Special Education 519

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Special Education 519

• UNIT FIVE
• Other Systems
• and Universal Precautions
• Kevin Anderson
• Minnesota State University Moorhead
• 2006

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Metabolic, Protective and Defensive Function and
Dysfunction

• Endocrine and exocrine systems
• Integumentary system - Skin
• Immune system

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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

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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 bodys metabolism and
  emotional status
• Pancreas - produces digestive enzymes and
  hormones
• Gonads - produces and stores gametes - sperm and
  eggs

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Dysfunction of Integumentary System

• Not typically life-threatening, however can be
  socially stigmatizing
• Can be non-infectious or infectious
• Can be systemic or localized

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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

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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

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Dysfunction of Integumentary System

• Non-infectious skin conditions
• Affecting skin appendages - congenital or
  acquired
• Disorders of nails
• Disorders of hair
• Disorders of glands

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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

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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

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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

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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

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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

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Function of Immune System

• Immunity - the bodys ability to defend itself
  against foreign substances
• Natural - born resistant to particular diseases
  due to transmission of mothers antibodies
• Acquired
• Self-producing antibodies due to previous contact
  with disease
• Artificially acquired immunity - by vaccination

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Function of Immune System

• Defensive system
• Made up of primary and secondary organs
• Serves a defensive reaction if the bodys first
  line of defense is compromised
• Lymph system - the bodys 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

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Dysfunction of Immune System

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

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Dysfunction of Immune System

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

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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

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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

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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

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Educational Considerations

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

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Dysfunction of Immune System

• Autoimmune diseases - autosensitivity leading to
  autoimmune disease
• Juvenile rheumatoid arthritis
• Glomerulonephritis
• Juvenile-onset insulin dependent diabetes

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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

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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

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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

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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

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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

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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

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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

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Educational Considerations

• Awareness of signs of STDs
• 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

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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

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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)

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Universal Precautions

• They are universal because they refer to steps
  that need to be taken in all cases, not only when
  a staff member or student is known to be
  HIV-infected.
• They are precautions because they require
  foresight and planning, and should be integrated
  into existing safety guidelines.

See document from the Boston Public Schools