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Module 2: Inflammation, Infection, and Immunity

Module Objectives:

Upon completion of this module, the learner will be able to:

1. Compare and contrast acute and chronic inflammation.

2. Explore the pathophysiologic reasons for clinical manifestations and management of health alterations related to inflammation.

3. Explore the pathophysiologic reasons for clinical manifestations and management of selected infectious processes.

4. Relate the development of infection to breaks in lines of defense.

5. Explore the pathophysiologic reasons for clinical manifestations and management of health alterations related to altered immune function.

Required readings and resources:

Sorenson, M., Quinn, L., & Klein, D. (2019). Pathophysiology: Concepts of human disease. Pearson Education. Read chapters 11, 13, 14, 15, & 16

Go to the CDC website (cdc.gov) and enter ‘antibiotic resistance’ in the search bar. There are multiple short and interesting videos (you do not need to watch them all, rather peruse)

The Agency for Healthcare Research and Quality (AHRQ) has developed the Comprehensive Unit Based Safety Program (CUSP) to address safety concerns (with a significant emphasis on infection control) in the health care system.

Here is the link to the AHRQ site that addresses the Science of Safety. AHRQ – the Science ofSafety Below are links to some shorter videos that will introduce you to CUSP.

Introductory video Learn about CUSP

CUSP from a nursing perspective. CUSP from a nursing perspective

CUSP Understand the Science of Safety. CUSP – Understanding the Science of Safety–

CUSP Project Summary health care acquired infections CUSP Project summary related to health care acquired infectionsPeruse the websites linked into the module.

Optional resources: 

The following resources may be helpful as you start to work on your first Health Alteration Analysis – take a look.

David Woodruff, MSN, RN-BC, CNS, CNE has published a number of excellent presentations on youtube. I am no longer linking them into specific modules as they are nearly or more than ten years old, and most are lengthy. However, if you want more detail on a specific concept, go to youtube and enter David Woodruff in the search bar. His videos are excellent in explaining pathophysiology

Alilia Medical Media is a valuable Youtube channel with lots and lots of excellent and short videos. I have not watched all of them, but what I have watched are excellent. Here is the link https://www.youtube.com/c/Alilamedicalmedia/videos

Osmosis is another Youtube channel I have found valuable. Again, I have not watched all of them, but what I have seen has been good. As an example, I was challenged trying to understand the cytokine storm we heard much about during COVID. Osmosis has a video (just over 10 minutes long) that helped me. Here is the link to Osmosis https://www.youtube.com/c/osmosis/videos

The Khan Academy has a lot of engaging videos. Those I have viewed are high quality and accurate. I find this site a little more challenging to navigate than Alilamedicalmedia or Osmosis. You can start your investigation at https://www.khanacademy.org/

‘Crash Course’ videos on Youtube can provide a nice overview before you get started reviewing professional evidence based resources. Go to youtube and then in the search bar, enter ‘crash course pathophysiology’.

Items due: 

Health Alteration Analysis One-Chronic Lymphocytic Leukemia

Substantive Additions to the Health Alteration Analysis to two peers

Please see the course calendar for due dates. See the Health Alteration folder (found under content) for guidance. Note: a video overview, examples, and a template are available in that folder. See the grading rubric in the syllabus appendices (the identical grading rubric is copied below for your convenience)

Appendix B. Health alteration analysis rubric

Students will develop two health alteration analyses over the semester. Choose one of the topics included in the appropriate discussion forum. If you have a health alteration you wish to address that fits with the concepts being studied and is not listed, please email Ruth. I am looking for succinct responses that demonstrate understanding. More detail is not always better. I want you to ‘drill down’ to the essential information and share that with your peers. You may not be able to find the specific ‘why’ in a textbook – this will require you to understand essential information and make meaningful connections.

Students will make a substantive addition to two different alterations other than the one addressed in their initial post. Will address a minimum of three health alterations (one primary post, two substantive additions)

For more guidance, and an example, go to the Health Alteration Analysis folder under Content

Health alteration analysis rubric – 30 points possible

 

Criteria -primary post

Excellent

Developing

Not   Satisfactory

 

Criterion 1: Succinct   description of the health alteration.

Summarizes information essential for nursing   understanding clearly, including contributing factors. Three to six   sentences. Well structured, logical.

(2 points)

Essential information is not complete. More than six sentences. Organization is   sporadic. (1 point)

Inaccurate.

Lacks   clarity.

(0 points)

 

2. Expected assessment   findings

Accurate. Includes   crucial, expected assessment findings (2 points)

Some, but not all crucial   assessments included (1 point)

Inaccurate.   Incomplete. (0 points)

 

3. Physiologic causes of   assessment findings

Accurate. Explains physiologic causes (the why) of   signs / symptoms. Makes meaningful   connections.

(3 points)

Physiologic   ‘why’ is incomplete. Some, but not all connections made.

(1.5 points)

Inaccurate. Meaningful connections lacking.

(0 points)

 

4: Relevant lab   tests/diagnostics

Accurate. Includes crucial labs and diagnostics. (1 point)

Accurate. Some crucial labs/diagnostics not included.

(0.5 points)

Inaccurate,   incomplete.

