WEEK_4_N2112_Module_FOUR_Inflammation_Pain_Surgical_1_

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Mount Royal University *

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2112

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Nursing

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May 16, 2024

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1 Week 4: Nursing 2112 – Module 4 Alterations to the Defense System: Inflammation & Pain (Includes Arthritis, Healing, Care of the Patient Undergoing Surgery) Concept Content Inflammation Cellular response to injury, permeability, emigration, acute vs chronic, nursing implications, cellular healing, Pain Pathophysiology of pain Assessment and management:  pharmacological and nonpharmacological  barriers to management of pain Types of pain Factors influencing pain Wounds Relationship with ischemia and O2 delivery, stages of wound healing. Surgical Care Care of the surgical patient Inflammation OBJECTIVES: Students should be able to: 1. Discuss function, purpose and events of inflammation. 2. Differentiate between the different types and causes of inflammation and discuss the related nursing process. 3. Discuss the concept of inflammation as it relates to arthritis and inflammatory bowel disease. 4. Describe the reparative process for cellular healing. Arthritis and Inflammatory Bowel Disease (IBD) OBJECTIVES: Students should be able to: 1. Apply the concept of inflammation to: a. Rheumatoid arthritis and osteoarthritis. b. Inflammatory bowel disease (IBD) – will cover this content in more detail in N2113. 2. Explain collaborative nursing and client measures to reduce the symptoms of arthritis. 3. Explain collaborative nursing and client measures to reduce the symptoms of IBD – will cover this content in more detail in N2113. Pain OBJECTIVES: Students should be able to: 1. Discuss the connection between the inflammatory process and pain. 2. Explain the physiology/pathophysiology of pain. 3. Describe the various types of pain and they affect the patient (chronic, acute, cancer related, neuropathic, ischemic and referred pain). 4. Discuss the Nursing Care in pain management (Paul et al, 2016,, p. 258) 5. Discuss how and where non-pharmacological and pharmacological agents interrupt the pain cycle. 6. Explain the pharmacokinetics and pharmacodynamics of analgesic agents used to manage pain 7. List the nursing responsibilities for the pharmacologic treatment of pain. Developed by N2112 Teaching Team

2 8. Identify other non-analgesic pharmaceutical agents that are useful in alleviating pain and describe why these modalities would be helpful for the treatment of pain. 9. Explain cognitive and behavioural techniques used to manage pain. 10. Identify how surgical management may be used to manage pain. 11. Identify nurse/client and community-based collaborative management strategies to prevent or manage pain. Wounds OBJECTIVES: Students should be able to: 1. Relate the concept of ischemia to the pathogenesis of pressure ulcers and arterial ulcers. 2. Identify the phases of wound healing and list the physiological process occurring in each. 3. Identify factors which may cause a client to have delayed wound healing and what the nurse needs to assess a patient for. Apply W.O.U.N.D. 4. Identify nurse/client collaborative measures and nursing strategies that should be implemented to optimize timely wound healing. 5. Recall and discuss wound care as it relates to primary, secondary and third intention healing. 6. Identify assessments required for overall wound care including dressings, staples, sutures. 7. Incorporate a relevant pain assessment into the care of the surgical client including planning and providing wound care. 8. Differentiate between wound dehiscence, wound evisceration in relation to surgical wounds and related nursing care. 9. Differentiate between venous, arterial and diabetic ulcers. Pre-operative and Post-operative client care OBJECTIVES: Students should be able to: 1. Explain the differing complications a client undergoing surgery may be at risk for. Identify nursing strategies to prevent or manage these complications. 2. Recall and extend your knowledge: What are factors that determine the health outcomes of minor and major surgeries and what are nursing interventions associated with each factor. 3. Discuss pre-operative care of the client-remote, 24 hour before surgery and immediate. 4. Discuss the Nursing Process for the Patient Recovering from Surgery. Preparation Terminology for Review: The following terms will be utilized within this module and throughout the course. Please familiarize yourself with these terms and be able to define them. Developed by N2112 Teaching Team

3 Angiogenesis Antagonist Antiplatelet Antipyretic Bradykinin Chemokines Chemotaxis Complement Cox 1 enzyme Cox 2 enzyme C-reactive protein Cytokines Epithelialization ESR Fever Fibroblasts Histamine Infection Inflammation Kinins Leukotriene Maceration Neuralgia Neuropathy Nociceptive Opioid Phagocytosis Prostaglandin Referred Somatic Thromboxane Visceral Recall/Review the Following Concepts from Biology and first year  Cardinal signs of inflammation.  Assessment and characteristics of pain.  Role of neutrophils, monocytes, granulocytes, lymphocytes  Mu and Kappa receptors  Surgical asepsis.  Skin assessment o Braden Scale  Risk factors and prevention of ulcers.  Required Readings Adams, M.P., Urban, C.Q., Sutter, R.E., El-Hussein, M. and J. Osuji, J. (2021), Pharmacology for nurses: A pathophysiological approach, Third Canadian Edition . North York, ON: Pearson Canada Inc. For all pharmacology also review the Nursing Considerations section for each class of medication.  Chapter 23  Chapter 42 Power-Kean, K., Zettel, S., El-Hussein, M.T., ,Huether, S.E., McCance, K.L., Brashers, V.L. & Rote, N.S. (2022). Understanding pathophysiology (2nd Canadian edition) . Milton, ON, Canada: Elsevier.  Chapter 6 (Innate Immunity: Inflammation and Wound Healing)  Chapter 14 (Pain, Temperature, Sleep and Sensory Function)  Chapter 39 (Alterations in Musculo-skeletal Function) EL Hussein, M. & Osuji,J. (2020). Brunner & Suddarth’s Canadian Textbook of Medical-Surgical Nursing (4 rd Ed.). Wolters Kluwer . Philadelphia.  Chapter 9 Homeostasis, Stress and Adaptation.  Chapter 16 Pain Management. Developed by N2112 Teaching Team

