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Adult Health 2
Ex. 1 week 1
| Question | Answer |
|---|---|
| Chronic illness | A medical condition or health problem with associated symptoms or disabilities that require long-term management (>3 months). |
| Chronic illness requires patients to: | learn to live with symptoms and disabilities comes to terms with identity changes manage regimens necessary to keep symptoms under control |
| Acute illness | Diseases that have a rapid onset and short duration. Examples: colds, influenza, acute gastroenteritis |
| Acute illness characteristics | Usually self-limiting responds readily to treatment complications infrequent after illness, return to previous level of functioning |
| Chronic illness | Diseases that are prolonged, do not resolve spontaneously, and are rarely cured completely. |
| Chronic illness characteristic | Permanent impairments or deviations from normal irreversible pathologic changes residual disability special rehabilitation required need for long-term medical and/or nursing management |
| Statistics | chronic illness does not discriminate, affects all ages, socioeconomic groups, cultures, and ethnicities billions of dollars spent annually on care for people with chronic conditions |
| Statistics | raises difficult ethical issues, allocating scarce resources, defining quality of life |
| Factors influencing development of chronic illness | increasing age: differentiate between aging and illness, not all change is disease socioeconomic status: related to access to health care, nutrition, and lifestyle factors |
| Factors influencing development of chronic illness | Impaired healthcare management: affected by support systems. education, economics, and culture |
| Key cascades to follow | terminal illness: chronic illness (cancer, AIDS with treatment advances) critically ill patients: become (chronically critically ill" One chronic illness leads to another (diabetes to renal failure, blindness, peripheral neuropathy) |
| Characteristics of chronic illness | physical, psychological, and social impact one chronic illness tends to lead to others affects the whole family home is the primary care center of care patient and family assume day-to-day management responsibility |
| Characteristics of chronic illness | management is a process of discovery, influenced by patient's experience and phase of illness chronic illness is expensive creates an atmosphere of uncertainly, course is unknown and unpredictable |
| Characteristics of chronic illness | Causes ethical dilemmas for patient, healthcare professional, and society |
| Characteristics of chronic illness | 1. little impact on activity: independent functioning 2. moderate limitation: some assistance needed 3. significant dependence: technology & support 4. complete dependence: end state Parkinson's rehabilitation towards self management |
| Characteristics of chronic illness influenced by | nature of the health problem patient's coping skills access to resources |
| Characteristics of chronic illness trajectory features | has stable and unstable periods includes remission and flare ups each phase has a distinct set of illness and impact |
| Phases of the trajectory | pre-trajectory trajectory onset stable unstable acute crisis comeback downward dying |
| Pre-trajectory phase | Person is at risk; no symptoms yet |
| Trajectory onset phase | Onset of symptoms or disability |
| Stable phase | symptoms and disability are managed |
| Unstable phase | exacerbation of symptoms, complications, reactivation of illness in remission |
| Acute phase | sudden, severe symptoms - usually requires hospitalization |
| Crisis phase | critical, life-threatening situation |
| Comeback phase | recovery after acute episode |
| Downward phase | symptoms and disability worsen despite attempts; patient usually at home managed in the community |
| Dying phase | gradual or rapid decline despite all efforts, hospice |
| Why chronic illness is increasing | Medical advances: Decreased mortality rates; people survive acute illness and live with chronic conditions Living longer: Improved nutrition → longer life → more age-related illness |
| Why chronic illness is increasing | Pharmacology advances: Drugs expand lifespan without curing disease (Diabetes, Heart disease, HIV/AIDS) Lifestyle changes: Smoking, stress, high-fat diet, sedentary living (see Healthy People 2010) |
| Why chronic illness is increasing | Early detection: Improved screening, disease management programs, and improved patient compliance Workplace safety: Improved safety laws reduce acute injury but more workers survive to develop chronic issues |
| Common issues in chronic illness | decreased mobility: Not necessarily bedbound. Effect on: Protection, Elimination, Rest/Sleep/Activity, Self-concept, Oxygenation, Nutrition (PERSON framework) |
