Special Education 519

1. Special Education 519 UNIT FIVE Other Systems and Universal Precautions Kevin Anderson Minnesota State University Moorhead 2006

2. Metabolic, Protective and Defensive Function and Dysfunction • Endocrine and exocrine systems • Integumentary system - Skin • Immune system

3. Function of Endocrine System • System - network of glands that release secretions into circulatory system • Functions • Regulation of heartbeat • Maintains fluid and electrolyte balance • Maturation of reproduction system • Parts • Endocrine cell • Target cells or end organ • Environment

4. Function of Endocrine System • Glands • Pituitary gland - controls growth and development • Thyroid gland - regulates metabolic rate of body • Parathyroid gland - regulates calcium levels in blood • Adrenal glands - affects body’s metabolism and emotional status • Pancreas - produces digestive enzymes and hormones • Gonads - produces and stores gametes - sperm and eggs

5. Dysfunction of Endocrine System • Excessive hormone production - such as hyperpituitarism, hyperthyroidism, hypocalcaemia • Insufficient hormone production - such as hypopituitarism, hypothyroidism, hypocalcaemia, or hypoinsulinism or Diabetes, which is the most common form

6. Dysfunction of Endocrine System • Diabetes • Insipidus - “bland” urine diabetes, less common in children • Mellitus - “sweet” urine diabetes, Type I Diabetes Mellitus most common • Lack of or inadequate insulin production • Two types • Type I-(insulin dependent) • Type II (non-insulin-dependent) diabetes

7. Implications • Lack of insulin causes glucose shortage in cells • Blood glucose levels rise • Loss of glucose reserves lead to fatigue • Fats and proteins may be used as energy source

8. Implications • Levels monitoring • Glucose testing of blood • Ketone testing of urine if blood glucose is high • Prognosis • Controlled by diet, exercise, and insulin therapy • No known cure other than pancreas transplant

9. Implications • Continuum between hypoglycemia and hyperglycemia • Hypoglycemia - below normal blood glucose level • Too much insulin, rapid insulin absorption, sudden exercise, delayed eating • Too little sugar leads to insulin reaction • Needs sugar

10. Implications • Continuum between hypoglycemia and hyperglycemia • Hyperglycemia - above normal blood glucose level • Missed insulin dosing, not following recommended diet, lack of physical activity, illness or infection, emotional stress • Too much sugar leads to ketoacidosis • Needs insulin

11. Educational Considerations • Understanding condition • Should not require change in curriculum or instruction • May develop educational needs despite normal intellectual functioning • Consider physical vs. psychosocial factors • Be aware of hypo- or hyperglycemia symptoms • Encourage self-sufficiency • Using condition as excuse • Controlled diet but not different foods • Encourage fluid intake and allow access to bathroom • Support groups if necessary • Occupational impact

12. Educational Considerations • Maintain effective communication • Contact with school nurse • Share information with family • Collaboration • Trained personnel for any necessary procedures • Advocate for exercise with caution

13. Function of Exocrine System • System - network of glands that release secretions to outer surface of organs or tissues • Functions • Regulates digestive glands • Produces digestive enzymes • Regulates body temperature • Glands • Sweat glands - regulate body heat • Sebaceous glands - maintains skin • Digestive glands - breaks down food • Lymph glands - fights off infection

14. Dysfunction of Exocrine System • Problems with exocrine glands mostly related to system involved • One disease affects all glands of exocrine system - Cystic Fibrosis • Abnormally viscous secretions • Secretions with abnormal electrolytes

15. Dysfunction of Exocrine System • Cystic Fibrosis - thick secretions may plug ducts and damage gland and surrounding tissues • Pancreatic involvement • “Cystic” - cyst-like appearance of pancreas ducts • “Fibrosis” - pancreatic tissue becoming fibrous

16. Dysfunction of Exocrine System • Pancreatic involvement • “Cystic” - cyst-like appearance of pancreas ducts • “Fibrosis” - pancreatic tissue becoming fibrous • Respiratory involvement • Abnormal mucus in the bronchioles of the lungs • Prevents removal of bacteria and foreign particles • Progressively leads to exercise intolerance and increased fatigue • Initially looks like asthma, but is not reversible

17. Dysfunction of Exocrine System • Cardiac involvement • Respiratory dysfunction leads to decreased oxygenation of blood to heart • Heart compensates by beating harder to circulate blood through the lungs • Right side of heart becomes thicker and larger • Gastrointestinal involvement • Decrease pancreatic enzymes to aid in metabolism • Increased risk for insulin-dependent diabetes • Liver damage • Growth deficiencies • Bodily odors • Glandular involvement • Elevated sodium and chloride levels • “salty” kiss

