- 1 What is the role of the nurse in the management of inflammation
- 2 What is the nursing process of inflammation
- 2.1 What are the 5 steps of inflammation?
- 2.2 What are the roles of a nurse in treatment of diseases?
- 2.3 What is the nurses role in the pain management nursing process?
What is the role of the nurse in the management of inflammation
Nurses have a key role to play in diagnosing inflammatory arthritis in patients, particularly if they suspect inflammatory arthritis in patients with persistent joint pain and swelling. They will also provide vital support for newly diagnosed patients who are coming to terms with their diagnosis.
What is the nursing process of inflammation
The inflammatory process, or simply inflammation, is an innate, nonspecific, immediate, defensive mechanism that helps protect the body against infections and injuries. The goal of inflammation is to respond to the stimuli and restore balance.
What are the 4 steps of the inflammatory response?
Inflammation is a protective response of cells to pathogens, infection or tissue damage. It involves the coordinated communication of different immune cells and blood vessels through an intricate cascade of molecular signals. Inflammation can cause fever, cardiovascular pathology, allergy anaphylaxis, fibrosis, autoimmunity, etc.
- The inflammatory response has four phases: inflammatory inducers (infection or tissue damage), inflammatory sensors (mast cells and macrophages), inflammatory mediators (cytokines, chemokines, etc.) and the tissues that are affected,
- Each phase has many options that are triggered based on the type pathogen introduced,
For example bacterial pathogens trigger toll-like receptors ( TLRs ) and viral infections trigger type I interferons ( IFN ), In addition, chronic inflammatory conditions, where an inducer is not well defined, are becoming more common. These conditions are of particular interest because they coincide with other diseases such as obesity, type 2 diabetes, atherosclerosis, neurodegenerative diseases and cancer,
What are the interventions for inflammation?
Inflammation is a process by which your body’s white blood cells and the things they make protect you from infection from outside invaders, such as bacteria and viruses. But in some diseases, like arthritis, your body’s defense system – your immune system – triggers inflammation when there are no invaders to fight off.
In these autoimmune diseases, your immune system acts as if regular tissues are infected or somehow unusual, causing damage. Inflammation can be either short-lived ( acute ) or long-lasting ( chronic ). Acute inflammation goes away within hours or days. Chronic inflammation can last months or years, even after the first trigger is gone.
Conditions linked to chronic inflammation include:
Cancer Heart disease Diabetes Asthma Alzheimer’s disease
Some types of arthritis are the result of inflammation, such as:
Rheumatoid arthritis Psoriatic arthritis Gouty arthritis
Other painful conditions of the joints and musculoskeletal system that may not be related to inflammation include osteoarthritis, fibromyalgia, muscular low back pain, and muscular neck pain, Symptoms of inflammation include:
RednessA swollen joint that may be warm to the touch Joint pain Joint stiffness A joint that doesn’t work as well as it should
Often, you’ll have only a few of these symptoms. Inflammation may also cause flu-like symptoms including:
Fever Chills Fatigue /loss of energy Headaches Loss of appetiteMuscle stiffness
When inflammation happens, chemicals from your body’s white blood cells enter your blood or tissues to protect your body from invaders. This raises the blood flow to the area of injury or infection. It can cause redness and warmth. Some of the chemicals cause fluid to leak into your tissues, resulting in swelling. Your doctor will ask about your medical history and do a physical exam, focusing on:
The pattern of painful joints and whether there are signs of inflammationWhether your joints are stiff in the morningAny other symptoms
They’ll also look at the results of X-rays and blood tests for biomarkers such as:
C-reactive protein (CRP)Erythrocyte sedimentation rate (ESR)
Inflammation can affect your organs as part of an autoimmune disorder. The symptoms depend on which organs are affected. For example:
Inflammation of your heart ( myocarditis ) may cause shortness of breath or fluid buildup.Inflammation of the small tubes that take air to your lungs may cause shortness of breath.Inflammation of your kidneys (nephritis) may cause high blood pressure or kidney failure.
