ASSESSMENT AND DIAGNOSTIC may produce

EXAMS, AND DEPENDENT AND phlegm

INDEPENDENT NURSING CARE  Shortness of
FOR INFECTIOUS, breath
INFLAMMATORY, AND  Vulvar and
IMMUNOLOGIC DISEASES vaginal burning
and itching
Part 1: Nursing Assessment  Pain on coitus
RISK FACTORS or on tampon
 Gender insertion
 Age  Intense pain on
 Race contact with
 Past medical history clothing or
 Family history/Genetics acidic urine
 Current treatment  Flu-like
 Lifestyle/High risk behaviors symptoms
 Travel history/Geography
 Occupation OBJECTIVE DATA
 Observe for pallor, cyanosis,
SUBJECTIVE DATA jaundice, and erythema
Infectious Immunologic  Evaluate skin integrity
 Headache,  Increased thirst  Check for rash and note is distribution
nausea,  Frequent  Observe hair texture and distribution
vomiting, urination  Inspect nails
abdominal pain  Extreme  Inspect the oral mucous membranes
 Nuchal rigidity, hunger  Inspect the male and female genitalia
more severe  Pink or cola-  Palpate the peripheral pulses
headache, colored urine  Palpate superficial lymph nodes
back, and  Foamy urine  Palpate for masses or lesions
lower  Sneezing  Percuss the anterior, lateral, and
extremity pain  Itching of the posterior thorax
 Spasms and nose, eyes, or  Auscultate over the lungs
stiffness in jaw roof of the
muscles mouth Part 2: Non-Invasive Diagnostic
 Stiffness of  Itching or hives Examinations
your neck all over the
muscles body A. Urinalysis (UA) and Urine Culture
 Difficulty  Fatigue and Sensitivity (Urine CS)
swallowing  Joint pain - A group of manual and/or automated
 Excessive (usually worse qualitative and semi-quantitative tests
salivation in mornings performed on a urine sample.
 Hydrophobia and after - A routine UA usually includes:
 Hallucinations activity),  Color
 Loss of stiffness  Transparency
appetite  Headaches,  Specific gravity
 Nausea and confusion and  pH
vomiting memory loss  Protein
 Weakness and  Tender, warm,  Glucose
fatigue and swollen  Ketones Blood
 Fever joints  Bilirubin
 Night sweats  Nitrite
 Chills  Urobilinogen
 Chest pain  Leukocyte esterase
when you - To perform this, first urinate a small
breathe or amount into the toilet bowl to clear the
cough urethra of any contaminants.
 Cough, which
- Then, collect a sample in a clean or
sterile container. About 1-2 oz is needed.
- Remove the container from the urine
stream w/out stopping the flow.
- You may finish urinating into the bowl
- Take the sample to the lab
- For infants, the genital area is cleaned
and dried, and then a collection device is
attached.
- If you are asked to collect, be sure the
collection device is attached securely to
prevent leakage.
- After baby has urinated, the urine (at
least 20 cc) is place in a sterile container.
Nursing Considerations:
 Instruct the patient to void directly
into a clean, dry container. Sterile,
disposable containers are
recommended.
 Cover all specimens tightly, label
properly and send immediately to the
laboratory.
 If a urine sample is obtained from an
indwelling catheter, it may be
necessary to clamp the catheter for
about 15-30 minutes before obtaining
the sample.
 Observe standard precautions when
handling urine specimens.
B. Chest X-ray (Chest Radiography)
- A painless, non-invasive test uses
electromagnetic waves to produce visual
images of the heart, lungs, bones, and
blood vessels of the chest.
Indications:
 Assist in the diagnosis of
diaphragmatic hernia, lung tumors,
and metastasis.
 Detect known or suspected
pulmonary, cardiovascular, and
skeletal disorders.
 Identify the presence of chest trauma.
 Confirm correct placement and
position of the endotracheal tube,
tracheostomy tube, chest tubes,
nasogastric feeding tube.
 Evaluate positive purified protein
derivative (PDD) or Mantoux test for
pulmonary tuberculosis.
