Question

SURGICAL NURSING FOR MIDWIVES I ASSIGNMENT ON INFLAMMATION

A 50-year-old woman is admitted into your ward with the diagnosis of cellulitis (inflammation) of the right leg.

1. Describe the process of inflammation under the following headings:

1. Vasodilation                                  
2. Increased vascular permeability      
3. Leukocytic cellular infiltration         

2. State FIVE (5) CARDINAL signs and symptoms of inflammation.

Answer 1

Ans:

a. Vasodilation:

Vasodilation is a natural process to drop down the blood pressure by widening the blood vessels at that area. It help to increase the blood flow. During inflammation, vasodilation play a significant role to provide a spacious trail for immune system cells to reach that area for a cure.

Plasma contains interconnected mediator-producing system: It is an enzymatic cascade also called as Kinin System that begins when a plasma clotting factor, called the Hageman factor, is activated following tissue injury.

Hageman factor get activated and then activates prekallikrein to form kallikrein, which cleaves kininogen to produce bradykinin . This inflammatory mediator is a potent basic peptide that increases vascular permeability causes vasodilation.

Mast-cell degranulation with release of histamine. Histamine is a potent mediator of inflammation, causing vasodilation and smooth-muscle contraction. The prostaglandins can also contribute to the vasodilation with the acute inflammatory response.

b. Increased Vascular permeability:

Many of the vascular changes that occur early in a local response are due to the direct effects of plasma enzyme mediators such as bradykinin and fibrinopeptides, which increased vascular permeability.

The prostaglandins (a group of lipids made at sites of tissue damage or infection that are involved in dealing with injury and illness and help in the control of inflammation) can also contribute to the vasodilation and increased vascular permeability associated with the acute inflammatory response.

The clotting system is triggered very rapidly after tissue injury or damage to prevent bleeding and restrict the spread of invading pathogens into the bloodstream. The fibrino peptides act as inflammatory mediators, inducing increased vascular permeability.

c. Leukocyte cellular infiltartion:

The cell type infiltrating the tissue is the neutrophil , a type of white blood cells i.e. leukocytes. Neutrophil
infiltration into the tissue peaks within the first 6 h of an inflammatory response, with production of neutrophils in the bone marrow increasing to meet this need.

A normal neutrophils production in an adult: More than 10¹⁰ neutrophils per day,

During a period of acute inflammation, neutrophil production may increase upto tenfold.
The neutrophils leave the bone marrow and circulate within the blood. In response to mediators of acute inflammation, The circulating neutrophils express mucins such as PSGL-1,  which bind to E- and P-selectin.

Activated Leukocytes: Express increased levels of Fc receptors for antibody and receptors for complement, enabling these cells to bind more effectively to antibody- or complement-coated pathogens, thus increasing phagocytosis.

Leukocytes releases: Primary and Secondary granules or mediators (proteases, phospholipases, elastases, and collagenases) play an important role in killing various pathogens.

CARDINAL signs and symptoms of inflammation:

1. Rubor (redness) : Redness and heat are due to increased blood flow to the painful area;

2.Calor (increased heat): The increased heat of inflamed skin is due to the gate of a large amount of blood at body core temperature into the normally cooler skin.

3.Tumor (swelling): Swelling is due to the accumulation of fluid

4.Dolor (pain): Pain is due to release of chemicals that excite nerve endings

5.Functio laesa (loss of function): Loss of function is due to a combination of factors