Chapter 18 Systemic Conditions

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 18

Systemic Conditions

Chapter 18

Systemic Conditions


Bronchial AsthmaBronchial Asthma• Caused by:

– Constriction of smooth bronchial muscles

– Increased bronchial secretions

– Mucosal swelling

• Leads to inadequate airflow during respiration (especially expiration)


Bronchial Asthma (cont’d)Bronchial Asthma (cont’d)

• S&S

– Wheezing

– Rapid fatigue

– Acute attack

– Thick yellow/green sputum

– Anxiety

– Sweating

– Rapid heart rate

– Cyanosis

– ↓ LOC in severe cases


Bronchial Asthma (cont’d)Bronchial Asthma (cont’d)

• Management

– If available, administer prescribed medication

– If severe and prescribed medication is not available, activate emergency plan … summon EMS


Exercise-Induced Bronchospasm (EIB)Exercise-Induced Bronchospasm (EIB)

• Various factors can contribute to severity; ↑ risk with allergies, sinus disease, hyperventilation

• Key—amount of ventilation and temperature of inspired air

– ↑ ventilations in cold, dry, air → ↑ EIB risk

– ↑ strenuous exercise → ↑ ventilations


Exercise-Induced Bronchospasm (cont’d)Exercise-Induced Bronchospasm (cont’d)

• S&S

– Chest pain and tightness

– Regular dry cough

– SOB after or during exercise

– Symptoms appear after 8–10 minutes of activity and may worsen after activity stops

– Refractory period


Exercise-Induced Bronchospasm (cont’d)Exercise-Induced Bronchospasm (cont’d)

• Management

– Prescribed medications

– Proper warm-up and cool-down

– Refer to Application Strategy 18.1


•Chronic metabolic disorder characterized by near or absolute lack of insulin

•Risk and severity of diabetes increased by:

− Heredity− Aging− Minority ethnicity− Obesity− Gender

− Stress− Infection− Sedentary lifestyle− Poor diet

Diabetes Mellitus Diabetes Mellitus


Diabetes Mellitus (cont’d)Diabetes Mellitus (cont’d)

• Physiologic Basis

– Insulin

• Needed after carbohydrate ingestion to transfer glucose from the blood into the skeletal and cardiac muscles

• Also promotes glucose storage in the muscles and liver in the form of glycogen

– If little or no insulin is secreted by the pancreas, blood glucose bypasses the body cells and rises to abnormally high levels in the blood


Diabetes Mellitus (cont’d)Diabetes Mellitus (cont’d)Maintaining a balance of BG



• Physiology (cont’d)

– Excess glucose is excreted in the urine, drawing large amounts of water and electrolytes with it

• Leads to weakness, fatigue, malaise, and increased thirst

• Electrolyte imbalance leads to abdominal pains, vomiting, and stress reaction spirals



• Physiology (cont’d)

– When glucose cannot enter the cells, they shift from carbohydrate metabolism to fat metabolism for energy

• Results in dehydration and ketoacidosis

• Can depress cerebral function

• Produces acetone




Hypoglycemia Hypoglycemia

• Common in type 1

• Mild (60–70 mg/dL)—minimal or no symptoms; Severe (<40 mg/dL)—neurologic symptoms

• Monitoring is key to prevention!

• Can lead to insulin shock


Insulin ShockInsulin Shock

• S&S

– Rapid onset

– Dizziness

– Headache

– Intense hunger

– Aggressive behavior

– Pale, cold, clammy skin

– Profuse perspiration

– Salivation

– Drooling

– Tingling in face, tongue, and lips

– "umbles": stumbles, mumbles, fumbles


Insulin Shock (cont’d)Insulin Shock (cont’d)

• Management

– Administer 10-15 g of sugar

– Wait 15 minutes for blood sugar to rise

– If no change or worse, administer another 10-15 g; repeat until normal range reached (80-120 mg/dL)

