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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