Inflammation, Tissue Repair, and Wound Healing



Inflammation, Tissue Repair, and Wound Healing

QUESTION
Select one of the case studies below for your assignment. In your discussion, be sure to integrate your knowledge of advanced pathophysiology across the lifespan with the clinical implications for the advanced practice nurse

Case Study Assignment Requirements:

Make sure all of the topics in the case study have been addressed.
Cite at least three references in your case study paper; this may include peer-reviewed journal articles, textbooks, or evidence-based practice websites to support the content.
All reference sources must be within 5 years.
Do not use sources such as Wikipedia or UpToDate as a reference.
Assignments must have at least four full pages of analytic content, double-spaced (the cover and reference pages do not count in the page count, but must be included with the assignment), and follow APA 7th edition format.

Case Study 4: Inflammation, Tissue Repair, and Wound Healing

Carlton, a 6-year-old boy, was playing on a sandy beach with his mother. He began to run along the shoreline when he stepped on the sharp edge of a shell, giving himself a deep cut on his foot. His mother washed his foot in the lake and put on his running shoe to take him home. One day later, Carlton’s foot looked worse. The gash was red and painful. The foot was warm to touch and appeared swollen. Carlton’s mom put some gauze over the wound and prepared to take him to the local community health clinic.

What is the physiologic mechanism causing the wound to become red, hot, swollen, and painful? How is this different from the inflammatory response that might occur in an internal organ?
What are the immunologic events that are happening at the local level during Carlton’s acute inflammatory response?
Nutrition plays an important factor in wound healing. What stages of wound healing would be affected by a deficiency in vitamins A and C?
Inflammation, Tissue Repair, and Wound Healing

