special education 519

Special Education 519

UNIT FOUR

Respiratory, Circulatory, Digestive Systems

Kevin AndersonMinnesota State University Moorhead

2006

Respiratory System

Respiratory System

Respiratory FunctionRespiratory Function

Structure Upper respiratory tract Lower respiratory tract

Function Inspiration Expiration

Respiratory DysfunctionRespiratory Dysfunction

Asthma Bronchopulmonary Dysplasia Cystic Fibrosis

AsthmaAsthma

Etiology Viral infections Exercise Allergies and irritants Weather influence Emotional factors

AsthmaAsthma

Prevalence Most common chronic pulmonary

disorder in children Leading cause of death in children 8 million U.S. children 4.3% overall Leading cause of absenteeism

CharacteristicsCharacteristics

Asthmatic episode Spasm of smooth muscle of bronchi Inflammation of lining of bronchial tubes Increased production of mucoid secretions

Wheezing Coughing Nocturnal asthma

Diagnosis & TreatmentDiagnosis & Treatment

Diagnosis Medical history Physical examination Lab work

Goals of treatment Symptom reduction Prevent chronic nature Induce complete remission

InterventionsInterventions Bronchodilators

Used PRN (as needed) Relax bronchial muscles Relieve airway obstruction “Rescue medication” to alleviate symptoms “Preventative” to prevent an attack

Anti-asthma medications Reduce inflammation of airways and decrease phlegm

Improve pulmonary function Reduce airway “hyper-responsiveness”

Environmental control Reducing allergens and irritants Avoidance of triggers Immunotherapy

Non-pharmacological approaches Natural foods, herbs, relaxation, biofeedback, breathing training

Educational ImplicationsEducational Implications

Inhalants Metered-Dose Inhaler (MDI) Powder inhaler Nebulizer

Warning signs Runny nose, cough, breathing changes, etc.

Emergency procedures Emergency care plan Look for signs of attack Remove triggers Reassurance Medication Drink clear fluids Maintain record and supplies

Emergency ResponseEmergency Response

Blue-gray lips or nail beds, fatigue from lack of breath, low level of alertness

Lack of response to medical interventions Peak flow rate does not improve after treatment Increased need for bronchodilators Vomiting Impaired function

Educational Considerations


Maintain normalcy Communication Allow use of medical interventions as needed Environmental concerns Maintain physical capacity Alternative to activity when needed Allergy-free environment Emotional impact Watch for symptoms

Tips for AttendanceTips for Attendance

Send child to school: Stuffy nose with no wheezing Mild wheezing which responds to treatment Tolerates exercise Lack of extra effort in breathing

Keep child at home: Infection Feverish Continued wheezing Weakness or extreme fatigue Irregular breathing pattern

Bronchopulmonary DysplasiaBronchopulmonary Dysplasia

Chronic respirator lung disease VLBW Prematurity Leading cause of chronic lung disease in U.S. Iatrogenic condition

Result of treatment that “force” oxygen into lungs Leads to cellular changes, reduction in airway diameter,

and increased effort to obtain oxygen

TypesTypes

Mild to moderate Bronchodilator Diuretic

Severe Tracheostomy Ventilator support Concomitant disabilities



Accommodations for limited endurance Respiratory infections Increased breathing and effort Language delay may require intervention Chest percussion and medication needs May lead to adult asthma

TuberculosisTuberculosis

Communicable disease Primarily affects lungs Children under age 3 and adolescent girls Transmission through coughing, sneezing or

laughing Incubation period 2-10 weeks, may not develop

an active case, but remain at-risk throughout life

ImplicationsImplications

Symptoms Fatigue or malaise Weight loss or lack of appetite Coughing or wheezing Tightness in chest

Diagnosis X-ray, skin test, sputum smear

Treatment Medication



Increasing concern in U.S. Mostly non-communicable May require rest periods Stigma affects social interactions Need for increased knowledge

