Introduction to Medical-Surgical Nursing, 6th ed.
13
Lesson Plans for
Immunity, Inflammation, and Infection
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 13.1:
2. Describe the immune response.
4. Compare natural and acquired immunity.
Lesson 13.2:
6. Identify the signs and symptoms of inflammation.
8. Differentiate infection from inflammation.
10. Describe the ways that infections are transmitted.
12. Compare community-acquired and health care–associated infections.
13. Discuss the nursing care of patients with infections.
Lesson 13.3:
14. Describe the Centers for Disease Control and Prevention (CDC) Standard Precautions guidelines for
infection prevention and control.
16. Describe the CDC isolation guidelines for a Protective Environment.
18. Describe the nursing care of patients with immunodeficiency and of those with allergies.
19. Describe the process of autoimmunity.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to physical and chemical barriers, the signs and
symptoms of inflammation including how inflammatory changes act as bodily defense mechanisms,
and the process of repair and healing.
• Students will examine the differences between inflammation and infection; the signs, symptoms, and
transmission of infections; the actions of commonly found infectious agents; the differences between
community-acquired and nosocomial infections; and the nursing care for patients with infections.
2 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) What is the main function of neutrophils in the body?
a) To fight fungal infections
b) To fight viruses
c) To prevent inflammation
d) To fight bacterial infections
2) A series of cellular changes that signals the body’s response to infection or injury is __________.
a) phagocytosis
b) the inflammatory process
c) immunity
d) the antibody response
3) Which of the following is the most common cause of anaphylaxis?
a) Spider bites
b) Snake bites
c) Allergy to antibiotics
d) Asthma
4) Which of the following organisms can cause a severe superinfection of the gastrointestinal tract,
including colitis and profuse diarrhea?
a) Clostridium difficile
b) Staphylococcus aureus
c) Pseudomonas
d) Legionella
5) An infective agent that is common in areas with poor sanitation is __________.
a) bacteria
b) viruses
c) helminths
d) rickettsiae
6) An infective agent enters the body through the __________.
a) portal of exit
b) reservoir
c) portal of entry
d) host
7) An infection that occurs while a patient is hospitalized is a __________.
a) community-acquired infection
b) communicable disease
c) public health infection
d) nosocomial infection
8) Handwashing is one of the most basic and effective ways to prevent __________.
a) cross-contamination
b) skin breakdown
c) airborne infections
d) infectious disease
9) A condition that would require the use of airborne precautions is __________.
a) a skin infection
b) tuberculosis
c) human immunodeficiency virus (HIV)
d) hepatitis B
10) The body’s ability to resist and fight off infections is known as __________.
a) contamination
b) asepsis
c) immunity
d) autoimmune response
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 3
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are the body’s first lines of defense against infection? How do these work?
Question: What is inflammation? What are the four classic signs of inflammation?
4 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.1
Instructor Preparation
Textbook Objectives Covered
2. Describe the immune response.
4. Compare natural and acquired immunity.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying inflammation, infection, and immunity, including:
• Signs, symptoms, and treatment of inflammation and infection
• Community-acquired and nosocomial infections
• Nursing care for infections, allergies, and immunodeficiencies
• CDC infection control and isolation guidelines
• Types of immunity and the autoimmune process
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
• flash cards
Key Terms
• allergen (p. 186)
• antibodies (p. 168)
• antigen (p. 168)
• autoimmunity (p. 188)
• bacteria (p. 173)
• communicable disease
(p. 175)
• inflammation (p. 170)
• medical asepsis (p. 179)
• multidrug-resistant organism
(MDRO) (p. 177)
• surgical asepsis (p. 180)
• virus (p. 173)
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 167-168)
ANSWER – Study Guide
• Part IIL: 1, 2 (p. 67)
2
READ – Textbook (pp. 168-170)
REVIEW
ANSWER – Study Guide
• Part IA: 1-7 (p. 64)
3
READ – Textbook (pp. 168-170)
ANSWER – Study Guide
• Part IJ: 1, 2 (p. 67)
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.1
4
READ – Textbook (pp. 168-169)
ANSWER – Study Guide
• Part IB: 12, 17 (p. 64)
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 13
Inflammation, Infection, and Immunity
Side 2
Physical and Chemical Barriers
• Skin and mucous membranes are the first line of defense
• Second line of defense is the inflammatory response
1
Slide 3
Skin and Mucous Membranes
• The body’s first line of defense
• Protective covering; secretes substances that inhibit the growth of microorganisms
• Sweat glands secrete lysozyme, an antimicrobial enzyme
immunoglobulin; also clean up phagocytes
Slide 4
Skin and Mucous Membranes (cont.)
