Coping with Disability and Chronic Illness

Coping with Disability and Chronic Illness

• Acute illness is a sudden condition, typically short in duration, that resolves with or without medical intervention.
  • Physiologically, it presents as a rapid, reversible decline in health.
  • Sociologically, it's a temporary disruption requiring short-term medical attention.
• Chronic illness is a long-term condition persisting for months or years, needing ongoing care.
  • Physiologically, it progressively affects bodily functions, often managed rather than cured.
  • Sociologically, it's a continuous adaptation impacting social roles, work, and family life.
• Disability is a physical, mental, or cognitive impairment limiting major life activities.
  • Physiologically, it affects bodily functions leading to activity or participation limitations.
  • Sociologically, it's the interaction between a health condition and societal barriers hindering participation.

Implications of Chronicity for Developmental Tasks

• Childhood: Can cause delays in growth, education, and socialization.
• Adolescence: Can cause challenges in identity formation, peer relationships, and independence.
• Adulthood: Can cause impacts on career, relationships, and family planning.
• Elderly: Can cause increased dependence on caregivers, adaptation to functional decline, and end-of-life planning.

Roles of the RN vs. Interdisciplinary Team in Tertiary Healthcare

• Registered Nurse (RN): Offers direct patient care, coordinates treatment plans, educates patients/families, and advocates for patient needs.
• Physician: Diagnoses and prescribes treatments.
• Physical Therapist (PT): Helps restore movement and function.
• Occupational Therapist (OT): Assists with activities of daily living (ADLs) and adaptive strategies.
• Speech-Language Pathologist: Aids in communication and swallowing disorders.
• Social Worker: Provides emotional support and connects patients to resources.
• Case Manager: Coordinates care and discharge planning.
• Chaplain: Addresses spiritual and emotional needs.

Common Nursing Diagnoses Related to Chronic Illness

• Ineffective Coping
• Chronic Pain
• Activity Intolerance
• Risk for Impaired Skin Integrity
• Risk for Caregiver Role Strain
• Self-Care Deficit
• Impaired Social Interaction

Historical Dates and Concepts in Disability, Handicap, and Rehabilitation Legislation

• 1973: Rehabilitation Act prohibited discrimination based on disability.
• 1990: Americans with Disabilities Act (ADA) ensured rights and accessibility for disabled individuals.
• 1999: Olmstead Decision advocated for community-based services for disabled individuals.
• 2008: ADA Amendments Act expanded the definition of disability for broader protections.
• Affordable Care Act enhanced access to healthcare and preventive services for disabled individuals.

Medication Administration - Routes of Medication Administration and Dosage Variations

• Oral (PO): Tablets, capsules, liquids, sublingual, buccal.
• Topical: Applied to skin, eyes, ears, nose, transdermal patches.
• Enteral: Administered through feeding tubes into the stomach or intestines.
• Parenteral: Administered via IV, IM, SC, and ID injections.
• Inhalation: Nebulizers, metered-dose inhalers (MDI).
• Rectal/Vaginal: Suppositories, creams, and gels.

Elements of a Medication Order and Types of Orders

• Elements of medication order: Date, patient name, medication name, dosage, route, frequency, provider signature.
• Standing (Scheduled): Administered regularly until discontinued.
• PRN (As Needed): Given only when necessary, requires assessment before administration.
• Single (One-time): Given once at a specified time.
• STAT: Administered immediately for urgent situations.
• Verbal/Telephone Orders: Taken by RN, must be signed by provider later.

Legal and Ethical Implications

• FDA regulates drug safety and efficacy.
• Controlled substances must be securely stored and documented.
• Medication administration follows state Nurse Practice Acts.
• Nurses must never misuse medications.
• Patients have the right to informed consent and to refuse medication.

Professional Nursing Responsibilities

• Preparation: Verify order, assess patient condition, check allergies, contraindications, and necessary vitals, use three medication checks.
• Administration: Follow the Five Rights: Right patient, drug, dose, route, and time.
• Evaluation: Monitor for effectiveness and side effects, document administration and patient response.

Patients’ Right to Refuse Medication

• Patients have the right to be informed, refuse medications unless legally mandated, and be supported in decision-making.
• Educate patient on risks and benefits, document refusal, and notify provider.

Differences in Injection Techniques for Pediatric and Adult Patients

• Pediatric Considerations: Use smaller needles, lower volumes, preferred sites: vastus lateralis for infants, deltoid for older children.
• Adult Considerations: IM sites: deltoid, ventrogluteal, vastus lateralis, dorsogluteal; SC sites: upper arms, abdomen, thighs.

