© 2011 mcgraw-hill higher education. all rights reserved. chapter twelve: managing chronic...
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Chapter Twelve: Managing Chronic Conditions
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Categories of Chronic Diseases• Genetic/inherited
• Congenital
• Metabolic
• Autoimmune
• Degenerative
• Infectious
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Acute vs. Chronic Conditions
• Acute conditions– Sudden onset and prompt resolution
• Chronic conditions– Develop slowly and persist for an
extended period of time– Many of the chronic conditions
discussed in this chapter are difficult to prevent
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Genetic/Inherited Conditions
• Abnormal genes transmitted from either parent at conception
• Abnormal genetic materials formed by mutation at an early stage of cell replication
• Abnormal number of chromosomes – More or fewer than 46
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Abnormal Number of Sex Chromosomes
• Klinefelter’s syndrome
• Turner’s syndrome
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Klinefelter’s Syndrome
• 1 in 1,000 male births• Due to abnormal sex chromosomes
present (44XXY) = 47 chromosomes• Characteristics at puberty:
– Tall, thin, gynecomastia, underdeveloped secondary sex characteristics
• Infertility, learning impairment
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Turner’s Syndrome
• 1 in 5,000 female births
• Altered chromosome number (44XO)– “O” is the absence of a second X
chromosome
• Equivalent version of Klinefelter’s syndrome (infertility)
• Diminished secondary sex characteristics
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Inherited Genetic Mutations
• Cystic fibrosis
• Sickle-cell trait and sickle-cell disease
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Cystic Fibrosis
• 1 in 2,000 live births
• Disruption of exocrine glands due to absence of a protein
• Symptoms: Respiratory and digestive symptoms
• Management: Medications, diet (no cure)
• Diagnosis/prevention: Genetic tests
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Sickle Cell Trait/Sickle Cell Disease
• 8% of African Americans carry recessive gene for sickle-cell trait
• Red blood cells cannot pass through blood capillaries (sickle-shaped RBCs)
• Symptoms: Impaired lung function, heart failure, infections, bone changes
• Management: Drug therapy, stem cell transplant• Diagnosis: Blood test• Prevention: Screening for the recessive gene
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Sex-Chromosome-Linked Inherited Genetic Mutations• Color vision deficiency
• Fragile X syndrome
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Congenital Abnormalities
• Present at birth• No involvement of abnormal genetic
materials• Multiple potential causes resulting in
inappropriate changes to tissues during embryonic development:– Infections– Drug use– Many environmental factors
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Common Congenital Abnormalities• Cleft palate/cleft lip
– Structures of face and lips separate– 1 in 800 births
• Patent foramen ovale (PFO) – Foramen fails to close completely in the
heart, resulting in a heart murmur
• Scoliosis– Lateral curvature of the spine (S-shaped)
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Metabolic Disorders
• Body’s inability to control chemical processes that regulate the building up (anabolism) and tearing down (catabolism) of tissue
• Examples:– Diabetes mellitus (type 2)– Diabetes mellitus (type 1)– Hypoglycemia
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Normal Blood Glucose Regulation
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Diabetes Mellitus (Type 1)
• Pancreas produces no insulin at all
• Symptoms (develop rapidly): Weakness, thirst, hunger, frequent urination
• Management: Insulin must be obtained by injections or pump
• Diagnosis: Urine and blood tests
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Diabetes Mellitus (Type 2)
• Body is insensitive to insulin• Symptoms (develop gradually)
– Thirst– Hyperglycemia– Frequent urination
• Management– Dietary modification– Exercise– Drug therapy
• Diagnosis: Urine and blood tests
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Hypoglycemia
• Abnormally low levels of blood sugar• Reactive hypoglycemia
– Hypersensitivity to sugar due to excessive insulin products (rare)
• Functional hypoglycemia– Vague symptoms; now less frequently seen
• Symptoms– Low energy, headaches, anxiety
• Management– Small meals of complex carbohydrates
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Autoimmune/Hypersensitivity Disorders
Fibromyalgia Chronic, painful neurological disorder that affects 2% of the population; can be managed and treated
Asthma Chronic respiratory disease results in closing of airways; extrinsic and intrinsic causes; treatable with medication
Inflammatory Bowel Disease
Inflammatory bowel disease leading to abdominal pain and discomfort; treatable with medication
Functional and structural breakdown caused by the immune system’s failure to recognize the body as “self”
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Fibromyalgia: Tenderpoint Locations
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Common Asthma Triggers
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Systemic Lupus Erythematosus (SLE)
Autoimmune disorder in which the body attacks itself for no reason; affects women more than men; treated with long-term non-steroidal anti-inflammatory drugs
Multiple Sclerosis (MS) Progressive disease that causes the myelin to be destroyed, leading to disrupted neurological function. Treatment includes immune targeted drugs, nerve blockers, and physical therapy
Autoimmune/Hypersensitivity Disorders
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Degenerative Diseases
Parkinson’s Disease
Neurological disorder (“shaking palsy”) due to decreased production of dopamine in areas of the brain; medication can only delay progression
Alzheimer’s Disease
Organic brain syndrome associated with aging; symptoms such as memory loss, confusion, and dementia are common; treatments are still relatively experimental
Functional and structural breakdown of the body that generally appear later in life
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Chapter Twelve: Managing Chronic Conditions