Oxygen TherapyOxygen Therapy

For students with chronic respiratory problems Prevention of hypoxemia that leads to

hypoxia Promote growth rate, exercise

tolerance, and chronic lethargy Intermittent or continuous

administration

Considerations for Oxygen

Considerations for Oxygen

Sources Oxygen concentrator Liquid oxygen Compressed oxygen gas

Delivery Nasal cannula Face mask Tracheostomy collar

Mechanical ventilation Safety guidelines

Mechanical VentilatorsMechanical Ventilators

Negative pressure machines “pulling out” of abdominal wall Used for persons with muscle

weakness but normal pulmonary function

Positive pressure machines “Inflate” lungs Invasive or noninvasive



Monitor battery power and use of electricity Notify local electrical company and fire department Monitor equipment and supplies Equipment needs for students with tracheostomy Maintain proper settings Alarm system Individualized alarm system Watch for infection and illness Safe transportation

Special Considerations for Tracheostomy

Special Considerations for Tracheostomy

Surgical opening of trachea “trach tube” “stoma” Temporary or permanent

Educational considerations “trach kit” and hygiene supplies Emergency plan Documentation and communication with caregiver Communication limitations Does not interfere in food ingestion

Circulatory SystemCirculatory System

Circulatory SystemCirculatory System Cardiovascular Function and

Dysfunction Hematological Function and

Dysfunction

Cardiovascular FunctionCardiovascular Function

System Heart Blood vessels

Major functions Transportation of blood Transfer of waste products

Cardiovascular FunctionCardiovascular Function Heart

“Mechanical pump” that propels blood to specific location of body

Muscle tissue and series of one-way openings

Four chambers Upper atrium receives blood Lower ventricles pump out blood

Blood vessels Arteries - carries oxygenated blood away

from the heart to the body tissues Veins - returns de-oxygenated blood from

the body tissues to the heart

Cardiovascular FunctionCardiovascular Function

Cardiac rate and rhythm Rate is the speed of contractions; rhythm is the regularity of

contractions Rate and rhythm combined is known as the “pulse” Controlled by “electrical” system working with nervous

system and endocrine system 120 beats per minute (bpm) at birth; 100 bpm at school age;

70-75 at adolescence Blood pressure

Pressure of blood on the arterial walls Measured by blood pressure monitor Systole is measurement of pressure on large arteries during

contraction phase Dystole is measurement of pressure during relaxation phase 84-120 systole and 54-80 dystole at school age; 94-140

systole and 62-88 dystole at adolescence

Cardiovascular Dysfunction


Dysfunction Rate and rhythm problems

Bradycardia Tachycardia

Blood pressure problems Hypertension Hypotension

Disease or disorders Congenital Acquired



Congenital heart disease (CHD) Increased or decreased pulmonary

blood flow Obstructive disorders Mixed blood flow Acquired cardiac disorders (ACD)


Treatment Surgical Pharmacologic

Preventative Diet Exercise



Physical activity demands Structuring day appropriately Determining what is safe to do Self-limiting behavior AHA guidelines

StrenuousModerately strenuousNonstrenuous



Specific health concerns Pacemaker Signs and symptoms Medication regimen Modified diets Fluid intake Potential infection Medic-alert bracelets

Social issues Invisible disease Determination and internalization of sexual identity Peer influences Occupational restrictions

Hematological FunctionHematological Function

Controlled by blood - organ of body composed of different tissue and specific function Consists of plasma and formed elements

Plasma - clear liquid portion of blood Formed elements - cellular portions floating in

plasma

Blood cells formed in blood-forming organs (red bone marrow and lymphatic organs)

Only “organ” of body that is “fluid”

Hematological FunctionHematological Function

Plasma 92% water; 8% protein, metabolites, and ions Maintains “homeostasis”

Moving blood cells throughout body Transporting nutrients Maintaining acid-base balance of body Removal of wastes

Formed elements Red blood cells - carries oxygen White blood cells - fights infection Platelets - aids in clotting of blood

Hematological Dysfunction


Red blood cells - oxygen deprivation

White blood cells - development of infection

Platelets - bleeding disorders



Disorders of red blood cells Anemia - decrease or deficient concentration

of red blood cells resulting in inadequate oxygenation of cells Iron deficiency anemia - insufficient iron altering

hemoglobin production Sickle-cell anemia - abnormal forming of

hemoglobin Lead poisoning - acquired toxic condition

due to concentration of lead or lead compounds in red blood cells


Excessive bleeding Invisible conditions Need for replacement factor therapy Contact with parent or medical

personnel Impact on physical endurance



Teacher awareness and general understanding of condition

Fatigue and stamina issues Encourage participation as possible Provide rest breaks Energy conservation activities