 Monitor progressions, resolutions, or
maintenance of disease
 Evaluate the patient’s response to a
therapeutic regimen (antibiotic,
chemotherapy)
Nursing Considerations:
 Remove all metallic objects
 No preparation is required
 Ensure the pt is not pregnant or
suspected to be
 Assess the pt’s ability to hold his
breath
 Provide appropriate clothing
 Instruct pt to cooperate during the
procedure
Part 3: Invasive Diagnostic
Examination
A. Complete Blood Count (CBC)
- one of the most commonly ordered
blood tests which include the calculation
of the cellular (formed elements) of blood
- special machines analyze the different
components of blood in less than a minute
generally determine these calculations
Uses:
 It may be a part of a routine check-up
or screening, or as a follow-up test to
monitor certain treatments
 can be done as a part of an evaluation
based on a pt’s symptoms
 Screen for a wide range of conditions
and diseases
 Help diagnose various conditionas,
such as anemia, infection,
inflammation, bleeding disorder or
leukemia, etc.
 monitor the condition and/or
effectiveness of treatment after a
diagnosis is established
 Monitor treatment that is known to
affect blood cells, such as
chemotherapy or radiation therapy
Nursing Responsibility:
 Explain procedure
 Encourage to avoid stress if possible
because altered physiologic status
influences and changes normal
hematologic values
 Explain that fasting is not necessary
 Apply manual pressure and dressings
over puncture site on removal of
dinner
 Monitor the puncture site for oozing
or hematoma formation
 Instruct to resume normal activities
and diet
B. Anti-Streptolysin O titer (ASO titer)
- looks for antibodies that the body makes
while fighting group A Streptococcus
bacteria
- the antibodies work against a substance
made by the bacteria called streptolysin O.
- group A stretococcus causes strep throat
that may lead to rheumatic fever
Purpose:
 To find out a current or recent strep
infection
 Antibodies from a strep infection
begin to increase about 1 week after
infection
 Get higher for several weeks before
decreasing
 As antibodies don’t increase righgt
away, the better test to use to
diagnose a strep infection is the rapid
strep test.
Other tests maybe done
 Throat culture for group A beta-
hemolytic streptococci
 If a rheumatic fever may ensure, there
is also a need for other antibody tests
(anti-DNase B, antihyaluronidase,
or anti-Streptozyme)
Results of the test and its meaning
 The results may not mean the patient
have a problem
 A negative result - no antobodies to
the strep bacteria in the blood
 A positive result - antibodies have
been found
Reference Values
 <5 years: < or =70 IU/mL
 5-17 years: < or =640 IU/mL
 > or =18 yrs: < or =530 IU/mL
 Elevated values - infection by group
A streptococci
Risks
 Bleeding
 Infection
 Bruising
 Feeling lightheaded
 Slight sting or pain
 Soreness
Nursing Responsibilities
 Explain that slight discomfort may be
felt when the skin is punctured
 Encourage to avoid stress if possible
because altered physiologic status
influences and changes normal
hematologic values
 Explain that fasting is not necessary
 Apply manual pressure and dressings
over puncture site on removal of
dinner
 Monitor the puncture site for oozing
or hematoma formation
 Instruct to resume normal activities
and diet
C. Biopsy
- to remove a piece of tissue or a sample
of cells from the body so that it can be
analyzed in a laboratory
- imaging tests can’t differentiate
cancerous cells for noncancerous cells
Kinds:
 Bone marrow biopsy
 Endoscopic biopsy
 Needle (thyroid)
 Procedures:
1. Fine-needle aspiration
2. Core needle biopsy
3. Vacuum-assisted biopsy
4. Image-guided biopsy
 Skin
 Shave
 Punch
 Incisional
 Excisional
Biopsy analysis and results:
 Tissue sample sent to a laboratory for
analysis
 Sample may be chemically treated or
frozen and sliced into very thin
sections, stained to enhance contrast
and studied under a microscope
 The grade is on a scale of 1 to 4
 Low-grade (grade 1) cancers are
generally the least aggressive and
high-grade (grade 4) are the most.
Nursing Responsibilities
Before the test
 Confirm pt’s identity
 Describe the procedure
 Needle biopsy - need to sit still during
the procedure
 W/ local anesthetic - no restriction of
food, fluids, and medication
 General anesthetic - fast from mn
before the procedure
 Explain that pretest studies - blood,
urine, and chest x-rays, may be
required.