• Surfaces colonized by “normal” bacterial flora: prevent pathogens (disease-causing
organisms) from entering the body
• Cilia in respiratory tract, motility of the GI tract, and sloughing of dead skin distribute and
remove microorganisms, preventing their overgrowth and invasion
2
Slide 5
Immunocompromised Patients
• Decreased immunity to infection; are at increased risk for bacterial, fungal, parasitic, and
viral infections
TALKING POINTS:
• Patients receiving chemotherapy and other patients with low white blood cell counts are at
increased risk of infection.
6 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.1
Slide 6
Immunity
• Provides resistance to invading organisms; enables body to fight off invaders once they
have gained access
• Antigen
• Any substance capable of stimulating a response from the immune system
• Usually foreign; body recognizes it because it’s different
• Antibodies
• Also known as immunoglobulins
• Proteins are created in response to specific antigens
TALKING POINTS:
• If the immune system is intact and functioning properly, it is able to provide adequate
Slide 7
Immunity (cont.)
• Innate (natural) immunity
• Present at birth; not dependent on a specific immune response or previous contact
with an infectious agent
• Acquired immunity
TALKING POINTS:
• What factors may influence innate immunity?
• Nonspecific defense mechanisms, including physical and chemical barriers to infection,
phagocytosis, and the inflammatory process, contribute to natural immunity.
3
Slide 8
Immunity (cont.)
• Leukocytes (white blood cells)
• Key role in immune responses to infectious organisms and other antigens
Slide 9
Immunity (cont.)
• Lymph nodes
• Attack antigens and debris in the interstitial fluid and produce and circulate
lymphocytes
• Spleen
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.1
4
Slide 10
Nonspecific Defenses Against Infection
• Innate (natural) immunity
• Present at birth; physical and chemical barriers to invasion of the body as well as
substances that protect and repair tissues and stimulate the body to fight off disease
• Physical and chemical barriers, inflammation, and phagocytosis are nonspecific
defenses against infection
TALKING POINTS:
• Other nonspecific defenses against infection that protect the body include complement,
pyrogen, and interferon.
• How do complement, pyrogen, and interferon assist with defense against infections?
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Write the headings “physical barrier” and
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
2
DISCUSS
• Discuss the normal immune system
response and common immune system
disorders.
• Write the key terms from the chapter on one
POST AND COMMENT
• Post the following discussion topic online
and have students comment. List steps of
the immune response. Give a brief
explanation of what occurs in each step.
8 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.1
3
DISCUSS
• Discuss the role each organ plays in
immunity.
• Divide the class into small groups and assign
each group one or two of the organs in Figure
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe what
you believe are the two most important
organs in the immune response. Explain
4
DISCUSS
• Discuss factors that influence the proper
functioning of both natural and acquired
immunity.
• Divide the class into two groups. Assign one
group the topic of innate immunity and the
other group acquired immunity. Have each
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Compare and
contrast natural and acquired immunity.
Critical Thinking Question
A patient is hospitalized after a cerebrovascular accident (CVA) and has an indwelling
urinary catheter. During the course of the hospitalization, the patient develops a urinary tract
infection. What type of infection is this, and why is the patient at increased risk for this
infection?
Discussion Guidelines: An infection that is developed while a patient is hospitalized is considered
a nosocomial infection. Any patient with an indwelling urinary catheter has an open port to the
