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Chronic Illness

Chronic Illness The irreversible presence, accumulation, or latency of disease states or impairments that involve the total human environment for supportive care and self-care, maintenance of function and prevention of further disability (Lubkin)
Chronic Illness Duration Lasts for an extended period, six months or longer
Chronic Illness Incidence Common in older adults but impacts all ages
Chronic Illness Predictability One chronic condition impacts 85% of adults 65 years of age and older.
Most Common Chronic Illnesses Visual impairment, diabetes, heart disease, deafness and hearing impairment, arthritis, Alzheimer's, osteoporosis, hip fractures, urinary incontinence, stroke, Parkinson's disease and depression.
Shape of Chronic Illness Multiple health problems with protracted, unpredictable course. Management during the acute phase is in the hospital, other phases are managed at home.
Implications of Chronicity Adaptation is a continuous process. There are stable and unstable periods. Requires persistent adherence to treatments. One illness can lead to others. It affects the whole family. Management is a major responsibiltity. Management is expensive.
Phases in the Trajectory Model of Chronic Illness Pre-trajectory, Trajectory onset, Stable, Unstable, Acute, Crisis, Comeback, Downward, Dying.
Pre-Trajectory State where the person is at risk for developing a chronic condition because of genetic factors or lifestyle behaviors. The preventive phase, no s/sx present.
Trajectory Onset Onset of symptoms or disability associated with a chronic condition. Accompanied by uncertainty as symptoms are being evaluated and test are performed.
Stable Symptoms and disability are under control or managed.
Unstable Instability because of recurrence of symptoms, complications, or reactivations of the illness.
Acute Sudden onset of severe or unrelieved symptoms or complications that cause hospitalization.
Crisis Critical or life-threatening situation that requires emergency tx or care.
Comeback Recovery after an acute period- includes learning to live with or to overcome disabilites.
Downward Symptoms worsen or disability progresses despite attempts at control.
Dying Gradual or rapid decline in the trajectory despite efforts to halt the disorder or slow the decline.
Factors that Influence Coping Ability Biologic or genetic factors, physical and emotional growth and development, family and childhood experiences and learning.
5 Characteristics of Emotional Responses to PTSD Anxiety, Anger, Aggression, Depression, Fear of Being Threatened
Events That Can Trigger PTSD Rape, domestic violence, torture, earthquake, terrorism, fire, military combat.
Treatment of PTSD Establishing a trust relationship Providing education about recovery and self-care Teaching stress manaement techniques Helping the pt work thru the trauma Helping the pt integrate the trauma experience
Four Major Tasks of the Grief Process Acceptance of the loss Acknowledgment of the intensity of the pain Adaptation to life after the loss Cultivation of new relationships and activities
Common Fears of Dying People Fear of the unknown, pain, suffering, loneliness, loss of the body, and loss of personal control
Signs of Spiritual Distress Despair, discouragement, ambivalence, detachment, anger, resentment, or fear.
Seven Coping Skills for Families Under Stress Communication Spirituality Cognitive Abilities Emotional Strength Relationship Capabilities Use of Community Resources Personal Talents and Strengths
Stigma People who may be looked down upon because of prejudice, discrimination, and lack of status/power or who have illnesses that are feared or misunderstood.
Denial Refusal to accept reality of threatening situations.
Anger Follow denial. Feelings of powerlessness due to lack of control over situation.
Depression Loss of ability can no longer be delayed and accepts it.
Regression Return to previous developmental level as a coping response.
Dissociation Client removes/seperates themselves from chronic illness or disability and believes it is not happening.
Overcompensation Caregiver protects the client from opportunities in which he may be capable of taking part.
Learned Helplessness Person allows/expects more to be done for him than is necessary based on his abilities.
Emotional Balance Achieved by grieving for the loss of health, and moving forward to strive for the best quality of life possible.
Normalization Incorporation of chronic illness/disability into daily life/lifestyle.
Reactions to Disability or Chronic Illness 1. Shock and denial 2. Adjustment 3. Reintegration 4. Acknowledgement
Six Progressive Stages in the History of Chronic Diseases 1. No-risk stage 2. Risk stage 3. Infiltration stage 4. Critical stage 5. Symptom stage 6. Overt disease stage
No-risk Stage The period in an individual's life when no risk of developing the disease exists, varying from a few to many years.
Risk Stage One or more of the causative agents or factors becomes part of the host's environment.
Infiltration Stage Causative agent or agents are active in the individual, although no symptoms or signs of overt disease can be detected by any known diagnostic means.
Critical Stage Signs are present. Transition from wellness to illness. If the risks had been eliminated before this stage, then the disease process might have been reversed. Arresting or reducing seriousness of the disease and enhancing longevity are still possible.
Symptom Stage The individual is now aware of the problem and seeks help. Diagnosis may be elusive. Behavioral changes unlikely to effect course of disease.
Overt Disease Stage Evidence is seen, and a definitive diagnosis can be established readily.
Factors Affecting Family Adjustment to Chronic Illness Available support system Perception of the Illness/Disability Coping Mechanisms Available Resources Concurrent Stresses
Acute Grief Syndrome with intense and distressing psychologic and somatic symptoms that appear at the time of death.