 Make sure the pt or surrogate a
consent form
 Check the pt’s history for
hypersensitivity to anesthetics
During the test
 Remind the pt undergoing a needle
biopsy to sit still
 Assist w/ the collection of specimens
into the appropriate containers, if
indicated
 Send the specimens to the laboratory
immediately, if appropriate
After the test
 If pt received a general or local
anesthetic - monitor VS regularly
 General anesthetic - check VS q15
minutes for 1h, every 30m for 2h,
every hour for the 4h, and then every
4h
 Administer analgesics for pain and
provide ice bags for comfort
 Instruct the pt to wear a support brace
at all times until healing is complete
 Observe and report bleeding,
tenderness, and redness at biopsy site
 Provide emotional support while
waiting Dx.
D. Blood Culture & Sensitivity Test
- blood is injected into bottles with culture
media to determine whether
microorganisms have invaded the pt’s
bloodstream
- a test to find germs (such as bacteria or a
fungus) that can cause an infection
- checks to see what kind of medicine,
such as an antibiotic, will work best to
treat the illness or infection
Nursing Responsibilities:
After the test
 If pt received a general or local anes -
monitor VS regularly
 General anes - check VS q15m for 1h,
every 30m for 2h, every h for the next
4h, and then every 4h
 Administer analgesics for pain and
provide ice bags for comfort
 Instruct the pt to wear a support brace
at all times until healing is complete
 Observe and report bleeding,
tenderness, and redness at biopsy site
 Provide emotional support while
awaiting Dx.
Blood Culture
- to find out systemic infection
- infection that affects the whole body, not
just one part
- sample of blood is studied in a lab to
check for bacteria or a type of fungus
called yeast
Purpose:
Symptoms of a systemic infection:
 Chills
 Fever
 Tiredness (fatigue)
 Confusion
 Nausea
 Rapid breathing or heart rate
 Passing urine less often
This test is done to confirm an infection
(pneumonia) and figure out the best way
to treat it.
Other tests
 If HCP penumonia - a gram stain on
sputum (find out what causes
infection)
 Susceptibility testing - find out which
antibiotic is applicable for infection
 CBC either before or with the blood
culture - test level of WBC
Results
 Test results may not mean a problem
 A positive result means bacteria or
yeast are present in your blood
 A negative result means that no signs
of any bacteria or yeast were found in
the blood
Procedure
 Done with at least 2 blood samples
(multiple samples produces accurate
results)
 Blood samples are placed in a dish
with a substance that promotes
growth of bacteria or yeast - called
culture
 Results after 24h, but it can take 48h
to 72h to find out the specific bacteria
or yeast causing your infection
Risks
 Bleeding
 Infection
 Bruising
 Feeling lightheaded
 Slight sting or pain when needle is
inserted
 Soreness of the site
Antibiotic effect
 Blood sample should be drawn just
before taking antibiotics
 Antibiotic could slow the growth of
the infecting bacteria
Nursing Responsibilities
Before the test
 Confirm the pt’s identity
 Explain to pt that procedure is used to
help identify the organism
 Inform pt NO restriction of food and
fluids
 Advise pt slight discomfort from the
tourniquet and needle punctures
 Perform a venipuncture: draw 1-
20mL of blood for an adult
After the test
 Apply direct pressure to the
venipuncture site until bleeding stops
 Assess the venipuncture site for
hematoma formation; if one develops,
apply direct pressure.
