AACN clinical issues
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AACN clinical issues · Aug 1996
ReviewStress and immunity after traumatic injury: the mind-body link.
Traumatic injury poses a significant psychologic and physiologic threat, challenging a victim's perceptions of control over their environment and life outcomes. The multiple stressors presented by traumatic injury diminishes the patient's perceptions of control, resulting in a subjective stress response. ⋯ It then presents evidence suggesting that the trauma patient's subjective stress response and diminished perceptions of control may act as factors in the immune changes occurring after injury. Recent studies supporting this hypothesis are reviewed, and recommendations for interventions, nursing practice, and research are discussed.
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AACN clinical issues · Aug 1996
ReviewThe immune system: relation to sepsis and multiple organ failure.
The immune system plays a dual role in the pathogenesis of sepsis and organ failure, intended for host defense but also possessing significant cytodestructive capacity. As the understanding of the epidemiology and pathophysiology of these disorders improves, so too does the appreciation for the complexity of this system. No longer is the immune response viewed as simply cellular or humoral but rather as a network of cells, chemical mediators, and molecular elements. ⋯ Conventional therapy is limited to supportive care and has been ineffective in improving mortality. To date, efforts to modulate the inflammatory response by inhibition of specific components have been unsuccessful. In the future, better patient selection, combination therapy (perhaps using strategies of early augmentation followed by inhibition), and alternative techniques such as blood purification may prove to be more effective.