(0 points)

 

5. Physiologic cause of   alterations in labs/diagnostics

Accurate.   Explains physiologic cause (they

‘why’) of alterations. Makes meaningful connections.

(1 point)

Physiologic ‘why’   incomplete(

0.5 points)

Inaccurate.   Incomplete. (0 points)

 

6. Expected essential   nursing interventions (include dependent and independent)

Accurate. Includes all crucial, expected   interventions.

(2 points)

Most, but not all crucial interventions included

(1 point)

Inaccurate.   Incomplete. (0 points)

 

7. Rationale for   interventions from physiologic perspective

Accurate. Explains the physiologic ‘why’ for   interventions. Makes meaningful   connections.

(3 points)

Accurate. Physiologic ‘why’ is incomplete. Some, but   not all connections made.

(1.5 points)

Inaccurate.   Incomplete. Meaningful connections   lacking. (0 points)

 

8: Prevention

(incorporate lifestyle and social determinants as   appropriate)

Addresses prevention strategies. Consider both   potential social determinants and potential lifestyle considerations. Makes meaningful connections

(2 points)

Prevention   considered OR social determinants   considered.

(1 point)

Inaccurate.   Incomplete. (0 points)

 

9. Priorities for Safety

/ Potential

Complications

Addresses   priorities for safety. Addresses potential complications.

(2 points)

Priorities to safety OR potential complications addressed   (but not both) (1 point)

Inaccurate. Incomplete. (0   po

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Patho

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Consider the following scenarios:

Scenario 1:
Jennifer is a 2-year-old female who presents with her mother. Mom is concerned because Jennifer has been “running a temperature” for the last 3 days.  Mom says that Jennifer is usually healthy and has no significant medical history. She was in her usual state of good health until 3 days ago when she started to get fussy, would not eat her breakfast, and would not sit still for her favorite television cartoon. Since then she has had a fever off and on, anywhere between 101oF and today’s high of 103.2oF. Mom has been giving her ibuprofen, but when the fever went up to 103.2oF today, she felt that she should come in for evaluation. A physical examination reveals a height and weight appropriate 2-year-old female who appears acutely unwell.  Her skin is hot and dry. The tympanic membranes are slightly reddened on the periphery, but otherwise normal in appearance. The throat is erythematous with 4+ tonsils and diffuse exudates. Anterior cervical nodes are readily palpable and clearly tender to touch on the left side. The child indicates that her throat hurts “a lot” and it is painful to swallow. Vital signs reveal a temperature of 102.8oF, a pulse of 128 beats per minute, and a respiratory rate of 24 beats per minute.

Scenario 2:
Jack is a 27-year-old male who presents with redness and irritation of his hands. He reports that he has never had a problem like this before, but about 2 weeks ago he noticed that both his hands seemed to be really red and flaky. He denies any discomfort, stating that sometimes they feel “a little bit hot,” but otherwise they feel fine. He does not understand why they are so red. His wife told him that he might have an allergy and he should get some steroid cream. Jack has no known allergies and no significant medical history except for recurrent ear infections as a child. He denies any traumatic injury or known exposure to irritants. He is a maintenance engineer in a newspaper building and admits that he often works with abrasive solvents and chemicals. Normally he wears protective gloves, but lately they seem to be in short supply so sometimes he does not use them. He has exposed his hands to some of these cleaning fluids, but says that it never hurt and he always washed his hands when he was finished.

Scenario 3:
Martha is a 65-year-old woman who recently retired from her job as an administrative assistant at a local hospital. Her medical history is significant for hypertension, which has been controlled for years with hydrochlorothiazide. She reports that lately she is having a lot of trouble sleeping, she occasionally feels like she has a “racing heartbeat,” and she is losing her appetite. She emphasizes that she is not hungry like she used to be. The only significant change that has occurred lately in her life is that her 87-year-old mother moved into her home a few years ago. Mom had always been healthy, but she fell down a flight of stairs and broke her hip. Her recovery was a difficult one, as she has lost a lot of mobility and independence and needs to rely on her daughter for assistance with activities of daily living. Martha says it is not the retirement she dreamed about, but she is an only child and is happy to care for her mother. Mom wakes up early in the morning, likes to bathe every day, and has always eaten 5 small meals daily. Martha has to put a lot of time into caring for her mother, so it is almost a “blessing” that Martha is sleeping and eating less. She is worried about her own health though and wants to know why, at her age, she suddenly needs less sleep.

To prepare:

  • Review the three scenarios, as well as Chapter 6 in the Huether and McCance text.
  • Identify the pathophysiology of the disorders presented in the scenarios, including their associated alterations. Consider the adaptive responses to the alterations.
  • Review the “Mind Maps—Dementia, Endocarditis, and Gastro-oesophageal Reflux Disease (GERD)” media in this week’s Learning Resources. Then select one of the disorders you identified from the scenarios. Use the examples in the media as a guide to construct a mind map for the disorder you selected. Consider the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

To complete:

Write a 2- to 3-page paper that addresses the following:

  • Explain the pathophysiology of the disorders depicted in the scenarios, including their associated alterations. Be sure to describe the patients’ adaptive responses to the alterations.
  • Construct a mind map of your selected disorder. Include the epidemiology, pathophysiology, risk factors, clinical presentation, and diagnosis of the disorder, as well as any adaptive responses to alterations.

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