disease ch 2

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joyjohnson
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130740
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disease ch 2
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2012-01-26 07:56:18
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disease ch 2
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  1. metabolic and nutritional disorders
    purpose:
    physiological process that allows cells to transform food into energy and continually rebuild body cells
  2. 2 phases
    Catabolism

    energy producing phase of metabolism, breaking down of large food, molecules into smaller ones

    annabolism

    tissue building phase, body converts small molecules into larger ones
  3. Stats:
    60% of an adult's body weight is water

    Children and lean body types have higher water content since fat weighs more than water
  4. the critical component of metabolism is
    fluid and electrolyte balance
  5. tests and treatment:
    daily weighing

    IV fluids

    blood and urine test
  6. Deficiencies:
    Vitamin A

    epithelial tissue and rentinal function

    Vitamin B

    normal metabolism, cell growth and blood formation

    Vitamin C

    wound healing, burn healing, collagen and extracellular tissue that binds teeth, bones and capillaries

    Vitamin D

    failure for normal bone calcification (rickets)

    Vitamin E

    formation of red blood cells, assists with vitamin K, antioxidant, protects tissue from free radicals

    Vitamin K

    prothrombin and clotting

    Iodine

    hypothrodism, goiter,dental

    zinc

    bones, teeth, hair,skin, testes, lives, and muscles

    Magnesium

    body aches,muscle fatigues
  7. Diagnosis
    Obesity
    excess of body fat, generally 20% above ideal weight

    etiology

    hypothalamus, genetic predisposition, abnormal absorption of nutrients, hormones, environmental factors, activity level, learned patterns of eating, stress, and emotional eating

    poor prognosis for correction of obesity, less than 30% succeed in losing 20 lbs and only 50% of them maintain the loss over a long period of time

    Cause

    results from excessive calorie intake and inadequate expenditure of energy. There is a genetic/family/environment factors especially parent to child along with psychological factors such as stress which leads to over eating

    stats

    children and adolescent obesity has doubled in the past 20 years

    treatment

    lifestyle management-reducing calories while increasing physical activity. Techniques include: behavior modifications, hypnosis, or bariatric surgery for morbid obesity (gastroplasty: lap band or gastric bypass)
  8. Diabetes
    chronic disease of absolute or relative insulin deficiency or resistance which disturbs carbohydrate, protein, and fat metabolism

    syndrome characterized by hyperglycemia resulting from absolute or relative impairment in insulin secretion and or insulin reaction
  9. diabetes
    stats
    leading cause of death by disease in the US.

    contributes to 50% of myocardial infractions and 75% strokes, renal failure, and peripheral vascular disease.

    leading cause of blindness.

    DM affects 6% of the population in the US, half of which are undiagnosed.

    greater occurrence in females and increases with age.

    Type 2 DM accounts for 90% of all cases
  10. Diabetes
    type I
    accepted to be an autoimmune disease, triggered by a nonspecific viral infection that inflames the beta cells of the pancreas

    affects an estimated 5% of the population

    some cases is IDDM are viral in origin

    heredity strongly influences most diabetics
  11. diabetes type I
    cause
    failure to release insulin and ineffectively transport through the body

    usually higher in children then adults

    unknown cause since most do not have any evidence of autoimmunity or failure to produce insulin

    type 2-insulin is produced but ineffectively transported throughout the body to support body weight and chemical components
  12. diabetes
    signs
    begins dramatically

    usually with ketoacidosis-fatigue, polyuria, dehydration, polydipsia, dry mucous membranes, poor skin tugor and unexplained weight loss.

    long term effects: retinopathy, nephropathy, atherosclerosis(obesity, fat), peripheral and autonomic neuropathy(loss of feeling in hands, feet)
  13. type I
    immune-mediated or idiopathic

    children and adolescents with type I DM rapidly develop ketoacidosis while adults with type ! only experience modest hypoglycemia unless there is an infection or other stressors.

    pancreas produces little or no insulin, therefore a person in dependent on insulin being added to their sustem.

    neuropathy occursin 1/3 of patients.

