Special Education 519

1. Special Education 519 UNIT FOUR Respiratory, Circulatory, Digestive Systems Kevin Anderson Minnesota State University Moorhead 2006

2. Respiratory System

3. Respiratory Function • Structure • Upper respiratory tract • Lower respiratory tract • Function • Inspiration • Expiration

4. Respiratory Dysfunction • Asthma • Bronchopulmonary Dysplasia • Cystic Fibrosis

5. Asthma • Etiology • Viral infections • Exercise • Allergies and irritants • Weather influence • Emotional factors

6. Asthma • 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

7. Characteristics • Asthmatic episode • Spasm of smooth muscle of bronchi • Inflammation of lining of bronchial tubes • Increased production of mucoid secretions • Wheezing • Coughing • Nocturnal asthma

8. Diagnosis & Treatment • Diagnosis • Medical history • Physical examination • Lab work • Goals of treatment • Symptom reduction • Prevent chronic nature • Induce complete remission

9. Interventions • 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

10. Educational 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

11. Emergency 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

12. 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

13. Tips 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

14. Bronchopulmonary 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

15. Types • Mild to moderate • Bronchodilator • Diuretic • Severe • Tracheostomy • Ventilator support • Concomitant disabilities

16. Educational Considerations • 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

17. Tuberculosis • 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

18. Implications • 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

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

20. Oxygen 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

21. Considerations for Oxygen • Sources • Oxygen concentrator • Liquid oxygen • Compressed oxygen gas • Delivery • Nasal cannula • Face mask • Tracheostomy collar • Mechanical ventilation • Safety guidelines

22. Mechanical 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

23. Educational Considerations • 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

24. 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

25. Circulatory System

26. Circulatory System • Cardiovascular Function and Dysfunction • Hematological Function and Dysfunction

27. Cardiovascular Function • System • Heart • Blood vessels • Major functions • Transportation of blood • Transfer of waste products

28. Cardiovascular 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

29. Cardiovascular 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

30. Cardiovascular Dysfunction • Dysfunction • Rate and rhythm problems • Bradycardia • Tachycardia • Blood pressure problems • Hypertension • Hypotension • Disease or disorders • Congenital • Acquired

31. Cardiovascular Dysfunction • Congenital heart disease (CHD) • Increased or decreased pulmonary blood flow • Obstructive disorders • Mixed blood flow • Acquired cardiac disorders (ACD)

32. Implications • Treatment • Surgical • Pharmacologic • Preventative • Diet • Exercise

33. Educational Considerations • Physical activity demands • Structuring day appropriately • Determining what is safe to do • Self-limiting behavior • AHA guidelines • Strenuous • Moderately strenuous • Nonstrenuous

34. Educational Considerations • 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

35. Hematological 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”

36. Hematological 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

37. Hematological Dysfunction • Red blood cells - oxygen deprivation • White blood cells - development of infection • Platelets - bleeding disorders

38. Hematological Dysfunction • 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

39. Implications • Excessive bleeding • Invisible conditions • Need for replacement factor therapy • Contact with parent or medical personnel • Impact on physical endurance

40. Educational Considerations • 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

41. Hematological Dysfunction • 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

42. Digestive System

43. Digestive System • Gastrointestinal Function and Dysfunction • Urinary Function and Dysfunction

44. Gastrointestinal System • Structures • Mouth • Throat • Stomach • Intestines • Accessory organs • Functions • Ingestion • Digestion • Absorption • Elimination

45. Components • Upper GI • Mouth • Pharynx • Esophagus • Stomach • Lower GI • Small and large intestines • Anus

46. Function • 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

47. Mouth and Salivary Glands • Oral cavity • Mastication - chewing and salivation • Digestive enzyme • Semisolid - bolus • Deglutition - swallowing

48. Pharynx and Esophagus • Tongue • Pharynx • Esophagus • Soft palate • Epiglottis • Lower esophageal sphincter • Gastroesophageal reflux

49. Stomach • 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

50. Small Intestine • Long and narrow • Plicae increase surface capacity • Villi absorb nutrients • Parts • Duodenum • Jejunum • Ileum