chapter 18 systemic conditions
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Chapter 18 Systemic Conditions. Bronchial Asthma. Caused by: Constriction of smooth bronchial muscles Increased bronchial secretions Mucosal swelling Leads to inadequate airflow during respiration (especially expiration). Bronchial Asthma (cont’d). S&S Wheezing Rapid fatigue - PowerPoint PPT PresentationTRANSCRIPT
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 18
Systemic Conditions
Chapter 18
Systemic Conditions
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Bronchial AsthmaBronchial Asthma• Caused by:
– Constriction of smooth bronchial muscles
– Increased bronchial secretions
– Mucosal swelling
• Leads to inadequate airflow during respiration (especially expiration)
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Bronchial Asthma (cont’d)Bronchial Asthma (cont’d)
• S&S
– Wheezing
– Rapid fatigue
– Acute attack
– Thick yellow/green sputum
– Anxiety
– Sweating
– Rapid heart rate
– Cyanosis
– ↓ LOC in severe cases
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Bronchial Asthma (cont’d)Bronchial Asthma (cont’d)
• Management
– If available, administer prescribed medication
– If severe and prescribed medication is not available, activate emergency plan … summon EMS
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Exercise-Induced Bronchospasm (EIB)Exercise-Induced Bronchospasm (EIB)
• Various factors can contribute to severity; ↑ risk with allergies, sinus disease, hyperventilation
• Key—amount of ventilation and temperature of inspired air
– ↑ ventilations in cold, dry, air → ↑ EIB risk
– ↑ strenuous exercise → ↑ ventilations
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Exercise-Induced Bronchospasm (cont’d)Exercise-Induced Bronchospasm (cont’d)
• S&S
– Chest pain and tightness
– Regular dry cough
– SOB after or during exercise
– Symptoms appear after 8–10 minutes of activity and may worsen after activity stops
– Refractory period
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Exercise-Induced Bronchospasm (cont’d)Exercise-Induced Bronchospasm (cont’d)
• Management
– Prescribed medications
– Proper warm-up and cool-down
– Refer to Application Strategy 18.1
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•Chronic metabolic disorder characterized by near or absolute lack of insulin
•Risk and severity of diabetes increased by:
− Heredity− Aging− Minority ethnicity− Obesity− Gender
− Stress− Infection− Sedentary lifestyle− Poor diet
Diabetes Mellitus Diabetes Mellitus
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Diabetes Mellitus (cont’d)Diabetes Mellitus (cont’d)
• Physiologic Basis
– Insulin
• Needed after carbohydrate ingestion to transfer glucose from the blood into the skeletal and cardiac muscles
• Also promotes glucose storage in the muscles and liver in the form of glycogen
– If little or no insulin is secreted by the pancreas, blood glucose bypasses the body cells and rises to abnormally high levels in the blood
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Diabetes Mellitus (cont’d)Diabetes Mellitus (cont’d)Maintaining a balance of BG
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Diabetes Mellitus (cont’d)Diabetes Mellitus (cont’d)
• Physiology (cont’d)
– Excess glucose is excreted in the urine, drawing large amounts of water and electrolytes with it
• Leads to weakness, fatigue, malaise, and increased thirst
• Electrolyte imbalance leads to abdominal pains, vomiting, and stress reaction spirals
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Diabetes Mellitus (cont’d)Diabetes Mellitus (cont’d)
• Physiology (cont’d)
– When glucose cannot enter the cells, they shift from carbohydrate metabolism to fat metabolism for energy
• Results in dehydration and ketoacidosis
• Can depress cerebral function
• Produces acetone
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Diabetes Mellitus (cont’d)Diabetes Mellitus (cont’d)
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Hypoglycemia Hypoglycemia
• Common in type 1
• Mild (60–70 mg/dL)—minimal or no symptoms; Severe (<40 mg/dL)—neurologic symptoms
• Monitoring is key to prevention!
• Can lead to insulin shock
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Insulin ShockInsulin Shock
• S&S
– Rapid onset
– Dizziness
– Headache
– Intense hunger
– Aggressive behavior
– Pale, cold, clammy skin
– Profuse perspiration
– Salivation
– Drooling
– Tingling in face, tongue, and lips
– "umbles": stumbles, mumbles, fumbles
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Insulin Shock (cont’d)Insulin Shock (cont’d)
• Management
– Administer 10-15 g of sugar
– Wait 15 minutes for blood sugar to rise
– If no change or worse, administer another 10-15 g; repeat until normal range reached (80-120 mg/dL)
– Eat sensible meal soon
– Call 911 if symptoms do not resolve or worsen, activate emergency medical plan – summon 911
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Diabetic ComaDiabetic Coma
• Occurs with hyperglycemia; glucose in blood cannot be metabolized
• Fat metabolism = diabetic ketoacidosis
• Ketones in the breath, blood, and urine
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Diabetic Coma (cont’d)Diabetic Coma (cont’d)
• S&S
– “Juicy fruit” breath
– Gradual onset (days)
– Restlessness
– Dry mouth, intense thirst
– Abdominal cramping
– Vomiting
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Diabetic Coma (cont’d)Diabetic Coma (cont’d)
• S&S
– Coma begins
• Dry, red, warm skin
• Deep, sunken eyes
• Exaggerated respirations
• Rapid, weak pulse
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Diabetic Coma (cont’d)Diabetic Coma (cont’d)
• Management
– Difficult to differentiate between insulin shock and diabetic coma at times; therefore, give sugar—it cannot hurt!