 Prepare to initiate antimicrobial
therapy, as ordered
E. CSF Gram staining
- lab proc used to detect the presence of
bacteria and sometimes funi in a sample
taken from the site of a suspected
infection
- permits rapid identification of bacterial
cause in 60-90% of pts w/ bacterial
meningitis
- presence of bacteria is 100% specific,
but the sensitivity of this test for detection
is variable
Gram Staining
 Involves applying a sample from the
infected area onto a glass slide and
allowing it to dry - then treated w/ a
special stain and examined under a
microscope
 Any bacteria that may be present are
categorized by color and shape during
the microscopic evaluation:
 Color - “gram positive” purple or
“gram negative” pink
 Shape - round (cocci) or rod-
shaped (bacilli)
Collection of sample
 Lumbar puncture or “spinal tap”
- used to sample spinal fluid or give
medication
Patient Safety Tips Prior to a Lumbar
Puncture
 Know of any allergies or adverse
reactions to medications
 For pregnant or may be pregnant -
doctor or technologist must be aware
 Leave valuables at home or in the
room
 Interpreting services
 List of current medications
 Stop taking Aspirin and other blood
thinning medications
 For outpatients, must be accompanied
by an adult
Risks
 Discomfort or pain during the
procedure
 Bleeding into the spinal cord,
particularly in ppl who take blood
thinners or have a low platelet count
(thrombocytopenia)
 Headache as a result of CSF leakage
 Infection
 Nerve damage
Uses
 Identify cause of bacterial infection
 Shape of bacteria and whether they
are Gram-positive or negative - to
prescribe an appropriate antibiotic
while waiting for more specific tests,
such as a culture, to be completed
 For evaluation of a culture - to help
determine the type of bacteria and to
help determine what other tests may
need to be performed
 To detect fungi, including yeast
 Viruses cannot be detected with a
gram stain
Nursing Responsibility for Lumbar
Puncture
Before the procedure
 Explain the procedure - the purpose
of lumbar puncture
 Obtain a signed consent form
 Reinforce diet
 Promote comfort
 Establish a baseline assessment data -
VS and neurologic
 Assist the client to assume a lateral
decubitus (fetal) position
 Instruct to remain still
After the procedure
 Apply brief pressure to the puncture
site
 Place the pt flat on bed
 Monitor VS, neurologic status, and
I/O - at least every 4h for 24h
 Monitor the puncture site for signs of
CSF leakage and drainage of blood
 Encourage increase fluid intake
 Label and number the specimen tube
correctly
 Administer analgesia as ordered
F. ELISA Test
- an abbreviation for “enzyme-linked
immunosorbent assay”
- substitute for certain radioimmunoassay
tests, and eventually, it replaced the
Western blot test for HIV confirmation
- versatile and medical professionals can
perform it easily
- uses components of the immune system
(such as IgG or IgM antibodies) and
chemicals for the detection of immune
responses in the body (for example, to
infectious microbes)
- involves an enzyme (a protein that
catalyzes a biochemical reaction) or an
antibody or antigen (immunologic
molecules) that may form an antigen-
antibody reaction to provide a positive
result or, if they do not react, a negative
result
Uses
 Primarily detect proteins (as opposed
to small molecules and ions such as
glucose and potassium)
 As blood tests to detect antigens that
may be present in the blood.
The substances detected:
 Hormones, an allergen, viral antigens
(dengue fever), bacterial antigens
(TB, for example), and antibodies that
the body has made in response to
infection (antibodies to hepatitis B,
for example) or vaccination.
 Can also identify an infectious disease
FOUR TYPES:
1. Direct ELISA: attachment of an
antigen to a polystyrene plate followed by
an enzyme-labeled antibody.
2. Indirect ELISA: attachment of an
antigen to a polystyrene plate followed by
an unlabeled or primary antibody
followed by an enzyme-labeled antibody.
3. Sandwich ELISA: a capture antibody
is attached to the polystyrene plate, then
antigen is added that specifically attaches
or captures the antigen.
4. Competitive ELISA: like the sandwich
ELISA but involves the addition of
competing antibodies or proteins when the
second antibody is added.
Advantages
 Generally good and accurate tests
 Considered highly sensitive and
specific (accurate) and compare
favorably with other methods used for
the detection of substances in the
body
 More straightforward and easier to
perform than older laboratory
techniques, which often required
radioactive materials.
Preparation & Risks:
 P: no special preparation
 P: blood is required - blood
collection.
