Chronic Illness (FHNIII)

• -duration > 6 months
• -permanent or residual disability
• -nonreversible pathological changes
• -need for special rehabilitation
• -long term medical and/ or nursing care

• -loss of control of illness
• -times of instability with need of medical/ nursing assistance
• -increased dependence on family members

a limited functional ability as the result of an impairment; it is the term preferred over "handicap"

• -limitation of functions; disfigurement
• -dependence on medications or special diet
• -current need for medical care/related services
• -special ongoing treatments at home, work

• -chronic sinusitis             -Psoriasis
• -Allergic rhinitis               -Arthritis 
• -Asthma                        -Orthopedic 
• -Chronic bronchitits            impairments
• -Heart disease                -Migraine HA
• -Hypertension           -Visual impairment
• -Diabetes                 -Hearing impairment

• Each chronically ill person has average of 2 chronic diseases
• -Related- HTN and CHF
• -Unrelated- HTN and arthritis

Highest incidence in people >=age 65

• -31% of children under 18 years have chronic health condition
• -Incidence of chronic conditions have not changed
• -Prevalence of children affected increased d/t increasing survival and enhanced recognition

those who have or are at risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.

• Adults affected by relatively small number of common diseases that increase in morbidity with age.
• - Generally stable conditions

• -Changes in family roles
• -Drains major power sources (income, self esteem, autonomy)
• -Grief over loss of normal function

• Shock and disbelief over the diagnosis
• -Unable to accept fact of illness
• Development of awareness
• -Aware of lifelong implication of illness
• -Depression

• Resolution
• -Responds to loss with psychological coping
• -Roles are adjusted to normalize activities of daily living.

• -Relationship between the disease and person's functioning in social roles
• -Amount and type of family support
• -Pain, fatigue, and fear

• -Impact on patient
•    -social isolation
•    -lack of social support

Led to interactional model identifying 7 problems of living with chronic illness:

• Managing a medical crisis
• -Delegation of control to others
• -Can result in damage to patients' self concept and body image

• Carrying out prescribed regimens
• -Family and/ or family must learn regimens of care
• -Timing of interventions
• -Coping with side effects
• -Learning how to use equipment
• -Pain management

• Controlling symptoms
• -Learning acceptance of limitations on lifestyle imposed by disease
• -Redesigning/ timing activities and hobbies

• Dealing with lack of monetary resources for treatment
• -Costly treatments
• -Limitations on ability to work
• -Worry, anxiety, and depression

Managing the trajectory (disease pattern)

-Variable, depending on predictability of illness and ability of patient to cope

Preventing social isolation

• -Dependent on patient response to his/ her tendency to withdraw from friends and society
• -Patient response to societal withdrawal from her/ him

• Normalization
• -No longer focused on seven problems of the disease itself
• -Involves working through above task
• -Occurs when patient and family accept new, relaistic identities and roles
• -Achieves normalization- optimal level of functioning within the limits by illness

• Further refinement of Strauss's earlier theory is applicable to:
• -Cardiac illness
• -Cancer
• -Multiple sclerosis
• -Diabetes
• -Elderly with chronic illness

• -Pre-trajectory
• -Trajectory onset
• -Crisis phase
• -Acute phase
• -Stable phase
• -Unstable phase
• -Downward phase
• -Dying phase

• -prior to diagnosis
• -emphasize prevention

-signs and symptoms

• -life threatening
• -inpatient care

• -interventions carried out
• -illness/ complications

-planned interventions

• -plan not working
• -managed out-patient

-deterioration

-terminal illness

-Increased dependence may be necessary during a medical crisis, but restoration to optimal functioning should be accomplished as soon as possible.

• -can provide much needed psychosocial support for the chronically ill patient
• -can utilize Engel's loss theory and Strauss' 7 tasks to plan theory based interventions for chronically ill patients

• -evaluate the patient's self-care abilities
• -help the patient adjust to limitation imposed by illness
• -help the patients adjust to change in body image
• -work to increase self-esteem
• -assist the patient to express feelings

• -assess coping & help the patient practice new coping mechanisms
• -facilitate the grieving process
• -promote social interaction
• -teach the family about the illness
• -participate with the health care team to devise a comprehensive plan of care

• -Most persons will carry a chronic illness diagnosis at the end of life
• -Role of the NP:
•    -Pain management
•    -Facilitator of hope
•    -Explore patient expectations about the end       of life

• -Patient/ family communications about care/ prognosis
• -Clarification of limits of care
• -Caring for the family
• -Follow-up and grieving for family

• -Chronic health conditions involve limitation of functions for patient and family adaptation
• -FNP role is vital for family adaptation