Absenteeism Pain issues No major diet restrictions Potential for infection Potential for intellectual impact Use of science curriculum for education Occupational goals



Disorders of white blood cells Affects general health status and body’s

ability to fight infection - leukemia is most common disease

Disorders of platelets and coagulation Affects body’s blood clotting mechanism -

thrombocytosis causes blood clotting in blood vessels Thrombocytopenia is most common cause of

bleeding disorders Hemophilia is most common bleeding disorder

Digestive SystemDigestive System

Digestive SystemDigestive System

Gastrointestinal Function and Dysfunction

Urinary Function and Dysfunction

Gastrointestinal SystemGastrointestinal System

Structures Mouth Throat Stomach Intestines Accessory organs

Functions Ingestion Digestion Absorption Elimination

ComponentsComponents

Upper GI Mouth Pharynx Esophagus Stomach

Lower GI Small and large intestines Anus

FunctionFunction

Layers Mucosa - secretes mucus Submucosa - absorbs nutrients Muscles - peristalsis Outermost tissue - lubrication

Catabolism Mechanical actions

Breaking down food Propelling food

Chemical actions Conversion by enzymes

Mouth and Salivary Glands

Mouth and Salivary Glands

Oral cavity Mastication - chewing and

salivation Digestive enzyme Semisolid - bolus

Deglutition - swallowing

Pharynx and EsophagusPharynx and Esophagus

Tongue Pharynx Esophagus Soft palate Epiglottis Lower esophageal sphincter

Gastroesophageal reflux

StomachStomach

Continued breaking down of bolus Kneading action Enzymes from gastric glands Mixed with water, hydrochloric acid, and

mucin Water dilutes secretions Hydrochloric acid softens bolus and kills bacteria Mucin - protects lining of stomach - prevents

ulcers

“Chyme” exits through pyloric sphincter

Small IntestineSmall Intestine

Long and narrow Plicae increase surface capacity Villi absorb nutrients Parts

Duodenum Jejunum Ileum

Accessory Digestive Organs

Accessory Digestive Organs

Add to digestive process Add secretions to chyme

Organs Liver Pancreas Gall bladder

Large Intestine and Anal Canal

Large Intestine and Anal Canal

Ileocecal valve Sections

Cecum Colon Rectum

Function Water and electrolytes absorbed Waste is collected Eliminated through anal canal

Urinary and Renal Systems

Urinary and Renal Systems

Urinary system - main excretory system

Major Organs Kidney - organ involved in filtration

of fluids and waste products Ureters - collecting tubes Urinary bladder Urethra

Problems with IngestionProblems with Ingestion

Cleft lip and palate Esophageal Atresia (EA) Gastroesophageal Reflux Disease Ingestion of foreign bodies or

substances

Problems with DigestionProblems with Digestion

Intestinal Atresia Pyloris stenosis

Problems with AbsorptionProblems with Absorption

Celiac disease Lactose intolerance Chronic Inflammatory Bowel

Disease

Problems with EliminationProblems with Elimination

Hirschsprung’s Disease Anorectal Malformations

Other Chronic ConditionsOther Chronic Conditions

Hepatitis Peptic Ulcer Disease



Accommodations needed Specialized diet Warning signs Energy level Exemption from physical activities Social impact Safety

Eating DisordersEating Disorders

Anorexia Nervosa Bulimia Nervosa Obesity



Warning signs Honesty and acceptance Realistic expectations and

educational program Gender difference

Alternatives for IngestionAlternatives for Ingestion

Parenteral feeding Administration of nutrients directly into vascular

system Total Parenteral Nutrition (TPN)

Central Venous Access Lines (VAD’s) - central lines Partially implanted (PID) or totally implanted (TID)

Enteral feeding Nutrition in liquid form directly administered into into

digestive system Nasogastric tube feeding (NG) Gastrostomy tube feeding (G-Tube)

Intermittent or continuous



Education Sepsis Hygienic and privacy concerns Restricted activity mostly with

parenteral feedings Stationary during enteral feedings

Alternatives for Elimination

Alternatives for Elimination

Surgical procedure - ostomy Ileostomy Cecostomy Colostomy



Independent self-care Potential problems Minimal restrictions to physical

activity

special education 519

Documents