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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!
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Antigen
The dust mite deposits antigens on our skin surface and are immune system system reacts
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Inflammatory Response
Antigens stick to the mast cell IgE antibodies, causing granules in the mast cell to fire their contents into the surrounding tissue.
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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
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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
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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
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Clinical ManifestationsLocalized
RednessHeatPainSwellingLoss of Function
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Clinical ManifestationsSystemic
LeukocytosisMalaiseNauseaAnorexiaIncreased pulseIncreased respiratory rateFever
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Primary Defense Mechanisms
Skin and mucous membranesMononuclear phagocyte systemInflammatory responseImmune system
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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
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Inflammatory ResponseVascular
VasoconstrictionRelease of histamine/chemicalsVasodilation Increased capillary permeabilityFluid exudate
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Inflammatory ResponseCellular
Margination and diapedesisChemotaxis to attract leukocytes NeutrophilsPus formation WBC’s (bands)MonocytesLymphocytesEosinophils and basophils
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Mediators in Inflammatory Response
HistamineSerotoninKininsComplement componentsFibrinopeptidesProstaglandins and leukotrienesLympokines
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Stages of Febrile Response
ProdromalChillFlushDefervescence
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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
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Primary Intention
Wound margins well approximated
Surgical incisionsPaper cuts
Phases:InitialGranulationScar contraction and maturation-
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Secondary Intention
Wide, irregular wound marginsTraumaUlcerationInfection
Wound classification RedYellowBlack
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Tertiary Intention
Delayed primary intentionDelayed suturingInfection
Larger deeper scar
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Complications of Healing
Keloid formationContractureDehiscenceAdhesions
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Factors that Delay Wound Healing
Nutritional deficienciesInadequate blood supplyCorticosteroid drugsInfectionMechanical friction on woundAdvanced ageDiabetes MellitusAnemia
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Health Promotion
PreventionAdequate nutritionEarly recognition
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Interventions
Observation of symptomsFever
Assess wound and documentConsistencyColorOdorDrainage
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Rest and immobilizationElevationOxygenationHeat/ColdWound managementPrevent infection
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Wound Classifications
Red wound Yellow woundBlack Wound
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Red Wound Treatment
PURPOSE: Protection and gentle atraumatic cleansingDressing:
Transparent film dressingGauze dressing with antimicrobial ointment or solutionTelfa dressing with antibiotic ointment
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Yellow Wound
PURPOSE: Wound cleansing to remove nonviable tissue and absorb excess drainage
Wound irrigationWet to dry dressingsWith or without antimicrobial agentHydrocolloidal dressing (Duoderm)
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Black Wound
PURPOSE: Debridement of eschar and nonviable tissue
Topical enzyme debridementSurgical debridementHydrotherapyChemical debridementMoist gauze dressingHydrogel covered with gauze
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Antibiotic Resistant Organisms
Methicillin-resistant Staphylococcus aureus (MRSA)Vancomycin-resistant enterococci (VRE)Penicillin-resistant Streptococcus pneumoniae (PRSP)
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The Immune Response
Immunity is a state in which the body is capable of responding to microorganisms such as bacteria, viruses, and tumor proteins.
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Immunity
Functions of immune responseDefenseHomeostasisSurveillance
Properties of the immune response SpecificityMemorySelf-recognitionSelf-limitationSpecialization
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Specificity
Antigen – introduced into bodyCellular reactionAntibody formedSensitized lymphocytesAntigen/antibody complex
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Types of Immunity
Natural ImmunityNot produced by an immune responseInnate
Acquired ImmunityActive acquiredPassive acquired
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Components - Immune System
ThymusBone marrowTonsilsGut – Genital – BronchialLymph nodesSpleen
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Humoral Immunity
Antibody-mediated immunityAntigen-antibody interactionsImmunoglobulins
IgGIgAIgMIgDIgE
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Cell Mediated Immunity
Immunity from pathogens that survive inside of cells such as viruses/bacteriaImmunity from fungal infectionsRejection of transplanted tissuesContact hypersensitivity reactionTumor immunity
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Cell Mediated ImmunityCell Types
T- lymphocytes (CD3)T-cytotoxicT-helper (CD4)T-suppressor (CD8)
Natural killer cellsCytokinesMacrophages
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Altered Immune Response
Hypersensitivity reactionsAllergic disordersImmunodeficiencyAutoimmune Disorders
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Hypersensitivity Reactions
Immediate – humoral immunity Types I, II, III
Delayed – cell mediated immunity Type IV
Immunoglobulins
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Type I: Anaphylactoid Reactions
SensitizedIgELocalized
Wheal and flare
SystemicAnaphylactic shock
Clinical significance
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Anaphylactic Shock
Bronchial constrictionAirway constrictionAirway obstructionVascular collapseTarget organs affected (Fig 12-7)
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Initial Symptoms
EdemaUticaria
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Symptoms of Shock
Rapid, weak pulseHypotensionDilated pupilsDyspneaPossible cyanosisBronchial edemaAngioedema
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Type II: Cytotoxic and Cytolytic Reactions
IgG or IgMComplement systemCytolisis/Enhanced phagocytosisClinical significance – transfusion reactions
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Type III: Immune-Complex Reactions
AntigenIgG and IgMComplement systemChemotactic factorsClinical significance
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Type IV: Delayed Hypersensitivity
ReactionIntracellular or extracellular antigensNo immunoglobulins involvedT-lymphocytesClinical significance
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Allergic Disorders
Health historyFamily historyPast and present allergiesPhysical exam
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Allergic DisordersDiagnostics
Lymphocyte count < 1200/µlEosinophil countRAST (radioallergosorbent test)Sputum/nasal/bronchial secretionsPFT’sSkin Tests
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Skin Tests
TypesCutaneous scratchIntracutaneous injection
Results:A + reaction - implies sensitivity
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Nursing Care/Therapy
Therapy:Reduce exposureTreat symptomsDesensitization
Be prepared:– Anaphylactic reactions– List allergies– Shell fish
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Anaphylaxis
Sudden onsetantibioticsblood productsinsect bites
Therapeutic ManagementRecognize signs/symptomsMaintain patent airwayPrevent spreadAdminister drugs:
EpinephrineBenadrylO2Establish IV: IVF’s/Dopamine
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Chronic Allergies
Allergen recognition and controlStress managementEnvironmental controlsBee-sting kitsMedic alert bracelets
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Drug Therapy
AntihistaminesEpinephrineCorticosteroidsAntipruriticsMast-cell stabilizers
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Immunotherapy
Anaphylactic reactions to insect venomUnavoidable exposureDrug therapy ineffective