequate blood supplyCorticosteroid drugsInfectionMechanical friction on woundAdvanced ageDiabetes MellitusAnemia
©SKUBALA24
Health Promotion
PreventionAdequate nutritionEarly recognition
©SKUBALA25
Interventions
Observation of symptomsFever
Assess wound and documentConsistencyColorOdorDrainage
©SKUBALA26
Rest and immobilizationElevationOxygenationHeat/ColdWound managementPrevent infection
©SKUBALA27
Wound Classifications
Red wound Yellow woundBlack Wound
©SKUBALA28
Red Wound Treatment
PURPOSE: Protection and gentle atraumatic cleansingDressing:
Transparent film dressingGauze dressing with antimicrobial ointment or solutionTelfa dressing with antibiotic ointment
©SKUBALA29
Yellow Wound
PURPOSE: Wound cleansing to remove nonviable tissue and absorb excess drainage
Wound irrigationWet to dry dressingsWith or without antimicrobial agentHydrocolloidal dressing (Duoderm)
©SKUBALA30
Black Wound
PURPOSE: Debridement of eschar and nonviable tissue
Topical enzyme debridementSurgical debridementHydrotherapyChemical debridementMoist gauze dressingHydrogel covered with gauze
©SKUBALA31
©SKUBALA32
Antibiotic Resistant Organisms
Methicillin-resistant Staphylococcus aureus (MRSA)Vancomycin-resistant enterococci (VRE)Penicillin-resistant Streptococcus pneumoniae (PRSP)
©SKUBALA33
The Immune Response
Immunity is a state in which the body is capable of responding to microorganisms such as bacteria, viruses, and tumor proteins.
©SKUBALA34
Immunity
Functions of immune responseDefenseHomeostasisSurveillance
Properties of the immune response SpecificityMemorySelf-recognitionSelf-limitationSpecialization
©SKUBALA35
Specificity
Antigen – introduced into bodyCellular reactionAntibody formedSensitized lymphocytesAntigen/antibody complex
©SKUBALA36
Types of Immunity
Natural ImmunityNot produced by an immune responseInnate
Acquired ImmunityActive acquiredPassive acquired
©SKUBALA37
Components - Immune System
ThymusBone marrowTonsilsGut – Genital – BronchialLymph nodesSpleen
©SKUBALA38
Humoral Immunity
Antibody-mediated immunityAntigen-antibody interactionsImmunoglobulins
IgGIgAIgMIgDIgE
©SKUBALA39
©SKUBALA40
Cell Mediated Immunity
Immunity from pathogens that survive inside of cells such as viruses/bacteriaImmunity from fungal infectionsRejection of transplanted tissuesContact hypersensitivity reactionTumor immunity
©SKUBALA41
Cell Mediated ImmunityCell Types
T- lymphocytes (CD3)T-cytotoxicT-helper (CD4)T-suppressor (CD8)
Natural killer cellsCytokinesMacrophages
©SKUBALA42
Altered Immune Response
Hypersensitivity reactionsAllergic disordersImmunodeficiencyAutoimmune Disorders
©SKUBALA43
©SKUBALA44
Hypersensitivity Reactions
Immediate – humoral immunity Types I, II, III
Delayed – cell mediated immunity Type IV
Immunoglobulins
©SKUBALA45
Type I: Anaphylactoid Reactions
SensitizedIgELocalized
Wheal and flare
SystemicAnaphylactic shock
Clinical significance
©SKUBALA46
Anaphylactic Shock
Bronchial constrictionAirway constrictionAirway obstructionVascular collapseTarget organs affected (Fig 12-7)
©SKUBALA47
Initial Symptoms
EdemaUticaria
©SKUBALA48
Symptoms of Shock
Rapid, weak pulseHypotensionDilated pupilsDyspneaPossible cyanosisBronchial edemaAngioedema
©SKUBALA49
Type II: Cytotoxic and Cytolytic Reactions
IgG or IgMComplement systemCytolisis/Enhanced phagocytosisClinical significance – transfusion reactions
©SKUBALA50
Type III: Immune-Complex Reactions
AntigenIgG and IgMComplement systemChemotactic factorsClinical significance
©SKUBALA51
Type IV: Delayed Hypersensitivity
ReactionIntracellular or extracellular antigensNo immunoglobulins involvedT-lymphocytesClinical significance
©SKUBALA52
Allergic Disorders
Health historyFamily historyPast and present allergiesPhysical exam
©SKUBALA53
Allergic DisordersDiagnostics
Lymphocyte count < 1200/µlEosinophil countRAST (radioallergosorbent test)Sputum/nasal/bronchial secretionsPFT’sSkin Tests
©SKUBALA54
Skin Tests
TypesCutaneous scratchIntracutaneous injection
Results:A + reaction - implies sensitivity
©SKUBALA55
Nursing Care/Therapy
Therapy:Reduce exposureTreat symptomsDesensitization
Be prepared:– Anaphylactic reactions– List allergies– Shell fish
©SKUBALA56
Anaphylaxis
Sudden onsetantibioticsblood productsinsect bites
Therapeutic ManagementRecognize signs/symptomsMaintain patent airwayPrevent spreadAdminister drugs:
EpinephrineBenadrylO2Establish IV: IVF’s/Dopamine
©SKUBALA57
Chronic Allergies
Allergen recognition and controlStress managementEnvironmental controlsBee-sting kitsMedic alert bracelets
©SKUBALA58
Drug Therapy
AntihistaminesEpinephrineCorticosteroidsAntipruriticsMast-cell stabilizers
©SKUBALA59
Immunotherapy
Anaphylactic reactions to insect venomUnavoidable exposureDrug therapy ineffective