You might not have pain with an inflammatory disease, because many organs don’t have many pain-sensitive nerves. Treatment for inflammatory diseases may include medications, rest, exercise, and surgery to correct joint damage, Your treatment plan will depend on several things, including your type of disease, your age, the medications you’re taking, your overall health, and how severe the symptoms are.
Correct, control, or slow down the disease processAvoid or change activities that aggravate painEase pain through pain medications and anti-inflammatory drugsKeep joint movement and muscle strength through physical therapy Lower stress on joints by using braces, splints, or canes as needed
Medications Many drugs can ease pain, swelling and inflammation. They may also prevent or slow inflammatory disease. Doctors often prescribe more than one. The medications include:
Nonsteroidal anti-inflammatory drugs ( NSAIDs, such as aspirin, ibuprofen, or naproxen )Corticosteroids (such as prednisone)Antimalarial medications (such as hydroxychloroquine )Other medicines known as disease-modifying antirheumatic drugs (DMARDs), including azathioprine, cyclophosphamide, leflunomide, methotrexate, and sulfasalazine Biologic drugs such as abatacept, adalimumab, certolizumab, etanercept, infliximab, golimumab, rituximab, and tocilizumab
Some of these are also used to treat conditions such as cancer or inflammatory bowel disease, or to prevent organ rejection after a transplant. But when ” chemotherapy ” types of medications (such as methotrexate or cyclophosphamide) are used to treat inflammatory diseases, they tend to have lower doses and less risk of side effects than when they’re prescribed for cancer treatment,
Quit smoking,Limit how much alcohol you drink.Keep a healthy weight, Manage stress,Get regular physical activity,Try supplements such as omega-3 fatty acids, white willow bark, curcumin, green tea, or capsaicin, Magnesium and vitamins B6, C, D, and E also have some anti-inflammatory effects. Talk with your doctor before starting any supplement.
Surgery You may need surgery if inflammation has severely damaged your joints. Common procedures include:
Arthroscopy. Your doctor makes a few small cuts around the affected joint. They insert thin instruments to fix tears, repair damaged tissue, or take out bits of cartilage or bone, Osteotomy. Your doctor takes out part of the bone near a damaged joint. Synovectomy. All or part of the lining of the joint (called the synovium) is removed if it’s inflamed or has grown too much. Arthrodesis, Pins or plates can permanently fuse bones together. Joint replacement. Your doctor replaces a damaged joint with an artificial one made of metal, plastic, or ceramic.
The things you eat and drink can also play a role in inflammation. For an anti-inflammatory diet, include foods like:
Tomatoes Olive oilLeafy green vegetables (spinach, collards)Nuts (almonds, walnuts)Fatty fish ( salmon, tuna, sardines)Fruits (berries, oranges )
These things can trigger inflammation, so avoid them as much as you can:
Refined carbohydrates (white bread )Fried foods (French fries)Sugary drinks (soda)Red and processed meats (beef, hot dogs)Margarine, shortening, and lard
What are the 5 steps of inflammation?
Introduction – Based on visual observation, the ancients characterised inflammation by five cardinal signs, namely redness ( rubor ), swelling ( tumour ), heat ( calor ; only applicable to the body’ extremities), pain ( dolor ) and loss of function ( functio laesa ).
- The first four of these signs were named by Celsus in ancient Rome (30–38 B.C.) and the last by Galen (A.D 130–200),
- More recently, inflammation was described as “the succession of changes which occurs in a living tissue when it is injured provided that the injury is not of such a degree as to at once destroy its structure and vitality”, or “the reaction to injury of the living microcirculation and related tissues,
Although, in ancient times inflammation was recognised as being part of the healing process, up to the end of the 19 th century, inflammation was viewed as being an undesirable response that was harmful to the host. However, beginning with the work of Metchnikoff and others in the 19 th century, the contribution of inflammation to the body’s defensive and healing process was recognised,
Furthermore, inflammation is considered the cornerstone of pathology in that the changes observed are indicative of injury and disease. The classical description of inflammation accounts for the visual changes seen. Thus, the sensation of heat is caused by the increased movement of blood through dilated vessels into the environmentally cooled extremities, also resulting on the increased redness (due to the additional number of erythrocytes passing through the area).