| Common issues in chronic illness | Chronic pain: Multiple types: musculoskeletal, neuropathic, disease process. Manage per WHO standards. Watch for: fear of addiction, tolerance, substance abusers |
| Common issues in chronic illness | Fatigue: Space activities around what matters most to patient. Exercise: Rehab, Walk! Walk! Walk! Consider how to make activities enjoyable |
| Common issues in chronic illness | Depression: differentiate from fatigue- state of sadness, distress, hopelessness, loss of interest in previously enjoyable activities. Assess with standard tools |
| Altered mobility, nursing intervention - PERSON framework | protection elimination rest, sleep, activity self-concept oxygenation nutrition |
| Altered mobility, nursing intervention - PERSON framework - nursing actions | walk ambulate whenever possible turning schedule for bed bound patients special rehab strategies document functional status and progress daily involve PT/OT early and consistently |
| Psychological adaptation what? | grief and loss progress from sick role to impaired role |
| Psychological adaptation how? | coping mechanisms mirror past coping reaction depends on understanding of illness & perception of impact greiving is necessary in order to accept disability |
| Psychological adaptation nurse's role | must be willing to listen without fixing help to explore options and reality-check support patients in their own fixing process |
| culture & chronic illness; western culture | cure oriented - illness that cannot be cured tend to receive less attention and research (beginning to change) focus on treatment over management less research funding for chronic conditions system geared toward acute care episodes |
| culture & chronic illness; other cultural adaptations | stoic: illness to be accepted, not treated punishment: illness seen as punishment for sins, won't seek help or learn self-care authority figure: expect to be told what to do, no patient input expected |
| culture & chronic illness; other cultural adaptations | society should care: don't learn self care, families refuse active involvement |
| Social issues | workplace role: ability to maintain employment may be impaired; role changes and income loss are common social isolation: withdrawal from friends, community activities, and social roles due to physical or emotional limitations |
| Social issues | family impact: roles and relationships shift, family members may take on caregiver roles unexpectedly Caregiver role strain: physical and emotional exhaustion of family caregivers is a major concern - assess and refer for support |
| Nursing considerations for chronic care | Patient/family are often MORE knowledgeable about their specific illness management than we are Never assume that because a patient has had a problem for months/years that they are fully knowledgeable about it |
| Nursing considerations for chronic care | Well-informed, educated patients are more likely to recognize changes and seek early intervention to prevent complications Consider psychological and social state when teaching — readiness, ability to learn, phase of illness, coping |
| Nursing considerations for chronic care | Re-assess periodically to reinforce and correct knowledge — anticipatory counseling Respect patient autonomy — decisions, values, and lifestyle choices |
| Difficulties for healthcare professionals | patient is in control: many decisions rest with the patient, not the clinician. Adjust your approach accordingly complementary/ alternative medicine: many patients use CAM (often found online) |
| Difficulties for healthcare professionals | Illness is not curable: requires a shift in mindset from cure-focused to quality of life and management focused care |
| Rehabilitation process | A dynamic, health-oriented process that assists an ill or disabled individual to achieve the greatest level of physical, mental, spiritual, social, and economic functioning — within realistic limits. |
| Rehabilitation process | Quality of life: achievable acceptable QOL, self respect, and independence as defined by the patient Existing abilities: focus on what the patient can do - build on strengths, not limitations |
| Rehabilitation process | Holistic approach: addresses physiological, psychological, and spiritual dimensions |
| Principles of Rehabilitation | Focus on EXISTING ABILITIES rather than disabilities Work WITH the patient — never do for the patient what they can do for themselves Holistic & individualized: physiological, psychological, spiritual |
| Principles of Rehabilitation | Goal: maximal independence and QOL as defined by the patient Assess for effective coping mechanisms Teach self-care, self-management, exercises, transfer techniques Rehabilitation begins with INITIAL CONTACT |
