Chapter 18 Systemic Conditions

1. Chapter 18 Systemic Conditions

2. Bronchial Asthma • Caused by: • Constriction of smooth bronchial muscles • Increased bronchial secretions • Mucosal swelling • Leads to inadequate airflow during respiration (especially expiration)

3. 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

4. Bronchial Asthma (cont’d) • Management • If available, administer prescribed medication • If severe and prescribed medication is not available, activate emergency plan … summon EMS

5. 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

6. 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

7. Exercise-Induced Bronchospasm (cont’d) • Management • Prescribed medications • Proper warm-up and cool-down • Refer to Application Strategy 18.1

8. Diabetes Mellitus • 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

9. 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

10. Diabetes Mellitus (cont’d) Maintaining a balance of BG

11. 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

12. 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

13. Diabetes Mellitus (cont’d)

14. 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

15. Insulin 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

16. 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

17. Diabetic Coma • Occurs with hyperglycemia; glucose in blood cannot be metabolized • Fat metabolism = diabetic ketoacidosis • Ketones in the breath, blood, and urine

18. Diabetic Coma (cont’d) • S&S • “Juicy fruit” breath • Gradual onset (days) • Restlessness • Dry mouth, intense thirst • Abdominal cramping • Vomiting

19. Diabetic Coma (cont’d) • S&S • Coma begins • Dry, red, warm skin • Deep, sunken eyes • Exaggerated respirations • Rapid, weak pulse

20. 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

21. Exercise 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

22. 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)

23. Seizure 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

24. 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

25. Seizure Disorders and Epilepsy (cont’d) • Causes of epilepsy • Directly related to age of onset • Provoked or unprovoked

26. 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

27. Seizure Disorders and Epilepsy (cont’d) • Partial or focal seizures • Complex • Characterized by purposeful movements or experiences • Followed by impairment in consciousness

28. 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)

29. 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

30. 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

31. Seizure Disorders and Epilepsy (cont’d) • Generalized seizures (cont’d) • Posttraumatic seizures • Provoked by head trauma • Classified as impact, immediate, early, and late

32. 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

33. 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

34. 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)

35. Seizure Disorders and Epilepsy (cont’d) • Physical activity guidelines • Requires neurologist evaluation