    can result in ESRD(end stage renal disease)
  14. immune-mediated diabetes caused:
    cell-mediated destruction of pancreatic beta-cells

    no know cause

    no evidence of autoimmunity

    in the past this was referred to as juvenile-onset, ketotic, or brittle diabetres

    usually occurs before age 30

    patient is usually thin

    requires exogenous(external source) insulin and dietary management
  15. type 2
    insulin is produced but has a problem attaching to things

    related with obesity

    lack of physical activity

    history of gestational diabetes, hypertension, strong family history, older than 45, high cholesterol, and ethnicities: black, hispanic,pacific islander, asian american and native americans.

    person is not dependent on insulin being added to their system and is treated with diest, exercise, and oral drugs

    insulin is resistant but ketoacidosis is rare

    neuropathy occurs in less the 1/3 of patients

    can lead to ESRD

    referred to as maturity-onset, nonketotic or stable diabetes

    usually occurs in obese adults after age 40, now more in children

    treat with diet/exercise

    beta cells release insulin, but receptors are insulin-resistant and glucose transport is variable and ineffective

    oral antidiabetic drugs stimulate endogenous insulin production and increase sensitivity
  16. Type 3
    other specific types

    • genetic defect
    • endorinopathies, or exposure to certain drugs or chemicals
  17. type 4
    gestational diabetes mellitus
    occurs during pregnancy and returns to normal after delivery of the child

    treatment:

    effective treatment to normalize blood glucose and decrease complications through insulin use, diet and exercise.

    long term complications include transplant or dialysis for renal failure aned vascular surgery for large-vessel disease(atherosclerosis)

    complications

    autonomic neuropathy: postural hypotension, impotence, impaired bladder function, delayed gastric emptying, esophageal dysfunction, constipation, diarrhea, ESRD

    large vessel disease leads to atherosclerosis

    neuropathy leads to injury to nerves, demyelination(rate nerves react) and schwann cell degeneration

    involves sensory and motor peripheral nerves & autonomic nervous system, hyperglycemia(high sugar), ketoacidosis

    acidosis due to an excess of ketone bodies, due to break down of fat for energy ketoacidosis

    diabetic ketoacidosis or diabetic coma-an acute life-treating complication of uncontrolled diabetes loss of water, potassium, ammonium, and sodium
  18. diabetesmay be
    a primary or secondary disease
  19. diabetes problems occure in:
    • self-care
    • productivity
    • leisure
    • sensorimotor
    • cognitive and psychosocial due to: difficulty administering and regulating insulin, fatigue, weakness, weight loss
    • loss or reflexes
    • flexion contractures
    • vision loss
    • loss of touch
    • decreased sense of pain
    • difficulty with temperature
    • depression
    • anziety
    • irritability
  20. no cognitive imlpairments
    • are due to this disorder except if associated with CVA
    • alz
    • aging process
  21. diabetic gangrene
    usually involving the lower extremities that develops secondary to peripheral vascular disease
  22. diabetic retinopathy
    vascular, non-inflammatory retinal disorder that results from interference with the blood supply to the eye
  23. medical management
    diet

    control number of claories and amount of carbohydraes ingested, spacing carbohydrates throughout the day

    hypoglycemic agents

    oral and injectable insulin

    control physical activities

    facilitates transportation of glucose into cells
  24. diabetic ketoacidosis(diabetic coma)
    increased acidity in blood and ketones leads to diabetic coma

    no natural insulin

    • flushed
    • hot/dry
    • restless/agitated
    • fruity odor to the breath
    • untreated-coma/death
  25. insulin shock
    hypoglycemic shock caused by overdoes in insulin

    decreased in take of food

    • excessive exercise:
    • sweating
    • trembling
    • chilliness
    • nervousness
    • irritability
    • hunger
  26. question:
    mrs. x is being seen by OT and PT for outpatient treatment. she has diabetes and finished an exercise session wiwth pt before starting her session with you. after completing (3 sets x 10) pulley exercises for shoulder flexion when you notoice she is sweating quite profusely and her skin is cold and clammy. she states she feels tremulous and nervous. you ask her if she had anything to eat or drink prior or during her pt session; she states that she took her insulin at 8.00 and had a glass of orange juice as she ran out the door because she was running.

    these are sign/symptoms of:

    diabetic ketoacidosis or insulin shock?







    insulin shock

    • what should you do?
    • stop the exercise and tell the patient to take her insulin
    • stop the exercise and ask her what she usually does? offer her some juice and or hard-candy



    ......hard-candy

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