Syringe and Needle Selection

• Syringe Types: Hypodermic (3-20 mL), insulin (in units), tuberculin (up to 1 mL).
• Needle Sizes and Selection:
  • Intradermal (ID): 25-28 gauge, 2/8”-5/8” needle, 15-degree angle.
  • Subcutaneous (SC): 25-28 gauge, 3/8”-5/8” needle, 45-90-degree angle.
  • Intramuscular (IM): 21-25 gauge, 1”-1.5” needle, 90-degree angle.

Medication Label Interpretation

• Name of drug (brand/generic)
• Strength (mg/mL, units, % concentration)
• Expiration date
• Storage requirements

Medication Calculations

• Ratio/Dimensional Analysis is used to convert and calculate correct dosage.
• Formula Method is (Desired dose / Available dose) x Quantity = Dose to administer.
• Body Weight Calculations: the dose is based on mg/kg.

Rounding Rules

• Round to nearest tenth for dosages greater than 1 mL.
• Round to nearest hundredth for dosages less than 1 mL.
• Do not round until final step of calculation.

Demographics of the Aging Population

• Elderly is defined as age > 65 years
• Life Expectancy Trends:
  • 1900: 48 years
  • 2019: 78.79 years (Global: 72.98 years) -Factors Affecting Aging Rate: Genetics, lifestyle, medical history, environment

Age-Related Physiological Changes

• Changes: Decreased skin elasticity, cognitive reactivity, bladder capacity, peristalsis, vital capacity, elasticity of blood vessels, hearing and visual acuity
• Pneumonia in Older Adults:
  • Causes: Weakened immunity, comorbidities
  • Symptoms: Cough, fever, confusion
  • Treatment: Antibiotics (bacterial), supportive care (viral)
• Geriatric Syndromes: Frailty, falls, incontinence, pressure ulcers
• Mental Health Issues: Depression, delirium, dementia

Common Healthcare Issues in Older Adults

• Nutrition:
  • Decreased taste/smell, chewing/swallowing difficulties
  • Medications affecting appetite
  • Financial barriers to food access
  • Dysphagia safety considerations
• Safety Concerns:
  • Fall risks
  • Medication management and polypharmacy
  • Abuse protection
  • Safe driving assessment

Care Priorities for Geriatric Patients

• Support independence and quality of life
• Encourage preventive care and screenings
• Address chronic illness management
• Support caregivers and families
• Promote proper nutrition and hydration

Support Strategies for Older Adults

• Social Supports:
  • Family and caregivers
  • Senior centers, community groups, religious organizations
  • Government aid (Medicare, Medicaid, social welfare programs)
• Living Arrangements:
  • Independent living, assisted living, long-term care
  • Factors affecting housing: health needs, finances, family support

Alzheimer's Disease

• Progressive, degenerative brain disease with no cure
• Early Signs: Forgetfulness, personality changes, disorientation, poor judgment
• Clinical Manifestations:
  • Cognitive Impairments: Memory loss, confusion, disorientation
  • Behavioral Changes: Aggression, anxiety, psychosis, sundowning
  • Physical Decline: Loss of ability to eat, dress, recognize family, eventual need for total care

Assessment & Management

• Tools: Mini-Mental State Exam (MMSE), Confusion Assessment Method (CAM)
• Management:
  • Medications: Cholinesterase inhibitors, NMDA receptor antagonists
  • Non-pharmacological interventions: Structured routines, validation therapy
  • Support for families: Education, respite care

Clinical Presentation & Management of Alzheimer's Complications

• Sundowning: Increased confusion and agitation in late afternoon/evening
• Aggression: Use calm reassurance, distraction, safety measures
• Wandering: Secure environment, alarms, ID bracelets
• Depression/Anxiety: Therapy, medications, structured activities

Common Visual Conditions: Cataracts

• Pathophysiology: Clouding of the lens reduces vision
• Clinical Manifestations: Blurred vision, night vision difficulty, glare sensitivity
• Management:
  • Non-surgical: Corrective lenses
  • Surgical: Lens replacement (when functional ability is affected)

Common Visual Conditions: Glaucoma

• Pathophysiology: Increased intraocular pressure damaging the optic nerve
• Types:
  • Open-angle: Gradual vision loss, tunnel vision
  • Closed-angle: Sudden onset, severe eye pain, medical emergency
• Management: Eye drops to lower pressure, surgery if needed

Common Visual Conditions: Macular Degeneration

• Pathophysiology: Deterioration of the macula causing central vision loss
• Clinical Manifestations: Blurry vision, distortion of straight lines
• Management:
  • Dry form: Lifestyle changes, vitamins
  • Wet form: Injections to slow progression

