Chronic Illness (FHNIII)

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Chronic Illness (FHNIII)
2014-06-09 16:01:13
chronic illness
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  1. Chronic illness are characterized by one or more of the following:
    • -duration > 6 months
    • -permanent or residual disability
    • -nonreversible pathological changes
    • -need for special rehabilitation
    • -long term medical and/ or nursing care
  2. Chronic illnesses may be relatively stable.
    Some have acute exacerbations resulting in:
    • -loss of control of illness
    • -times of instability with need of medical/ nursing assistance
    • -increased dependence on family members
  3. Disability:
    a limited functional ability as the result of an impairment; it is the term preferred over "handicap"
  4. Sequelae of chronic conditions
    • -limitation of functions; disfigurement
    • -dependence on medications or special diet
    • -current need for medical care/related services
    • -special ongoing treatments at home, work
  5. Major chronic conditions
    • -chronic sinusitis             -Psoriasis
    • -Allergic rhinitis               -Arthritis 
    • -Asthma                        -Orthopedic 
    • -Chronic bronchitits            impairments
    • -Heart disease                -Migraine HA
    • -Hypertension           -Visual impairment
    • -Diabetes                 -Hearing impairment
  6. 50% of adults have 1 or more chronic diseases
    • Each chronically ill person has average of 2 chronic diseases
    • -Related- HTN and CHF
    • -Unrelated- HTN and arthritis
  7. 1/3 of those with chronic illness have limitation in performing ADLs
    - Arthritis
    - Cancer
    - Coronary artery disease 
    - Spinal cord injury
    Highest incidence in people >=age 65
  8. Exact # of children with chronic illness unknown; estimates differ by definition of chronic illness in children
    • -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
  9. "Children with special health care needs are" for federal and state programs.
    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.
  10. Children affected by large number of rare disease, genetic, or prenatal conditions
    - Not stable; subject to acute exacerbations
    • Adults affected by relatively small number of common diseases that increase in morbidity with age.
    • - Generally stable conditions
  11. Any loss of physical/ mental function has major impact on a person's life.
    • -Changes in family roles
    • -Drains major power sources (income, self esteem, autonomy)
    • -Grief over loss of normal function
  12. Engel's Theory of Loss
    • Shock and disbelief over the diagnosis
    • -Unable to accept fact of illness
    • Development of awareness
    • -Aware of lifelong implication of illness
    • -Depression
  13. Engel's Theory of Loss

    -Family and patient provide mutual support in coping with reality of disease.
    • Resolution
    • -Responds to loss with psychological coping
    • -Roles are adjusted to normalize activities of daily living.
  14. Individual response to chronic illness
    -Pattern of coping strategies used in the past
    -Pathophysiology causing the disease
    -Visibility of the disease
    -Degree and type of limitations imposed by the disease
    • -Relationship between the disease and person's functioning in social roles
    • -Amount and type of family support
    • -Pain, fatigue, and fear
  15. Societal response to chronic illness
    -Members of society tend to avoid persons with chronic disease
    • -Impact on patient
    •    -social isolation
    •    -lack of social support
  16. Anselm Strauss et al (1984) studies on tasks/ problems of the chronically ill
    Led to interactional model identifying 7 problems of living with chronic illness:
  17. Anselm Strauss 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
  18. Anselm Strauss 7 problems of living with chronic illness
    • 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
  19. Anselm Strauss 7 problems of living with chronic illness
    • Controlling symptoms
    • -Learning acceptance of limitations on lifestyle imposed by disease
    • -Redesigning/ timing activities and hobbies
  20. Anselm Strauss 7 problems of living with chronic illness
    • Dealing with lack of monetary resources for treatment
    • -Costly treatments
    • -Limitations on ability to work
    • -Worry, anxiety, and depression
  21. Anselm Strauss 7 problems of living with chronic illness
    Managing the trajectory (disease pattern)

    -Variable, depending on predictability of illness and ability of patient to cope
  22. Anselm Strauss 7 problems of living with chronic illness
    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
  23. Anselm Strauss 7 problems of living with chronic illness
    • 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
  24. Corbin & Strauss
    -Trajectory Framework describes the experience of chronic illness
    • Further refinement of Strauss's earlier theory is applicable to:
    • -Cardiac illness
    • -Cancer
    • -Multiple sclerosis
    • -Diabetes
    • -Elderly with chronic illness
  25. Corbin & Strauss

    Common phases
    • -Pre-trajectory
    • -Trajectory onset
    • -Crisis phase
    • -Acute phase
    • -Stable phase
    • -Unstable phase
    • -Downward phase
    • -Dying phase
  26. Corbin & Strauss

    • -prior to diagnosis
    • -emphasize prevention
  27. Corbin & Strauss

    Trajectory onset
    -signs and symptoms
  28. Corbin & Strauss

    Crisis phase
    • -life threatening
    • -inpatient care
  29. Corbin & Strauss

    Acute phase
    • -interventions carried out
    • -illness/ complications
  30. Corbin & Strauss

    Stable phase
    -planned interventions
  31. Corbin & Strauss

    Unstable phase
    • -plan not working
    • -managed out-patient
  32. Corbin & Strauss

    Downward phase
  33. Corbin & Strauss

    Dying phase
    -terminal illness
  34. Psychosocial Adaptation to a chronic illness

    -is optimally achieved by maximizing self-control and independence
    -Increased dependence may be necessary during a medical crisis, but restoration to optimal functioning should be accomplished as soon as possible.
  35. Role of Nurse Practitioner in chronic illness:
    • -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
  36. General Management
    • -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
  37. General Management
    • -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
  38. Care at the end of life
    • -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
  39. Care at 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
  40. Conclusion
    • -Chronic health conditions involve limitation of functions for patient and family adaptation
    • -FNP role is vital for family adaptation