4  Chapters 19, 20 and 21 – Preoperative, Perioperative and Post-operative Nursing Management.  Chapter 38 – Inflammatory Bowel Disease (pp. 1017-1023, as an example – this will be covered in N2113).  Chapter 56 Assessment and Management of Patients with Rheumatic Disorders. https://librarysearch.mtroyal.ca/permalink/01MTROYAL_INST/fjpt3u/alma9923353050204656 D’Amico , Barbarito, Twomey & Harder. (2012). Health physical assessment in nursing (1 st Canadian Ed.). Toronto, ON: Pearson.  Chapter 11 (Skin, Hair, and Nail Assessment) Content Study Guide . Not all of this content will be covered. It still may be tested on exams. The following content questions/statements are meant to augment your learning objectives. These questions should direct your readings and help you sort out the required content as well as integrate the content from your required readings. Come to class, tutorials and labs prepared to participate in discussion and application of this information. Often, the lecture and materials will help to answer some of these questions for you. Print off your lecture materials and use them alongside this content study guide. Inflammation : 1. What is the role of histamine, cytokines and kinins in inflammation? Histamine actions -cause temporary, rapid constriction of smooth muscle - dilation of the postcapillary venules, which results in increased blood flow into the microcirculation. -increased vascular permeability resulting from retraction of endothelial cells lining the capillaries - increased adherence of leukocytes to the endothelium Cytokines - constitute a large family of small-molecular-weight soluble intercellular-signalling molecules that are secreted, bind to specific cell membrane receptors, and regulate innate or adaptive immunity Cytokines may be either proinflammatory or anti-inflammatory in nature, depending on whether they tend to induce or inhibit the inflammatory response lymphokines -cytokines secreted from lymphocytes Monokines -cytokines secreted from monocytes Developed by N2112 Teaching Team

5 Chemokines - cytokines that are chemotactic and primarily attract leukocytes to sites of inflammation. TNF-α -proinflammatory cytokines Some cytokines are anti-inflammatory and diminish the inflammatory response - interleukin-10 - transforming growth factor-beta Interleukin-10 (IL-10 - produced by lymphocytes - suppresses the growth of other lymphocytes and the production of proinflammatory cytokines by macrophages, leading to downregulation of both inflammatory and acquired immune responses Transforming growth factors - including transforming growth factor-beta (TGF-β) -are produced by many cells in response to inflammation and induce cell division and differentiation of other cell types, such as immature blood cells. Interferons (IFNs) -members of a family of cytokines that protect against viral infections -modulate the inflammatory response Type I interferons -primarily IFN-α, IFN-β - produced and released by virally infected cells in response to viral double-stranded RNA and other viral PAMPs - These IFNs do not kill viruses directly but instead are secreted and induce antiviral proteins and protection in neighbouring healthy cells Type II interferon -(IFN-γ) - produced primarily by lymphocytes -it activates macrophages, resulting in increased capacity to kill infectious agents (including viruses and bacteria) - enhances the development of acquired immune responses against viruses. Developed by N2112 Teaching Team

6 Fever is partially induced by specific cytokines -e.g., IL-1, released from neutrophils and macrophages - These cytokines are known as endogenous pyrogens Kinins -increase vascular dilations and permeability - attract neutrophils to the area 2. What is the sequence of events in the inflammatory process? Three key plasma protein systems are essential to an effective inflammatory response - the complement system - the clotting system -the kinin system Complement System Activation of the complement system causes -produces several factors that can destroy pathogens directly - can activate or increase the activity of many other components of the inflammatory and adaptive immune response The most important function of the complement cascade is activation of C3 and C5, which results in -a variety of molecules that are (1) opsonins, (2) chemotactic factors, or (3) anaphylatoxins Opsonins -coat the surface of bacteria and increase their susceptibility to being phagocytized (eaten) and killed by inflammatory cells, such as neutrophils and macrophage Chemotactic factors - diffuse from a site of inflammation - attract phagocytic cells to that site Anaphylatoxins -induce rapid degranulation of mast cells (i.e., release of histamine that induces vasodilation and increased capillary permeability), a major cellular component of inflammation most potent complement products are - C3b (opsonin) Developed by N2112 Teaching Team

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