Common Hearing Conditions: Hearing Loss

• Types:
  • Conductive: Due to blockage (earwax, infections, trauma)
  • Sensorineural: Due to aging (presbycusis), noise exposure, neurological issues
• Management: Hearing aids, cochlear implants, communication adaptations

Common Hearing Conditions: Vertigo

• Causes: Meniere’s disease, infections, tumors, drug toxicity
• Symptoms: Dizziness, nausea, imbalance
• Management: Medications, lifestyle modifications, safety precautions

Common Hearing Conditions: Meniere’s Disease

• Pathophysiology: Inner ear disorder affecting balance and hearing
• Symptoms: Episodes of vertigo, tinnitus, hearing loss
• Management:
  • Diet: Low salt
  • Medications: Diuretics, antihistamines
  • Surgery in severe cases

Nursing Interventions for Sensory Conditions: Vision Impairment

• Encourage regular eye exams
• Ensure proper lighting and contrast in the environment
• Assist with adaptive tools (magnifiers, large-print books)

Nursing Interventions for Sensory Conditions: Hearing Impairment

• Speak clearly and slowly
• Reduce background noise
• Teach use of hearing aids, assistive listening devices

Safety Measures for Sensory Loss

• Use call lights and alarms
• Assess fall risk
• Educate on medication side effects impacting balance

Role of the Integumentary System in Preventing Infections

• Functions: Protection, temperature regulation, vitamin D metabolism, sensation, excretion, absorption, insulation
• Age-Related Changes: Increased fragility, longer healing time, reduced temperature regulation, decreased sensation, higher risk for sun damage and tearing

Signs, Symptoms, and Risks for Various Infections

• Common Infections:
  • Bacterial: E. coli, Staphylococcus aureus
  • Viral: HIV, Influenza, COVID-19, RSV
  • Fungal: Candida albicans, Pneumocystis pneumonia (PCP)
  • Parasitic: Malaria, Toxoplasmosis
• Stages of Infection:
  • Incubation: Pathogen enters body, no symptoms
  • Prodromal: Vague symptoms, pathogen multiplication
  • Infectious: Full-blown illness
  • Convalescent: Recovery period
• Sepsis Indicators:
  • Fever >100.4°F or 90 bpm, RR >20 breaths/min, WBC >12,000/mm³

Interventions to Reduce Infection Risk: Universal Precautions

• Handwashing, PPE (gowns, gloves, masks, eye protection)
• Safe injection practices and respiratory etiquette

Interventions to Reduce Infection Risk: Isolation Precautions

• Contact Precautions: MRSA, VRE, C. Diff (Soap & water for hand hygiene)
• Droplet Precautions: Influenza, RSV, Pertussis
• Airborne Precautions: Tuberculosis, Measles, COVID-19 (Negative pressure rooms)

Nursing Interventions for Nosocomial and Resistant Infections: Healthcare-Associated Infections (HAIs)

• Nosocomial: Acquired in hospital
• Common Pathogens: MRSA, VRE, C. Diff, CRE
• Aseptic Techniques:
  • Medical Asepsis: Hand hygiene, clean technique
  • Surgical Asepsis: Sterile technique, no contamination

Hypersensitivity Reactions: Type I

• Allergens: Pollen, food, insect bites, medications
• Symptoms: Nasal discharge, sneezing, itching, anaphylaxis (dyspnea, hypotension, wheezing)
• Treatment: Antihistamines, steroids, bronchodilators

Hypersensitivity Reactions: Type IV

• Occurs 24-72 hours after exposure
• Common Triggers: Latex, poison ivy, contact dermatitis
• Treatment: Avoidance, steroids, antihistamines

Hypersensitivity Reactions: Patient Teaching for Allergies

• Identify and avoid triggers, proper use of antihistamines, emergency epinephrine administration

Hypersensitivity Reactions: Anaphylaxis Nursing Priorities

• Administer epinephrine (0.2-0.5 mg IM/IV)
• Maintain airway, provide oxygen, IV fluids, corticosteroids

Immune Deficiencies

• Primary (Congenital): SCID (Bubble Boy Disease), genetic absence/malfunction of immune cells
• Secondary (Acquired): HIV/AIDS, chemotherapy, organ removal, malnutrition

Precautions for Immune-Compromised Patients

• Avoid: Crowds, shared toiletries, raw foods, pet litter
• Maintain: Daily hygiene, proper nutrition, vaccination schedule

HIV vs. AIDS

• HIV: Virus that weakens immune system, transmitted via blood, sexual contact, perinatal exposure
• AIDS: CD4+ count

Understand acute vs. chronic illness and disability, including physiological and sociological impacts. Learn the implications of chronic conditions on developmental tasks. Explore coping mechanisms and support systems for managing long-term health challenges.