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Chapter Twelve:
Managing Chronic
Conditions
(c) 2005 The McGraw-Hill Companies, Inc. All rights reserved.
Specific Disease/Illnesses Are
Classified Into 5 Categories
1)
2)
3)
4)
5)
Genetic/Inherited
Congenital
Metabolic
Degenerative
Autoimmune
Differences Between
Acute vs. Chronic Conditions


Acute –has a sudden onset and a prompt
resolution
Chronic – develop slowly and persists for
an extended period of time
Most chronic conditions covered in this section are difficult
to prevent
Genetic/Inherited Conditions
Occurs by:



Abnormal genes transmitted from either
parent at conception
Abnormal genetic materials formed by
mutation at an early cell replication stage
Abnormal number of chromosomes (+/-46)
Abnormal Chronic Conditions


Klinefelter’s
Syndrome
Turner’s Syndrome
Klinefelter’s Syndrome
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1 in 1,000 male births
Due to abnormal sex chromosomes being present
(44xxy) = 47 chromosomes
Related to advanced maternal age
Characteristics at puberty are tall, thin,
gynecomastia, diminished sex characteristics
Infertility, learning impairment
No cure – hormonal treatments
Turner’s Syndrome


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
1 in 5,000 female births
Altered chromosome number (44XO), “O” is
the absence of a secondary x chromosome
Equivalent version of Klinefelter’s (infertility)
Diminished sex characteristics
Inherited Genetic Mutations

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Cystic fibrosis
Sickle cell disease
Duchenne Muscular Dystrophy (DMD)
Cystic Fibrosis
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1 in 2,000 live births
Disruption of exocrine glands due to absence of a protein
Symptoms – childhood respiratory and digestion
symptoms
Management – drugs and diet, but incurable
Diagnosis – blood test (abnormal gene 7) or saliva test
Prevention – genetic testing, recessive gene
Sickle Cell Trait/Sickle Cell Disease

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8% of African-Americans carry recessive gene for Sickle
Cell Trait
Red blood cells cannot pass through blood capillaries
(sickle shaped RBC’s)
Symptoms – impaired lung function, heart failure,
infections, bone changes
Management – drug therapy, stem cell transplant
Diagnosis – blood test
Prevention – screening for the recessive gene
Sickle Cell Disease
Figure 12-1
Duchenne Muscular Dystrophy
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Mutated maternal sex chromosome x
Muscle fiber lacks a protein (dystrophin) for normal
muscular function
Symptoms – deterioration of muscles eventually leading to
death
Management – physical and occupational therapy
Diagnosis – muscle wasting, lack of walking gait, blood
test
Prevention – genetic screening
Congenital Abnormalities



Present at birth
Does not involve abnormal genetic materials
Causes – multi-factors include infections, drug
use (environmental), resulting in inappropriate
changes to tissues during embryonic
development [3 month period]
Common
Congenital Abnormalities
1)
2)
3)
4)
Talipes (club foot) – heel points inward while
foot points outward (1 in 1,000 births)
Cleft palate/cleft lip – structures of face and lips
separate (1 in 800 births)
Patent Foramen Ovale – (hole) foramen fails to
close completely in the heart, resulting in a
heart murmur
Scoliosis – lateral curvature of the spine (Sshaped)
Metabolic Disorders


Inability to control chemical processes that
regular anabolism/catabolism (buildup/tearing down) of tissues
Types:



Diabetes Mellitus (type 2)
Diabetes Mellitus (type 1)
Hypoglycemia
Diabetes Mellitus (Type 2)

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Ineffective insulin production (hormone necessary for
glucose regulation) from insensitivity of cells
allowing increased sugar levels in the blood
Gradual symptoms – thirst, hyperglycemia, numbness
Management – dietary modification, exercise, drug
therapy
Diagnosis – urine/blood test
Diabetes Mellitus (Type 1)

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Pancreas produces no insulin at all
Rapid symptoms – weakness, thirst, hunger, frequent
urination
Management – insulin must be obtained by injections
or pump (if not properly managed, gangrene,
blindness, kidney disease can result)
Diagnosis – urine/blood test
Diabetes Mellitus (Type 1)
Hypoglycemia (Reactive) and
(Functional)

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Low levels of blood sugar
Reactive hypoglycemia – hypersensitivity to sugar
due to excessive insulin products
Functional hypoglycemia – vague symptoms that had
mental health ties but is less frequently seen
Symptoms– low energy, headaches, anxiety
Management– small meals of complex carbohydrates
Autoimmune/Hypersensitivity
Disorders
Functional and structural breakdown caused by
the immune system’s failure to recognize the body
as “self”
Fibromyalgia
Chronic, painful neurological disorder that affects 2%
of the population; can be managed and treated
Asthma
Chronic respiratory disease results in closing the
airways, extrinsic and intrinsic causes; treatable with
medication (see next slide)
Crohn’s Disease Inflammatory bowel disease leading to abdominal pain
and discomfort; treatable by medication
Asthma
Autoimmune/Hypersensitivity
Disorders (cont.)
Functional and structural breakdown caused by
the immune system’s failure to recognize the body
as “self”
Systemic Lupus Erythematosus
Autoimmune disorder while the body
attacks itself for no reason; affects women
more than men, treated with long term
non-steroidal 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
Degenerative Diseases
Functional and structural breakdown of the body
that generally appear later in life
Parkinson’s
Disease
Neurological disorder (shaking palsy) due to decreased of
dopamine in areas of the brain; medication can only delay
progression
Alzheimer’s
Disease
Organic brain syndrome associated with longevity;
symptoms such as memory loss, confusion, and dementia
are common; treatments are still relatively experimental
Chapter Twelve:
Managing Chronic Conditions
(c) 2005 The McGraw-Hill Companies, Inc. All rights reserved.