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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