| Principles of Rehabilitation | Psychological reaction to disability is a grief reaction — essential to adapt Grief reaction can occur in any sequence RN's willingness to "listen without fixing" is essential for grief process to progress |
| By rehab specialists | chest physiotherapy after surgery PT to teach walker/crutches use PT for strength, balance, gait training formal programs 3x/week x 6 weeks (COPD, cardiac) stroke programs - retraining brain and muscles |
| By rehab specialists | bowel and bladder training OT to adapt home environment swallowing evaluation after intubation/stroke |
| By nurses in acute care / home | instruct patient in foot and leg exercises communicate expected progress to patient develop plan for progressive ambulation & activity incorporate rehab goals into UAP assignments participate actively in discharge planning |
| rehabilitation settings | acute care general rehab center nursing home specialty rehab center home |
| rehabilitation team | physiatrist physical therapist occupational therapist speech therapist nurse |
| nurse's role on the rehabilitation team | prioritize & coordinate advocate delegate purposefully collaborate know & follow through discharge planning |
| rehabilitation nursing process APIE - (A) ASSESS | - functional ability - head to toe physical assessment - patient's rehabilitation goals - patient's motivation to engage - coping patterns - family status/resources - concerns about sexuality |
| rehabilitation nursing process APIE - (P) PLAN | - set realistic goals and time frames with the patient - short term goals = steps toward long term goal - select activities the patient agrees tp |
| rehabilitation nursing process APIE - (I) IMPLEMENT | - teaching, start where the patient is - tips for long term success - take control of your life - have well defined goals and priorities - emphasize abilities - conserve energy/ increase mobility - control environment with adaptive devices |
| rehabilitation nursing process APIE - (E) EVALUATE | - day by day help patient see progress toward goals - review the plan and adjust before the patient feels like failure |
| Promoting Success in Rehabilitation | - patient motivation is essential - plan with the patient - realistic, obtainable goals - individualized strategies - remain non-judgemental |
| Chronic Illness & Rehabilitation Have In Common | patient centered, individualized care focus on quality of life over cure grief reaction is part of the process teaching and self management are key inter-professional collaboration is essential success requires patient motivation and autonomy |
| Payors for Home Health Care | Medicare: Federally funded. (was HCFA(Healthcare Financing Administration) – now CMS Center for Medicare & Medicaid) Medicaid: State-administered, needs-based program. Jointly administered by CMS and the State. Private insurance: Mostly HMOs (e.g. HIP, United Health Care, Blue Cross/Blue Shield). Coverage varies significantly by plan. |
| Types of Community Agencies Providing Home Care | Visiting nurse services: Voluntary organizations — not dependent on state or tax dollars. Funded by donations and patient insurance. Hospital-based home care: Created to benefit from reimbursement. Tightly integrated with acute care systems. Proprietary agencies: For-profit; often specialize in one area (IV, pediatrics, dialysis, private duty nurses, HHAs, home attendants). |
| Types of Community Agencies Providing Home Care | Public Health departments: Prevention and health promotion — immunization, screening, health education, medical clinics, epidemiological work, maternal- child health. |
| Nurse's Role & Competencies in Home Care | Autonomous practice: Works independently in patient's home environment; accountable for own practice Skilled assessment: Highly skilled in assessment, diagnosis, evaluation, and communication. Coordination & Collaboration: Coordinator of care; collaborates with all disciplines. Locates and refers to community agencies. Documentation: Document measurable details on EVERY visit. Reimbursement awareness: Knows criteria, develops reimbursable plans of care, makes case for insurance coverage. |
| Home care nursing | Environment: patient owns the environment, nurse is a guest. Communication: clear, concise, verbal, written, telephone. Coordination: order supplies, DME, labs, refer to PT/OT/ST, locate community agencies. Autonomy: works alone, autonomous practice. Ambiguity: whats behind the door? Safety: patient, staff (HHA) and self, when patient is accepted, agency is responsible 24/7. Family: must include family in planning and care Reimbursement: needs to be aware of reimbursement issues and methods. |
| Hospital nursing |
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