1. © 2011 McGraw-Hill Higher Education. All rights reserved. Chapter Twelve: Managing Chronic Conditions

2. © 2011 McGraw-Hill Higher Education. All rights reserved. Categories of Chronic Diseases Genetic/inherited Congenital Metabolic Autoimmune Degenerative Infectious

3. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

4. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

5. © 2011 McGraw-Hill Higher Education. All rights reserved. Abnormal Number of Sex Chromosomes Klinefelter’s syndrome Turner’s syndrome

6. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

7. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

8. © 2011 McGraw-Hill Higher Education. All rights reserved. Inherited Genetic Mutations Cystic fibrosis Sickle-cell trait and sickle-cell disease

9. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

10. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

11. © 2011 McGraw-Hill Higher Education. All rights reserved. Sex-Chromosome-Linked Inherited Genetic Mutations Color vision deficiency Fragile X syndrome

12. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

13. © 2011 McGraw-Hill Higher Education. All rights reserved. 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)

14. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

15. © 2011 McGraw-Hill Higher Education. All rights reserved. Normal Blood Glucose Regulation

16. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

17. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

18. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

19. © 2011 McGraw-Hill Higher Education. All rights reserved. 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”

20. © 2011 McGraw-Hill Higher Education. All rights reserved. Fibromyalgia: Tenderpoint Locations

21. © 2011 McGraw-Hill Higher Education. All rights reserved. Common Asthma Triggers

22. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

23. © 2011 McGraw-Hill Higher Education. All rights reserved. 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

24. © 2011 McGraw-Hill Higher Education. All rights reserved. Chapter Twelve: Managing Chronic Conditions