 R: rare and associated with blood
withdrawal (infection, vessel damage)
Actual Results
 Hundreds of variations of ELISA
tests
 Results and their meaning depend on
what is being tested
 ELISA test for viral RNA can detect
it (a positive test), not detect it (a
negative test), or be indeterminate
(borderline test)
 Rarely false negative or false positive
result
Nurse Responsibility
 Explain test procedure - slight
discomfort may be felt when the skin
is punctured
 Encourage to avoid stress
 Explain that fasting is not necessary
 Apply manual pressure and dressings
over puncture site on removal of
dinner
 Monitor the puncture site for oozing
or hematoma formation
 Instruct to resume normal activities
and diet
G. Western Blot
- AKA immunoblotting
- a test for a specific protein within a
protein mixture
Performed after gel-electrophoresis or an
enzyme-linked immunosorbent assay
(ELISA) test, and it uses antibodies to
identify specific proteins
- typically used to confirm a positive HIV
diagnosis
Principle
 In this, gel electrophoresis is used to
separate proteins in a sample based on
their molecular weight
 The separated proteins are then
transferred to a solid support, which is
then exposed to antibodies that can
bind to the target protein
 This binding is detected using a
chemical or radioactive tag
 Large proteins molecules need to be
denatured before electrophoresis to
facilitate their movement in the gel
Procedure
Denaturation of proteins
 Involves unfolding of the protein’s
tertiary structure to a linear structure
 Detergents such as sodium dodecyl
sulfate are commonly used to
denature proteins’
Separation of proteins
 The denatured protein sample is
loaded onto an electrophoretic gel and
an electrical charge is applied
 Protein molecules are separated on
the basis of their size and electrical
charge
Transfer to a support membrane
 The separated proteins is transferred
to a sheet of blotting paper made of
nitrocellulose
Visualizing target protein
 A primary or monoclonal antibody is
added to the blot, which binds to the
target protein
 A labeled secondary antibody which
binds to the primary antibody is then
added, allowing detection of the
specific protein
Application
 Detection of circulating antibodies
specific to a single protein or several
proteins
 In clinical diagnosis - HIV testing to
detect anti-HIV antibody or as
confirmatory tests for diseases
(epidermolysis bullosa acquiaita or
paraneoplastic pemphigus)
 Analysis of biomarkers such as
hormones, growth factors, and
cytokines
 In gene expression studies
Disadvantages
 Very delicate and time-consuming
process
 The secondary antibody can cause
labeling of an incorrect protein
 Insufficient transfer time can result in
the larger proteins not transferring
properly
 Well trained technicians are a must
for this technique
 Semi-quantitative at best
 Primary antibody availability is
crucial
Nursing Responsibilities
Same as in blood testing
Tests for emerging infection
Emerging infectious diseases are those
whose incidence in humans has increased
in the past 2 decades or threaten to
increase in the near future
 It can challenge efforts to protect
workers as prevention and control
recommendations may not be
immediately available
Can be caused by:
 Previously undetected or unknown
infectious agents
 Known agents that have spread to
new geographic locations or new
populations
 Previously known agents whose role
in specific diseases has previously
gone unrecognized
 Re-emergence of agents whose
incidence of disease had significantly
declined in the past, but whose
incidence of disease has reappeared
(re-emerging infectious diseases)
Emerging diseases
 Respiratory viruses such as influenza
A viruses (IAV) or human respiratory
syncytial virus (RSV)
 Avian influenza viruses (AIV) such as
IAV H5N1, H7N7, or H9N2 crossed
the species barrier to infect humans
several times in the last years
(reviewed in Kim et al., 2016)
 Coronavirus disease (COVID-19)
Commercially Available Test Systems
 Respiratory viruses such as IAV,
influenza B virus (IBV), and RSV -
point-of-care tests (POCTs) and near-
POCTs
 Three newer generation rapid
multiplex polymerase chain reaction
systems (mPCRs) are highly accurate
 Diagnosis of emerging and novel
viruses, including HboV, RV-C,
coronaviruses as well as specific
subtypes of AIV and reassortant IAV
strains - Polymerase chain reaction
(PCR) remains the gold standard
technique for the diagnosis
Innovative Approaches for Future
POCTs
Biosensors
 A reliable and cost-effective way to
detect sepcific pathogens in POCT
setting
New Techniques and Prototypes