The swelling (oedema) is the result of increased passage of fluid from dilated and permeable blood vessels into the surrounding tissues, infiltration of cells into the damaged area, and in prolonged inflammatory responses deposition of connective tissue.
Pain is due to the direct effects of mediators, either from initial damage or that resulting from the inflammatory response itself, and the stretching of sensory nerves due to oedema. The loss of function refers to either simple loss of mobility in a joint, due to the oedema and pain, or to the replacement of functional cells with scar tissue.
Today it is recognised that inflammation is far more complex than might first appear from the simple description given above and is a major response of the immune system to tissue damage and infection, although not all infection gives rise to inflammation.
Inflammation is also diverse, ranging from the acute inflammation associated with S. aureus infection of the skin (the humble boil), through to chronic inflammatory processes resulting in remodeling of the artery wall in atherosclerosis; the bronchial wall in asthma and chronic bronchitis, and the debilitating destruction of the joints associated with rheumatoid arthritis.
These processes involve the major cells of the immune system, including neutrophils, basophils, mast cells, T-cells, B-cells, etc. However, examination of a range of inflammatory lesions demonstrates the presence of specific leukocytes in any given lesion.
That is, the inflammatory process is regulated in such a way as to ensure the appropriate leukocytes are recruited. These events are controlled by a host of extracellular mediators and regulators, including cytokines, growth factors, eicosanoids (prostaglandins, leukotrines, etc), complement and peptides.
In fact, it is the discovery of many of these mediators over the past 20 years that has increased our understanding of the regulation of the inflammatory process whilst, at the same time, revealing its complexity. These extracellular events are matched by equally complex intracellular signalling control mechanisms, with the ability of cells to assemble and disassemble an almost bewildering array of signalling pathways as they move from inactive to dedicated roles within the inflammatory response and site.
- Which cells and mediators come into play depends on wide range of factors.
- These include: what stage the process of inflation is at; the initiating event, i.e.
- Type of pathogen, auto-immune, chemical or physical injury, etc.; the tissue or organ involved; whether the inflammation is of an acute, resolving form or chronic, non resolving or long-lasting type; whether formation of granuloma is involved, or whether scarring results.
The role of inflammation as a healing, restorative process, as well as its aggressive role, is also more widely recognised today. Inflammation is now considered as the full circle of events, from initiation of a response, through the development of the cardinal signs above, to healing and restoration of normal appearance and function of the tissue or organ.
- However, in certain conditions there appears to be no resolution and a chronic state of inflammation develops that may last the life of the individual.
- Such conditions include the inflammatory disorders rheumatoid arthritis, osteoarthritis, inflammatory bowel diseases, retinitis, multiple sclerosis, psoriasis and atherosclerosis.
In order to study inflammation a multidisciplinary approach is necessary. Classically, it has required the study of the immune system, in order to understand the events involved in initiating and maintaining inflammatory conditions. Today it is recognised that the underlying genetics and molecular biology basis to cellular responses are also important in order to identify genetic predisposition to inflammatory diseases, while pharmacological studies are necessary to identify targets and develop novel treatments to bring relief from chronic life-threatening inflammatory conditions.
Thus research into inflammation includes not only the study of immunological and cellular responses involved but also the pharmacological process involved in drug development. Many of the drugs used in the treatment of inflammatory conditions, predate our current understanding of the biochemical processes involved in the disease.
Traditionally, the standard treatments for rheumatoid arthritis has been to use a non-steroidal anti-inflammatory drug (NSAID), such as aspirin, for pain relief and to use corticosteroids or even disease-modifying anti-rheumatic drugs in an attempt to reduce other symptoms of the disease.
- For many years the pharmaceutical industry attempted to develop NSAIDs which shared the therapeutic action of aspirin but which did not cause the main adverse event, namely gastric ulceration.
- This research led to the development of indomethacin, the fenamates, ibuprofen and many others.
- However, while all these drugs had clinical utility they also eroded the gastric mucosa.
In addition, this research also led to the development of some of the animal models still used in arthritis research today, such as carrageenin oedema and adjuvant arthritis ). The development of NSAIDs, with reduced potential to cause gastric ulcers, was finally realised with the demonstration that clinically useful NSAIDs inhibited the enzyme cyclo-oxygenase, which was also present in the gastric mucosa.