Instructor Notes/Student Feedback
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 9
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.2
Instructor Preparation
Textbook Objectives Covered
5. Describe how inflammatory changes act as bodily defense mechanisms.
7. Discuss the process of repair and healing.
9. Discuss the actions of commonly found infectious agents.
11. Identify signs and symptoms of infection.
13. Discuss the nursing care of patients with infections.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying inflammation, infection, and immunity, including:
• Signs, symptoms, and treatment of inflammation and infection
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• allergen (p. 186)
• antibodies (p. 168)
• antigen (p. 168)
• autoimmunity (p. 188)
• inflammation (p. 170)
• medical asepsis (p. 179)
• multidrug-resistant organism
(MDRO) (p. 177)
Student Preparation
Assignments 2 hours
5
READ – Textbook (pp. 170-172)
ANSWER – Text
• Review Questions for the NCLEX Examination: 2 (p. 190)
ANSWER – Study Guide
6
READ – Textbook (p. 172)
10 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.2
7
READ – Textbook (pp. 171-172)
8
READ – Textbook (pp. 172-178)
ANSWER – Text
• Review Questions for the NCLEX Examination: 3, 4 (p. 190)
ANSWER – Study Guide
• Part IA: 13, 14 (p. 64)
• Part IB: 3 (p. 64)
• Part IIL: 4 (p. 67)
9
READ – Textbook (pp. 175-178)
REVIEW
ANSWER – Text
• Review Questions for the NCLEX Examination: 5 (p. 190)
ANSWER – Study Guide
• Part IB: 1 (p. 64)
• Part IIL: 5-7, 20 (pp. 68-69)
10
READ – Textbook (p. 174)
REVIEW
• Figure 13-4: Hand hygiene (p. 179)
ANSWER – Text
• Review Questions for the NCLEX Examination: 6, 7 (p. 190)
11
READ – Textbook (pp. 175-176)
ANSWER – Study Guide
• Part IB: 2 (p. 64)
12
READ – Textbook (pp. 175-178)
ANSWER – Text
ANSWER – Study Guide
• Part IA: 11 (p. 64)
• Part IIL: 8, 9, 11 (p. 68)
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.2
13
READ – Textbook (pp. 178-185)
ANSWER – Study Guide
• Part IA: 8, 9 (p. 64)
• Part IB: 5 (p. 64)
• Part IIL: 10, 17-19 (pp. 68–69)
• Part IIIM: 5-10 (pp. 70-71)
50-Minute Lesson Plan
Lecture Outline 20 minutes
5
Phagocytosis and Inflammation
• The second line of defense
• Helps rid body of invading microorganisms
TALKING POINTS:
• What are the two types of leukocytes that are especially suited for this purpose?
Slide 12
The Inflammatory Process
• A series of cellular changes that signal the body’s response to injury or infection
• May be caused by
• Physical agents
Slide 13
The Inflammatory Process (cont.)
• Inflammation: literally “the fire within”
• This descriptive phrase illustrates the four classic manifestations of inflammation
• Rubor (redness)
TALKING POINTS:
• These signs are the direct result of several related actions that occur when the
inflammatory process is initiated.
• What actions are involved in the inflammatory process?
Actions in the Inflammatory Process
• Hemodynamic changes
• Dilation of the capillary bed
12 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.2
Slide 15
Actions in the Inflammatory Process (cont.)
• Increased capillary permeability
• Chemical mediators cause leukocytes to line the small blood vessel walls near the
inflammatory site
• Cells pass through the walls; inhabit inflamed area
TALKING POINTS:
• What is pavementing?
• Swelling may also produce pain.
Slide 16
Chemical Mediators
• The hemodynamic changes and vascular permeability occur with the help of several
chemical mediators
• Prostaglandins, histamine, and leukotrienes
Kinin System
• Produces bradykinin, which also mediates blood vessel dilation and permeability
Slide 18
Complement System
• Especially important in immunologically mediated reactions involving antigen–antibody
complexes
• Causes massive release of histamine and other substances that produce marked
Slide 19
Antiinflammation
• Cortisol
• Hormone produced by the adrenal cortex
• Antiinflammatory substance that slows the release of histamine, stabilizes lysosomal
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.2
6
Slide 20
Signs and Symptoms of Inflammation
• Local inflammation
• Produces the classic signs of heat, swelling, redness, and pain, all of which result in
loss of function
• Systemic inflammation
• Fever, headache, muscle aches, chills, sweating, and leukocytosis
TALKING POINTS:
• Fever is probably caused by pyrogens or by defense mechanisms that are liberated
during phagocytosis, or by bacterial endotoxins, antigen–antibody complexes, and certain
viruses.
• What is leukocytosis?
7
Slide 21
Wound Healing
• Tissue repair and regeneration set in motion from the beginning of the inflammatory
process
Slide 22
Wound Healing (cont.)
• Epithelial cells migrate over the wound and under the scab (usually formed of dried blood
and fibroblasts)
• The scab falls off
• Damaged cells are replaced by new cells of their own composition by process of
TALKING POINTS:
• The age and general health of the person affect how rapidly the regeneration and repair
process occurs.
Slide 23
Wound Healing (cont.)
