Understanding Chronic Illnesses

Chronic Illness: 12 Questions

• Chronic illness refers to persistent health problems that are often associated with limitations in participation and activity.
• Non-communicable diseases are noninfectious or non-transmissible disorders.
• In 2012, non-communicable diseases accounted for 68% of the world's 56 million deaths.
• Chronic heart disease, lung diseases, cancer, and diabetes are the highest-ranked non-communicable diseases.
• Morbidity refers to disease rates within a population.
• Mortality refers to death rates.
• Musculoskeletal conditions like arthritis and osteoporosis are the most prevalent and costly chronic conditions in Canada.
• Lung, prostate, breast, and colorectal cancers are the four most common types in Canada, accounting for 50% of new cancer cases.

Acute Illness vs. Chronic Illness

• Acute illness is characterized by rapid onset, short duration, and is usually self-limiting.
• Acute illnesses generally respond readily to treatment, have infrequent complications, with the patient returning to their previous level of functioning afterward like colds and influenza.
• Chronic illness is prolonged, does not resolve spontaneously, and can cause permanent impairments or pathological changes.
• Chronic illnesses often result in residual disability and require special rehabilitation and long-term medical/nursing management.

Disease vs. Illness

• Disease: a condition viewed from a pathophysiological model by a practitioner.
• Illness: the human experience of symptoms and suffering.
• Disease is perceived, lived with, and responded to by individuals and families.
• Health refers to complete physical, mental, and social well-being, not just the absence of disease.
• Signs are objective manifestations of a condition.
• Symptoms are subjective reports from a patient.
• Comorbidity is the presence of two or more unrelated chronic illnesses with an example of cancer and arthritis occurring together.
• Multimorbidity is the simultaneous occurrence of several medical conditions that may or may not be related and may be challenging to treat due to conflicting treatments.
• Multiple chronic medical conditions are associated with decreased quality of life, physiological distress, longer hospital stays, postoperative complications, higher costs, and higher mortality.
• Lifestyle includes individual choices and social, economic, and environmental factors impacting health decisions.
• Income significantly affects an individual's life expectancy, their ability to obtain nutritious food, good housing, and access health care.
• Poverty and socioeconomic disadvantage impact chronic illness development.

Individual Risk Factors

• These are categorized into background (sex, age, education, genetics) and behavioral factors such as smoking, unhealthy diet and physical inactivity.
• Intermediate risk factors include comorbid conditions, diabetes, hypertension, and obesity.

Community and Genetics Level Risk Factors

• Community level risk factors include, poverty, employment, family composition, environmental and culture conditions.
• Genetics relates to characteristics passed down through generations.
• Genetics play a key role in the development of chronic illnesses with cystic fibrosis and Huntington's disease two examples where genetic testing is available.
• Disability includes all impairments both physical and metal can results in functional limitations as the person interacts with others.

Illness and Sick Role

• Illness behaviour varies in how individuals respond to physical symptoms: how they monitor internal states, define and interpret symptoms, make attributions, take remedial action's.
• The sick role, described by Talcott Parsons in 1951, is a form of deviant behaviour that allows avoidance of social responsibilities.

Characteristics of the Sick Role:

• Sick person is exempt from normal social roles with legitimization from a physician required
• Not responsible for becoming sick, individual has right to be cared for with with accepted physical dependency and emotional support.
• Obligation to want to become well with secondary gains of the sick role can make the motivation to get better more important.
• Technical expertise is needed by the patient, from physicians and healthcare providers
• Cooperation with these experts is mandatory.
• Self-efficacy is an individual's belief in their ability to perform a behavior required to produce desired outcomes.
• Health-related hardiness is a personality trait by Kobasa that buffers stress.
• Those with this high degree of stress with possess 3 general character traits:
  • Control: belief that the individual can have influence
  • Commitment: ability to be deeply committed
  • Challenge: the anticipation of change

Mood Disorders, Fatigue & Illness Trajectory

• Depression increases with chronic conditions; inflammation is an etiological factor in mood disorders.
• Fatigue - subjective, unpleasant symptom ranging from tiredness to exhaustion which interferes individual's normal functions.
• Illness trajectory is a way to understand illness' complex, dynamic path.
• It's an experiential pathway along which a person with an illness progresses.
• Three trajectory time phases:
  • Crisis - period before and after diagnosis where learning to live with symptoms
  • Chronic - time between diagnosis and time of death where continuing to live normal life is key
  • Terminal - issues rise surrounding grief, and is impacted by the illness.