The finding that cyclo-oxygenase present in inflammatory lesions (COX2) was distinct from that found in the stomach (COX1) led to the development of selective COX2 inhibitors, such as celecoxib. These drugs provide relief from many of the symptoms of arthritis but have a reduced potential to cause gastric ulceration,
The differential responsiveness to these, and other, therapeutic agents and, indeed, the induction of the inflammatory response in some patients with asthma by aspirin, has led to the concept of pharmacogenomics to understand individual drug sensitivities with a view to producing therapy tailored to the individual.
Similarly, glucocorticoids are widely used in the treatment of inflammation. Unlike the NSAIDs these agents do not relieve pain but reduce inflammation by inhibiting leukocyte function. The active ingredient responsible for the anti-inflammatory activity of adrenal cortex extracts was discovered in the 1940s.
This led to the use of cortisol as an anti-inflammatory and the development of potent synthetic agents typified by dexamethasone. However, because cortisol, and synthetic glucocorticoids, produce their therapeutic action at supra-physiological concentrations, adverse effects, such as suppression of the HPA-axis and Cushingoid changes are inevitable.
Many of these adverse effects can be avoided by giving glucocorticoids topically. This has led to the development of inhaled glucocorticoids for the treatment of inflammatory diseases of the respiratory tract and steroid containing creams for the treatment of skin inflammation. However, applying this approach to the treatment of rheumatoid arthritis necessitates the use of intra-articular injection.
Thus, there is a clear unmet medical need for a drug that provides relief from the symptoms of inflammation but can be given systemically. The fact that a large number of patients with severe chronic inflammatory disease fail to respond to conventional systemic or topical therapy resulting in a huge clinical and socio-economic burdon underlies the need to develop novel therapies.
- Thus, modern research has used molecular techniques to identify which genes are regulated by glucocorticoid receptors in an attempt to identify novel therapeutic targets.
- This work has attempted to fine tune the immune system through use of agents that inhibit specific pathways and mediators rather than to suppress immune cell activity.
Examples of such approaches include the development of anti-TNFa therapies, anti adhesion molecule therapies and inhibitors of cytokines believed to be pivotal in a given pathology, Furthermore, inhibitors of selective pro-inflammatory intracellular signalling pathways are currently in use e.g.
- Cyclsporin or under development e.g.
- NF-κB, p38 MAPK and PDE4 inhibitors,
- As we understand more about the complexity of the inflammatory response and the actions of the currently available drugs the value of particular clusters of targets becomes apparent.
- However, the success of anti-TNFα therapy in RA underlines the importance of understanding/discovering the initial driver(s) of the inflammatory response in individual diseases and patients.
While research into inflammation has resulted in great progress in the latter half of the 20th century, we recognise that the rate of progress is accelerating. Furthermore, it is our perception that there is a need for a vehicle through which this very diverse research can readily be made available to the scientific community.
What are the steps in inflammation and healing?
Introduction – Wound healing is a complex process involving soluble mediators, blood cells, extracellular matrix, and parenchymal cells ( Singer and Clark, 1999 ; Bullers et al., 2012 ; Pesce et al., 2013 ). The process from inflammation to the wound healing is divided into three phases: (1) inflammation process, (2) tissue formation, and (3) tissue remodeling (Figure 1 ; Eming et al., 2007 ).
The inflammatory phase is marked by platelet accumulation, coagulation, and leukocyte migration. The tissue formation is characterized by re-epithelialization, angiogenesis, fibroplasia, and wound contraction. Finally, the remodeling phase takes place over a period of months, during which the dermis responds to injury with the production of collagen and matrix proteins and then returns to its pre-injury phenotype ( Kirsner and Eaglstein, 1993 ; Castillo-Briceno et al., 2011 ; Bainbridge, 2013 ).
The normal healing response begins the moment the tissue is injured. Peripheral blood components filtrated into the site of injury, the platelets contact with exposed collagen and other elements of the extracellular matrix through the process from inflammation to wound healing ( Diegelmann and Evans, 2004 ).
