Special Education 519

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Special Education 519

• UNIT FOUR
• Respiratory, Circulatory, Digestive Systems
• Kevin Anderson
• Minnesota State University Moorhead
• 2006

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Respiratory System
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Respiratory Function

• Structure
• Upper respiratory tract
• Lower respiratory tract
• Function
• Inspiration
• Expiration

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Respiratory Dysfunction

• Asthma
• Bronchopulmonary Dysplasia
• Cystic Fibrosis

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Asthma

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

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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

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Characteristics

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

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Diagnosis Treatment

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

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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

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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

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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

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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

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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

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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

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Types

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

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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

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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

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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

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Educational Considerations

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

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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

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Considerations for Oxygen

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

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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

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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

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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

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Circulatory System
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Circulatory System

• Cardiovascular Function and Dysfunction
• Hematological Function and Dysfunction

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Cardiovascular Function

• System
• Heart
• Blood vessels
• Major functions
• Transportation of blood
• Transfer of waste products

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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

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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

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Cardiovascular Dysfunction

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

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Cardiovascular Dysfunction

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

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Implications

• Treatment
• Surgical
• Pharmacologic
• Preventative
• Diet
• Exercise

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Educational Considerations

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

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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

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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

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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

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Hematological Dysfunction

• Red blood cells - oxygen deprivation
• White blood cells - development of infection
• Platelets - bleeding disorders

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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

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Implications

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

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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

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Hematological Dysfunction

• Disorders of white blood cells
• Affects general health status and bodys ability
  to fight infection - leukemia is most common
  disease
• Disorders of platelets and coagulation
• Affects bodys blood clotting mechanism -
  thrombocytosis causes blood clotting in blood
  vessels
• Thrombocytopenia is most common cause of bleeding
  disorders
• Hemophilia is most common bleeding disorder

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Digestive System
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Digestive System

• Gastrointestinal Function and Dysfunction
• Urinary Function and Dysfunction

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Gastrointestinal System

• Structures
• Mouth
• Throat
• Stomach
• Intestines
• Accessory organs
• Functions
• Ingestion
• Digestion
• Absorption
• Elimination

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Components

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

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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

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Mouth and Salivary Glands

• Oral cavity
• Mastication - chewing and salivation
• Digestive enzyme
• Semisolid - bolus
• Deglutition - swallowing

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Pharynx and Esophagus

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

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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

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Small Intestine

• Long and narrow
• Plicae increase surface capacity
• Villi absorb nutrients
• Parts
• Duodenum
• Jejunum
• Ileum

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Accessory Digestive Organs

• Add to digestive process
• Add secretions to chyme
• Organs
• Liver
• Pancreas
• Gall bladder

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Large Intestine and Anal Canal

• Ileocecal valve
• Sections
• Cecum
• Colon
• Rectum
• Function
• Water and electrolytes absorbed
• Waste is collected
• Eliminated through anal canal

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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

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Problems with Ingestion

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

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Problems with Digestion

• Intestinal Atresia
• Pyloris stenosis

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Problems with Absorption

• Celiac disease
• Lactose intolerance
• Chronic Inflammatory Bowel Disease

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Problems with Elimination

• Hirschsprungs Disease
• Anorectal Malformations

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Other Chronic Conditions

• Hepatitis
• Peptic Ulcer Disease

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Educational Considerations

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

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Eating Disorders

• Anorexia Nervosa
• Bulimia Nervosa
• Obesity

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Educational Considerations

• Warning signs
• Honesty and acceptance
• Realistic expectations and educational program
• Gender difference

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Alternatives for Ingestion

• Parenteral feeding
• Administration of nutrients directly into
  vascular system
• Total Parenteral Nutrition (TPN)
• Central Venous Access Lines (VADs) - 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

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Educational Considerations

• Education
• Sepsis
• Hygienic and privacy concerns
• Restricted activity mostly with parenteral
  feedings
• Stationary during enteral feedings

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Alternatives for Elimination

• Surgical procedure - ostomy
• Ileostomy
• Cecostomy
• Colostomy

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Educational Considerations

• Independent self-care
• Potential problems
• Minimal restrictions to physical activity