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Chronic Illness
- Prevalence and associated costs of chronic illness is a worldwide health concern
- Vulnerable and socially disadvantage people get sicker and die sooner from chronic illness than those with resources and support
- influences of chronic illness are education, income, gender, ethnicity
- older adults are at risk for chronic condition that include, dm, arthritis, congestive heart failure, and dementia
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chronic illness definition
- Chronic illness is known as a condition that last (>3 months) 1 yr or longer and requires ongoing medical attention and or limits activities of daily living
- Acute disorders have chronic sequelae(s/s that come from it but have these long term effects)
- exacerbations and remissions occur
- consequences of chronic illness includes physical suffering, loss, worry, grief, depression, functional impairment, and increased dependence on family and friends for support
- not all people with chronic illness need long term care.
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Factors that influence chronic illness
- Aging population- growing
- advancing in medical science extending the life span
- rise in condition such as asthma and dm
- obesity in young people
- Changing trajectory (path followed by the body) illnesses such HIV, AIDS, cancer and dementia
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Chronic illness and aging
- by 50 yrs old, most individuals have chronic illness such as arthritis, HTN, DM or obesity
- sinusitis is the most chronic illness of of ages
- chronic illness can be an inconvenience or impairment involving ADL's
- current older adults are more healthy than in previous decades
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Strategies that improve the health of older adults
- Healthy people 2020 goals and objectives
- Preventative measures:
- - lifestyle choices/changes
- - risk factor identification
- - early detection and management of risk factors
- Wellness approach to chronic illness
- - increase physical activity
- - improve nutrition
- - decre tobacco use
- - decre excessive alcohol comsumption
- - decre stress
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Models of Chronic Illness
- Trajectory Model
- - views chronic illness as a life course perspective and as an intergral part of lives- not as a single event (my words it is apart of ones life)
- Shifting perspectives model
- - views living with chronic illness as ongoing and focusing on the emotional, spirtual, and social aspects of life
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Phases of Chronic Illness Trajectory
- 1. Pre-trajectory- preventative phase: before anything happens
- 2. Trajectory Onset- definitive phase- dx test confirms, s/s present
- 3. Crisis phase- emergency-life threatening
- 4. Acute- active illness- need hospitalization
- 5. Stable phase- controlled
- 6. Unstable phase- illness not controlled
- 7. comeback- recovery after acute illness
- 8. Downward phase- increasing in s/s
- 9. Dying- days, weeks, months
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Key Points
Chronic illness Trajectory framework
- the majority of health problems in late life are chronic
- chronic illness maybe life long and require lifetime adaptions
- chronic illness and its management often profoundly affect the lives of both the individual and family or significant other
- the acute phrase of illness management is designed to stabilize physiological processes and promote a recovery (comeback) from acute phase
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Key points
chronic illness tracjectory framework 2
- other phases of management are designed to primarily maximize and extend the period of stability in the home with the help from family and augmented by visits to and from health care providers and other members of rehab and restoration team
- maintaining stable phrase is central to managing chronic illness
- a primary nurse is often the coordinator of the muliple resources that may be needed to promote quality of life along the trajectory
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Application of the nursing process using the phases of the chronic illness system
- Step 1- identify specific problem and the trajectory phase
- Step 2. establishing and prioritizing goals
- step 3. defining the plan of action to achieve desired outcome
- step 4. implementing the plan
- step 5. folllowing up and evaluating outcomes
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Ex. of goals nursing may establish
- 1. to assist a client in overcoming a plateau by increasing adherence to a regimen so that he.she might reach the highest level of functional ability within limits of the disability
- 2. assist a client in making the attitudinal and lifestyle changes that are needed to promote health and prevent disease
- 3. assist with advance care planning to assure wishes are met
- 4. assist a client who is in the unstable p\hase to gain greater control over symptoms that are interfering with his ability to carry out daily activities
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The shifting perspectives model of chronic illness
- this model views living with chronic illness as an ongoing, continually shifting process in which the person moves between the perspectives of wellness in the foreground or illness in the foreground
- the model is more reflective of an insider perspective on chronic illness as opposed to the more traditional outsider view
- - the ini
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Implications of Geron nursing and health aging
- assessment with those with chronic illness is ongoing in nature and involves careful observation and periodic monitoring
- functional assess quantity and quality of disabilities in those with a chronic illness
- assessments help identify gaps
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Improving care for those with chronic illnesses
- care needs to be coordinated all the time and centered to the clients needs, values, and preferences
- health care needs of those who are chronically ill are increasing in cost
- health care delivery system to those with chronic illnesses is complex and can be confusing
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Chronic illness late in life
- is an important issue for individuals, families the health care profession and the world
- healthy people 2020 is ready to prepare individuals for a more healthy older age and to enhance the health and wellness of older adults
- nurse's role is to deliver direct health care for the long term management of illness and to be a resource person, advisor, teacher, and facililator for those with chronic illnesses
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Maslow's hierarchy of needs
- nursing interventions enhance self care abilities
- a wellness approach assists in meeting maslow's needs
- care must support the potential for wellness
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