 Capillary convective PCR (CCPCR) -
the reagents circulate across a
temperature gradient in a simple
capillary tube, which allows run times
shorter than 30m - used to test for
non-respiratory viruses like hepatitis
C virus
Lab-Based nucleic acid amplification
tests (NAATs) with potential use as
Point-of-Care Applications
 In comparison to PCRs, isothermal
NAATs do not require complex
devices when working with extracted
nucleic acids
 Reverse transcription strand invasion-
based amplification (RT-SIBA) and
reverse transcription loop-mediated
 isothermal amplification (RT-LAMP)
- to detect Human metapneumovirus
(HMPV), IAV and MERS-CoV
COVID-19
An infectious disease caused by a newly
discovered coronavirus
 At this time, no specific vaccines or
treatments for COVID-19
 Most people infected will experience
mild to moderate respiratory illness
and recover without requiring special
treatment
 Older people, and those with
underlying medical problems like
CVD, diabetes, chronic respiratory
disease, and cancer are more likely to
develop serious illness
CDC 2019-nCoV RT-PCR Diagnostic
Panel
 In early 2020, CDC developed its first
laboratory test kit - CDC 2019 Novel
Coronavirus (2019-nCoV) Real-Time
Reverse Transcriptase (RT)-PCR
Diagnostic Panel
 During validation of the CDC SARS-
CoV-2 test, some laboratories
discovered a problem - reagent
produced a positive result with the
negative control
 On June 12, 2020, CDC add the
Promega Maxwell RSC 48 as an
authorized extraction instrument for
use with the CDC 2019-nCoV rRT-
PCR Diagnostic Panel
INFECTIOUS, INFLAMMATORY,
AND IMMUNOLOGIC:
INDEPENDENT AND DEPENDENT
NURSING CARE
Independent Nursing Care
A. Physiologic Care
- ensures that any physical needs are being
met and that the patient is in a healthy
condition
- promotes physical health and wellness
by providing care and comfort, reducing
and managing potential health alterations.
This include:
 Use of assistive devices
 Elimination
 Nutrition and oral hydration
 Personal hygiene
 Mobility/immobility
 Rest and sleep
 Non-pharmacological comfort
interventions
B. Psychosocial Care
- given to help meet the mental,
emotional, social, and spiritual needs of
patients and their families
Include:
Counseling: aim to assist pt identify goals
and potential solutions to problems which
cause emotional turmoil
Education: the process of influencing pt
behavior and producing the changes in
knowledge, attitudes, and skills.
Group support: a group of people
meeting either physically or online to
share information, experiences, problems
and solutions
Spiritual support: the goal is to help the
person feel peace and comfort
C. Spiritual Care
- aspect of health care that supports the
inner person (spirit/soul) to help deal with
the health challenges that patient and their
loved ones is facing
- spending time with the people important
to them; spending time in nature; spending
time on hobbies; following religious
customs
Dependent Nursing Care
A. Pharmacologic
1. Antibiotics
a. It is used based on the premise that:
infection trigger an immune reaction like
autoimmunity through several
mechanisms:
 Molecular mimicry
 Epitope spreading
 Bystander activation
b. Antibiotics are also utilized for their
anti-inflammatory and
immunomodulatory properties
2. Antifungal agents
- when there is immunosuppression, a
common therapeutic side-effect
predisposes pt to invasive fungal
infections
There are four main types of antifungal
drugs:
 Polyenes (Nystatin, Amphotericin B)
 Azoles (Imidazole - Clotrimazole,
Ketoconazole, Miconazole) (Triazole
- Fluconazole, Isavuconazole,
 Itraconazole, Posaconazole,
Voriconazole)
 Allylamines (Terbinafine)
 Echinocandins (Andidulafungin,
Caspofungin, Micafungin)
3. Keratolytic agents
- designed to dissolve skin flakes, scales
and a ranger of skin conditions
- Ex: mild to moderate acne, dandruff,
psoriasis, warts, and hyperpigmentation.
Sources:
> Salycylic Acid: breaks down connection
between dead cells on the surface of the
skin (exfoliant)
> Urea: soften and soothe the skin. Has
hydrating and anti-itching properties.
Helps other medications to penetrate the
skin.
> Lactic Acid: exfoliates the skin, while
also helping to stimulate skin cell renewal
and keeping the skin hydrated
> Olive oil: may also be used to remove
scales
> Other sources: coal tar, pyrithione zine,
glycolic acid, tretinoin, and acitretin.
4. Anti-inflammatory agents
- reduces inflammation (redness, swelling,
and pain) in the body.
- block the production of a certain body
chemicals caused by the activation of
inflammatory cells that results to
inflammation.