This contact triggers the platelets to release clotting factors as well as essential growth factors and cytokines such as platelet-derived growth factor (PDGF), such as stimulation of DNA synthesis and chemotaxis of fibroblasts moreover smooth muscle cells to induce the production of collagen, glycosaminoglycan, and collagenase by fibroblasts through the wound healing process ( Lynch et al., 1987 ; Price et al., 2004 ; Tettamanti et al., 2004 ).
Furthermore, PDGF appears to transduce its signal through wound macrophages and may trigger the activation of feedback loops and synthesis of endogenous wound PDGF and other growth factors, thereby enhancing the cascade of tissue repair processes required for a fully healed wound ( Pierce et al., 1991 ).
In a normal response to injury, platelet aggregation and degranulation of the earliest events in an inflammatory response trigger the release of numerous inflammatory mediators including transforming growth factor-β (TGF-β) from the granules ( Wahl et al., 1989 ; Tatler and Jenkins, 2012 ; Christmann et al., 2013 ).
TGF-β is implicated in pathogenic fibrotic conditions in kidney, liver, and lung disease, and in scarring of skin wounds as well ( Martin, 1997 ; Sgonc and Gruber, 2013 ). Accumulating evidence indicates that TGF-β affects integrin-mediated cell adhesion and migration by regulating the expression of integrins, their ligands and integrin-associated proteins ( Margadant and Sonnenberg, 2010 ). FIGURE 1. The process from inflammation to the wound healing is divided into three phases: (1) Inflammation process, (2) tissue formation, and (3) tissue remodeling. The important question, “what is the key linkage between the tissue formation and inflammation?”
What is the role of the nurse in acute pain management?
One of the more difficult scenarios you’ll face as a nurse is patient pain management. The patients you encounter may experience pain in very different ways and to very different degrees. Patients also respond differently to pain management medications and techniques.
What are the roles of a nurse in treatment of diseases?
Nurses in Nursing Homes – The role of nurses in nursing homes spans a variety of duties. These nurses work in both supervisorial and clinical capacities to ensure the well-being of their older patients. Nursing home patients receive care from several medical professionals, including nursing assistants and doctors.
Monitoring patients’ hygiene Administering medication Checking patients’ blood pressure, temperatures, and heart rates Monitoring and treating their patients’ health conditions, such as Alzheimer’s disease and diabetes Initiating treatment plans
In general, nursing home nurses look after the overall health of their patients and make sure that they get the care they need. They also interact with patients’ families and keep them informed about any health changes or additional patient needs.
What are the roles and responsibilities of a nurse in relation to infection control?
What Does an Infection Control Nurse Do? – Infection control nurses work not only with patients and physicians but also with scientists, public health experts, and government agencies to protect the health of individuals and the public. Each year, nearly two million healthcare-associated infections occur in the United States, resulting in close to 100,000 deaths.
- Monegro et al., “Hospital Acquired Infections,” StatPearls, last updated Jan.7, 2020: https://www.ncbi.nlm.nih.gov/books/NBK441857/ )) Clostridioides difficile (C.
- Diff), Staphylococcus aureus (staph), Klebsiella, and Escherichia coli (E.
- Coli) are the most common pathogens causing hospital-acquired infections.
Some responsibilities of infection control nurses include:
Gathering and analyzing infection data to make evidence-based decisions Educating medical and public health professionals on infection prevention protocols to facilitate emergency preparedness Isolating and treating infected individuals to contain the spread of infectious diseases Assisting with the development of action plans in case of a community or hospital outbreak to minimize the potentially devastating impact Collaborating with government agencies such as the CDC to ensure that infection control practices are implemented and enforced Studying pathogens to determine origin in order to prevent future outbreaks Assisting scientists and physicians with developing treatments and vaccines to ensure the health and safety of patients and the community
What is the nurses role in the pain management nursing process?
This includes but is not limited to: 1. Acknowledging and accepting the patient’s pain ; 2. Identifying the most likely source of the patient’s pain; 3. Assessing pain at regular intervals, with each new report of pain or when pain is expected to occur or reoccur.