18. Implications • Easily identified through sweat test and detection of CF gene • No known cure, treatment focuses on alleviation of symptoms • Improving pulmonary function through inhalation or chest therapy • Enzyme replacement therapy • Maintaining adequate nutrition • Surgical organ replacement

19. Educational Considerations • Does not affect intellectual development • Strong communicative and social skills • Decreased focus on physical activity • Increased interaction with adults through medical interventions • School attendance • Medical appointments or hospitalizations • Health-related procedures and medications during school • Prone to respiratory infections and may have persistent cough in effort to clear airway

20. Educational Considerations • Exercise and diet • Caution during hot weather • Prevent excessive perspiration • May need diet high in calories • Access to bathroom • Bowel movements • Hygiene needs • Social issues • Self-esteem and self-image • Prognosis increasing • Occupational outlook

21. Function of Integumentary System • Skin - serves as protector from environmental dangers and barrier against invading organisms • Three layers • Epidermis - outermost protects from invading organisms, prevents loss of body fluids, and stores pigment • Dermis - tough, thick inner layer protects body and contains blood vessels, sweat/sebaceous glands, nerves lymphatic vessels, and hair follicles • Hypodermis - innermost layer which “insulates” body

22. Function of Integumentary System • Appendages • Nails - hardened skin cells that serve to protect the soft tips of extremities and aid in grasping • Hair - filament of the protein, keratin which serves primarily as a decorative function • Glands • Sweat - produces sweat to fight off microorganisms and regulate body temperature • Sebaceous - attached to hair follicles and produces sebum for skin lubrication and water-resistence

23. Dysfunction of Integumentary System • Not typically life-threatening, however can be socially stigmatizing • Can be non-infectious or infectious • Can be systemic or localized

24. Dysfunction of Integumentary System • Non-infectious skin conditions • Not communicable • Can become infected • Types • Atopic Dermatitis (Eczema ) • Itchy, chronic skin condition characterized by lesions • Allergy-related • Allergic contact dermatitis - direct contact with natural or manufactured agent that triggers an allergic response • Psoriasis - recurrent inflammatory skin condition • Pigmentation disorders - either change in amount or dispersement

25. Dysfunction of Integumentary System • Non-infectious skin conditions • Resulting from injury • Abrasions, lacerations, punctures • Thermal injuries - burns and scalds • Depth of injury • 1st degree - partial-thickness burn at epidermis layer • 2nd degree - partial-thickness burn at epidermis and dermis layer • 3rd degree - full-thickness burn at all skin layers • 4th degree burn - extends beyond skin to muscles, tendons, and bones • Amount of body surface area affected - “rule of nines” • Treatment • From minor first aid to extended hospitalization • Goals of therapy include prevention of infection, growth of tissue, and regain functional abilities

26. Dysfunction of Integumentary System • Non-infectious skin conditions • Affecting skin appendages - congenital or acquired • Disorders of nails • Disorders of hair • Disorders of glands

27. Educational Considerations • School attendance • Dependent on severity of injury • May require specialized garments • Rehabilitation • Long and painful process • Intolerance of extreme temperatures • Education • Prevention • Appropriate and timely treatment response

28. Dysfunction of Integumentary System • Infectious skin conditions • Typically caused by microorganism entering body through a break in the skin - such as bacteria, viruses, fungi, or parasites • Contagious either directly or indirectly

29. Dysfunction of Integumentary System • Types of infections • Bacterial infections - such as impetigo • Viral infections - such as cold sores, warts, and molluscum • Fungal infections - such as nail infections • Parasitic infections - such as lice or scabies

30. Educational Considerations • Attendance • Most can attend school if Universal Precautions are followed • Treatment • May require treatments at school • Apply pressure to itch rather than scratch • Social issues • Appearance issues • Assumption of poor personal hygiene • Must learn and follow proper hygiene techniques

31. Function of Immune System • Immune system - collection of organs, glands, cells, and proteins located across body • Serve as protection from disease and microorganisms • Discriminate between essential components of body and foreign bodies or pathogens • Protects from excess cellular wastes and abnormal development of cells

32. Function of Immune System • Immunity - the body’s ability to defend itself against foreign substances • Natural - born resistant to particular diseases due to transmission of mother’s antibodies • Acquired • Self-producing antibodies due to previous contact with disease • Artificially acquired immunity - by vaccination