Example of commonly prescribed
NSAID:
 Celecoxib (Celebrex)
 Diclofenac (Voltaren)
 Fenoprofen (Nalfon)
 Indomethacin (Indocin)
 Ketorolac tromethamine (Toradol)
 Meclofenamate sodium
 Diflunisal
 Tolmetin
 Ketoprofen
 Flurbiprofen
5. Corticosteroids
- are powerful anti-inflammatory
medications from a class of human-made
or synthetic drugs
- when the body’s immune system fails to
function correctly, and attack its own
body organs, bones, or tissues.
STEROIDS:
a. Stop the body from making cytokines
that cause inflammation
b. Deplete certain immune cells called T
and B cells and eosinophils
c. Make it more difficult for immune cells
to travel to spots of infection or injury
though the body
Types:
Systemic - can be administered through:
oral medications, intramuscular, and
intravenous injection
Localized - can be applied through: skin
creams and ointments, eye drops, ear
drops, inhalers
Common Corticosteroids:
 Prednisone (Deltalone, Prednicot,
Cotolone)
 Prednisolone (Orapred, Omnipred)
 Cortisone (Cortone)
 Hydrocortisone (Cortef, Hydrocort)
 Triamcinolone (Aristocort)
 Dexamethasone (Decadron)
 Mometasone (Nasonex spray)
6. Immunologic Agents
- drugs that can alter the immune
response, either by enhancing or
suppressing the immune system
- used to fight infections, prevent and treat
certain diseases
Types of immunologic agents
 Immune globulins
 Immunostimulants
 Bacterial vaccines
 Colony stimulating factors
 Interferons
 Interleukins
 Other immunostimulants
 Therapeutic vaccines
 Vaccine combinations
 Viral vaccines
 Immunosuppressive agents
 Calcineurin inhibitors
 Interleukin inhibitors
 Selective immunosuppressants
 TNF alfa inhibitors
B. Surgical procedures
1. Debridement
- removal of devitalized tissue such as
necrotic tissue, slough, bioburden,
biofilm, and apoptotic cells
Common indications for sharp surgical
debridement:
 Removal of the source of sepsis,
mainly necrotic tissue
 “ of local infection to decrease
bacterial burden, to reduce the
probability of resistance from
 antibiotic treatment, and to obtain - excisions that involve removing the
accurate cultures epidermis and part of the dermis or
 Collection of deep cultures taken after epidermis and the entire dermal layers are
debridement from the tissue left generally termed partial- or full- thickness
behind to evaluate persistent infection surgical excisions
and requirements for systemic Possible Complications:
antibiotic treatment  Excessive scarring
 Stimulation of the wound bed to  Signs of infection such as fever and
support healing and to prepare for a chills
skin graft or flap  Drainage from the wound site
Complications include:  Nerve damage
 Irritation  Bleeding
 Bleeding  Swelling
 Damage to healthy tissue  Pain and discomfort
 Allergic reaction  Incision reopening/dehiscence
 Pain Post Excision Care:
 Bacterial infection  Keep the sterile bandage to prevent
Post debridement care the risk of infection
1. Regularly change the dressing  Maintain the excision site dry
2. Keep the dressing dry  Pt is on antibiotic therapy to promote
3. Keep the wound clean wound healing
4. Don’t apply pressure. Use special  Avoid strenuous activity for at least 2
cushions to avoid placing weight on weeks after the surgery
wound.  Pt is advised to refrain from smoking
for at least a week as it impairs would
2. Incision and Drainage (I&D) healing
- primary treatment for skin and soft tissue  Pain medication is given as necessary
abscesses, w/ or w/o adjunctive antibiotic  Follow-up w/ the doctor after 1-2
therapy weeks
Complications:
 Normally I&D is well tolerated with
pain as the most common
complication
 Becteremia and sepsis
 Chronic draining sinuses and fistulas,
secondary to inadequate drainage of
deep or complicated abscesses
Post I&D Care:
 Reevaluate and redress the wound in
24-48h except for some small
abscesses. Which do not need to be
monitored closely
 Postoperative analgesics may be
required for pain
 Instruct the pt to elevate the wound
and keep dressing and splint clean
and intact before the 1st follow-up
visit
 Pts should be reevaluated if they have
worsening pain, increased drainage,
or spreading erythema
 Antibiotic therapy at least 5-7 days
after the procedure

3. Excisional Surgery
- removal of growths on superficial
structures