– Eat sensible meal soon

– Call 911 if symptoms do not resolve or worsen, activate emergency medical plan – summon 911


Diabetic ComaDiabetic Coma

• Occurs with hyperglycemia; glucose in blood cannot be metabolized

• Fat metabolism = diabetic ketoacidosis

• Ketones in the breath, blood, and urine


Diabetic Coma (cont’d)Diabetic Coma (cont’d)

• S&S

– “Juicy fruit” breath

– Gradual onset (days)

– Restlessness

– Dry mouth, intense thirst

– Abdominal cramping

– Vomiting



• S&S

– Coma begins

• Dry, red, warm skin

• Deep, sunken eyes

• Exaggerated respirations

• Rapid, weak pulse



• Management

– Difficult to differentiate between insulin shock and diabetic coma at times; therefore, give sugar—it cannot hurt!

– Activate EMS

– Treat for shock and monitor vitals

– Refer to Application Strategy 18.2


Exercise RecommendationsExercise Recommendations

• Need balance of blood glucose, insulin, nutrition, and exercise

• Physician should be consulted before beginning exercise program

• Take readings 30 minutes before and 1 hour after exercise to see effects of exercise

• Aerobic exercise can make the body more sensitive to insulin, making it more effective


Exercise Recommendations (cont’d)Exercise Recommendations (cont’d)

• Kidney failure and cardiovascular diseases can be prevented with exercise

• Those with type 2 diabetes and systemic conditions need to be extremely cautious in their choice of exercise

• (Refer to Box 18.2)


Seizure Disorders and EpilepsySeizure Disorders and Epilepsy

• Seizure

– Abnormal electrical discharge in the brain

• Seizure disorder

– Entails recurrent episodes of sudden excessive charges of electrical activity in the brain from known or idiopathic causes


Seizure Disorders and Epilepsy (cont’d)Seizure Disorders and Epilepsy (cont’d)

• Epilepsy

– Term used to describe only recurrent idiopathic episodes (at least 2) of sudden, excessive discharges of electrical activity in brain

– Discharge may trigger altered sensation, perception, behavior, mood, LOC, or convulsions



• Causes of epilepsy

– Directly related to age of onset

– Provoked or unprovoked



• Partial or focal seizures

– Simple

• Characterized by involuntary movements of the face, limbs, or head

• May experience tingling or numbness

• May be followed by localized weakness or paralysis in body part in which seizure occurs



• Partial or focal seizures

– Complex

• Characterized by purposeful movements or experiences

• Followed by impairment in consciousness



• Generalized seizures

– Tonic-clonic (grand mal)

• Intermittent

• Tonic, clonic, or both

• Associated with LOC

• Sensory aura (e.g., taste or smell)

• Seizure lasts 50-90 seconds (5 minutes possible)



• Generalized seizures (cont’d)

– Tonic-clonic (grand mal) (cont’d)

• Intermittent (cont’d)

• May lose bladder or bowel control

• Post seizure: may be unarousable for a brief period; may not remember what happened




– Tonic-clonic (grand mal) (cont’d)

• Continuous

• Medical emergency

• >30 minutes or recurrent convulsions without full consciousness between attacks




– Posttraumatic seizures

• Provoked by head trauma

• Classified as impact, immediate, early, and late




– Absence (petit mal) attack

• Characterized by a slight LOC or blank staring into space for 3–15 seconds, without loss of body tone or falling

• Usually between ages 4 and 8; tends to resolve by age 30



• Immediate management of seizures

– Note time on your watch immediately on observing seizure

– Protect the individual from injury

• Remove nearby objects; protect head

• Do not stop or restrain the person



• Immediate management of seizures (cont’d)

– Never place fingers or any object in mouth

– If possible, remove any observers to allow for privacy

– Continuous seizure or a series of intermittent seizures >5 minutes—activate EMS

– (Refer to AS 18.3)



• Physical activity guidelines

– Requires neurologist evaluation

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Chapter 18 Systemic Conditions

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