33. Function of Immune System • Defensive system • Made up of primary and secondary organs • Serves a defensive reaction if the body’s first line of defense is compromised • Lymph system - the body’s drainage system • Chain of infection • “Cause” of condition - pathogen • “Host” - source of the pathogen • “Means” of transmission - mode of transmission • Communicable diseases • Caused by microorganisms not visible to the naked eye • Not always pathogenic or disease producing • Direct or indirect transmission

34. Dysfunction of Immune System • Dysfunction can be harmful • May occur due to many factors • Genetics • Developmental defects, • Infection • Malignancy • Injury • Drugs • Altered metabolic states

35. Dysfunction of Immune System • Most common dysfunction • Hypersensitivity disorders - asthma, drug/product/food reactions, rejection of transplanted organs/tissues • Immunodeficiency disorders • Autoimmune diseases • Cancer

36. Dysfunction of Immune System • Hypersensitivity disorders - asthma and allergies • Types • Immediate - immediate response to allergen • Delayed - may take 1-6 days • Characteristics • Localized - specific site • Systemic - found throughout body • Severity - depends on sensitivity and exposure

37. Educational Considerations • Attendance - not necessarily related to academic achievement in well supported environments • Symptoms - medication, removal of allergens, response to emergency • Awareness and acceptance • Medical response to certain conditions - emergency plan, auto-injectors

38. Dysfunction of Immune System • Hyposensitivity or immunodeficiency disorders • System underreactive and unable to defend against disease-producing organisms - immunodeficiency • Most well-known type is Acquired Immunodeficiency Syndrome (AIDS) • Results from invasion of retrovirus - Human immunodeficiency virus (HIV) • Spread by exposure to contaminated blood/blood products or exposure to bodily fluids of infected persons

39. Educational Considerations • Communication with parents of child who is immunosuppressed, especially if exposed to communicable diseases • Follow universal precautions • Prejudice and isolation

40. Dysfunction of Immune System • Autoimmune diseases - autosensitivity leading to autoimmune disease • Juvenile rheumatoid arthritis • Glomerulonephritis • Juvenile-onset insulin dependent diabetes

41. Dysfunction of Immune System • Malignant tumors • Abnormal cell growth and development • Replacement and kill normal cells • Kinds • Benign - non-life-threatening and easily removed • Malignant - life-threatening and easily spread or metastasize

42. Dysfunction of Immune System • Types of cancerous conditions • Hematopoietic system - leukemia • Central nervous system • Lymph system • Musculoskeletal system • Sympathetic nervous system • Urinary system • Visual system

43. Educational Considerations • Communication with family is crucial • Increased awareness and understanding of impact on student • Maintain attendance at school to maintain “normalcy” • Ongoing medical treatments may interfere in academic progress • Susceptibility to infections, bleeding, pain • Self-awareness and determination

44. Communicable Diseases • Invasion of pathogenic agents which are infectious • Common bacterial infections • Pinkeye, pneumonia, Lyme disease, meningitis, middle-ear infection, rubella, mononucleosis, Fifth disease, hepatitis • Treated with antibiotic medication • Common viral infections • adenoviruses, enteroviruses, rhinoviruses, myxoviruses • Treated with antiviral medication

45. Communicable Diseases • Common fungal infections • Certain types of fungi can be pathogenic in humans • Treated with antifungal medicines • Common parasitic infections • Tapeworms, pinworms, lice, and mites • Treated with antiparasitic agents

46. Educational Considerations • Decreased incidence due to widespread use of vaccines • May need to be remain home until condition is not communicable • Notice of exposure to communicable diseases is required • Enforce proper hygiene in the classroom and proper cleanliness in food preparation

47. Sexually-Transmitted Diseases • Transmitted primarily through sexual intercourse or contact • Second most common infection; the first is the common cold • Caused by bacterial, viral, and fungal agents • Often non-symptomatic and not treated properly

48. Educational Considerations • Awareness of signs of STD’s • Formal and informal instruction is necessary • Increasing numbers secondary to better medical treatment • Do not restrict access to education • Changes in programming should only be made amongst collaborative team

49. Policies and Procedures • School health services versus medical services • Handling and administration of medications • Provision of special health care procedures • Contact with bodily fluids • Use of Universal Precautions • Do Not Resuscitate (DNR) orders • Disagreement with physician orders

50. Universal Precautions • Definition - the usual and ordinary steps all school staff need to take in order to reduce their risk of infection with HIV, the virus that causes AIDS, as well as all other blood-borne organisms (such as the Hepatitis B virus)