Mourning A prolonged, painful process that consists of four phases: Shock and disbelief, Expression of grief, Disorganization and despair, Reorganization/awareness
Young Child's Concept of Death Sees death as temporary and reversible, main fear is separation.
School-Age Child's Concept of Death Sees death as irreversible but not inevitable, may fear mutilation. May resist the thought of their own death
Geriatrics The study of old age, includes the physiology, pathology, diagnosis and management of the diseases of older adults. Emphasis of care is place on promoting and maintaining functional status, thus promoting independence.
Heart Disease, cancer, and stroke account for more than 75% of elder deaths.
Common Stressors of Old Age impaired physical function, activities, and appearance, disability of chronic illness, social and environmental loses of income, roles, and activities, and the deaths of significant others.
Cardiovascular System Changes Decreased cardiac output; diminished ability to respond to stress; HR and SV do not increase with max demands, slower heart recovery rate, increased BP
Cardiovascular Health Promotion Exercise, pace activities, avoid smoking, eat less fat, low salt diet, stress-reduction activities, check BP regularly, med compliance, weight control
Respiratory System Changes Increase in residual volume, decrease in vital capacity, decrease in gas exchange and diffusing capacity, decrease in cough efficiency
Respiratory Health Promotion Exercise, avoid smoking, take adequate fluids, get yearly flu shot, avoid URIs
Integumentary System Changes Decreased protection against trauma, sun exposure and temp extremes; diminished secretion of natural oils and perspiration
Integumentary Health Promotion Avoid sun exposure; dress properly and maintain a safe indoor temp; shower preferable to bath, moisturize skin.
Reproductive System Changes Vaginal narrowing, decrease elasticity and secretions. Decreased penis size and testes. Slower sexual response.
Reproductive Health Promotion May require vaginal estrogen replacement; gyn/urology follow up, use lubricant
Musculoskeletal System Changes Loss of bone density and muscle strength and size; degenerated joint cartilage
Musculoskeletal Health Promotion Exercise regularly; increase calcium, limit phosphorus, take hormones and ca supplements.
Genitourinary System Changes Men- benign prostatic hyperplasia Women- Relaxed preineal muscles, Detrusor instability, urethral dysfunction.
Genitourinary Health Promotion Refer to urological specialist, have ready access to toilet, drink adequate fluids, avoid bladder irritants, pelvic floor muscle exercises.
Gastrointestinal System Changes Decreased salivation, difficulty swallowig, delayed esophageal and gastric emptying, reduced GI motility
Gastrointestinal Health Promotion Use ice chips, mouthwash, brush, floss, massage gums, regular dental care, small, frequent meals, sit up and avoid activity after eating, limit antacids and laxatives, increase fiber, decrease fat, drink adequate fluids
Nervous System Changes Reduced speed in nerve conduction, increased confusion with illness and loss of environmental cues, decreased cerbral circulation.
Nervous System Health Promotion Pace teaching, encourage visitors, enhance sensory stimulation, encourage slow rising.
Sensory System Changes Diminished ability to focus on close objects, inability to tolerate glare, difficulty adjusting to changes of light, dereased ability to distinguish colors. Decreased ability to hear high freq sounds, less ability to taste and smell.
Sensory System Health Promotion Wear eyeglasses/sunglasses; avoid abrupt changes from dark to light, large print books, magnifier, avoid night driving, use contrasting colors, avoid glare, hearing exam, enunciate, face pt, nonverbal cues, use lemon, spices, and herbs.
The Rehab Team family, physician, nurse, physical therapist, occupational therapist, speech therapist, psychologist, social worker, vocational counselor, ortho or prosthetics, rehab-engineer, sex counselor.
Stoke Recovery Programs/Traumatic Brain Injury Rehab Emphasis on cognitive remediation.
Spinal Cord Injury Rehab Intense efforts at vocational assessment, training, and reentry into the workforce and community.
Orthopedic Rehab Provide services to traumatic or non-traumatic amputee pts, pts undergoing joint replacements and pts with arthritis.
Cardiac Rehab begins during the acute hospitalization and continues on an outpatient basis.
Pulomonary Rehab Services of respiratory therapists are included to achieve more effective breathing patterns.
Pain Management Programs For sufferers of chronic pain. Focus on slternative pain tx modalities, exercise, counseling, and vocational evaluation.
Burn Rehab Focused on progressive joint mobility, self-care, and ongoing counseling.
Pediatric Rehab Meets the needs of children with developmental and acquired disabilities.
Congenital Disability Disability that has existed since birth but is not necessarily hereditary
Developmental Delay Maturational lag; an abnormal, slower rate of development in which a child demonstrates a functioning level below that observed in normal children of the same age.
Developmental Disability A mental or physical disability that is manifested before age 22 years and is likely to continue indefinitely.
Handicap Condition or barrier imposed by society, the environment, or one's own self - not a synonym for disability.
Technology-Dependent Child Child between the ages of birth to 21 with a chronic disability that requires the routine use of a medical device to compensate for the loss of life-sustaining body function
Beneficence Acts of kindnesses that are beneficial; used to describe one of the ethical positions
Biorhythms Cyclic, bioligic events such as sleep,menstrual, or respiratory cycles.
Chronotherapy Therapy that is given according to physiologic cyclic body processes.
Circadian Patterns based on a 24 hour cycle.
Created by: rjsnowrn