Question

A nurse is working in a community health center and is caring for a 5-year-old child who was diagnosed as having a right ear infection. When collecting the nursing history, the mother states that the child has had a fever to 102 F for 2 days, has been irritable, and complained of being tired. The child has been drinking fluids well but not eating. The physician describes the tympanic membrane as erythematous, bulging with fluid levels, and dull. The nurse collects the following vital signs: T 102, (Rectal), Pulse 110, and Respirations 18.

1). Fever is often considered to be associated with a bacterial infection. How does the body regulate temperature? Why is fever often associated with bacterial infections?

2).Which of the clinical manifestations given are associated with a localized inflammatory response? What physiological factors are responsible for the development of these manifestations?

3). a. If the physician ordered a complete blood count, what would you expect to see if there is a bacterial infection?

b. Which of the above manifestations are related to a systemic response to the infection?

Answer 1

1. Body temperature refers to the temperature of the viscera and body tissues. It is maintained by the balance between heat loss and gain and is regulated by hypothalamus. Normal body temperature ranges from 36.6ºC – 37.2ºC (98-99ºF) and optimum body temperature is 98.6⁰F. Factors that can cause rise in body temperature are exercise, process of digestion and infection.

Bacteria are identified as foreign materials by human immune system and causes an antigen antibody response to destroy and eliminate the organisms from our body through inflammatory response. Invasion of a pathogenic organism(bactera,viruse) causes our immune system to trigger the release of chemical mediators that causes the inflammatory response to fight infection. Interleukin 1, Prostaglandins, histamines, kinins and leukotrienes are those chemical mediators. The signs of inflammation caused due to chemical mediators are fever, erythema and warmth to touch, pain and swelling. Histamines causes local vasodilation and results in warmth and redness at the affected site. Prostaglandins causes rise in temperature. Capillary permeability increases due to action of chemical mediators leading to edema. Prostaglandins and kinins activates the pain sensory neurons causing localized pain. Chemotaxis also occurs that attracts WBCs to affected area to  phagocytize the bacteria .

2. Erythematous and bulging tympanic membrane with dull appearance is suggestive of localized ear infection.

Among the chemical mediators  prostaglandin travels through the blood stream to the brain and affects the neurons in the thermoregulatory reflex center causing rise in body temperature. This temperature rise is the immune response to kill the foreign organisms. But prolonged rise in temperature can damage the vital tissues too.

3.a. In case of a bacterial infection, a CBC report will show a high WBC count.

3.b. Vital signs showing rise in temperature and pulse: T 102, (Rectal), Pulse 110, irritability, tiredness and anorexia are systemic signs of infection.