Illness Trajectory Phases

• At each phase there is a definition and a goal of management
• Pre-trajectory involves the prevention of onset of chronic illness with management of genetics and/or lifestyle behaviors
• Trajectory onset is the projection and scheme at play as noticeable symptoms arise as they cope and discover the diagnosis
• Stable phases mean under control with maintenance plans in place that impact every day activity
• Instability requires a "return to stable" state to maintain the current level of health
• Acute phases involve severe symptoms where control of the illness and everyday life resumes
• Crisis involve a critical situation where the only step is the removal of life treat
• Comeback: Gradual return to acceptable way of life
• Downward : Adapt to increasing disabilty as rapid or gradual decline accompanies you
• Dying: Bring closure to be at peace before final days or weeks

Self-Management and Patient Care

• Refers to the health professional, caregivers, patient as a cohesive group to help manage all aspects of life in order to improve health conditions
• Patients want a diagnosis with implications, available treatments and their outcomes
• Focus on the patient as a whole, making the patient's future a priority with easy access to it
• Improve any infrastructure and focus on symptoms

Key Points by Med Surg with Chronic Illnesses

• In 2022 global deaths related to chronic illness were 68%, 37% from cardiovascular
• Important to also highlight the affects from acute with chronic
• Focus on risk factors: unchangeable and changeable and other behavioral factors
• Over 8 million Canadians provide care but are unpaid and people close to them
• There are two frameworks that have been used for understanding chronic illness:
  • Illness trajectory model (experiential along with patient and divide further phases)
  • Shifting perspectives model
• Chronic care model with improvements self management, clinical information systems and decision making

Health Teaching

• Focus on teaching and nursing skills to get the most out of the patient's life
• The health professional becomes a care center, school, industry ect...
• Teaching should be on multiple platforms like community, schools, homes etc
• Teaching planning, should improve the health of the patient
• Process of learning should improve with effective teaching using aids

Learning Principles

• Assessment: Patient outcomes and objectives should have interventions and diagnosis
• Measured through a cognitive ability that is reflected by a change in behavior like attitudes, or skills
• Andragogy relates to the learning abilities of adults
• As independent learners, need control of topic to understand
• Past experiences are a solid foundation for their experience, and should be highlighted
• Best to focus on immediately needing information that applies to the patient now
• Can be enhanced through a relaxed but respectful environment where the patient provides feedback as they gain traction
• Evaluate through a verbal or nonverbal way, with a method to increase
• Patient progression stages must be considered with each patient with the level of pain

Asthma: 13 Questions

• Asthma involves periodic episodes of severe but reversible bronchial obstruction in persons with hypersensitive or hyperresponsive airways.
• Acute attacks may be superimposed on the chronic condition.
• In the USA, 15 million individuals between 5 and 17 have asthma.

Asthma Pathophysiology

• Acute: a single episode
• Chronic: long term condition
• The bronchi and bronchioles respond to stimuli with:
  • Mucosal inflammation with edema
  • Smooth muscle contraction
  • Increased secretion of thick mucus in the passages
• Partial obstruction of small bronchi results in air trapping and hyperinflation where obstruction plugs the flow
• Status asthmaticus: persistent severe attack of asthma that does not respond.
• Chronic asthma and chronic obstructive lung disease may develop from irreversible damage in lungs from frequent and severe attacks.

Asthma Etiology

• Family history of hay fever, asthma, and eczema is common.
• Viral upper respiratory infections can precipitate attacks.
• Contributing factors:
  • Increased sedentary lifestyles and air pollution.

Asthma Signs & Symptoms

• Include cough, tight chest feeling, wheezing, rapid and labored breathing.
• Thick mucus is coughed up, hypoxia develops, severe respiratory distress may develop.
• Treatment needs to minimize the number and severity of attacks to prevent permanent lung damage.
• To avoid attacks common triggers (airborne, drugs) with good ventilation (home/school) and be breathing controlled
• Patient should learn self-administration of bronchodilators and glucocorticoids

Nursing Diagnosis towards Asthma

• Diagnose the breathing pattern with current interventions to help the patient improve for best function.

Hypertension: 13 Questions

• Hypertension is another name for high blood pressure which affects African Americans more
• Hypertension is a silent killer and one of the three most common causes
• One area of importance is to understand if there are any renal or endocrine relations from a previous diagnosis
• Pressure is found around 140/90mmHg constantly
• The bodies reaction is increase the production of kidney's function that can create even more constriction
• Kidneys, brain and retina are mostly damaged which can cause vision or heart failure

Hypertension: Etiology, Signs & Symptoms, Prevention, Treatment, and Related Topics.

• Increases with age and impacts men
• Lifestyle habits and diets are another common indication
• Inconsistent blood pressure and can be prevented with lifestyle and certain medications
• Diagnoses is an important consideration, and can play a key role throughout health management
• Key is to understand normal blood pressure and any medication intake as that plays a hand

Acute Coronary Syndrome

• Sometimes called coronary heart disease, coronary artery disease
• This leads to heart failure and possible death
• Associated with stability or plaque and or thrombus
• Unsteady chess, and is always unpredictable and considered emergency calls.
• Most cell of he heart can withstand for only 20 minutes before it turns into something more permanent
• The complications:
  • Cardiac shock when the body doesn't receive any help -Muscle dysfunction that causes multiple heart failure cases
• The only diagnostic tool is to look and see as any indication may results in something more permanent
• Any chest pains and/or heart complications should initially be diagnosed by aspirin, medication or nitroglycerin