• Occasionally wound becomes infected or ulcerated, resulting in tissue loss
• Granulation tissue and capillary buds form at wound margins; wound eventually filled
with granulation tissue
14 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
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LESSON 13.2
8
Slide 24
Infection
• Invasion by microorganisms, multiplication of invading organisms, and resulting tissue
damage
• Inflammation: nonspecific body reaction to tissue injury; infection: a specific process that
causes tissue injury
• Infection always results in inflammation, but inflammation may be caused by other
processes
9
Slide 25
Bacteria
• One-celled microorganisms capable of multiplying rapidly within a susceptible host
• Classified as gram-positive or gram-negative
• Classified according to shape
• Round bacteria: cocci
• Groups of two: diplococci
• Clusters: staphylococci
TALKING POINTS:
• What may protect the bacteria from phagocytosis?
• Classification of bacteria as either gram-positive or gram-negative depends on their
Slide 26
Bacteria (cont.)
• Classified according to their ability to grow in the presence of oxygen
• Aerobes
• Will grow in the presence of oxygen
TALKING POINTS:
• What is an example of how a bacteria classification may affect what antimicrobial drug is
used?
Viruses
• Very small microorganisms that cause significant morbidity (disease) in humans
• Illnesses range from the common cold to acquired immunodeficiency syndrome (AIDS);
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.2
Slide 28
Viruses (cont.)
• Damage by stimulating antigen-antibody response in tissues that causes inflammation
and cell destruction
• Because of replication of the virus within the host cell, seldom possible to kill virus
without harming the host cell
Slide 29
Fungi
• Vegetable-like organisms that exist by feeding on organic matter
• Many of these infections are superficial skin infections that rarely produce serious illness
• Systemic fungal infections caused by cryptococcus and aspergillus species; can be life-
threatening
TALKING POINTS:
• What are some examples of fungal organisms?
• Because fungi tend to form spores that are resistant to many antiseptics and
disinfectants, they are difficult to treat.
• Both systemic and topical antimycotic drugs are used to treat fungal infections.
Protozoa
• Make up a large group of one-celled organisms
• Those that produce disease in humans include the plasmodium species (malaria),
TALKING POINTS:
• Pneumocystis jiroveci is a protozoal infection that was relatively rare before the onset of
Rickettsiae
• Between bacteria and viruses in size
16 Chapter 13 Immunity, Inflammation, and Infection _______________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.2
Slide 32
Helminths
• Parasites (worms) are found in soil and water and are generally transmitted from hand to
mouth
• Infections occur commonly in the gastrointestinal tract and may produce mild abdominal
pain and bloating, or they may be asymptomatic
• Examples: pinworms, tapeworms, and hookworms
TALKING POINTS:
Slide 33
Mycoplasmas
• Gram-negative, multishaped organisms without cell walls that are responsible for several
infections in humans
• Responsible for primary atypical pneumonia and have been linked to Reiter syndrome
• Infections usually found in the upper respiratory tract and most often affect children and
young adults
• Respond well to erythromycin
TALKING POINTS:
• Reiter syndrome is a multisystem inflammatory disease that may be associated with
10
Slide 34
Transmission of Infection
• Chain of Infection
• Infection possible only when factors occur in sequence
1. Causative agent
3. Portal of exit
5. Portal of entry
6. Susceptible host
TALKING POINTS:
• Causative agents are the microorganisms that are present in sufficient number and
virulence to damage human tissue.
• Areas in which organisms can pool and reproduce are called reservoirs.
_______________________________________________ Chapter 13 Immunity, Inflammation, and Infection 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 13.2
11
Slide 35
Signs and Symptoms of Infection
• Localized infections
• Redness, pain, warmth, swelling, and pus
• Generalized infections
• May not show all signs apparent in localized infections
TALKING POINTS:
• Once an individual becomes infected with a pathogen, symptoms may or may not be
12
Slide 36
Types of Infection
• Community-acquired infection
• Acquired in day–to-day contact with the public
• Childhood illnesses, tuberculosis, HIV/AIDS, food-borne illness, sexually transmitted
infections
TALKING POINTS:
• Many viral infections are pervasive in society and occur at predictable times of the year.
• When are common childhood illnesses most prevalent? Food-borne illnesses?
Types of Infection (cont.)
• Health care–associated infections
• Occur within a health care facility; may affect patients as well as health care workers
TALKING POINTS:
• Vancomycin-resistant enterococcus (VRE) is one example; the incidence of vancomycin
resistance in patients with a health care–associated enterococcal infection is rapidly
increasing.