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Chapter Twelve:
Managing Chronic
Conditions
© 2011 McGraw-Hill Higher Education. All rights reserved.
Categories of Chronic
Diseases
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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
© 2011 McGraw-Hill Higher Education. All rights reserved.
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 of
airways; extrinsic and intrinsic causes; treatable
with medication
Inflammatory
Bowel
Disease
Inflammatory bowel disease leading to abdominal
pain and discomfort; treatable with medication
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Fibromyalgia: Tenderpoint
Locations
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Common Asthma Triggers
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Autoimmune/Hypersensitivity
Disorders
Systemic Lupus
Erythematosus (SLE)
Autoimmune disorder in which the
body attacks itself for no reason;
affects women more than men;
treated with long-term nonsteroidal 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
© 2011 McGraw-Hill Higher Education. All rights reserved.
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 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
© 2011 McGraw-Hill Higher Education. All rights reserved.
Chapter Twelve:
Managing Chronic Conditions
© 2011 McGraw-Hill Higher Education. All rights reserved.