– Activate EMS
– Treat for shock and monitor vitals
– Refer to Application Strategy 18.2
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Exercise RecommendationsExercise Recommendations
• Need balance of blood glucose, insulin, nutrition, and exercise
• Physician should be consulted before beginning exercise program
• Take readings 30 minutes before and 1 hour after exercise to see effects of exercise
• Aerobic exercise can make the body more sensitive to insulin, making it more effective
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Exercise Recommendations (cont’d)Exercise Recommendations (cont’d)
• Kidney failure and cardiovascular diseases can be prevented with exercise
• Those with type 2 diabetes and systemic conditions need to be extremely cautious in their choice of exercise
• (Refer to Box 18.2)
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Seizure Disorders and EpilepsySeizure Disorders and Epilepsy
• Seizure
– Abnormal electrical discharge in the brain
• Seizure disorder
– Entails recurrent episodes of sudden excessive charges of electrical activity in the brain from known or idiopathic causes
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Seizure Disorders and Epilepsy (cont’d)Seizure Disorders and Epilepsy (cont’d)
• Epilepsy
– Term used to describe only recurrent idiopathic episodes (at least 2) of sudden, excessive discharges of electrical activity in brain
– Discharge may trigger altered sensation, perception, behavior, mood, LOC, or convulsions
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Seizure Disorders and Epilepsy (cont’d)Seizure Disorders and Epilepsy (cont’d)
• Causes of epilepsy
– Directly related to age of onset
– Provoked or unprovoked
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Seizure Disorders and Epilepsy (cont’d)Seizure Disorders and Epilepsy (cont’d)
• Partial or focal seizures
– Simple
• Characterized by involuntary movements of the face, limbs, or head
• May experience tingling or numbness
• May be followed by localized weakness or paralysis in body part in which seizure occurs
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Seizure Disorders and Epilepsy (cont’d)Seizure Disorders and Epilepsy (cont’d)
• Partial or focal seizures
– Complex
• Characterized by purposeful movements or experiences
• Followed by impairment in consciousness
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Seizure Disorders and Epilepsy (cont’d)Seizure Disorders and Epilepsy (cont’d)
• Generalized seizures
– Tonic-clonic (grand mal)
• Intermittent
• Tonic, clonic, or both
• Associated with LOC
• Sensory aura (e.g., taste or smell)
• Seizure lasts 50-90 seconds (5 minutes possible)
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Seizure Disorders and Epilepsy (cont’d)Seizure Disorders and Epilepsy (cont’d)
• Generalized seizures (cont’d)
– Tonic-clonic (grand mal) (cont’d)
• Intermittent (cont’d)
• May lose bladder or bowel control
• Post seizure: may be unarousable for a brief period; may not remember what happened
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Seizure Disorders and Epilepsy (cont’d)Seizure Disorders and Epilepsy (cont’d)
• Generalized seizures (cont’d)
– Tonic-clonic (grand mal) (cont’d)
• Continuous
• Medical emergency
• >30 minutes or recurrent convulsions without full consciousness between attacks
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Seizure Disorders and Epilepsy (cont’d)Seizure Disorders and Epilepsy (cont’d)
• Generalized seizures (cont’d)
– Posttraumatic seizures
• Provoked by head trauma
• Classified as impact, immediate, early, and late
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Seizure Disorders and Epilepsy (cont’d)Seizure Disorders and Epilepsy (cont’d)
• Generalized seizures (cont’d)
– Absence (petit mal) attack
• Characterized by a slight LOC or blank staring into space for 3–15 seconds, without loss of body tone or falling
• Usually between ages 4 and 8; tends to resolve by age 30
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Seizure Disorders and Epilepsy (cont’d)Seizure Disorders and Epilepsy (cont’d)
• Immediate management of seizures
– Note time on your watch immediately on observing seizure
– Protect the individual from injury
• Remove nearby objects; protect head
• Do not stop or restrain the person
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Seizure Disorders and Epilepsy (cont’d)Seizure Disorders and Epilepsy (cont’d)
• Immediate management of seizures (cont’d)
– Never place fingers or any object in mouth
– If possible, remove any observers to allow for privacy
– Continuous seizure or a series of intermittent seizures >5 minutes—activate EMS
– (Refer to AS 18.3)
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Seizure Disorders and Epilepsy (cont’d)Seizure Disorders and Epilepsy (cont’d)
• Physical activity guidelines
– Requires neurologist evaluation