Nursing- concept of chronicity

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  1. leading cause of kidney failure
    diabetes, non traumatic lower extremity amputation and blindness among those 20-74
  2. characteristics of chronic illness
    • slow with gradual onset
    • symptoms come and go with periods of remission and exacerbation.
    • requires long term medicla and nursing management
    • accepts inability to be well
    • role inferior - does not feel as valued
    • knowledge of patient role
    • retains decision making often seen as problem patient
  3. characteristics of acute disorders
    • sudden dynamic onset.
    • signs and symptoms resolve infrequently.
    • ends in recovery or death
    • responds readily to treatment
    • desire to get wellrole less desirable but acceptable. decision making by staffsick role reinforced by staff
  4. in caring for the chronically ill a nurse should
    need to focus on promoting the highest level possible of independence, sense of control and wellness.
  5. eight stages of chronic illness trajectory
    • initial/pretrajectory
    • trajectory
    • crises
    • acute
    • stable
    • unstable
    • downward
    • dying
  6. initial /prejectory phase
    occur before signs and symptom appear
  7. trajectory phase
    occurs with first onset of signs and symptoms and includes diagnostic period
  8. crises phase
    potentially life threatening situation occurs
  9. acute phase
    patient symptoms are controlled by regimen. follows crises phase
  10. stable
  11. symptoms are controlled
  12. unstable phase
    symptoms become uncontrolled by regimen
  13. downward phase
    progressive deterioration in mental and physical status
  14. dying phase
    period preceding death.
  15. Caregiver strain (feelings of caregiver)
    • increased demand on time
    • increased stress due to anxiety
    • financial problems with healthcare cost
    • lonelines as a result of pending loss
    • change in social customs
  16. 3 aspect of client response to symptom experience
    • phycal experience of syptom
    • interpretations of symptoms
    • emotional response
  17. why medical care contact
    • validation of illnes
    • explanation of terms
    • reassurance they will be alright
    • accepts or rejects diagnoses. if accepted they follow advice
  18. nurses role in caring for chronically ill
    • palliative care for symptom control
    • provide info and educate
    • discuss self care practices to enhance independence
    • promote psychological well being by enhancing the client's sese of control or power, self esteem, sense of meaning or purpose
    • promote good communication
  19. Congenital disability
    a disability that has existed since birth but not necessarily hereditary
  20. Developmental delay
    a maturational lag, an abnormal slower rate of development in which a child demonstrate functional level below that observed in normal children of the same age
  21. ecomap
    documents energy expenditures within the community setting. provides visualization of how the family unit interacts.
  22. extended family
    family that includes teh relatives of the nuclear family - eg grandparents and uncles
  23. family centered nursing
    considers the health of the family as a unit in addition to the health of indivdual family members
  24. genogram
    gender and line of birth
  25. handicap
    a condition or barier imposed by society, not synonym for disability
  26. impairment
    a loss or abnormality of structure or function
  27. nuclear family
    a family of parents and their offsprings
  28. descrive family centered nursing
    considers the health of the family as a unit in addition to the health of the individuals
  29. components of a comprehensive family assessment
    • family structure- age /gender, size and type of family
    • family roles and function- job outside home, child rearing responsibilities
    • physical health status- current health of each family members. preventive care and routine.
    • interaction patters- ways of expressing affection, love, sorrow, anger
    • family values- cultural religious practices, use of leisure time, view of education, and school system. health values
    • coping resources- degree of emotional support found in family. availability of suport persons, afiliations outside family, friends church. sources of stress and how its handled. financial ability to meet current and future needs
  30. types of work
    • comfort work- what client has to do to function. exercise, ap of heat cold, keeping warm
    • usual life work- whatever it takes for client to maintain their family life, work life, student life, and relationship, firends, community.
    • clinical safety work- involves adding the things the client must do to keep their illness under control and avoid crises. ie taking meds, visit doc, daily blood sugar check, having plan when crisis occurs
  31. tasks of chronically ill
    • prevention and management of crisis- pot risk,, signs and sx
    • carrying prescribed regimen
    • Controlling symptoms
    • reordering time- has to do with illnes management- client report having no time or to little time. client need to learn about the pattern of symptoms, onset, duration, severity
    • adjusting to changes in course of disease. client must develop personal identity
    • prevention of isolation
    • attempting to normalize
  32. Work on trajectory scheme
    • involves client working on what their future hold . ask should you buy long term care insurance. should you sell your home should you move
    • how will illness affect future. who will be there
  33. work on biorgraphy
    • the reshaping and remolding of self concept. new story to write. questiosn client must answer. who am i now that i have illnes
    • how will illness change me as a person
    • how will it effect my life.
  34. self concept includes
    appearance, values and beliefs
  35. 4 dimention of self concept
    • self knowledge
    • self expectation
    • social self
    • social evaluation
  36. components of self concept
    • personal identity
    • body image
    • role performance
  37. signs of positive body image
    • incred self confidence
    • rewarding relationship with others
    • succes at work
  38. signs of negative self image
    • lower self confidence
    • impaired relationship with others
    • failures in the workplace
  39. factors that effect illness trajectory
    • growth and development.
    • age and life
  40. signs of caregiver overload
    • difficulty performing routine tasks for client
    • reports of declining physcial energy or insufficient tirme for caregiving
    • concern caregiving responsibility interfere with other roles
    • anxiety about ability to meet future care need of client
    • feeling of anger and depression
    • dramatic change in the home environment's appearance
  41. roles of the family
    • caring, nurturing and educating chilfren on how to get along in the owrld
    • maintaining continuity of society
    • receiving and givng love
    • preparing the next generation
    • meeting the needs of its members
    • serving as a buffer between family members and demands from outside
  42. afterload
    peripheral resitance agianst which the left ventrical must pump to eject blood.
  43. angina
    chest pain-
  44. chronic stable angina
    • clinical manifestation of reversible myocardial ischemia. chest apin that occur interittently over long period with the same pattern of onset, duration and intensity of symptoms
    • unstable engina- chest pain that is new in onset ocurs at rest or has a worsening pattern
  45. intermittent claudication
    an ischemic muscle ache or pain that is precipitated by consistent level of exercise, resolves within 10 minutes or less with rest, and is reproducible.
  46. ischemia
    deficiency of blood supply cause by obstruction of circulation to the body part
  47. orthopnea
    respiratory problems bought on by lying flat. ability to breathe only when in upright position.
  48. paroxysmal nocturnal dyspnea
    attacks of shortness of breath especially at night that awaken the patient; caused by reabsorption of fluid from dependent body areas when patient is recumbent
  49. preload-
    volume of blood in the ventricles at the end of diastole. determines stretch on cardiac muscle.
  50. rubor
    discoloration or redness caused by inflammation; one of the four classic symptoms of inflammation.
  51. systemic vascular resistance
    force opposing the movement of blood within the blood vessels.
  52. thromboemolism
    the blocking of a blood vessel by a clot
  53. varicose vein
    enlarge, dilated uperficial vein, can occur in any part of body, but most common in lower extremities.
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Nursing- concept of chronicity
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