Inflammation Chapter 12 Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Sequential response to cell injury Neutralizes and dilutes inflammatory agent Removes necrotic materials Establishes an environment suitable for healing and repair Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Mechanism of inflammation basically the same regardless of injuring agent Intensity of the response depends on Extent and severity of injury Reactive capacity of injured person Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Inflammatory response can be divided into Vascular response Cellular response Formation of exudate Healing Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Vascular and Cellular Response to Injury Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Vascular Response After cell injury, arterioles in area briefly undergo transient vasoconstriction. After release of histamine and other chemicals by the injured cells, vessels dilate, resulting in hyperemia. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Vascular and Chemical Response Vasodilation chemical mediators Endothelial cell retraction Increased capillary permeability Movement of fluid from capillaries into tissue spaces Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Vascular Response Fluid in tissue spaces Initially composed of serous fluid Later contains plasma proteins, primarily albumin Proteins exert oncotic pressure that further draws fluid from blood vessels. Tissue becomes edematous. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Vascular Response As plasma protein fibrinogen leaves blood, it is activated into fibrin by products of the injured cells. Fibrin strengthens a blood clot formed by platelets. In tissue, clots trap bacteria to prevent spread. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Blood flow through capillaries in the area of inflammation slows as fluid is lost and viscosity increases. Neutrophils and monocytes move to the inner surface of the capillaries and then migrate through the capillary wall to the site of the injury. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Chemotaxis Directional migration of WBCs along concentration gradient of chemotactic factors Mechanism for accumulating neutrophils and monocytes at site of injury Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Chemotactic factors Bacterial-derived Complement-derived (C5a, C3a) Lipid-derived Platelet-derived Coagulation-related Chemokines Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Neutrophils First leukocytes to arrive at site of injury (6 to 12 hours) Phagocytize bacteria, other foreign material, and damaged cells Short life span (24 to 48 hours) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Neutrophils Pus is composed of Dead neutrophils accumulated at the site of injury Digested bacteria Other cell debris Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Neutrophils Bone marrow releases more neutrophils in response to infection, resulting in elevated WBC. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Monocytes Second type of phagocytic cells to migrate to site of injury from circulating blood Attracted to the site by chemotactic factors Arrive within 3 to 7 days after the onset of inflammation Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Monocytes On entering tissue spaces, monocytes transform into macrophages. Assist in phagocytosis of inflammatory debris Macrophages have a long life span and can multiply. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Macrophage Important in cleaning the area before healing can occur May stay in damaged tissues for weeks Cells may fuse to form a multinucleated giant cell. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Lymphocytes Arrive later at the site of injury Primary roles of lymphocytes involve Cell-mediated immunity Humoral immunity Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Complement system Major mediator of the inflammatory response Enzyme cascade (C1-C9) consisting of pathways to mediate inflammation and destroy invading pathogens Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Major functions of the complement system Enhanced phagocytosis Increased vascular permeability Chemotaxis Cellular lysis Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Complement system C8 and C9, the final components of the complement system, pierce the cell surface, causing rupture of the cell membrane and lysis. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Prostaglandins Following injury, arachidonic acid is converted into prostaglandins, thromboxane, and leukotrienes. Considered proinflammatory Potent vasodilators Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Pathway of Generation Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Thromboxane Powerful vasoconstrictor Platelet-aggregating agent Promotes clot formation Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Cellular Response Exudate Consists of fluid and leukocytes that move from the circulation to the site of injury Nature and quantity depend on the type and severity of the injury and the tissues involved. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Clinical Manifestations Systemic response to inflammation Increased WBC count with a shift to the left Malaise Nausea and anorexia Increased pulse and respiratory rate Fever Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Clinical Manifestations Systemic response to inflammation Fever Onset is triggered by release of cytokines. Cytokines cause fever by initiating metabolic changes in the temperature- regulating center in hypothalamus. Epinephrine released from the adrenal medulla increases metabolic rate. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Production of Fever Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Clinical Manifestations Systemic response to inflammation Fever Patient then experiences chills and shivering. Body is hot, yet person seeks warmth until the circulating temperature reaches core body temperature. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Clinical Manifestations Systemic response to inflammation Fever Beneficial aspects of fever include increased killing of microorganisms, increased phagocytosis, and increased proliferation of T lymphocytes. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Types of Inflammation Acute Healing occurs in 2 to 3 weeks, usually leaving no residual damage. Neutrophils are the predominant cell type at the site of inflammation. Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Types of Inflammation Subacute Has same features as acute inflammation but persists longer Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammatory Response Types of Inflammation Chronic May last for years Injurious agent persists or repeats injury to site. Predominant cell types involved are lymphocytes and macrophages. May result from changes in immune system (e.g., autoimmune disease) Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Acute Intervention Observation Vital signs Fever management Nursing and Collaborative Management Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Nursing Implementation Health promotion Prevention of injury Adequate nutrition Early recognition of inflammation Immediate treatment Nursing and Collaborative Management Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Drug therapy Aspirin Acetaminophen NSAIDs Corticosteroids Nursing and Collaborative Management Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

RICE Rest Ice Compression Elevation Nursing and Collaborative Management Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Inflammation Healing Process The final phase of the inflammation process is healing. Healing includes two major components: Regeneration Repair Copyright © 2014 by Mosby, an imprint of Elsevier Inc.