ANSWER
Inflammation, Tissue Repair, and Wound Healing

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Inflammation, Tissue Repair, and Wound Healing
When body tissues are damaged due to exposure to either a pathogen or other stimuli such as chemicals or damages caused by pressure injuries, a coordinated response is evoked to facilitate the healing process to help in returning the cells or tissues to normal functioning. A defect in such a response or certain factors may hinder the healing process, causing delays in tissue repair and healing. This is a similar process in Carlton following the injury he received at the beach.
Physiologic Mechanism Causing the Wound to Become Red, Hot, Swollen, and Painful
Acute inflammation, an immunological response, is characterized by; redness, swelling, heat, loss of function, and pain. The symptoms exhibited by Carlton are all the cardinal signs of acute inflammation, indicating that these symptoms, therefore, were too due to the injury. The acute inflammatory process is responsible for the symptoms exhibited by Carlton, as the body tries to repair and heal the damaged tissues which occurred following the injury (Singh et al., 2017). The physiologic mechanism involves those directed towards ensuring the repair of the damaged tissues and protecting the injured tissues from infection by microorganisms (Singh et al., 2017). Immediately after an injury occurs, the inflammation process initiates the repair.
As fluids and white blood cells move to the injured party, there is swelling (Singh et al., 2017).
This is characterized by the release of prostaglandins which cause local vasodilation that increases blood supply to the area of trauma. The increased blood flow causes redness and heat in the area of trauma. The distortion of tissues due to the injury hence stimulation of pain fibers in the nerve endings is responsible for the pain symptoms experienced. The release of various pain mediators such as serotonin, bradykinins, and prostaglandins are also responsible for the pain symptoms (Singh et al., 2017).
How is this Different from the Inflammatory Response That Might Occur in an Internal Organ?
Inflammation involving internal organs manifests differently; hence patients will perceive them differently and presents differently in terms of signs and symptoms. Carlton’s presentation was due to local inflammatory response, thus specific to the area of injury. In inflammatory responses involving internal organs, the inflammatory mediators are not localized to a specific region, resulting in systemic manifestations (Singh et al., 2017). Besides the activation of the acute-phase inflammatory response and elevated cells such as leukocytes, the individual affected may experience fever. The lymphatic system may also be involved in causing enlargement of the lymph nodes (Singh et al., 2017). Patients may also have sepsis and, in some severe cases, go into septic shock due to systemic inflammation. Lastly, pain experienced during inflammation of internal organs is due to stretch of organ receptors, inflammation of the organs, or even their enlargements.
Immunologic Events That Are Happening at the Local Level during Carlton’s Acute Inflammatory Response
At the local level following the injury, acute inflammatory response predominates. It facilitates the elimination of various microbes and antigens at the injured site before the adaptive immune response starts, given that it takes time. The acute inflammatory response that occurs in response to the injury occurs in two phases: the vascular and cellular phases (Ellis et al., 2018). The vascular phase is characterized by the release of prostaglandins which causes vasodilation, which increases blood flow to the area of trauma. This causes redness and warmth, which are some of the symptoms exhibited by Carlton. There is also increased vascular permeability, which results in extravasation of fluids causing regional swelling.
The release of inflammatory mediators such as serotonin, bradykinin, and prostaglandins, together with activation of the nociceptors present in the injured part, are responsible for the pain experienced (Ellis et al., 2018). The cellular phase is characterized by the release of granulocytes, which mainly include monocytes and neutrophils, to the injury site. Granulocytes are white blood cells that form part of the innate immune system. These immune system cells leave the vessels through extravasation and move to the site of injury by adhesion, transmigration, and chemotaxis (Ellis et al., 2018). Once they reach the site of injury, they help kill microorganisms present at the site of injury through phagocytosis, thereby preventing the injury site from getting infected, a factor that may hinder the healing process.
Stages of Wound Healing Would Be Affected By a Deficiency in Vitamins A and C
Proper wound healing requires a properly functioning immune system. Certain factors are also critical in ensuring faster healing of damaged tissues. One of the critical factors that are useful in enhancing the healing process is effective and proper nutrition with many vitamins A and C (Barchitta et al., 2019). Vitamins are essential micronutrients with a critical role in wound healing and tissue repair. The wound healing process is categorized into four stages: hemostasis, which aims to stop bleeding, clotting, growth, and proliferative stage, and lastly, the maturation phase. Vitamins such as vitamin C are involved in all phases of wound healing. For instance, in the proliferative phase, it plays an essential role in neutrophil apoptosis and clearance (Barchitta et al., 2019). Vitamin C is also required in the proliferative phase in the synthesis, secretion, maturation, and collagen degradation
. Therefore, deficiency in vitamin C will result in an impaired maturation phase since such deficiencies affect collagen production, which hinders wound healing. In addition, Vitamin A also plays a crucial role in wound repair and the healing process (Barchitta et al., 2019). It enhances epidermal turnover, thereby increasing the re-epithelialization rate. Such a role is necessary for restoring the epithelial structure, which completes the healing process. In addition, vitamin A such as retinoids performs a crucial role in reversing the effects that anti-inflammatory steroids have on wound healing. Local and systemic supplementation with vitamin A has also been attributed to increased collagen deposition, which is fundamental in the healing process (Barchitta et al., 2019). Therefore, the deficiency of vitamin A would impair wound healing due to the critical role it performs that is necessary for the wound healing process.
Conclusion
Effective healing requires various factors, including proper and adequate nutrition. Inflammation following damage to body tissue or cells is an essential process that helps protect the injured area against infections and facilitates the healing process. Therefore, the inflammation process in case of injury should be allowed to progress since it is entirely physiological and enhances the healing process. Various micronutrients, specifically vitamins A and C, play critical roles in the healing process, given their roles in various phases of wound healing. Proper nutrition and supplementation of these nutrients should be encouraged during an injury to facilitate the healing process.

References
Barchitta, M., Maugeri, A., Favara, G., Magnano San Lio, R., Evola, G., Agodi, A., & Basile, G. (2019). Nutrition and wound healing: An overview focusing on the beneficial effects of curcumin. International journal of molecular sciences, 20(5), 1119. https://www.mdpi.com/422100
Ellis, S., Lin, E. J., & Tartar, D. (2018). Immunology of wound healing. Current dermatology reports, 7(4), 350-358. https://link.springer.com/article/10.1007/s13671-018-0234-9
Singh, S., Young, A., & McNaught, C. E. (2017). The physiology of wound healing. Surgery (Oxford), 35(9), 473-477. https://www.sciencedirect.com/science/article/pii/S0263931917301369

Inflammation, Tissue Repair, and Wound Healing


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